Communication and respect for people with dementia: student learning (CARDS) - the development and evaluation of a pilot of an education intervention for pre-qualifying healthcare students

Comparison of face to face and online delivery of a dementia-specific experiential learning activity

During the COVID-19 pandemic, healthcare professions shifted from face to face(F2F) to online educational delivery methods. Research evaluating the effectiveness of online educational delivery is mixed.The purpose of this study was to compare the effectiveness of a dementia-specific experiential learning activity(ELA) delivered to Doctor of Physical Therapy(DPT) students face to face(F2F) versus online. Participants included a sample of DPT students (n = 171) from four consecutive cohorts. In this quasi-experimental, single-site two-factor design study, students participated in either a F2F(n = 84) or online version (n = 87) of an ELA. They completed a dementia survey pre-(T1) and post-ELA(T2). Pre- and post-survey analysis demonstrated significant improvements between T1 and T2 for both groups. The interaction of group by time F(1,169) = 287.61, p < 0.01 indicates a main effect for groups over time. Analysis did not demonstrate significance between versions for T1 or T2. The interaction of time by group F(1,169) = 1.08, p = 0.30 indicates there was not an interaction of time by group.This study provided strong evidence that students benefitted from the dementia-specific ELA regardless of delivery method. Both methods proved equally effective, as there was no statistically significant difference between them. Programs may consider online experiences to increase schedule flexibility and content accessibility.

Physiotherapy students are underprepared to work with people living with dementia: a qualitative study

OBJECTIVES

To 1) explore physiotherapy students' experience in caring for people with dementia; 2) develop a rich understanding of their perceived preparedness to work with people with dementia upon graduation; and 3) identify opportunities to improve dementia education from the perspectives of students.

DESIGN

A qualitative study comprised of semi-structured interviews via web conferencing software. Thematic analysis was undertaken, with themes/subthemes derived and a qualitative framework generated.

SETTING

Three Victorian Universities in Australia.

PARTICIPANTS

Physiotherapy students of entry-to-professional practice education programs (n = 17; mean age 23.7 years, 65% female), having completed at least 15 weeks of clinical placements.

RESULTS

The overarching theme was that students' experience of providing care for people with dementia was variable. The three sub-themes were: 1) students experience significant challenges when working with people with dementia, 2) students experience a range of emotions when working with people with dementia, and 3) the quality of dementia learning experiences during entry-to-professional practice training is mostly inadequate. Students described the importance of the supervisor during clinical placements, and suggested incorporating 'real-life' scenario training in the classroom to assist them learn to manage the challenging symptoms of dementia.

CONCLUSION

Physiotherapy students believe that entry-to-practice dementia education is insufficient. These findings have important implications for the future planning and delivery of physiotherapy dementia education. CONTRIBUTION OF THE PAPER.

Impact of a short-duration experiential learning activity on DPT students' attitudes toward patients living with a dementia

Healthcare practitioners (HCP) have expressed inadequate preparation in providing care to patients living with a dementia. Research suggests experiential learning activities (ELAs) can improve HCP knowledge and comfort toward this population. The purpose of this study was to evaluate the impact of a short-duration (2-hour) dementia ELA on Doctor of Physical Therapy (DPT) students' knowledge and comfort toward individuals living with a dementia. Participants included a sample of first-year DPT students (n=82).  In this pre-experimental, single-site, longitudinal study, students participated in an ELA at a memory care facility. They completed a dementia knowledge and comfort survey pre-(T1) and post-ELA(T2), as well as prior to their first clinical experience (nine months post-ELA; T3). Pre- and post-survey analysis demonstrated significant improvements between T1 to T2 and T1 to T3 with overall effect sizes ranging from very large (d=1.256) to huge (d=1.520). There were no significant differences between T2 to T3 analysis. Students demonstrated positive improvements in attitudes toward individuals living with a dementia following this ELA. Improvements were maintained over time. An ELA as short as two hours may improve person-centered care for patients living with a dementia. These types of activities should be considered for inclusion in DPT curricula.

Understanding the experiences of people with dementia and their family carers participating in healthcare student dementia education: A mixed-methods evaluation from the time for dementia programme

BACKGROUND

There is increasing awareness of the potential for positive impacts on student learning from involving people with dementia and family carers within undergraduate teaching. However, research on the experience of people with dementia and their family carers is sparse. This study aimed to evaluate the satisfaction and views of families (people with dementia and their family carers) who volunteered in Time for Dementia (TFD); an educational programme where undergraduate healthcare students visit families at home over a 2-year period.

