Recommendations for staff education and training for older people with mental illness in long-term aged care

Ageism in the Mental Health Setting

PURPOSE OF REVIEW

This paper summarizes the prevalence, impact, and presentation of ageism across multiple mental health care settings including inpatient, outpatient, long-term care, and criminal justice. Strategies for combating ageism are described.

RECENT FINDINGS

Ageism is a common form of bias that has deleterious medical and psychosocial consequences for older adults. Ageism manifests in a variety of ways in mental health settings. Clinical, educational, and public policy strategies are recommended to combat ageism in mental health settings. Ageism remains pervasive in society and in mental health care settings. Ageism impacts healthcare trainees, healthcare providers, healthcare systems, and older adults themselves. Age-friendly practices and strategies for combating ageism exist and need broader dissemination.

Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study

The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.

Effectiveness of dementia education for professional care staff and factors influencing staff-related outcomes: An overview of systematic reviews

BACKGROUND

Care staff often lack knowledge, confidence, skills, and competency to provide optimal care for people with dementia. Dementia education can increase staff competency and wellbeing along with the actual care of people with dementia. Several factors can affect the effectiveness of dementia education; however, it is not yet established which factors are most important.

OBJECTIVE

The aim of the overview of systematic reviews is to investigate the effectiveness of dementia education for care staff on staff-related outcomes and influencing factors, identify needs for future research, and provide practical recommendations for effective dementia education.

METHODS

Systematic searches were conducted in PubMed, Cinahl, and PsycInfo accompanied by manual citation and reference searches. For inclusion, reviews must report on either effectiveness of one staff-related outcome or on factors influencing the effectiveness of dementia education for care staff. Quality assessments were conducted using AMSTAR2. After data extraction, results on effectiveness were structured according to satisfaction, learning, behavior, and results. Results on contributing factors to effectiveness were categorized into program, personal and organizational factors. All results were qualitatively summarized and reported according to the PRISMA statement.

RESULTS

Seventeen systematic reviews of low to medium quality were included. Dementia education positively affects knowledge, self-efficacy, and attitudes towards dementia and people with dementia. Care staff experienced improvements in communication and behavior management and reduction in behavioral symptoms of dementia of people with dementia was seen as well. Most reviews found no changes within restraints, medication, staff well-being and job satisfaction. Factors contributing to effectiveness are relevant and directly applicable content, active learning methods, classroom teaching combined with practical experience, theory-driven approaches and feedback sessions. Finally, the instructor needs to be experienced within dementia and sensitive to the needs of participants.

CONCLUSION

There is no one-size-fits-all in dementia education: however, perceived relevance and applicability are key elements for effective dementia education. Due to low quality of primary studies, further research of high methodological quality is needed on effectiveness of dementia education on staff behavior, wellbeing, and job satisfaction as well as on influencing factors and their impact on mechanisms of change.

Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature

INTRODUCTION

Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood.

METHODS

This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors.

RESULTS

Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited.

DISCUSSION

Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.

Understanding the training and education needs of homecare workers supporting people with dementia and cancer: A systematic review of reviews

Many people with dementia, supported by family carers, prefer to live at home and may rely on homecare support services. People with dementia are also often living with multimorbidities, including cancer. The main risk factor for both cancer and dementia is age and the number of people living with dementia and cancer likely to rise. Upskilling the social care workforce to facilitate more complex care is central to national workforce strategies and challenges. Training and education development must also respond to the key requirements of a homecare workforce experiencing financial, recruitment and retention difficulties. This systematic review of reviews provides an overview of dementia and cancer training and education accessible to the homecare workforce. Findings reveal there is a diverse range of training and education available, with mixed evidence of effectiveness. Key barriers and facilitators to effective training and education are identified in order to inform future training, education and learning development for the homecare workforce supporting people with dementia and cancer.

Shaping attitudes: The association between prior contact with residential aged care and resistance to enter residential aged care

BACKGROUND

The ageing population is increasing, and negative attitudes towards older people are all too common and largely overlooked. However, little research has examined how ageist, prejudice, and discrimination, that often occur in healthcare settings, impact the community's perceptions of entering Residential Aged Care (RAC) in the future. In particular, studies have not investigated how contact with RAC influences individuals' attitudes towards RAC facilities, residents and staff. This study is the first to examine individuals' resistance towards living in RAC using the contact hypothesis, a theory of prejudice reduction.

