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Yan E, To L, Wan D, Lai DWL, Leung E, Lou VWQ, Fong DYT, Cheng ST, Chaudhury H, Pillemer K, Lachs M. Resident Aggression and Staff Burnout in Nursing Homes in Hong Kong. J Appl Gerontol 2024:7334648241272027. [PMID: 39116274 DOI: 10.1177/07334648241272027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
This study examined the effects of exposure to resident aggression, self-efficacy, neuroticism, and attitudes toward dementia on burnout among direct care workers (DCWs) in nursing homes. A convenience sample of 800 DCWs from 70 randomly selected nursing homes in Hong Kong were recruited and individually interviewed. DCWs reported past-month experiences of resident aggression, levels of burnout, self-efficacy, neuroticism, attitudes toward dementia, and other personal and facility characteristics. Hierarchical multiple regression analysis revealed that, while physical environment of the facilities, and demographic background and self-efficacy of DCWs were not significant contributing factors, DCWs' exposure to resident aggression, insufficient experience and training in dementia care, negative attitudes toward dementia, and neurotic personality were associated with higher levels of staff burnout. Findings point to the importance of mitigating resident aggression and adequately screen and train staff to optimize their empathy and competence in minimizing the risk of burnout.
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Affiliation(s)
- Elsie Yan
- The Hong Kong Polytechnic University, Hong Kong
| | - Louis To
- The Hong Kong Polytechnic University, Hong Kong
| | - Debby Wan
- The Hong Kong Polytechnic University, Hong Kong
| | | | - Edward Leung
- Hong Kong Association of Gerontology, Kowloon, Hong Kong
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McKenzie C, Smith-Tamaray M, Conway E, Flanagan K. "Time is a Big Factor": Aged-Care Workforce Perspectives on Communication Partner Training for Working With Residents With Dementia. J Appl Gerontol 2024:7334648241255080. [PMID: 38770598 DOI: 10.1177/07334648241255080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Many individuals who reside in permanent residential aged care (RAC) have a diagnosis of dementia, with the majority experiencing a communication disorder. Existing literature has placed an emphasis on the need for staff to undertake communication partner training. This study aimed to investigate the preferences of RAC staff, and their perceived barriers and facilitators to workplace training. Through an exploratory cross-sectional online survey, a sample of RAC workers in Australia were recruited (n = 104). Descriptive statistics revealed that the majority of participants preferred training to be delivered face to face and being paid for participation. Through content analysis of open-ended questions, seven categories were identified regarding perceived barriers and facilitators for communication partner training in the workplace. These included staff shortages, time pressures, remuneration and training delivery method, and quality of the educators. Additionally, management attitudes were pertinent. These findings may inform the development and outcomes of future communication partner training in RAC.
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Affiliation(s)
| | | | - Erin Conway
- Australian Catholic University, Brisbane Campus, Banyo, QLD, Australia
| | - Kieran Flanagan
- Australian Catholic University, Brisbane Campus, Banyo, QLD, Australia
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Guzmán A, Orellana K, Ortega ML, Robledo LMG, Castro ST. Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation. EVALUATION AND PROGRAM PLANNING 2024; 103:102399. [PMID: 38194783 DOI: 10.1016/j.evalprogplan.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/24/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES We explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes. METHOD We undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation. RESULTS Two pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members. CONCLUSION Funding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers' long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer's and other dementias plan.
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Affiliation(s)
- Azucena Guzmán
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Old Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
| | - Katharine Orellana
- NIHR Policy Research Unit on Health & Social Care Workforce, The Policy Institute at King's, King's College London, Strand Campus, London WC2R 2LS, United Kingdom
| | - Mariana López Ortega
- National Institute of Geriatrics, Av. Contreras 428, San Jerónimo Lídice, Mexico City 10200, Mexico
| | | | - Sara Torres Castro
- National Institute of Geriatrics, Av. Contreras 428, San Jerónimo Lídice, Mexico City 10200, Mexico
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Yan E, Wan D, To L, Ng HKL, Lai DWL, Cheng ST, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue. J Am Med Dir Assoc 2024; 25:396-402. [PMID: 37972647 DOI: 10.1016/j.jamda.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DESIGN Cross-sectional descriptive study design. SETTING AND PARTICIPANTS A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. METHODS The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. RESULTS Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. CONCLUSIONS AND IMPLICATIONS Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.
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Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Debby Wan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Louis To
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Haze K L Ng
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong SAR, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Daniel Fong
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Karl Pillemer
- Cornell College of Human Ecology, Cornell University, New York, NY, USA
| | - Mark Lachs
- Weill Cornell Medicine, Cornell University, New York, NY, USA
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Antipas H. Interventions for mitigating occupational stress for professional dementia caregivers in residential aged care: A systematic review with meta-analysis. DEMENTIA 2024; 23:292-311. [PMID: 38069510 PMCID: PMC10807264 DOI: 10.1177/14713012231220963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Occupational stress in professional dementia caregivers in residential aged care facilities has adverse effects on care quality, caregivers' health, and workforce sustainability. The purpose of this study was to examine the evidence regarding interventions to mitigate occupational stress for this population. METHODS A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original RCT research reporting on stress interventions, published in English between 1995 and March 2022. Search results were screened by two independent reviewers. Quality and risk of bias were appraised using the Downs and Black Checklist and Risk of Bias by two reviewers. Meta-analysis and subgroup analysis examined the pooled intervention effects on stress compared to control. RESULTS 10 studies met the inclusion criteria, and these reported on 15 interventions and 28 outcomes from 92 facilities, involving 1,397 caregivers. We found a small and insignificant effect of interventions on caregiver stress (g = -.27, p = .16). Heterogeneity was partially explained by subgroup analysis. Interventions can mitigate stress and burden not attributed to client behaviour (n = 3) (g = -.85, p < .001), and improve caregivers' self-efficacy (n = 4) (g = -.35, p = .07). We were unable to determine the most effective type of intervention, although organisation focused interventions showed the greatest potential (g = -.58, p = .08). CONCLUSION Interventions that improve caregivers' personal and organisational resources can reduce non-client associated stress and burden and increase self-efficacy. Aged care providers are recommended to prioritise education with organisational support interventions. Research on longitudinal effects and high-risk caregivers is required. Limitations are discussed. PROSPERO REGISTRATION NUMBER CRD42022313715 (registered April 2022).
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Affiliation(s)
- Hayley Antipas
- Creative Arts and Music Therapy Research Unit, Faculty of Fine Arts and Music, The University of Melbourne, Australia
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Shiri R, Nikunlaakso R, Laitinen J. Effectiveness of Workplace Interventions to Improve Health and Well-Being of Health and Social Service Workers: A Narrative Review of Randomised Controlled Trials. Healthcare (Basel) 2023; 11:1792. [PMID: 37372909 DOI: 10.3390/healthcare11121792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Health and social service workers face high levels of workload and job stressors, which can affect their health and well-being. Therefore, it is important to evaluate the effectiveness of workplace interventions that aim to improve their mental and physical health outcomes. This review summarizes the findings of randomized controlled trials (RCTs) that examined the impact of different types of workplace interventions on various health indicators among health and social service workers. The review searched the PubMed database from its inception to December 2022 and included RCTs that reported on the effectiveness of organizational-level interventions and qualitative studies that explored barriers and facilitators to participation in such interventions. A total of 108 RCTs were included in the review, covering job burnout (N = 56 RCTs), happiness or job satisfaction (N = 35), sickness absence (N = 18), psychosocial work stressors (N = 14), well-being (N = 13), work ability (N = 12), job performance or work engagement (N = 12), perceived general health (N = 9), and occupational injuries (N = 3). The review found that several workplace interventions were effective in improving work ability, well-being, perceived general health, work performance, and job satisfaction and in reducing psychosocial stressors, burnout, and sickness absence among healthcare workers. However, the effects were generally modest and short-lived. Some of the common barriers to participation in workplace interventions among healthcare workers were inadequate staff, high workload, time pressures, work constraints, lack of manager support, scheduling health programs outside work hours, and lack of motivation. This review suggests that workplace interventions have small short-term positive effects on health and well-being of healthcare workers. Workplace interventions should be implemented as routine programs with free work hours to encourage participation or integrate intervention activities into daily work routines.
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Affiliation(s)
- Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Risto Nikunlaakso
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
| | - Jaana Laitinen
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland
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Heijkants CH, de Wind A, van Hooff MLM, Geurts SAE, Boot CRL. Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:37-60. [PMID: 36149548 PMCID: PMC10025231 DOI: 10.1007/s10926-022-10064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/16/2023]
Abstract
Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.