METHODS

Families taking part in TFD completed a satisfaction survey after taking part in the programme (n = 803). Frequencies of satisfaction survey items were summarised and multiple linear regression models for factors associated with total satisfaction scores were produced. Open text responses were analysed using thematic framework analysis as to the most favourable aspects of the programme and areas requiring improvement.

RESULTS

Overall satisfaction was high for taking part in TFD, with a perception of contribution, and being of value. There was strong evidence that families enjoyed the experience and would recommend participation to others. Higher numbers of student visits were significantly associated with greater satisfaction. Families identified aspects of the programme that benefited them, with social interaction rating highly. Improvements suggested by the families included increased visit structure and organisational improvements.

CONCLUSIONS

This study has sought to evaluate at scale the satisfaction of families taking part in a dementia education programme. It is positive that families report high satisfaction in the programme and identify perceived value for themselves as well as students, suggesting reciprocal benefits. This study contributes to the broader understanding of what Experts by Experience value when taking part in educational interventions.

Development and Validation of Dementia Care Content in Nursing Curricula Instrument-Revised

Background: Understanding the extent to which dementia care content is integrated into curricula is vital to prepare the nursing workforce to provide quality dementia care. Purpose: To revise and examine the content validity of the Dementia Care Content in Nursing Curricula Instrument (DCCNCI), an instrument for assessing dementia care content in prelicensure nursing curricula. Method: We generated additional items and refined the original DCCNCI. Ten recruited expert reviewers rated each item for relevancy and assessed their clarity, meaningfulness, and completeness. Results: 39 of 47 items on the DCCNCI-Revised indicated significant content validity (cut-off value: 0.62, as calculated by applying Lawshe's formula for calculating content validity ratio). Conclusion: The DCCNCI-Revised demonstrated acceptable content validity for assessing dementia care content and its integration into prelicensure nursing curricula.

Education and training interventions for physiotherapists working in dementia care: a scoping review

OBJECTIVES

Physiotherapy plays a key role in many aspects of dementia care, most notably in maintaining mobility. However, there is a lack of dementia care training at undergraduate and postgraduate level, and more importantly, a paucity of evidence as to what constitutes effective dementia education and training for physiotherapists. The aim of this scoping review was to explore and map the evidence, both quantitative and qualitative, relating to education and training for physiotherapists.

DESIGN

This scoping review followed the Joanna Briggs Institute methodology for scoping reviews. A chronological narrative synthesis of the data outlined how the results relate to the objectives of this study.

SETTING

All studies, both quantitative and qualitative on dementia education and training conducted in any setting, including acute, community care, residential or any educational setting in any geographical area were included.

PARTICIPANTS

Studies that included dementia education and training for both qualified and student physiotherapists were considered RESULTS: A total of 11 papers were included in this review. The principal learning outcomes evaluated were knowledge, confidence, and attitudes. Immediate post- intervention scores showed an improvement in all three outcomes. The Kirkpatrick four level model was used to evaluate the level of outcome achieved. Most educational interventions reached Kirkpatrick level 2, which evaluates learning. A multi-modal approach, with active participation and direct patient involvement seems to enhance learning.

CONCLUSIONS

Allowing for the heterogeneity of intervention design and evaluation, some common components of educational interventions were identified that led to positive outcomes. This review highlights the need for more robust studies in this area. Further research is needed to develop bespoke dementia curricula specific to physiotherapy. CONTRIBUTIONS OF THE PAPER.

Physical Therapists' and Physical Therapist Students' Experiences and Views on the Provision of Physical Therapy Services to People With Dementia: A Scoping Review

BACKGROUND AND PURPOSE

Physical therapists (PTs) require specialized education and training to increase the capacity and competence of the dementia care workforce. Four areas of critical dementia workforce education and training gaps that apply to the physical therapy profession have been identified, including recruitment/retention, financing and cost of training, interprofessional education, and translation/implementation of effective dementia care. A critical step in developing effective training programs and educational curricula is to understand PTs' and PT students' experiences and views on working with people with dementia (PwD). Therefore, the purpose of this scoping review was to examine the extent and types of evidence that explore the experiences and views of PTs and PT students on the provision of physical therapy services to PwD.

METHODS

The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, ERIC, PEDro, Web of Science, and Medline databases and sources of gray literature were searched for sources of evidence that met the inclusion criteria of the review protocol. The literature was mapped according to author, participant role, setting, publication type, study design, study aim, key findings, and dementia workforce training gaps addressed.