AIMS

To explore how positive or negative contact with RAC residents and staff impacts individuals' behavioural intentions towards entering RAC in the future. To examine whether perceptions of trust, independence and RAC staff mediate the relationship between contact and behavioural intentions towards entering RAC in the future.

DESIGN

A cross-sectional survey design.

METHOD

Data were collected via online surveys using contact (positive or negative), trust, independence, perceptions of RAC staff and resistance levels (mild refusal or extreme refusal) measures. Participants (n = 373) from Australia and USA were recruited using social media, word of mouth and Amazons Mechanical Turk.

FINDINGS

Individuals who experienced negative contact with RAC residents and staff were more likely to report intense resistance to RAC, "I would rather die than enter RAC". Whereas, positive contact with RAC residents and staff was associated with reductions in the adverse appraisal of RAC staff; a diminished perception that individuals lost their independence, and an increased trust in RAC residents, facilities and staff. Participants from USA reported greater levels of resistance towards RAC in comparison with participants from Australia. This study demonstrates how interactions with RAC residents, facilities and staff are critical in shaping attitudes towards RAC.

IMPLICATIONS FOR PRACTICE

It is recommended that the public are exposed to opportunities where they can experience positive contact with RAC. RAC facilities can promote interaction between the public and RAC residents through encouraging participation in community partnership programs/intergenerational programs.

Outcomes in knowledge, attitudes and confidence of nursing staff working in nursing and residential care homes following a dementia training programme

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.

StressadaMente: Mental health promotion program for direct care workers of older people

Background:

In the current context, associated with the increase in longevity, there is a greater need for institutionalization of old people in search of formal support. The direct care workers of institutionalized older people, who work at day care centers and residential homes, are at risk of being victims of occupational psychosocial risks. There are several psychological complaints of these workers, highlighting the need to develop a mental health promotion program aiming at job satisfaction of direct care workers, improving their provision of care at work and quality of life.

Aim:

The StressadaMente program is a mental health promotion program for direct care workers of institutionalized older people in day care centers and residential homes. This article aims to describe the StressadaMente program and to evaluate the level of satisfaction of the direct care workers with the program.

Methods:

The program was implemented in two day centers/residential homes, enrolling 25 participants, and comprised one session per week, with 90 min per session, during 7 weeks. Sociodemographic information of direct care workers was collected. The assessment protocol comprised a satisfaction questionnaire of the program.

Results:

In general, the program was evaluated as “very good” and “excellent” by 9.5% and 90.5% of the participants, respectively. These results may indicate that mental health promotion intervention seems to encourage new skills and changes to a better practice, prevent adverse effects of caregiving by improving the mental health of professionals.

The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review

OBJECTIVES

Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes.

DESIGN

Systematic review.

DATA SOURCES

Search of on-line databases in English between January 2000 and January 2017.

REVIEW METHODS

Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research.

RESULTS AND CONCLUSION

Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.

Individual and organizational predictors of allied healthcare providers' job satisfaction in residential long-term care

Background

Job satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC.

Methods

We conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers’ job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.

Results

Both individual and organizational context variables predicted job satisfaction among allied healthcare providers employed in LTC. Demographic variables did not predict job satisfaction. At the individual level, burnout (cynicism) (β = −.113, p = .001) and the competence subscale of psychological empowerment (β = −.224, p = < .001), were predictive of lower job satisfaction levels while higher scores on the meaning (β = .232, p = .001), self-determination (β = .128, p = .005), and impact (β = .10, p = .014) subscales of psychological empowerment predicted higher job satisfaction. Organizational context variables that predicted job satisfaction included: social capital (β = .158, p = .012), organizational slack-time (β = .096, p = .029), and adequate orientation (β = .088, p = .005).

Conclusions

This study suggests that individual allied healthcare provider and organizational context features are both predictive of allied healthcare provider job satisfaction in residential LTC settings. Unlike demographics and structural characteristics of LTC facilities, all variables identified as important to allied healthcare providers’ job satisfaction in this study are potentially modifiable, and therefore amenable to intervention.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3307-3) contains supplementary material, which is available to authorized users.

Dementia training programmes for staff working in general hospital settings - a systematic review of the literature

OBJECTIVES

Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes. This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

METHOD

Literature from five databases were searched, based on a number of inclusion criteria. The selected studies were summarised and data was extracted and compared using narrative synthesis based on a set of pre-defined categories. Methodological quality was assessed.

