Analysis on nursing competence and training needs of dementia caregivers in long-term care institutions

Nursing standards, language and age as variables associated with clinical competence for nurses in long-term care facilities: A cross-sectional study

AIM

To identify and examine the explanatory variables associated with clinical competence among registered nurses (RNs) and practical nurses (PNs) working in long-term care facilities (LTCF) for older adults.

DESIGN AND METHODS

This was a cross-sectional study. The competence test, 'the Ms. Olsen test', was used for data collection. A convenience sample of 337 nursing staff working in LTCFs for older adults was selected between December 2020 and January 2021. A quantitative, non-experimental approach with multiple linear regression analysis examined the explanatory variables associated with clinical competence and the outcome variables.

RESULTS

The main findings of the linear regression analysis show that the nursing staff's increasing age, use of Swedish as a working language and use of the Finnish nursing practice standards had statistically significant relationships with clinical competence among the participating nursing staff.

CONCLUSION

This is the first knowledge test that has been developed to test nursing staff's clinical competence in elderly care. In this study in Finland, the highest clinical competence was among the nursing staff who were Swedish-speaking RNs working in institutional care homes caring for patients according to national practice standards.

IMPLICATIONS

These results may be useful to nursing staff and managers working in elderly care to understand the explanatory variables associated with clinical competence in elderly care in Finland and in bilingual settings. The study highlights the importance of using national nursing standards in elderly nursing care. Knowing the explanatory variables associated with clinical competence can provide guidance for the further education of nursing staff in these settings.

IMPACT

Caring according to national practice standards and caring for severely ill patients are associated with clinical competence.

REPORTING METHOD

The authors adhered to the EQUATOR network guidelines Appendix S1 STROBE to report observational cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

Registered and PNs completed a questionnaire for the data collection.

Feasibility of Implementing Dementia Collaborative Coaching into Routine Care in Nursing Homes

OBJECTIVES

The study evaluated the feasibility of implementing Dementia Collaborative Coaching (DCC) into the routine workflow of speech-language pathologists (SLPs) working in nursing homes (NHs). DCC is an intervention delivered by SLPs to train nursing assistants (CNAs) in communication strategies to support people living with dementia (PLWD).

METHODS

We assessed the feasibility of identifying eligible PLWD; estimated intervention fidelity; evaluated suitability of outcome measures; and determined the preliminary impact on behavioral and psychological symptoms of distress (BPSD) among PLWD. SLPs completed a semi-structured interview to collect further acceptability data.

RESULTS

Four SLPs in four NHs completed DCC with 10 CNAs and 15 eligible PLWD that they appropriately identified from their caseloads. SLPs conducted 90 DCC sessions with 64% fidelity and billed Medicare for all sessions. The outcome measure of Minimum Data Set item E0200B: Rejection of Care did not vary enough to be useful, but positive changes were noted on the Cohen-Mansfield Agitation Inventory, t(14) = 10.51, p < .001, Cohen's d = 2.76. Interviews further indicated feasibility.

CONCLUSIONS

It is feasible to implement DCC into the workflow of SLPs in NHs.

CLINICAL IMPLICATIONS

Given the feasibility and preliminary positive impacts, SLPs could consider implementing DCC in routine care.

Correlation between organizational support, self-efficacy, and core competencies among long-term care assistants: a structural equation model

Introduction

Long-term care assistants are taking on more important roles in the healthcare system. The purpose of this study was to investigate what demographic factors influence the core competencies of nursing assistants, as well as to investigate the levels of organizational support, self-efficacy, and core competencies among nursing assistants in China, to explore the relationship between them.

Methods

This is a cross-sectional study with prospective data collection based on a self-report questionnaire. A total of 320 long-term care assistants from two healthcare institutions. We collected socio-demographic characteristics and measured their perceived organizational support, self-efficacy, and core competency levels of the participants. Pearson correlation tests were conducted to examine the relationships among three variables, and a structural equation model was developed to test the interrelationships among these variables.