RESULTS AND DISCUSSION

A total of 552 sources of evidence were screened for eligibility, and 16 studies were selected for inclusion. Twelve studies included PTs as participants, and 5 included PT students. Included sources explored PTs' experiences, behaviors, knowledge, attitudes, and confidence in working with PwD and the influence of educational, organizational, and other factors on these domains. Challenges to and strategies for delivering effective care to PwD were examined in multiple sources. The 4 areas of critical dementia workforce education and training gaps were each addressed by at least 1 of the included studies.

CONCLUSIONS

The current body of literature identifies several gaps in both research and education that need to be addressed before our profession is truly prepared to effectively manage this challenging population of patients with specialized needs.

Physical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review

OBJECTIVE

The purpose of this study was to determine physical therapists' and physical therapist students' attitudes and beliefs, knowledge, and confidence in working with people with dementia.

METHODS

This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were "qualitized" using thematic analysis and synthesized with qualitative data using thematic synthesis.

RESULTS

Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia).

CONCLUSIONS

Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed.

IMPACT

This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice.

Innovation in dementia education within undergraduate healthcare programmes: A scoping review

OBJECTIVES

The increase in the number of people living with dementia has resulted in a greater need for healthcare professionals from all disciplines to meet the needs of those living with the condition. This means a workforce which is competent in delivering dementia care which is person-centred, regardless clinical specialism. The aim of scoping review is to provide an overview of the novel education models being used to ensure the future healthcare workforce are able to meet this aspiration.

DATA SOURCES

Online databases PubMed, Web of Science, CINAHL, Medline, PsychInfo, ERIC were used.

REVIEW METHODS

Search terms 'Healthcare Student(s)', 'Dementia or Alzheimer's Education' were used. Inclusion criteria included papers published in English between 2009 and September 2019, with data pertaining to the assessment of dementia knowledge and attitudes among healthcare students. Abstracts were reviewed and identified for inclusion for full-text review. Included studies were assessed using the MMAT (Mixed Methods Appraisal Tool).

RESULTS

27 studies were included within the review. These were groups into five educational categories; long term experiential (n=5), activity-centered programmes with people with dementia (n=11), interprofessional education (IPE) (n=5), immersive conference style programmes (n=3) and dementia simulation (n=3). Long term experiential and activity centered programmes gave students the greatest increase in perceived confidence, and improvement in dementia attitudes. Programmes were most effective when directly involving people living with dementia.

CONCLUSION

The majority of the education programmes showed a potential benefit in improving either knowledge, confidence, attitude, or all three among healthcare students. This highlights the benefit that novel experiential programmes may have in aiding a culture of positive attitudes among future healthcare professionals who will be treating people with dementia. This review also demonstrates the positive benefit that directly involving people living with dementia within education can have on both student learners.

Evaluation of a Training Toolkit to Improve Clinicians' Skills for Dementia Advance Care Planning

Background: Primary care clinicians care for most persons with Alzheimer's disease and related dementias (ADRDs), yet lack dementia-specific skills in advance care planning (ACP). Objectives: To develop and evaluate a training toolkit for primary care clinicians to improve ACP communication for people with ADRD and their families. Design: Clinical practice outcomes assessment and pre-post-training evaluation. Intervention training toolkit addressed ACP skills by dementia stage: (1) advance directives in early dementia, (2) decision-making capacity in moderate dementia, (3) Physician Orders for Life-Sustaining Treatment (POLST) in late-stage dementia, and (4) hospice and hospitalization in advanced dementia. Setting/Subjects: Nonhospitalized clinical care sites, 51 clinicians in North Carolina, USA. Measurements: Data collection utilized structured chart abstractions and pre- and post-training surveys. Results: Of 51 participants trained, 33 had encounters with patients with ADRD in study period. Most participants were women (n = 42), white (n = 37), and physicians (n = 31). Participants increased documentation of surrogates (22.7% vs. 35.5%, p = 0.03), decision-making capacity (13.5% vs.23.2%, p = 0.04), and POLST completion (9.2% vs. 18.8%, p = 0.03). Training increased ACP documentation (6.4% vs. 14.5%, p = 0.031) and goals of care (GOC) decision-making discussions (17.0% vs. 31.9%, p = 0.005). In pre-post-comparisons, participant confidence increased in determining capacity, exploring dementia prognosis, GOC, eliciting surrogates, and leading family meetings (all p < 0.001). Most participants strongly agreed that the training addressed skills used in practice (n = 34), contained clear language (n = 40), took an appropriate amount of time (n = 32), and was designed effectively (n = 35). Conclusion: This video-based training resource increased the use of dementia-specific ACP communication skills and clinician confidence.