RESULTS

Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients' outcomes.

CONCLUSION

This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

Fragmentation in Australian Commonwealth and South Australian State policy on mental health and older people: A governmentality analysis

Mental health care for older people is a significant and growing issue in Australia and internationally. This article describes how older people's mental health is governed through policy discourse by examining Australian Commonwealth and South Australian State government policy documents, and commentaries from professional groups, advocacy groups and non-governmental organisations. Documents published between 2009 and 2014 were analysed using a governmentality approach, informed by Foucault. Discourses of 'risk', 'ageing as decline/dependence' and 'healthy ageing' were identified. Through these discourses, different neo-liberal governmental strategies are applied to 'target' groups according to varying risk judgements. Three policy approaches were identified where older people are (1) absent from policy, (2) governed as responsible, active citizens or (3) governed as passive recipients of health care. This fragmented policy response to older people's mental health reflects fragmentation in the Australian policy environment. It constructs an ambiguous place for older people within neo-liberal governmental rationality, with significant effects on the health system, older people and their carers.

Implementing a psycho-educational intervention for care assistants working with people with dementia in aged-care facilities: facilitators and barriers

Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho-educational intervention for care assistants caring for people with dementia in aged-care facilities. A process evaluation was carried out alongside a pretest/post-test controlled study conducted in aged-care facilities. Seven focus-group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi-structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged-care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions.

Implementing Montessori Methods for Dementia™ in Ontario long-term care homes: Recreation staff and multidisciplinary consultants’ perceptions of policy and practice issues

Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants’ perceptions of factors that affected implementing Montessori Methods for Dementia™ in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia™ into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia™ approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia.

The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework

BACKGROUND

In the past decades many psychosocial interventions for elderly people with dementia have been developed and implemented. Relatively little research has been done on the extent to which these interventions were implemented in the daily care. The aim of this study was to obtain insight into strategies for successful implementation of psychosocial interventions in the daily residential dementia care. Using a modified RE-AIM framework, the indicators that are considered important for effective and sustainable implementation were defined.

METHODS

A systematic literature search was undertaken in PubMed, PsycINFO, and Cinahl, followed by a hand search for key papers. The included publications were mapped based on the dimensions of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance.

RESULTS

Fifty-four papers met the inclusion criteria and described various psychosocial interventions. A distinction was made between studies that used one and studies that used multiple implementation strategies. This review shows that to improve their knowledge, caregivers needed at least multiple implementation strategies, only education is not enough. For increasing a more person-centered attitude, different types of knowledge transfer can be effective. Little consideration is given to the adoption of the method by caregivers and to the long-term sustainability (maintenance).

CONCLUSIONS

This review shows that in order to successfully implement a psychosocial method the use of multiple implementation strategies is recommended. To ensure sustainability of a psychosocial care method in daily nursing home care, innovators as well as researchers should specifically pay attention to the dimensions Adoption, Implementation, and Maintenance of the RE-AIM implementation framework.

"The educating nursing staff effectively (TENSE) study": design of a cluster randomized controlled trial

Background

Challenging behavior exhibited by people with dementia can have adverse outcomes, like stress, low morale, low work satisfaction and absenteeism for nursing staff in long-term care settings. Training nursing staff to manage challenging behavior may reduce its impact. Although much of the research into training nursing staff shows methodological limitations, several studies find some effect of training programs on knowledge about and on management of challenging behavior. Effects on stress or burnout are almost not found.

Methods/Design

The TENSE-study is a randomized controlled study on 18 nursing home units (9 control, 9 intervention) investigating the effects of a continuous educational program for nursing staff about managing challenging behavior. Nursing staff of intervention units receive the program, nursing staff of control units do not and continue usual care. The primary outcome is stress experienced by nursing staff (N = 135). Secondary outcomes are: emotional workload, work satisfaction, stress reactions at work and knowledge about challenging behaviour of nursing staff; and frequency of challenging behavior, quality of life and social engagement of residents (N = 135). Because there are many unknown factors influencing the effect of the training, a process evaluation to evaluate sampling-, implementation- and intervention quality as well as barriers and facilitators to implementation will also be included in the analysis. Nursing staff could not be blinded to the intervention, but were blinded for the outcomes.

Discussion

Strengths of this study are the (good) description of the intervention complemented by a process evaluation and the tailoring of the intervention to the wishes and needs of the nursing homes at any moment during the study. Sustaining the effects of the intervention by using follow up sessions is another strength. Possible drawbacks may be dropout because of the frailty of the elderly population and because nursing staff might move to another job during the study.