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Affiliation(s)
- Ceciel H Heijkants
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
- , Thomas van Aquinostraat 4, room 04.362, 6525GD, Nijmegen, The Netherlands.
| | - Astrid de Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Sabine A E Geurts
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Cécile R L Boot
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Hoel V, Koh WQ, Sezgin D. Enrichment of dementia caregiving relationships through psychosocial interventions: A scoping review. Front Med (Lausanne) 2023; 9:1069846. [PMID: 36687423 PMCID: PMC9849912 DOI: 10.3389/fmed.2022.1069846] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives Enrichment, defined as "the process of endowing caregiving with meaning or pleasure for both the caregiver and care recipient" can support relationships between people living with dementia (PLWD) and their caregivers. This study aims to explore (1) the types of psychosocial interventions that may enrich relationships between dementia caregiving dyads, and (2) the components within these psychosocial interventions that may contribute to enrichment. Methods A scoping review was conducted based on the Joanna Briggs Institute framework. We operationalized and contextualized core elements from Cartwright and colleagues' enrichment model, which was also used to guide the review. Five electronic databases were searched. Psychosocial intervention components contributing to enrichment were identified and grouped within each core element. Results Thirty-four studies were included. Psychosocial interventions generating enrichment among dyads mainly involved supporting dyadic engagement in shared activities, carer education or training, or structural change to the environment around PLWD. Intervention components contributing to the enrichment of dyadic relationships were identified within "acquired symbolic meaning", "performing activity", and "fine tuning". Dyadic communication support and skill-building were common contributors to enrichment. Conclusion Our findings may inform the planning and development of interventions to enrich dyadic relationships in the context of dementia. In formal caregiving contexts, future interventions may consider dedicating space for relationships to build and grow through positive interactions. In informal caregiving contexts, existing relationships should be considered to better support dyads engage in positive interactions.
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Affiliation(s)
- Viktoria Hoel
- Department of Nursing Science Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Wei Qi Koh
- School of Nursing and Midwifery, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
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Zhao Y, Ding Y, Liu L, Chan HYL. Feasibility of a Culturally Specific DEmentia Competence Education for Nursing Home Taskforce (DECENT) Programme: A Mixed-Method Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16679. [PMID: 36554559 PMCID: PMC9779405 DOI: 10.3390/ijerph192416679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Although educational resources have been developed to build staff's dementia care competence in Western culture, their applicability and cultural relevance to the Chinese population are questionable. To address this gap, the DEmentia Competence Education for Nursing home Taskforce (DECENT) programme was developed and tailored to Chinese staff. This study aimed to evaluate the feasibility and preliminary effects of the DECENT programme. A one-group pretest-posttest study, embedded with a qualitative component, was conducted among 12 healthcare professionals. The DECENT programme comprised eight topics covering essential competencies in dementia care. It was delivered face-to-face by a qualified educator once per week for 60-90 min over 8 weeks. Outcomes were measured at baseline and immediately post-intervention. A satisfaction survey and individual interviews were conducted post-intervention to understand participants' perceptions and experience with the intervention. Nine participants finished the post-intervention assessment. Except for staff's attitudes towards people with dementia, quantitative findings generally demonstrated positive changes following the intervention. Three categories were identified from the qualitative data: well-developed programme, perceived benefits, and barriers. The findings showed that the DECENT programme is feasible and is perceived by nursing home staff as relevant and useful to daily practice. A larger-scale study is needed to evaluate its effectiveness.
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Affiliation(s)
- Yayi Zhao
- School of Nursing, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Xianlin District, Nanjing 210038, China
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing 211100, China
| | - Li Liu
- Xiangya Nursing School, Central South University, No. 172 Tongzi Slopes Road, Yuelu District, Changsha 410013, China
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin 999077, Hong Kong SAR, China
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Zhao Y, Liu L, Ding Y, Chan HYL. Effect of a culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in China: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 116:105434. [PMID: 35728332 DOI: 10.1016/j.nedt.2022.105434] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Existing educational programmes for building capacity in dementia care are developed in the Western culture; their applicability and cultural relevancy to other cultures is questionable. There is a dearth of culturally specific dementia-care educational programme for Chinese communities. OBJECTIVES To evaluate a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China. DESIGN A multi-site quasi-experimental study. METHODS Nursing homes were pair-matched and allocated into intervention (n = 5) and control group (n = 5). The DECENT programme was delivered face-to-face using multiple pedagogies for 60-90 min per session by a trained educator once per week over 8 weeks. The primary outcome was the sense of competence in dementia care. The secondary outcomes were dementia knowledge, attitudes towards people with dementia, person-centred care in nursing homes and the severity of behavioral and psychological symptoms of dementia of residents with dementia and staff-perceived disturbance. They were measured at baseline (T0), immediately post-intervention (T1) and 3 months after the intervention (T2). RESULTS The intervention group has significantly greater improvement than control group in sense of competence both at T1 (B = 5.24, p < .001) and T2 (B = 4.43, p = .013). Regarding dementia knowledge and person-centred care, intervention group only showed greater improvement than control group at T1 (B = 3.18, p = .001; B = 5.75, p = .018, respectively), but not at T2 (p = .089 and .104, respectively). Group differences in attitudes and severity of behavioral and psychological symptoms of dementia and staff-perceived disturbance were not significant at both time points. CONCLUSIONS The DECENT programme is applicable and beneficial in improving staff's sense of competence in dementia care in Chinese communities, but reinforcement strategies are needed to sustain the effect for maintaining the learnt knowledge and changed person-centred care practice.
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Affiliation(s)
- Yayi Zhao
- School of Nursing, Nanjing University of Chinese Medicine, No. 138 Xianlin Avenue, Qixia District, Nanjing, 210000, Jiangsu Province, China.
| | - Li Liu
- Xiangya Nursing School, Central South University, No. 172 Tongzi Slopes Road, Yuelu District, Changsha, 410000, Hunan Province, China.
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, Jiangning District, 210000, Jiangsu Province, China.
| | - Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, 999077, Hong Kong Special Administrative Region.
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Chan HYL, Ho FKY, Chui KCM, Wong BPS, Chui MYP, Zhao Y, Yang C, Kwok TCY. Evaluation of a multicomponent restraint reduction intervention in care homes. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sefcik JS, Boltz M, Dellapina M, Gitlin LN. Are Interventions for Formal Caregivers Effective for Improving Dementia Care? A Systematic Review of Systematic Reviews. Innov Aging 2022; 6:igac005. [PMID: 35496650 PMCID: PMC9042653 DOI: 10.1093/geroni/igac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers' knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested in RCTs and directed at formal caregivers. Research Design and Methods Smith et al.'s methodology guided this systematic review of systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) for quality appraisals. Reviews were included if they contained interventions with an RCT design that focused on changing staff behavior and/or practice toward persons living with dementia, in any setting and for any health care discipline. Results We identified six systematic reviews, one rated as high-quality on the AMSTAR 2. Most interventions were directed at nursing staff, in long-term care facilities, focused on agitation, and were atheoretical. There is insufficient evidence to guide implementation of currently tested interventions; however, training in communication skills, person-centered care, and dementia-care mapping with supervision show promise for improving agitation. Discussion and Implications There's a critical need for additional research with well-designed RCTs, and clear reporting of protocols and findings to inform the field on how best to train and support the workforce. Although there is no conclusive evidence on what interventions are most effective, it could be argued that providing training using interventions with modest evidence of impact is better than no training at all until the evidence base is strengthened.
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Affiliation(s)
- Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Maria Dellapina
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Riquelme-Galindo J, Lillo-Crespo M. Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179296. [PMID: 34501886 PMCID: PMC8431306 DOI: 10.3390/ijerph18179296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
People with dementia (PwD) occupy around 25% of the hospital beds. Once PwD are admitted to hospitals, their cognitive impairment is not considered in most of the cases. Thus, it causes an impact on the development of the disease becoming a stressful situation as care plans are not adapted to PwD. The aim of this study was to explore the published core elements when designing a dementia care pathway for hospital settings. A scoping review was conducted to provide an overview of the available research evidence and identify the knowledge gaps regarding the topic. This review highlights person-centered care, compassionate care and end-of-life process as some of the key elements that should integrate the framework when designing a dementia care pathway. Architectonical outdoor and indoor hospital elements have also been found to be considered when adapting the healthcare context to PwD. Findings provide information about the key points to focus on to successfully design dementia interventions in hospital environments within available resources, mostly in those contexts in which national dementia plans are in its infancy. Hospitals should transform their patients’ routes and processes considering the increasing demographic changes of people with cognitive impairment.