Nursing Students' Relational Skills with Elders Improve through Humanitude Care Methodology

Nursing students have difficulties interacting with cognitively impaired elders. This study aimed to identify students' difficulties in interacting with elders, the causes of the difficulties in interacting with elders, the strategies used to reduce these difficulties, and the importance attributed to the Structured Sequence of Humanitude Care Procedures (SSHCP). It also aimed to assess the contribution of the Humanitude Care Methodology (HCM) to the development of interaction skills in nursing students. An exploratory descriptive study with a quasi-experimental design was conducted with a sample of 64 nursing students during their hospital clinical training. A control group (usual training) and an experimental group (HCM training) were used. Data were collected through a questionnaire applied at baseline and follow-up. Content analysis, chi-square tests, and Student's t-tests were performed. The main difficulty identified was caring for agitated and confused elders. Difficulties were associated with a lack of theoretical-practical teaching, the clinical training context, lack of experience, and personality traits. HCM impacted positively on the development of students' interaction skills. This study shows that HCM is an innovative methodology in nursing education that will allow for moving from an instrumental and technicist education into a more humanized training capable of transforming care.

Virtual reality program to develop dementia-friendly communities in Japan

OBJECTIVES

Dementia-friendly communities promote community coherence and reduce the risk of ageism in the community. This study examined the effects of a Virtual Reality (VR) educational program on participants' attitudes towards dementia and their sense of community related to supporting community-dwelling older adults.

METHODS

We delivered an educational program using a virtual reality platform that provided a first-person perspective of people with dementia in the courtyards of two convenience stores in the Tokyo Metropolitan Area, Japan. We investigated attitudes towards dementia and participants' sense of community before and after the educational program.

RESULTS

There were 42 study participants (average age = 48 years). The total scores of attitudes towards dementia and sense of community changed positively from pre- to postintervention (P = .004 and <.001, respectively).

CONCLUSION

This educational program for understanding dementia could enhance people's support of community members living with dementia.

Paid worker and unfamiliar partner communication training: A scoping review

BACKGROUND

Communication partner training could be employed to train people working in the community to facilitate interaction with individuals who live with a variety of communication disorders. However, current evidence syntheses are limited to a single disorder (e.g., aphasia) and focus on a variety of familiar and unfamiliar communication partners. An understanding of the scope of literature across the evidence-base of acquired neurological populations may provide a better basis to develop interventions and future research tailored for community workers.

AIMS

To explore the scope of literature on paid worker and unfamiliar partner communication training for acquired neurogenic communication disorders with a focus on describing: 1) the types of communication disorders addressed by interventions; 2) the types of learners who received the interventions; 3) the nature of the interventions; and 4) the reported effects on trainees and people with a communication disorder.

METHODS & PROCEDURES

A scoping review was conducted. Studies were selected by a systematic keyword search, undertaken through four databases. Eligibility criteria included studies that: (i) reported an intervention directed at paid workers or unfamiliar partners where the primary goal was to improve communication with people with acquired neurogenic communication disorders, (ii) reported original results, (iii) contained quantitative or qualitative data on the effects of the intervention, (iv) were written in English or French and (v) were published in a peer-reviewed journal. The PRISMA-ScR was used to guide design and reporting of the scoping review.

RESULTS

Seventy publications met the inclusion criteria. Interventions were mostly disorder-specific and addressed communication with people with dementia, aphasia or traumatic brain injury. 15/70 studies examined training programs that were not restructured to a specific population (e.g., aphasia). Learners were mostly working or studying in the healthcare field and only 2/70 studies included community workers without primarily health training. Sixty different interventions were reported and were mostly delivered by speech-language pathologists. Training varied in terms of duration (a few minutes to 46 h) and content, but many shared training methods (e.g., presentation of theory on communication disorders). Nearly all studies demonstrated positive results, 23/26 studies suggested that paid worker and unfamiliar partner communication training may increase the knowledge of trainees, 24/26 studies suggested that it could improve their confidence when interacting with people with a communication disorder and 44/46 studies suggested that it could improve the trainees' communication abilities.

CONCLUSION

A small developing evidence-base exists for communication training programs for paid and unfamiliar communications partners that focuses beyond a single diagnosis or disorder. However, there is very limited knowledge on interventions for community workers from non-health professions. Future research should focus on the evaluation of existing programs tailored to, or explicitly designed for this context with the aim of identifying active ingredients that lead to improved and sustainable outcomes.