Trial registration

NTR (Dutch Trial Registration) number NTR3620

Mental illness training on the Internet for nurse aides: a replication study

Internet training courses for nurse aides (NAs) in long-term care facilities (LTCs) have been shown to be effective. Little is known, however, about Internet training effects on NAs in a non-research context, or about continued utilization of an available training programme. In this research, a replication study was conducted with the Internet training programme Caring Skills: Working with Mental Illness. Three LTCs provided the training to all NAs, each within a 1-month interval scheduled during consecutive months. Supervisors were interviewed subsequently about their experiences organizing and supervising the training. Participants in all three LTCs showed positive pre-post-tests effects with large effect sizes on situational knowledge and self-efficacy, and knowledge about mental illness. Users rated the programme highly, and they indicated that it would improve quality of their resident care. Supervisors praised the training, and they said NAs were using recommended training behaviours. Although available to all staff, nursing and other staff made little use of the training in subsequent months. Training for NAs on the Internet thus appears feasible, and it is perceived to be beneficial for resident care. Plans for continued utilization and dissemination of best practices to other staff, however, should be integrated when planning for staff training on the Internet.

A staff intervention targeting resident-to-resident elder mistreatment (R-REM) in long-term care increased staff knowledge, recognition and reporting: results from a cluster randomized trial

BACKGROUND

Elder abuse in long-term care has received considerable attention; however, resident-to-resident elder mistreatment (R-REM) has not been well researched. Preliminary findings from studies of R-REM suggest that it is sufficiently widespread to merit concern, and is likely to have serious detrimental outcomes for residents. However, no evidence-based training, intervention and implementation strategies exist that address this issue.

OBJECTIVES

The objective was to evaluate the impact of a newly developed R-REM training intervention for nursing staff on knowledge, recognition and reporting of R-REM.

DESIGN

The design was a prospective cluster randomized trial with randomization at the unit level.

METHODS

A sample of 1405 residents (685 in the control and 720 in the intervention group) from 47 New York City nursing home units (23 experimental and 24 control) in 5 nursing homes was assessed. Data were collected at three waves: baseline, 6 and 12 months. Staff on the experimental units received the training and implementation protocols, while those on the comparison units did not. Evaluation of outcomes was conducted on an intent-to-treat basis using mixed (random and fixed effects) models for continuous knowledge variables and Poisson regressions for longitudinal count data measuring recognition and reporting.

RESULTS

There was a significant increase in knowledge post-training, controlling for pre-training levels for the intervention group (p<0.001), significantly increased recognition of R-REM (p<0.001), and longitudinal reporting in the intervention as contrasted with the control group (p=0.0058).

CONCLUSIONS

A longitudinal evaluation demonstrated that the training intervention was effective in enhancing knowledge, recognition and reporting of R-REM. It is recommended that this training program be implemented in long-term care facilities.

Caring for older people with dementia: an exploratory study of staff knowledge and perception of training in three Australian dementia care facilities

AIM

To ascertain care staff's knowledge of dementia relating to aetiology and/or pathology, symptoms and care/treatment; and explore their perceptions of the importance and adequacy of dementia education and training opportunities.

METHODS

Thirty-five care staff working in three secure dementia care facilities were recruited. Dementia knowledge was surveyed using the Staff Knowledge of Dementia Test (SKDT). Perceptions of dementia education and training were examined via semi-structured individual interviews.

RESULTS

An average of 21 out of 33 SKDT questions (SD = 4.0) was correctly answered. Knowledge discrepancy was attributed to participants' cultural and ethnic origin and the length of residency in Australia of migrant care staff. Participants acknowledged the importance of dementia education and training but were critical of the content relevancy to direct care practices.

CONCLUSION

There is a need to improve care staff knowledge of dementia, and dementia education and training should include direct practical competencies required for effective care delivery.

Building capacity and resilience in the dementia care workforce: a systematic review of interventions targeting worker and organizational outcomes

BACKGROUND

Dementia increasingly impacts every health and social care system in the world. Preparing the dementia care workforce is therefore paramount, particularly in light of existing problems of staff retention and turnover. Training interventions will need to increase worker and organizational capacity to deliver effective patient care. It is not clear which training interventions best enhance workers' capacity. A review of the evidence for dementia care training interventions to enhance worker capacity and facilitate organizational change is presented.