Results

The results indicated that age, employment type, licensing status, monthly income, pre-job training, and training methods were associated with core competency, with nursing knowledge identified as a weak area in core competencies. There were significant associations among each dimension of perceived organizational support, self-efficacy, and core competencies (p < 0.01). The structural equation model demonstrated good fit: X 2/df = 2.486, GFI = 0.974, CFI = 0.988, IFI = 0.988, TLI = 0.977, RMSEA = 0.068, SRMR = 0.013. The direct effect of organizational support on core competencies was 0.37, with self-efficacy mediating the relationship between organizational support and core competencies, yielding an indirect effect of 0.122 and a total effect coefficient of 0.492 (all p < 0.001).

Conclusion

Training in core competencies should prioritize nursing knowledge. Enhanced perceived organizational support and self-efficacy among nursing assistants were associated with higher core competencies.

Influencing factors associated with mental workload among nurses: A latent profile analysis

Objective

This study aimed to examine the latent profile of nurses' mental workload (MWL) and explore the influencing factors via a person-centred approach.

Methods

From March to July 2023, a quantitative cross-sectional study was carried out to investigate 526 Chinese clinical nurses from five tertiary hospitals in Sichuan Province, China, by using demographic information, the Perceived Social Support Scale, Simplified Coping Skill Questionnaire, and NASA-Task Load Index. Latent profile analyses were performed using Mplus 7.3 software. Pearson's chi-squared and logistic regression analysis was done using SPSS 24.0 software.

Results

Three profiles of mental workload were identified based on the nurses' responses to the mental workload assessment, designated as "low MWL-high self-rated (n = 70, 13.3%)", "moderate MWL (n = 273, 51.9%)", and "high MWL-low self-rated (n = 183, 34.8%)". Based on the analysis of the three subtypes, nurses with working years < 5 years (χ 2  = 12.135, P < 0.05), no children (χ 2  = 16.182, P < 0.01), monthly income < 6000 (χ 2  = 55.231, P < 0.001), poor health status (χ 2  = 39.658, P < 0.001), no psychological training in the past year (χ2 = 56.329, P < 0.001) and suffering from workplace violence (χ 2  = 19.803, P < 0.001) were significantly associated with MWL. Moreover, the multivariate logistic regression analysis showed that negative coping styles (OR = 1.146, 95% CI: 1.060-1.238, P = 0.001) were accompanied by higher MWL while negatively associated with perceived social support (OR = 0.927, 95% CI: 0.900-0.955, P < 0.001).

Conclusion

Our results showed that the MWL of nurses could be classified into three subtypes. Monthly income, health status, psychological training, workplace violence, negative coping style, and perceived social support were the factors influencing MWL. Managers can employ personalised intervention strategies according to the individual characteristics of different subgroups to reduce nurses' MWL.

Exploring the associations between competence in dementia care and work attitudes among formal caregivers in nursing homes

AIMS

Based on the two-factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations.

DESIGN

A cross-sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study.

METHODS

Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China.

RESULTS

The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction.

CONCLUSIONS

The results demonstrate that the two-factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

Revealing a gap in the clinical competence of nursing staff in nursing homes: a cross-sectional study with the Ms. Olsen test

BACKGROUND

Nursing staff, caring for frail older people in long-term care, needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care. In Finland, nursing care is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff's clinical competence and adequate and continuous education.

AIM

This study aimed to explore nursing staff, i.e. the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses' clinical competence and fundamental background factors.

METHODS

We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland, between December 2020 and January 2021. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence.

RESULTS

This study with the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the clinical competence test. In the self-evaluation, almost all participants evaluated themselves with good clinical competence. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. Significant correlation was found between Swedish as a working language and mother tongue and the score for clinical competence.

CONCLUSION

The clinical competence test, the Ms. Olsen test, was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. We found gaps in the clinical competence in Finnish nursing homes, both for PNs and RNs. The result differed remarkably from their self-assessments and the staff did not use the national nursing guidelines as required to develop their nursing skills and knowledge. Gaps in the clinical competence have been identified and can be used to develop targeted continuous education.