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Affiliation(s)
- Jorge Riquelme-Galindo
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
- Correspondence:
| | - Manuel Lillo-Crespo
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
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Zhao Y, Liu L, Chan HYL. Dementia care education interventions on healthcare providers' outcomes in the nursing home setting: A systematic review. Res Nurs Health 2021; 44:891-905. [PMID: 34431120 DOI: 10.1002/nur.22180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/20/2021] [Accepted: 08/13/2021] [Indexed: 11/09/2022]
Abstract
Given the increasing prevalence of people with dementia in long-term care, various educational interventions have been developed to enhance the dementia care competence of healthcare providers. The study aim was to appraise the evidence of the effects of dementia care educational programs on improving the preparedness of nursing home staff. Articles on dementia care education interventions for nursing home staff were searched from eight databases. The primary outcomes were staff knowledge, attitude, competence, and sense of competence or self-efficacy related to dementia. The secondary outcomes were psychological outcomes, including burnout, caregiving stress, well-being, and job satisfaction. The quality of evidence was appraised using the Joanna Briggs Institute Critical Appraisal tool. Out of the 3269 articles identified, 19 randomized controlled trials comprising 3947 participants from eight countries were included. The methodological quality of included studies was fair. A significant improvement in staff knowledge regarding dementia was reported. The intervention effects on attitudes and competence were insignificant, and the effects on the sense of competence or self-efficacy related to dementia care were inconsistent. The effects on psychological outcomes seem limited because few significant changes were found. Multiple teaching methods, peer support, qualified trainers, and post-training support were effective components in designing the educational interventions. However, given the variations in content and dose and the methodological limitations of the included studies, the effects of educational programs were inconclusive. The findings highlight the necessity of high-quality studies on dementia-care educational interventions, especially in other cultures than Western countries, such as in Asia.
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Affiliation(s)
- Yayi Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,School of Nursing, Nanjing University of Chinese Medicine, Xianlin, Nanjing, Jiangsu, China
| | - Li Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Mulyani S, David Saifullah A. Effect of Dementia Training on Knowledge and Attitude Among Long-Term Care Staff in Yogyakarta, Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The number of patients with dementia has increased globally. Caring for these patients is very challenging and demanding. There are many patients with dementia in long-term care facilities in Yogyakarta, Indonesia. However, most staff members do not have proper training regarding how to care for patients with dementia.
AIM: This research aimed to investigate the effect of dementia care skills training on knowledge and attitudes about dementia among long-term care staff in Yogyakarta, Indonesia.
METHODS: A pre-experimental study was conducted using a one-group pre-test and post-test method. There were 30 staff members in a long-term care facility in Yogyakarta, Indonesia, who participated in this study in July 2019. Training given was the Dementia Care Skills 18 h version for care workers provided by Alzheimer’s Indonesia by two certified trainers. Outcomes measured were knowledge and attitudes of the participants, which were measured using the Dementia Knowledge Assessment Scale and Dementia Attitude Scale. Data were analyzed using paired and independent t-tests as well as Pearson correlation tests.
RESULTS: The results showed that staff knowledge of dementia (t = 4.78, p = 0.000) and attitudes toward persons with dementia (t = 3.27, p = 0.003) were improved significantly after the dementia training provided by the Alzheimer’s Indonesia trainers.
CONCLUSIONS: Training in dementia care can improve knowledge and attitude of long-term care staff. This study recommends that dementia care skills training be provided for staff and nurses in long-term care to improve their knowledge and attitudes regarding patients with dementia and their care.
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Degen C, Frankenberg C, Meyer-Kühling I, Wendelstein B, Knebel M, Pantel J, Zenthöfer A, Rammelsberg P, Andrejeva N, Schröder J. Communication skills in nursing home residents with dementia : Results of a prospective intervention study over 21 months. Z Gerontol Geriatr 2021; 55:27-31. [PMID: 34170351 DOI: 10.1007/s00391-021-01929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The dementia syndrome compromises effective communication and may thus lead to social isolation, psychological distress and decreased quality of life. It is therefore of importance to maintain communication capacity in dementia as long as possible. MATERIAL AND METHODS A total of 24 professional caregivers from 8 nursing homes were assigned to train 254 of their respective colleagues using the train-the-trainer program MultiTANDEMplus. As in the 6 control nursing homes, severity of dementia, depressive symptoms and communication capacity were assessed in a total of 358 residents at baseline and 21 months later. Overall, 189 residents completed the study. RESULTS Communication capacity declined in control home residents but remained stable in the intervention group although dementia severity increased in both groups. The intervention group exhibited significantly fewer depressive symptoms after the intervention than the control group. CONCLUSION A standardized training of communication skills for professional caregivers can stabilize communication capacity and reduce depressive symptoms in nursing home residents. These effects are likely sustainable and could be demonstrated 21 months postintervention.
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Affiliation(s)
- C Degen
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany.
| | - C Frankenberg
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - I Meyer-Kühling
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - B Wendelstein
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - M Knebel
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - J Pantel
- Institute of General Medicine, Johann Wolfgang Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M, Germany
| | - A Zenthöfer
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - P Rammelsberg
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - N Andrejeva
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - J Schröder
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
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Assessing Caregivers' Skills in Assisting People with Dementia during Mealtime: Portuguese Cultural Adaptation of the Feeding Skills Checklist. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126467. [PMID: 34203784 PMCID: PMC8296295 DOI: 10.3390/ijerph18126467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
In advanced dementia, individuals usually develop feeding difficulties. The Feeding Skills Checklist (FSC) is an instrument to assess caregivers’ skills when assisting people with dementia (PwD) at mealtimes. This study aimed to adapt and culturally validate a European Portuguese version of the FSC (FSC-PT) and test its reliability. Initially, translation and cultural validation of the FSC, with estimation of the content validity index (CVI), was conducted. Then, the FSC was applied to 23 female nursing assistants (mean age 44.73 ± 10.42 years) while offering lunch (n = 41 meals) to institutionalized PwD. Inter-rater reliability was determining using Cohen’s Kappa. FSC-PT showed excellent content validity, with item-content validity index ranging from 0.85 to 1, scale level average CVI = 0.94 and universal agreement CVI = 0.54. It also showed very satisfactory inter-observer reliability, with Cohen’s Kappa = 0.844. Of the 41 meals analyzed, only 37.7% of the actions/good practices in feeding PwD were observed. A positive and moderate correlation was found between the length of time working as nursing assistance and the FSC environment dimension (rs = 0.435; p = 0.038). The results supported the content validity of the FSC-PT, which shows considerable potential to be an instrument for verifying caregivers’ skills when helping PWD to eat and should be increasingly studied.
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18
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Effects on staff outcomes and process evaluation of the educating nursing staff effectively (TENSE) program for managing challenging behavior in nursing home residents with dementia: A cluster-randomized controlled trial. Int J Nurs Stud 2021; 120:103982. [PMID: 34171518 DOI: 10.1016/j.ijnurstu.2021.103982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Challenging behavior is prevalent in people with dementia residing in nursing homes and places a high burden on the nursing staff of dementia special care units. This study evaluates an educational program for nursing staff for managing challenging behavior: The Educating Nursing Staff Effectively (TENSE) program. This program can be tailored to care organizations' wishes and needs and combines various learning styles. OBJECTIVE The aim of this cluster-randomized controlled trial was to examine the short-term (3 months) and long-term (9 months) effects of the TENSE training program on experienced stress, work contentment, and stress reactions at work in nursing staff working in dementia special care units. DESIGN Cluster-randomized controlled trial. METHODS Nursing staff members of 18 dementia special care units within nine nursing homes from different Netherlands regions were randomized into an intervention (n = 168) or control (n = 129) group. The TENSE program consisted of a three-day training course and two follow-up sessions after three and six months, respectively. The primary outcome was stress experienced by nursing staff measured with the Utrecht Burnout Scale - C. Secondary outcomes were work contentment and stress reactions at work. Furthermore, process evaluation data on the reach of and compliance with the program and the program's feasibility and relevance were collected. Data were collected between November 2012 and November 2014. RESULTS In general, the participants appreciated the quality and relevance of the TENSE training and evaluated the content of the training as beneficial. The TENSE training had no effect on the components of experienced stress, i.e., emotional exhaustion (p = 0.751), depersonalization (p = 0.701), and personal accomplishment (p = 0.182). Furthermore, no statistically significant effects of the intervention on work contentment and stress reactions at work were found. CONCLUSIONS The TENSE training program did not have an effect on experienced stress, work contentment, nor stress reactions at work of nursing staff working in dementia special care units. In future studies, more focus on practicing new skills seems needed. TRIAL REGISTRATION NTR (Dutch Trial Registration) number NTR3620.