METHODS

A systematic literature review was conducted. All selected randomized intervention studies aimed to enhance some aspect of dementia care worker or workforce capacity such as knowledge of dementia, psychological well-being, work performance, and organizational factors such as retention or service delivery in dementia care.

RESULTS

Seventy-four relevant studies were identified, but only six met inclusion criteria for the review. The six studies selected focused on worker and organizational outcomes in dementia care. All interventions were multi-component with dementia education or instructional training most commonly adopted. No interventions were found for the community setting. Variable effects were found for intervention outcomes and methodological concerns are raised.

CONCLUSION

The rigor of scientific research in training interventions that aim to build capacity of dementia care workers is poor and a strong need exists for evaluation and delivery of such interventions in the community sphere. Wider domains of interest such as worker psychological health and well-being need to be examined further, to understand capacity-building in the dementia care workforce.

Mental illness training for licensed staff in long-term care

Licensed care staff working in long-term care facilities may be poorly prepared to work with residents with mental illness. This research reports on the program evaluation of Caring Skills: Working with Mental Illness, a training program delivered on the Internet. It was tested with a randomized treatment-control design, with an eight-week follow-up. The training provided video-based behavioral skills and knowledge training. Measures included video situations testing and assessment of psycho-social constructs including empathy and stigmatization. ANCOVA analysis at 4-weeks posttest showed significant positive effects with medium-large effect sizes, which were largely maintained at the 8-week follow-up. The training was well-received by the users.

Morality in the mundane: specific needs for ethics support in elderly care

Ethics support is called for to improve the quality of care in elderly institutions. Various forms of ethics support are presented, but the needs for ethics support remain unknown. Using a mixed-methods design, this article systematically investigates the specific needs for ethics support in elderly care. The findings of two surveys, two focus groups and 17 interviews demonstrate that the availability of ethics support is limited. There is a need for ethics support, albeit not unconditionally. Advice-based forms of ethics support are less appropriate as they are removed from practice. Ethics support should be tailored to the often mundane and easily overlooked moral issues that arise in long-term care. Attention should also be given to the learning styles of nurses who favour experiential learning. Raising awareness and developing a climate of openness and dialogue are the most suitable ways to deal with the mundane moral issues in elderly care.

A cluster-randomised trial of staff education to improve the quality of life of people with dementia living in residential care: the DIRECT study

Background

The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care.

Methodology/Principal Findings

This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention.

Conclusion

The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit.

Trial Registration

ANZCTR.org.au ACTRN12607000417482

Exploring the gap between rhetoric and reality in dementia care in Australia: Could practice documents help bridge the great divide?

Quality of care, and indeed, quality of life, for people living with dementia in long-term care is often underpinned by philosophies of care, such as person-centred care and relationship-centred care. The translation of these philosophies into practice is influenced by a range of individual and organizational features, including the context in which such care occurs. Within modern care organizations, the context of care is evidenced through organizational documents.

This study sought to identify the key documents guiding dementia care within one large Australian long-term care organization and to explore points of consistency and tension within the documented system of care. Results highlight a lack of consistency and clarity in the philosophy of dementia care and a disconnection between the key documents guiding practice. This disconnection creates tension for clinicians and carers, and may contribute to the gap between rhetoric and reality in dementia care.

This study suggests that a congruent documented dementia system can help bridge the gap between espoused philosophies of care and everyday care practices.

‘You’ve got to keep account of heads all the time’: staff perceptions of caring for people with dementia

Research aim: Little is known regarding the pressures of working within dementia care units, as the majority of literature has focused broadly on long-term care rather than the provision of specialised dementia care. This study aimed to explore the perceptions of staff in relation to their capacity to manage behaviour and care needs of people with dementia living within the dementia-specific environment. Individual interviews were conducted with 35 care staff from three dementia care units in Brisbane, Australia.

Major findings: Four themes were identified: role definition, relationships, workplace environment, and workforce issues. Although the findings highlight the importance of peer support for staff when managing difficult situations, questions regarding the quality of peer support and its impact on care provision were raised.

Conclusions: Dementia units are complex systems with well-motivated and educated staff contributing to the effectiveness of the care. An understanding of care staff, perceptions of their role and its effects on care practices can help to identify appropriate support structures and training strategies, thereby improving job satisfaction for staff and quality of life for the residents with dementia.