Experiences of older people, healthcare providers and caregivers on implementing person-centered care for community-dwelling older people: a systematic review and qualitative meta-synthesis

BACKGROUND

Person-centered care (PCC) is a critical approach to improving the quality of care for community-dwelling older people. Old-age care services could be provided according to older peoples' choices, needs, and preferences. The purpose of this study was to synthesize research evidence on the experiences of older people, healthcare providers, and caregivers with PCC and to identify the enablers and barriers to implementing PCC for community-dwelling older people.

METHODS

A meta-synthesis of qualitative research design was adopted. Data searches were performed using CINAHL (EBSCOhost), PubMed (OvidSP), Embase (Ovid), Cochrane Database, and PsycINFO (Ovid) in published articles and were reviewed from the earliest date to February 2023. The Qualitative Method Appraisal Tool was used to conduct a quality appraisal on selected articles. Data were extracted based on the capacity, opportunity, and motivation-behavior model (COM-B model), and the findings were synthesized using the meta-aggregative approach.

RESULTS

Twelve included articles were analyzed to identify 122 findings that were organized into 11 categories and combined into three synthesized findings-capacities of older people, healthcare providers, and caregivers; opportunities in the implementation of PCC; motivation in implementing PCC. Capacities consisted of a lack of person-centered knowledge and skills, negative attitudes toward shared decision-making, and a lack of formal training to enhance capabilities among HCPs. Opportunities included a lack of coordination in resource allocation, strengthening multidisciplinary teamwork, establishing a desirable environment, and time constraints. Motivation in implementing PCC included encouraging self-reflection and regulation, respecting the autonomy of older people, lack of clear reward and empowerment mechanisms, and being resilient and optimistic.

CONCLUSIONS

The findings of this research provide a reference for implementing successful PCC in the community. The researchers identified barriers and facilitators of implementing PCC, facilitating through stakeholder's person-centered knowledge and skills being valued and respecting the autonomy of older people. Establishing a positive environment and strengthening multidisciplinary team members also promotes the implementation of PCC. However, additional studies are required to explore the influencing factors and address the barriers.

Translation and psychometric testing of the sense of competence in Dementia Care Staff Scale in Chinese amongst dementia care staff in nursing homes of China

BACKGROUND

Although China has the largest population of persons with dementia, there is no validated tool available to accurately assess formal caregivers' competence in dementia care in long-term care settings. Appropriately assessing nursing staff's level of competence in dementia care is the first step to develop precision training interventions to improve the quality of dementia care. The Sense of Competence in Dementia Care Staff scale (SCIDS) is a user-friendly tool with satisfactory reliability and validity. We adapted SCIDS into a Chinese version (SCIDS-C) and validated its uses in China's socio-cultural context to assess nursing staff's capability and competence in dementia care at nursing homes.

AIMS

We aimed to adapt and psychometrically test the tool among frontline nursing staff in long-term care settings in China.

METHODS

The research employed a correlational design with repeated measures. In translation section, we adapted and tailored the original scale in the cultural and social context in China's nursing homes. The scale's adaptation consists of translating adaptation and semantic equivalence. In psychometric testing phase, we tested the validity and reliability of the scale with 174 nursing staff conveniently from six nursing homes. Construct validity was tested using exploratory factor analysis (EFA), including principal component analysis and maximum variance rotation method. Reliability was tested using Cronbach's alpha value and intraclass correlation coefficient (ICC).

RESULTS

The SCIDS-C has 17 items, which belong to the two sub-scales, the Relationship-Centered Care(RCC) and Professional Care(PC). The Cronbach's alpha value was 0.88, showing a good internal consistency. The full scale's value of ICC was 0.94 which indicated good reliability. Exploratory factor analysis(EFA) extracted 2 common factors in each sub-scale, cumulative variance contribution rate was 56.71% and 53.92%, respectively. The named four factors are the same as the Sense of Competence in Dementia Care Staff (SCIDS) scale in English, including Building Relationships, Sustaining Personhood, Professionalism and Care Challenges.