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Mulyani S, Probosuseno P, Nurjannah I. The Effect of Training on Dementia Care among Nurses: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Dementia has become a global concern in ageing societies nowadays. Nurses have major roles in caring for dementia patients in various settings. There have been many trainings on dementia conducted for nurses and other health staff. However, reviews of the effect of the trainings on nurses are still scarce. This paper aims to review the impact of training on dementia care among nurses in differents settings.
Method: systematic search from Medline, Pubmed and Scopus was conducted until February 2019. Additional references were collected using Google Scholar. The inclusion criteria were: primary papers, written in English, involving nurses, and related to dementia.
Results: There were 20 papers included in this review. In terms of methodology, most of the articles employ quantitative method (90%). Only one article uses qualitative method (5%) and another one employs mixed methods design (5%). Pretest and posttest design is the mostly used design and four articles use Randomized Control Trial (RCT). The settings of the papers were nursing home or long-term care facilities (45%), hospitals (35%) and other settings (20%). The lenght of the training was varied from 2 hours to 18 hours within a maximum period of eight months. The various outcome measures are categorised into four domains: cognitive, physical, psychological and working performance. The results of the review indicate that training and education for nurses can improve their knowledge, attitude, confidence and self efficacy towards better dementia care. However, the results regarding staff burnout, stress and physical health complaint are still unclear.
Conclusion: raining and education in dementia care were varied and generally improve nurses’ capacities mainly in cognitive domain. However, the effect for the psychological and their working performance were still doubted
Keywords: dementia, training, education, nurses
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20
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Pereira N, Kochhann R, Wagner GP, Fonseca RP. Development and content validity of the CENEES program - psychoeducation for health staff on neuropsychology of aging. Aging Ment Health 2021; 25:386-396. [PMID: 31791137 DOI: 10.1080/13607863.2019.1693975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Worldwide life expectancy has increased dramatically in recent years. Also on the rise are incidents of pathologies related to aging, such as Mild Cognitive Impairment (MCI) or Alzheimer's Disease (AD). An inaccurate diagnosis impairs the well-being and the quality of life of patients and their relatives, as well as being a financial burden on the health system. Continued education pertaining to the neuropsychological field is uncommon for health workers involved in general practice. This article aims to present the process of development and content validity of the "CENEES Program - Psychoeducation for Health Staff on The Neuropsychology of Aging". The CENEES Program was developed in six steps which include: literature review, first draft, focal group, adjustments after focal group, judgment analysis (n = 4), and finally the last version. The inter-rater reliability index after judgment analysis was 0.785. The final version of the CENEES Program contains eight meetings, divided into 4 modules: 1) Fundamentals of Neuroscience; 2) Memory; 3) Executive Functions; and 4) Communication. The final meeting was called "Review". The CENEES Program is a new resource to help professionals who work within the general practice field, especially community health workers. As far as we know, there is no psychoeducation program on aging which contains the four subjects that are covered in the CENEES Program. The CENEES Program could assist the workers' daily activities and make them comfortable to offer and build actions in the community. A pilot and follow-up studies are suggested.
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Affiliation(s)
- Natalie Pereira
- Psychology Department, Pontíficia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Renata Kochhann
- Psychology Department, Hospital Moinhos de Vento (HMV), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Peretti Wagner
- Psychology Department, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rochele Paz Fonseca
- Psychology Department, Pontíficia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
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21
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Pu L, Moyle W. Restraint use in residents with dementia living in residential aged care facilities: A scoping review. J Clin Nurs 2020; 31:2008-2023. [PMID: 32890437 DOI: 10.1111/jocn.15487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To provide an overview of restraint use in residents with dementia in the context of residential aged care facilities. BACKGROUND Restraints are commonly used in people with dementia living in residential aged care facilities to manage behaviours and reduce injuries, but the concept of restraint use in people with dementia remains ambiguous, and current practices to reduce restraint use in long-term care residents with dementia remain unclear. DESIGN A scoping review using the methodological frameworks of Arskey and O'Malley and colleagues. METHODS Nine databases (CINAHL, MEDLINE, EMBASE, PubMed, Scopus, Web of Science, OVID, Cochrane Central Register of Controlled Trials and ProQuest) were searched from 2005 to 20 May 2019. Articles were included if they were written in English, peer-reviewed and used any research method that described restraint use in residents with dementia living in residential care settings. The PRISMA-ScR checklist was used. RESULTS From 1,585 articles, 23 met the inclusion criteria. There is a lack of a clear definition of restraint use, and the prevalence of restraint use varied from 30.7% to 64.8% depending on the different operational concepts. People with dementia were at a higher risk for restraint use, and the decision-making process for restraint use was largely ignored in the literature. The effect of staff educational interventions to reduce restraint use was inconsistent due to varying delivery duration and content. CONCLUSIONS The prevalence of restraint use in people with dementia living in residential care settings remains high alongside the absence of a clear definition of restraint use. More research about the decision-making process involved in using restraint and development of effective interventions are needed. RELEVANCE TO CLINICAL PRACTICE Better education about the decision-making regarding staff, conditions of residents and organisations for restraint use is needed to improve the care for people with dementia living in care settings.
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Affiliation(s)
- Lihui Pu
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
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Briones-Peralta MÁ, Pardo-García I, Escribano-Sotos F. Effects of a practical training programme on burnout among professional caregivers in a care home for older adults with dementia: a pilot study. Psychogeriatrics 2020; 20:391-397. [PMID: 32034853 DOI: 10.1111/psyg.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/10/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
AIM As the number of persons with dementia has increased so has the need for both specialized care and long-term care centres. Professional caregivers working in these centres encounter specific problems, including stress, burnout, and feelings of dissatisfaction, each which can affect the quality of care. Due to the nature of their work, they are more likely to experience stress, which may lead to burnout syndrome. Therefore, the aim of this work was to assess the results of a practical training programme with regard to burnout among direct care professionals in a nursing home for people with dementia. METHODS A practical training programme was conducted for caregivers at the Sagrado Corazón de Jesús Nursing Home in Cuenca, Spain. The programme used a dynamic, interactive methodology to provide training related to concepts and strategies for dementia care. Weekly 2-h sessions were held over 9 months, from April 2016 to January 2017, with the post-test administered in February. Pretest and post-test measures were taken for a sample of 36 caregivers. An anova was used to analyze the differences in means before and after training. An ancova was also performed to determine the effects of the intervention. RESULTS The results revealed a significant difference between pre- and post-intervention emotional exhaustion and depersonalization scores. Personal accomplishment scores improved, but the changes were not significant. CONCLUSION A practical training programme for direct care professionals working with dementia patients can decrease burnout levels.
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Affiliation(s)
| | - Isabel Pardo-García
- School of Economics and Business Administration, Sociosanitary Research Center, Castilla-La Mancha University (UCLM), Albacete, Spain
| | - Francisco Escribano-Sotos
- School of Economics and Business Administration, Sociosanitary Research Center, Castilla-La Mancha University (UCLM), Albacete, Spain
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Rivett E, Hammond L, West J. What influences self-perceived competence and confidence in dementia care home staff? A systematic review. Psychogeriatrics 2019; 19:440-456. [PMID: 30809893 DOI: 10.1111/psyg.12422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 06/10/2018] [Accepted: 01/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia care staff working in long-term care settings are often exposed to a variety of complex situations that can be emotionally challenging, and a lack of adequate support and limited training opportunities may contribute to high levels of staff turnover in this area. Good-quality training may be beneficial for improving the quality of care provided, and in improving staff confidence and morale. This systematic review aimed to establish how dementia care home staff perceived their own competence and confidence in relation to the care they deliver, whether there are any specific interventions that improve these feelings, and whether feeling more competent and confident impacts on care delivery. METHOD A search of the literature focusing on staff perceptions of competence and confidence identified 14 873 studies. Following the removal of duplicates and papers that did not meet the inclusion criteria, 19 studies were included in the review and subject to quality assessment. RESULTS Studies varied in terms of quality and design, and were categorised as either intervention or non-intervention studies. Four studies found a significant increase in feelings of competence and confidence following intervention, although many studies did not statistically analyze their data. The most successful interventions seemed to be those that involved practical support alongside education, and non-intervention studies highlighted the importance of specific dementia and palliative care training with regard to feelings of competence and confidence. CONCLUSION Teaching alone may not be an adequate method of training dementia care staff, and the most successful interventions were those where practical support was also provided. Most studies suggested that improvements in competence and confidence also had benefits for care delivery and staff wellbeing. More research needs to be done using validated outcome measures and with competence and confidence as the primary aim.