Dementia care boot camp: interprofessional education for healthcare students

Dementia prevalence is increasing exponentially and has a profound effect on individuals diagnosed as well as their family caregivers. Dementia care should be patient focused, not task or medically oriented. Patient-centered dementia care requires more staff time, is complex, and, as a result, financially threatens the healthcare system. Therefore, professionals must be prepared to meet the needs of this growing population. The aims of this mixed methods study were to examine the effect of a 16-h interprofessional program on healthcare students' dementia knowledge, attitudes toward people with dementia, confidence for dementia care and empathy, and to understand the relationships among the listed variables. Nursing, occupational therapy assistant, pharmacy, and psychology students participated in a 16-h team-based learning Dementia Care Bootcamp. Students reported significant improvements in dementia attitudes and knowledge, confidence for dementia care and empathy immediately after Bootcamp and 3 months later. Significant relationships among listed variables were noted. Qualitative data complemented the quantitative findings. In addition, the concept of dementia care competency emerged. Students recognized the benefits of learning about, with and from others from diverse professions. Interprofessional education has great potential to improve students' ability to care for people with dementia.

A feasibility study of dementia communication training based on the VERA framework for pre-registration nurses: Part II impact on student experience

BACKGROUND

People living with dementia have complex communication needs, especially during acute hospital admissions. The VERA framework (validation, emotion, reassurance, activity) was designed to promote person centred communication between student nurses and people living with dementia, but there is limited evaluation of its impact.

AIM

To measure the impact of dementia communication training (based on VERA) plus older adult unit (OAU) placement on students' ability to recognise opportunities for person centred (PC) communication compared to OAU placement alone.

METHOD

A control pre-post-study design was used. Dementia communication training plus follow-up during OAU placement was delivered to 51 students (5 OAU, two hospitals) while 66 students (7 OAUs, five hospitals) acted as controls. The primary outcome was students' ability to recognise PC communication assessed using case vignettes. Data were collected using electronic survey and focus group interviews. Data analysis used independent non-parametric Mann-Whitney U test and thematic analysis.

RESULTS

In total 52 students (response rate 40%) completed surveys at the end of placements (38 intervention, 14 control group students). In the intervention group, participants were significantly more likely to identify PC responses with a mean score of 10.5 (SD 3.0) compared with 7.5 (SD 3.0) in the control group (p = 0.006). In focus group interviews (n = 19 students), the main themes were connecting with patients, VERA in practice, communication challenges, and learning environment. VERA was described as a flexible approach that added to participants' communication toolkit. The learning environment, complexity of patients and organisational resources were important contextual factors.

CONCLUSION

The VERA framework has potential as a foundation level dementia communication training intervention, but it requires more rigorous testing. Nursing can lead the way in developing and embedding evidence-based, interdisciplinary dementia communication training in preregistration curricula.

A dementia communication training intervention based on the VERA framework for pre-registration nurses: Part I developing and testing an implementation strategy

BACKGROUND

People living with dementia experience progressive difficulty in expressing physical and emotional needs. Health care staff including student nurses require training to develop compensatory communication strategies. However, there is no standardised foundation level dementia communication training within pre-registration curricula.

AIM

This article describes the theoretical underpinnings and development of a foundation level dementia communication skills training based on the VERA (Validation, Emotion, Reassurance, Activity) framework.

METHOD

The training strategies drew on behavioural change theory using the COM-B model and Gagné's 9 Events of Instruction. The VERA framework was operationalised using a multicomponent teaching strategy. The intervention was refined based on quality improvement Plan-Do-Study-Act cycles with feedback from people living with dementia, facilitators and student nurses. Data collection used semi-structured questionnaires (n = 51) and four focus group (n = 19) interviews with students. Data analysis involved descriptive statistics and thematic analysis.

RESULTS

The intervention was a 2.5-hour face-to-face training session delivered at the start of students' older adult unit placement with follow-up reflection sessions during placement. Training was delivered to 51 students, all students described the training as useful and would recommend it to their peers. Elements of the training that were highly valued were: opportunities to express concerns in caring for people with dementia, applying the VERA framework using role play and outlining realistic expectations of VERA. Students recognised the need for on-going training especially for more complex patients.

CONCLUSION

Combining behaviour change and education theory with stakeholder feedback strengthened the development of VERA as a foundation level dementia communication training for pre-registration nurses.