CONCLUSION

The SCIDS-C has shown good reliability and validity. It can be used as an appropriate tool to evaluate the competence of nursing care staff to provide dementia care for residents in nursing homes.

How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?

Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.

Transcultural adaptation and psychometric evaluation of the mainland China version of Nursing Home Survey on Patient Safety Culture Questionnaire: a cross-sectional survey based on 50 nursing homes in China

OBJECTIVE

To provide a validated Chinese-language measurement of the Nursing Home Survey on Patient Safety Culture (NHSOPS) in mainland China. The primary goal is to carry out a transcultural adaptation of the NHSOPS Questionnaire into Chinese and evaluate its psychometric properties.

DESIGN

A psychometric evaluation study is constructed. First, the 'translation-back-translation-cultural adaptation' and the pretesting procedure were followed to introduce the NHSOPS. Second, a cross-sectional survey was used to assess the psychometric properties for the mainland China version of the NHSOPS (M-NHSOPS), and a test-retest survey was then applied.

SETTING AND PARTICIPANTS

The survey was carried out among 1397 nursing home staff from 50 nursing homes in Southwest China.

OUTCOME MEASURES

Exploratory factor analysis (EFA) was used to assess the potential structure, and confirmatory factor analysis (CFA) was then applied. Reliability was assessed by the content validity index, Cronbach's α and the test-retest value.

RESULTS

Among the 1397 respondents, 1211 were included (86.7%). EFA was used, and a nine-factor structure was explored. Five factors (Cronbach's α ＞0.6) were selected into the new structure for the M-NHSOPS. Moreover, data showed that it was suitable for CFA, and convergent validity and discriminant validity were satisfactory. On the other hand, M-NHSOPS contains five dimensions and 22 items. The overall Cronbach's α value was 0.883; the values of each dimension ranged from 0.648 to 0.913. Additionally, content validity showed significant performance. Eventually, test-retest reliability was 0.892, and each dimension was 0.713, 0.809, 0.924, 0.795 and 0.859, respectively (p<0.001).

CONCLUSIONS

M-NHSOPS has acceptable reliability and satisfactory validity among staff of nursing homes in Southwest China, and further verification among samples in other regions of mainland China is required.

Challenging situations and competence of nursing staff in nursing homes for older people with dementia

BACKGROUND

Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require.

METHODS

Data were collected using mixed methods in a cross-sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open-ended questions. Quantitative data acquired were analysed statistically, and responses to the open-ended question were analysed using content analysis methodology.

RESULTS

Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self-management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia.

CONCLUSION

Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.

Demands for Telenursing-Based Long-Term Care Among Disabled Older Adults in Qingdao, China: A Cross-Sectional Study

PURPOSE

The purpose of the present study was to investigate the current status of and factors influencing the demands for telenursing-based long-term care in disabled older adults.

METHODS

In this cross-sectional study, data from 213 participants from five districts of Qingdao, China, were investigated using multistage stratified sampling. The assessment scale of the long-term care demands level and the questionnaire of the demands of telenursing-based long-term care for disabled older adults were used to estimate the demands for telenursing-based long-term care for older adults with disabilities in Qingdao.

RESULTS

Of the participants, 60.51% were willing to receive telenursing-based long-term care. The item with the highest score was "Internet +" information management and first aid (3.77 ± 0.71); the item with the lowest score was "Internet +" daily care (2.97 ± 0.72). Average family income (P < 0.001), age (P = 0.004) and educational level (P = 0.003) were significant factors influencing the demands for telenursing-based long-term care.

CONCLUSION

Disabled older adults had a high demand for telenursing-based long-term care. Urgent actions are needed to integrate telenursing with long-term care as soon as possible. In the development of telenursing-based long-term care, it is necessary to fully consider the average family income, age and educational level of disabled older adults.