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Affiliation(s)
- Emma Rivett
- Research Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Laura Hammond
- Research Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Juniper West
- Research Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Scerri A, Scerri C. Outcomes in knowledge, attitudes and confidence of nursing staff working in nursing and residential care homes following a dementia training programme. Aging Ment Health 2019; 23:919-928. [PMID: 29115867 DOI: 10.1080/13607863.2017.1399342] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: Dementia training programmes for staff working in long-term care settings have been found to be effective in improving staff outcomes. This study investigated the impact of a dementia training programme for all Maltese nursing staff working in public nursing/residential homes on their knowledge, attitudes and confidence. Additionally, we identified the predictors of these domains before and after the programme. Method: A 14-hour training programme focusing on dementia management, care and policy was developed for all nursing staff working in public nursing and residential homes in Malta. A pretest-posttest design was used to evaluate the participants' knowledge of dementia, attitudes and confidence in working with residents with dementia using validated tools. Demographic variables were measured and compared with each staff domain. Results: The majority of nursing staff attended the training programme with 261 fully completed questionnaires being collected pre-training and 214 post-training. The programme significantly improved nursing staff knowledge, attitudes and confidence. Stepwise regression analysis of each staff domain showed that the strongest predictor in all models at pre-training was the intensity of previous training programmes. Furthermore, staff who attended previous training continued to improve in their attitudes and confidence following programme completion. Conclusion: The study continues to shed further evidence on the impact of dementia training programs on staff outcomes. It also indicated that the intensity of previous participation in dementia training programmes was related to the participants' knowledge, attitudes and confidence and that continual exposure to training had a cumulative effect.
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Affiliation(s)
- Anthony Scerri
- a Department of Nursing, Faculty of Health Sciences , University of Malta , Msida , Malta
| | - Charles Scerri
- b Department of Pathology, Faculty of Medicine & Surgery , University of Malta , Msida , Malta
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Gil I, Costa P, Parola V, Cardoso D, Almeida M, Apóstolo J. Efficacy of reminiscence in cognition, depressive symptoms and quality of life in institutionalized elderly: a systematic review. Rev Esc Enferm USP 2019; 53:e03458. [DOI: 10.1590/s1980-220x2018007403458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022] Open
Abstract
ABSTRACT Objective: To identify the best available evidence on the efficacy of Reminiscence Therapy in cognition, depressive symptoms and quality of life in elderly individuals with cognitive impairment. Method: The methodology proposed by the Joanna Briggs Institute was used. Studies focused on group Reminiscence Therapy aimed at institutionalized elderly people with cognitive impairment aged 65 or over were considered. The critical analysis, extraction and synthesis of results was performed by two independent researchers. Results: Four randomized clinical trials and two quasi-experimental studies (n=296) were included. Given the heterogeneous characteristics of studies found, it was impossible to perform a meta-analysis. Of the six studies included, two presented statistically significant results for efficacy in cognition, and three for efficacy in reducing depressive symptoms. In none of the studies was evaluated the elderly’s quality of life. Conclusion: Reminiscence Therapy has potential efficacy for maintaining cognition and decrease of depressive symptomatology in the target population.
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Affiliation(s)
- Isabel Gil
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal
| | - Paulo Costa
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal
| | - Vítor Parola
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal; Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Portugal
| | - Daniela Cardoso
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal; Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Portugal
| | - Maria Almeida
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal
| | - João Apóstolo
- Escola Superior de Enfermagem de Coimbra, Portugal; Unidade de Investigação em Ciências da Saúde, Portugal; Portugal Centre for Evidence Based Practice: A Joanna Briggs Institute Centre of Excellence, Portugal
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26
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Nguyen H, Terry D, Phan H, Vickers J, McInerney F. Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review. J Clin Nurs 2018; 28:1050-1069. [DOI: 10.1111/jocn.14697] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/16/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Daniel Terry
- Faculty of Health; Federation University; Ballarat Victoria Australia
| | - Hoang Phan
- Menzies Institute for Medical Research; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - James Vickers
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
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Blankart CR, Foster AD, Mor V. The effect of political control on financial performance, structure, and outcomes of US nursing homes. Health Serv Res 2018; 54:167-180. [PMID: 30294780 PMCID: PMC6338305 DOI: 10.1111/1475-6773.13061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the effect of partisan political control on financial performance, structure, and outcomes of for‐profit and not‐for‐profit US nursing homes. Data Sources/Study Setting Nineteen‐year panel (1996‐2014) of state election outcomes, financial performance data from nursing home cost reports, operational and aggregate resident characteristics from OSCAR of 13 737 nursing homes. Study Design A linear panel model was estimated to identify the effect of Democratic and Republican political control on next year's outcomes. Nursing home outcomes were defined as yearly facility revenues, expenses, and profits; the number of Medicaid, Medicare, and private‐pay residents; staffing levels; and selected resident outcomes. Principal Findings Democratic political control leads to an increase in financial flows to for‐profit nursing homes, boosting profits without producing observable improvements in resident outcomes. Republican political control leads to lower revenues and profits of for‐profit nursing homes. A shift from Medicaid to more profitable private‐pay residents following Republican political control is observed for all nursing homes. Financial performance of not‐for‐profit nursing homes is not significantly affected by changes in political control. Conclusion Political control of the two legislative chambers—but not of the governorship—shapes the structure of the nursing home industry as seen in provider behavior.
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Affiliation(s)
- Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Andrew D Foster
- Department of Economics, Brown University, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
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Spencer S, Johnson P, Smith IC. De-escalation techniques for managing non-psychosis induced aggression in adults. Cochrane Database Syst Rev 2018; 7:CD012034. [PMID: 30019748 PMCID: PMC6513023 DOI: 10.1002/14651858.cd012034.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Aggression occurs frequently within health and social care settings. It can result in injury to patients and staff and can adversely affect staff performance and well-being. De-escalation is a widely used and recommended intervention for managing aggression, but the efficacy of the intervention as a whole and the specific techniques that comprise it are unclear. OBJECTIVES To assess the effects of de-escalation techniques for managing non-psychosis-induced aggression in adults in care settings, in both staff and service users. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and 14 other databases in September 2017, plus three trials registers in October 2017. We also checked references, and contacted study authors and authorities in the field to identify additional published and unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing de-escalation techniques with standard practice or alternative techniques for managing aggressive behaviour in adult care settings. We excluded studies in which participants had psychosis. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes just one cluster-randomised study of 306 older people with dementia and an average age of 86 years, conducted across 16 nursing homes in France. The study did not measure any of our primary or secondary outcomes but did measure behavioural change using three measurement scales: the Cohen-Mansfield Agitation Inventory (CMAI; 29-item scale), the Neuropsychiatric Inventory (NPI; 12-item scale), and the Observation Scale (OS; 25-item scale). For the CMAI, the study reports a Global score (29 items rated on a seven-point scale (1 = never occurs to 7 = occurs several times an hour) and summed to give a total score ranging from 29 to 203) and mean scores (evaluable items (rated on the same 7-point scale) divided by the theoretical total number of items) for the following four domains: Physically Non-Aggressive Behaviour, such as pacing (13 items); Verbally Non-Aggressive Behaviour, such as repetition (four items); Physically Aggressive Behaviour, such as hitting (nine items); and Verbally Aggressive Behaviour, such as swearing (three items). Four of the five CMAI scales improved in the intervention group (Global: change mean difference (MD) -5.69 points, 95% confidence interval (CI) -9.59 to -1.79; Physically Non-Aggressive: change MD -0.32 points, 95% CI -0.49 to -0.15; Verbally Non-Aggressive: change MD -0.44 points, 95% CI -0.69 to -0.19; and Verbally Aggressive: change MD -0.16 points, 95% CI -0.31 to -0.01). There was no difference in change scores on the Physically Aggressive scale (MD -0.08 points, 95% CI -0.37 to 0.21). Using GRADE guidelines, we rated the quality of this evidence as very low due to high risk of bias and indirectness of the outcome measures. There were no differences in NPI or OS change scores between groups by the end of the study.We also identified one ongoing study. AUTHORS' CONCLUSIONS The limited evidence means that uncertainty remains around the effectiveness of de-escalation and the relative efficacy of different techniques. High-quality research on the effectiveness of this intervention is therefore urgently needed.
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Affiliation(s)
- Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Paula Johnson
- Mersey Care NHS Foundation TrustDepartment of Research and DevelopmentMitton Road, WhalleyLancashireClitheroeLancashireUKBB7 9PE
| | - Ian C Smith
- Lancaster UniversityDivision of Health ResearchBailriggLancasterLancasterUK
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Birkenhäger-Gillesse EG, Kollen BJ, Achterberg WP, Boersma F, Jongman L, Zuidema SU. Effects of Psychosocial Interventions for Behavioral and Psychological Symptoms in Dementia on the Prescription of Psychotropic Drugs: A Systematic Review and Meta-Analyses. J Am Med Dir Assoc 2018; 19:276.e1-276.e9. [DOI: 10.1016/j.jamda.2017.12.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Clinical and Economic Outcomes of Interventions to Reduce Antipsychotic and Benzodiazepine Use Within Nursing Homes: A Systematic Review. Drugs Aging 2018; 35:123-134. [DOI: 10.1007/s40266-018-0518-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gerolimatos LA, Page KS, Balestracci P, Hinrichs KLM. Interdisciplinary development and implementation of a dementia skills training program in a VA community living center: a pilot study. Geriatr Nurs 2018; 39:400-406. [PMID: 29336830 DOI: 10.1016/j.gerinurse.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
This pilot study investigates the usefulness of a dementia care training program developed by an interdisciplinary team to address problem behaviors associated with dementia. Staff members of a VA Community Living Center completed an 8-hour workshop covering fundamental knowledge about dementia and instruction in skills to use with patients through video, lecture, and role-plays. Measures on dementia knowledge and perceived self-efficacy were completed by staff members before and after the workshop. Results revealed increases in self-efficacy and knowledge, with particular gains in general knowledge of dementia and communicating with patients. Younger staff members scored higher on tests of knowledge at pre- and post-test, whereas staff members with more years of work experience rated their self-efficacy higher at post-test only. There was an associated decrease in assaultive behaviors by patients with dementia in the year this workshop was implemented. Results highlight the benefit of interdisciplinary collaboration in developing educational content and the value of providing staff training on managing dementia-related behaviors. Adjustments to this training program are discussed.
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Affiliation(s)
| | - Kyle S Page
- VA Central Iowa Healthcare System, Des Moines, IA
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Latham I, Brooker D. Reducing anti-psychotic prescribing for care home residents with dementia. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/npre.2017.15.10.504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Isabelle Latham
- Senior Lecturer, Association for Dementia Studies, University of Worcester
| | - Dawn Brooker
- Professor of Dementia Studies and Director, Association for Dementia Studies, University of Worcester
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Yasuda M, Sakakibara H. Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia. Aging Ment Health 2017; 21:991-996. [PMID: 27248843 DOI: 10.1080/13607863.2016.1191056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home. METHODS An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention). RESULTS The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p < 0.001, respectively); over 50% of the residents had better WIB values. The behavior category 'interactions with others' in DCM also demonstrated a significant increase in the third round compared to the first round (p = 0.041). CONCLUSION Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.
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Affiliation(s)
- Mami Yasuda
- a Department of Nursing , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Hisataka Sakakibara
- a Department of Nursing , Nagoya University Graduate School of Medicine , Nagoya , Japan
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Dementia-specific training for nursing home staff : A systematic literature review. Z Gerontol Geriatr 2017; 51:523-529. [PMID: 28831611 DOI: 10.1007/s00391-017-1296-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/28/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND For people with dementia high-quality care is vital, since at present dementia cannot be cured. In nursing homes this care is provided by the staff, who therefore require dementia-specific training enabling them to improve the quality of life for people with dementia. OBJECTIVE This article compares existing dementia-specific training for nursing home staff with recommendations, based on the current state of research, by the Alzheimer's Association and the National Institute for Health and Care Excellence, and discusses the outcome of this training. MATERIAL AND METHODS A systematic review of the literature was conducted to identify studies addressing dementia-specific training. The electronic databases Embase, Medline, Cochrane, CINAHL, PsychINFO, PSYNDEX, and ScienceDirect were searched. RESULTS The training topics most commonly considered were person-centered care, communicating with people affected by dementia, and information about dementia. The roles of different social and healthcare professionals, palliative care of people with dementia, and understanding family dynamics are least featured in the training. There are training concepts which focus not only on the transfer of knowledge but also on practical exercises. CONCLUSION In general, the recommended topics were addressed in dementia-specific training concepts, but there is potential for optimization. Further research is needed to identify success criteria in dementia-specific training and identify the successful combination of theoretical knowledge and practical exercise.
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Guzmán A, Wenborn J, Swinson T, Orrell M. Evaluation of the 'Ladder to the Moon, Culture Change Studio Engagement Programme' staff training: Two quasi-experimental case studies. Int J Older People Nurs 2017; 12. [PMID: 28185441 DOI: 10.1111/opn.12147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 11/17/2016] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the impact of the CCSEP on care home staff in two care settings for older people in one nursing home and one residential home. BACKGROUND Care homes provide personal care and accommodation for older people. The English Dementia Strategy aims to improve the quality of service provision for people with dementia. This includes specific mention of improving the quality of life in care homes and as such includes objectives related to developing the workforce knowledge and skills. The Ladder to the Moon Culture Change Studio Engagement Programme (CCSEP) is a staff training approach based on the Positive Psychology framework that uses theatre- and film-based activities. METHODS This study used a wait-list controlled design. However, the data analysis plan was amended to reflect difficulties in data collection, and a quasi-experimental case study approach was consequently utilised. Outcome measures for staff attitudes and beliefs were as follows: Sense of Competence in Dementia Care Staff; Approaches to Dementia Questionnaire; Job Satisfaction Index; Brief Learning Transfer System Inventory; and Scale of Positive and Negative Experience. The Quality of Interaction Schedule (QUIS) was used to observe changes in staff-resident interaction. RESULTS Fifty staff in two care homes completed the questionnaires and forty-one undertook formal CCSEP training. In Home A (nursing home), there was no significant change in any of the measures. In Home B (residential home), the QUIS showed an increase in positive interactions post intervention; a significant increase in the Building Relationship subscale of Sense of Competence; and a significant increase in staff sense of hopefulness towards people with dementia. The Brief Learning Transfer System Inventory showed a significant decrease post-intervention. The intervention did not significantly affect the happiness or job satisfaction of care home staff. CONCLUSION The results of this study provide tentative evidence about the efficacy of this staff training programme. Some significant improvement in staff attitudes to people with dementia, staff sense of competence and positive staff-resident interactions were found in one of two homes. It is likely that the organisational problems affecting the other care home limited the implementation and therefore efficacy of the intervention there. The results therefore suggest that when a supportive management structure is in place, CCSEP may be more effective in improving staff attitudes, sense of competence and interactions with residents.
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Affiliation(s)
- Azucena Guzmán
- Clinical Psychology Department, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Jennifer Wenborn
- Division of Psychiatry, University College London, London, UK.,Dementia Research Centre, North East London NHS Foundation Trust, London, UK
| | - Tom Swinson
- Dementia Research Centre, North East London NHS Foundation Trust, London, UK
| | - Martin Orrell
- Division of Psychiatry, University College London, London, UK.,Institute of Mental Health, Nottingham University, Nothingham, UK
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Rapaport P, Livingston G, Murray J, Mulla A, Cooper C. Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia. BMJ Open 2017; 7:e014177. [PMID: 28183810 PMCID: PMC5306506 DOI: 10.1136/bmjopen-2016-014177] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes. DESIGN A systematic review of qualitative and quantitative intervention studies was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes. METHODS We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change. RESULTS We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care. CONCLUSIONS Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes. TRIAL REGISTRATION NUMBER CRD42015017621.
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Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Joanna Murray
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
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Arthur A, Aldus C, Sarre S, Maben J, Wharrad H, Schneider J, Barton G, Argyle E, Clark A, Nouri F, Nicholson C. Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundOlder people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.Objective(s)We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).Design(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.Setting(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.Participants(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.InterventionsFor the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.Main outcome measuresPatient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.Results(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial, 187 of the 192 planned ward observation sessions were completed; the response to HCA questionnaires at baseline and at 8 and 12 weeks post randomisation was 64.2%, 46.4% and 35.7%, respectively, and 57.2% of eligible patients returned completed questionnaires.LimitationsThis was an intervention development and feasibility study so no conclusions can be drawn about the clinical effectiveness or cost-effectiveness of the intervention.ConclusionsThe intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.Future workMethods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.Trial registrationCurrent Controlled Trials ISRCTN10385799.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antony Arthur
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Clare Aldus
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Jill Maben
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Heather Wharrad
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Garry Barton
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Elaine Argyle
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Allan Clark
- Norwich Clinical Trials Unit, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Nouri
- School of Health Sciences, Queen’s Medical Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Caroline Nicholson
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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Hsieh PL, Chen CM. Long term care nursing competence and related factors among Taiwanese nurses: A national survey for those who completed the LTC training course. Geriatr Nurs 2016; 38:192-198. [PMID: 27866668 DOI: 10.1016/j.gerinurse.2016.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 11/25/2022]
Abstract
The aim of this study was to explore Taiwanese nurses' LTC competence and to examine its relationship with their LTC-related knowledge, care intention, and practical experience. The total sampling was selected from nurses who participated in a 2013 LTC course offered by the Ministry of Health and Welfare. Participants in this study (n = 122) voluntarily provided email addresses and responded to an online survey. A self-developed scale with acceptable reliability and validity was used for data collection. Findings from this study showed median high levels of LTC nursing competence, which was found to be positively correlated with LTC knowledge, care intention, practical experience, continuing education, and marital status. The study revealed that through on-the-job training, nurses' LTC knowledge, care intention, practical experience and nursing competence can be improved, which will benefit the quality of care for LTC clients.
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Affiliation(s)
- Pei-Lun Hsieh
- Doctoral Student, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
| | - Ching-Min Chen
- Department of Nursing, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan; Indiana University, School of Nursing, USA.
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Abstract
BACKGROUND Despite the numerous warnings of European and national drug agencies as well as clinical guidelines since the year 2004, psychotropic drugs are still frequently used in dementia. A systematic review comparing the use of psychotropic drugs in nursing homes from different European countries is lacking. OBJECTIVE The aim of this study was to examine prescription rates of psychotropic drug use in nursing home patients between different Western European countries since the first warnings were published. METHODS A literature review was performed and the various psychotropic prescribing rates in European nursing homes were investigated. The prescription rates of antipsychotic and antidepressants were pooled per country. Other classes of psychotropic drugs could not be pooled because of the limited number of studies found. RESULTS Thirty-seven studies on antipsychotic drug use and 27 studies on antidepressant drug use conducted in 12 different European countries. The antipsychotic use in nursing homes ranged from 12% to 59% and antidepressant use from 19% to 68%. The highest rates of antipsychotic drug prescription were found in Austria, Ireland, and Belgium while for antidepressants in Belgium, Sweden, and France. CONCLUSIONS Despite warnings about the side effects and recommendation to focus on non-pharmacological interventions, antipsychotics and antidepressants are commonly used drugs in nursing homes. The data suggest that Norway does best with regards having a low antipsychotic drug usage. Studies are needed to explain the differences between Norway and other European countries.
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Spector A, Revolta C, Orrell M. The impact of staff training on staff outcomes in dementia care: a systematic review. Int J Geriatr Psychiatry 2016; 31:1172-1187. [PMID: 27161855 DOI: 10.1002/gps.4488] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Caring for people with dementia can be emotionally challenging and is often linked to low job satisfaction and burnout in care staff. Staff training within care settings is potentially valuable in improving well-being and quality of care. This review aimed to (i) establish the impact of training on staff outcomes; (ii) compare the impact of different training approaches; (iii) explore the influence of training intensity; and (iv) explore potential barriers to success. METHOD A database search of staff training interventions revealed 207 papers, 188 of which were excluded based on prespecified criteria. Nineteen studies were included and appraised using a quality rating tool. RESULTS Overall, the studies were found to be of variable quality; however, 16 studies found a significant change following training in at least one staff domain, with knowledge improving most frequently. Approaches focusing on managing challenging behaviours appeared to be the most effective. CONCLUSION Training staff can be an effective method of improving well-being, and programmes helping staff to manage challenging behaviour appear to be the most beneficial. There is no clear relationship between training intensity and outcome. Most studies point to the importance of addressing organisational factors as a barrier to change. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Catherine Revolta
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martin Orrell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Hoben M, Estabrooks CA, Squires JE, Behrens J. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care. Front Psychol 2016; 7:1339. [PMID: 27656156 PMCID: PMC5013130 DOI: 10.3389/fpsyg.2016.01339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90-0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program, Faculty of Nursing, University of AlbertaEdmonton, AB, Canada; Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-WittenbergHalle, Germany; Network Aging Research, Heidelberg UniversityHeidelberg, Germany
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta Edmonton, AB, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of OttawaOttawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa HospitalOttawa, ON, Canada
| | - Johann Behrens
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg Halle, Germany
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Williams L, Rycroft-Malone J, Burton CR, Edwards S, Fisher D, Hall B, McCormack B, Nutley SM, Seddon D, Williams R. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions. BMJ Open 2016; 6:e011964. [PMID: 27566640 PMCID: PMC5013423 DOI: 10.1136/bmjopen-2016-011964] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services. DESIGN Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) 'testing out' the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations. PARTICIPANTS Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process. RESULTS Eight context-mechanism-outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about 'what works' to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations. CONCLUSIONS It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the employing organisations within which workforce development operates. Workforce development interventions need to balance the technical, professional and emotional aspects of care. TRIAL REGISTRATION NUMBER CRD42013006283.
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Affiliation(s)
- L Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - C R Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - S Edwards
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - D Fisher
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - B Hall
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - S M Nutley
- University of St Andrews, St Andrews, UK
| | - D Seddon
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - R Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Sposito G, Barbosa A, Figueiredo D, Yassuda MS, Marques A. Effects of multisensory and motor stimulation on the behavior of people with dementia. DEMENTIA 2016; 16:344-359. [PMID: 26112166 DOI: 10.1177/1471301215592080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A quasi-experimental study using a pre-posttest design was conducted in four aged care facilities to assess the effects of a person-centred care (PCC) multisensory stimulation (MSS) and motor stimulation (MS) program, implemented by direct care workers, on the behaviors of residents with dementia. Data were collected at baseline and after the intervention through video recordings of morning care routines. Forty-five residents with moderate and severe dementia participated in the study. A total of 266 morning care routines were recorded. The frequency and duration of a list of behaviors were analyzed. The frequency of engagement in task decreased significantly ( p = .002) however, its duration increased ( p = .039). The duration of gaze directed at direct care workers improved significantly ( p = .014) and the frequency of closed eyes decreased ( p = .046). There was a significant decrease in the frequency of the expression of sadness. These results support the implementation of PCC-MSS and MS programs as they may stimulate residents' behaviors.
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Affiliation(s)
- Giovana Sposito
- School of Medical Sciences, State University of Campinas (Unicamp), Campinas-SP, Brazil
| | - Ana Barbosa
- Department of Health Sciences, University of Aveiro, Portugal
| | - Daniela Figueiredo
- School of Health Sciences, University of Aveiro, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), University of Aveiro, Portugal
| | - Mônica Sanches Yassuda
- School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo-SP, Brazil
| | - Alda Marques
- School of Health Sciences, University of Aveiro, Portugal.,CINTESIS, University of Aveiro, Portugal
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Guzmán A, Wenborn J, Ledgerd R, Orrell M. Evaluation of a Staff Training Programme using Positive Psychology coaching with film and theatre elements in care homes: views and attitudes of residents, staff and relatives. Int J Older People Nurs 2016; 12. [DOI: 10.1111/opn.12126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Azucena Guzmán
- Clinical Psychology Department; School of Health in Social Science; University of Edinburgh; Edinburgh UK
| | - Jennifer Wenborn
- Division of Psychiatry; University College London; London UK
- Dementia Research Centre; North East London NHS Foundation Trust; London UK
| | - Ritchard Ledgerd
- Dementia Research Centre; North East London NHS Foundation Trust; London UK
| | - Martin Orrell
- Institute of Mental Health; University of Nottingham; Nottingham UK
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Brooker DJ, Latham I, Evans SC, Jacobson N, Perry W, Bray J, Ballard C, Fossey J, Pickett J. FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes. Aging Ment Health 2016; 20:709-18. [PMID: 26167720 PMCID: PMC4898161 DOI: 10.1080/13607863.2015.1063102] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. METHOD An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. RESULTS Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. DISCUSSION AND CONCLUSIONS The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.
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Affiliation(s)
- Dawn J. Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK,Corresponding author.
| | - Isabelle Latham
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Simon C. Evans
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Nicola Jacobson
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Wendy Perry
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | - Jennifer Bray
- Association for Dementia Studies, University of Worcester, Worcester, UK
| | | | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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Palm R, Jünger S, Reuther S, Schwab CGG, Dichter MN, Holle B, Halek M. People with dementia in nursing home research: a methodological review of the definition and identification of the study population. BMC Geriatr 2016; 16:78. [PMID: 27052960 PMCID: PMC4823911 DOI: 10.1186/s12877-016-0249-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background There are various definitions and diagnostic criteria for dementia, leading to discrepancies in case ascertainment in both clinical practice and research. We reviewed the different definitions, approaches and measurements used to operationalize dementia in health care studies in German nursing homes with the aim of discussing the implications of different approaches. Methods We conducted a systematic search of the MEDLINE and CINAHL databases to identify pre-2016 studies conducted in German nursing homes that focused on residents with dementia or cognitive impairment. In- or exclusion of studies were consented by all authors; data extraction was independently carried out by 2 authors (RP, SJ). The studies’ sampling methods were compared with respect to their inclusion criteria, assessment tools and methods used to identify the study population. Results We summarized case ascertainment methods from 64 studies. Study participants were identified based on a diagnosis that was evaluated during the study, or a recorded medical dementia diagnosis, or a recorded medical diagnosis either with additional cognitive screenings or using screening tests exclusively. The descriptions of the diagnostics that were applied to assess a diagnosis of dementia were not fully transparent in most of the studies with respect to either a clear reference definition of dementia or applied diagnostic criteria. If reported, various neuropsychological tests were used, mostly without a clear rationale for their selection. Conclusion Pragmatic considerations often determine the sampling strategy; they also may explain the variances we detected in the different studies. Variations in sampling methods impede the comparability of study results. There is a need to consent case ascertainment strategies in dementia studies in health service research in nursing homes. These strategies should consider resource constraints and ethical issues that are related to the vulnerable population of nursing home residents. Additionally, reporting about dementia studies in nursing homes need to be improved. If a diagnosis cannot be evaluated based on either ICD or DSM criteria, the study population may not be reported as having dementia. If a diagnosis is evaluated based on ICD or DSM criteria within the study, there is a need for more transparency of the diagnostic process. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0249-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany. .,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany.
| | - Saskia Jünger
- Hannover Medical School, Institute of General Medicine, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sven Reuther
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Christian G G Schwab
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Martin N Dichter
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
| | - Margareta Halek
- German Centre for Neurodegenerative Diseases (DZNE), Site Witten, Stockumer Str. 12, 58453, Witten, Germany.,Faculty of Health, School of Nursing Science, Witten/Herdecke University (UW/H), Stockumer Str. 12, 58453, Witten, Germany
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Franzmann J, Haberstroh J, Pantel J. Train the trainer in dementia care. Z Gerontol Geriatr 2016; 49:209-15. [DOI: 10.1007/s00391-016-1041-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/27/2016] [Accepted: 02/05/2016] [Indexed: 11/29/2022]
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Rycroft-Malone J, Burton CR, Williams L, Edwards S, Fisher D, Hall B, McCormack B, Nutley S, Seddon D, Williams R. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSupport workers make up the majority of the workforce in health and social care services for older people. There is evidence to suggest that support workers are not deployed as effectively as possible, are often undervalued, and that there are gaps in understanding support worker roles across different care settings. In the context of a population that is growing older, having a skilled and knowledgeable workforce is an imperative. Workforce development includes the support required to equip those providing care to older people with the right skills, knowledge and behaviours to deliver safe and high-quality services.ObjectiveThe review answered the question ‘how can workforce development interventions improve the skills and the care standards of support workers within older people’s health and social care services?’.DesignA realist synthesis was conducted. In realist synthesis, contingent relationships are expressed as context–mechanism–outcomes (CMOs), to show how particular contexts or conditions trigger mechanisms to generate outcomes. The review was conducted in four iterative stages over 18 months: (1) development of a theoretical framework and initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce, guided by the programme theories; (3) ‘testing out’ the synthesis findings to refine the programme theories and establish their practical relevance/potential for implementation; and (4) forming recommendations about how to improve current workforce development interventions to ensure high standards in the care of older people.ParticipantsTwelve stakeholders were involved in workshops to inform programme theory development, and 10 managers, directors for training/development and experienced support workers were interviewed in phase 4 of the study to evaluate the findings and inform knowledge mobilisation.ResultsEight CMO configurations emerged from the review process, which provide a programme theory about ‘what works’ in developing the older person’s support workforce. The findings indicate that the design and delivery of workforce development should consider and include a number of starting points. These include personal factors about the support worker, the specific requirements of workforce development and the fit with broader organisational strategy and goals.Conclusions and recommendationsThe review has resulted in an explanatory account of how the design and delivery of workforce development interventions work to improve the skills and care standards of support workers in older people’s health and social care services. Implications for the practice of designing and delivering older person’s support workforce development interventions are directly related to the eight CMO configuration of the programme theory. Our recommendations for future research relate both to aspects of research methods and to a number of research questions to further evaluate and explicate our programme theory.LimitationsWe found that reports of studies evaluating workforce development interventions tended to lack detail about the interventions that were being evaluated. We found a lack of specificity in reports about what were the perceived and actual intended impacts from the workforce development initiatives being implemented and/or evaluated.Study registrationThis study is registered as PROSPRERO CRD42013006283.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jo Rycroft-Malone
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Christopher R Burton
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Stephen Edwards
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Denise Fisher
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Beth Hall
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Brendan McCormack
- Division of Nursing, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sandra Nutley
- School of Management, University of St Andrews, St Andrews, UK
| | - Diane Seddon
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - Roger Williams
- School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
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Ayalon L, Lev S, Green O, Nevo U. A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment. Age Ageing 2016; 45:216-27. [PMID: 26744361 DOI: 10.1093/ageing/afv193] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND elder maltreatment is a major risk for older adults' mental health, quality of life, health, institutionalisation and even mortality. OBJECTIVES to perform a systematic review and meta-analysis of interventions designed to prevent or stop elder abuse. METHODS Studies that were posted between January 2000 and December 2014, written in English, specifically designed to prevent or stop elder maltreatment were included. RESULTS overall, 24 studies (and four records reporting on the same participants) were kept for the systematic review and the meta-analysis. Studies were broadly grouped into three main categories: (i) interventions designed to improve the ability of professionals to detect or stop elder maltreatment (n = 2), (ii) interventions that target older adults who experience elder maltreatment (n = 3) and (iii) interventions that target caregivers who maltreat older adults (n = 19). Of the latter category, one study targeted family caregivers, five targeted psychological abuse among paid carers and the remaining studies targeted restraint use. The pooled effect of randomised controlled trials (RCTs)/cluster-RCTs that targeted restraint use was significant, supporting the effectiveness of these interventions in reducing restraint use: standardised mean difference: -0.24, 95% confidence interval = -0.38 to -0.09. INTERPRETATION the most effective place to intervene at the present time is by directly targeting physical restraint by long-term care paid carers. Specific areas that are still lacking evidence at the present time are interventions that target (i) elder neglect, (ii) public awareness, (iii) older adults who experience maltreatment, (iv) professionals responsible for preventing maltreatment, (v) family caregivers who abuse and (vi) carers who abuse.
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Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Sagit Lev
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Ohad Green
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Uziel Nevo
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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Gaugler JE, Hobday JV, Robbins JC, Barclay MP. Direct Care Worker Training to Respond to the Behavior of Individuals With Dementia: The CARES® Dementia-Related Behavior ™ Online Program. Gerontol Geriatr Med 2016; 2. [PMID: 26894209 PMCID: PMC4755277 DOI: 10.1177/2333721415626888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Only a handful of online training programs are available for direct care workers (DCWs) to acquire the strategic skills needed to improve dementia care in instances of challenging or inappropriate behavior. Utilizing pre- and post-test data from a convenience sample of 40 DCWs, the present study sought to determine (a) whether DCWs' knowledge of responding to dementia-related behavior increased following participation in the CARES® Dementia-Related Behavior™ Online Training Program (or CARES® Behavior) and (b) if CARES® Behavior was acceptable and useful. The average number of correct scores on a dementia care knowledge measure was significantly higher among DCWs after viewing the online modules when compared with pre-test scores (p < .01). Descriptive empirical and open-ended data also suggested that the interactive, "real-world" content of CARES® Behavior was feasibly delivered online, acceptable, and may influence how DCWs deliver clinical care to individuals with dementia-related behavior.
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