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Trinca V, Wu SA, Dakkak H, Iraniparast M, Cammer A, Lengyel C, O'rourke HM, Rowe N, Slaughter SE, Carrier N, Quiring S, Harvie R, Keller H. Characteristics Associated with Relationship-Centred and Task-Focused Mealtime Practices in Older Adult Care Settings. CAN J DIET PRACT RES 2024; 85:66-75. [PMID: 38572747 DOI: 10.3148/cjdpr-2023-023] [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] [Indexed: 04/05/2024]
Abstract
Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic.Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices.Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices.Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Hana Dakkak
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Maryam Iraniparast
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB
| | - Hannah M O'rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Rowe
- Faculty of Creative Industries, School of Design, Fanshawe College, London, ON
| | - Susan E Slaughter
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Carrier
- Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB
| | | | - Ruth Harvie
- Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
- Schlegel-UW Research Institute for Aging, Waterloo, ON
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Suen J, Dyer S, Shulver W, Ross T, Crotty M. A systematic review of typologies on aged care system components to facilitate complex comparisons. Health Serv Manage Res 2024; 37:123-134. [PMID: 37247254 DOI: 10.1177/09514848231179176] [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] [Indexed: 05/31/2023]
Abstract
Objectives: Typologies are frequently utilised in analyses of the quality, funding, and efficiency of aged care systems. This review aims to provide a comprehensive resource identifying and critiquing existing aged care typologies. Methods: Systematic search of MEDLINE, Econlit, Google Scholar, greylit.org and Open Grey databases from inception to July 2020, including typologies of national, regional or provider aged care systems. Article screening, data extraction, and quality appraisal were conducted in duplicate. Results: 14 aged care typologies were identified; five applied to residential care, two to home care and seven to mixed settings; eight examined national systems and seven regional or provider systems. Five typologies classifying national financing or home care services, provider financing of staff and services and quality of residential care were considered high quality. The schematic provided summarises the focus area and aids in typology selection. Discussion: The aged care typologies identified cover a wide range of areas and contexts of aged care provision. This schematic, summary and critique will aid researchers, providers, and aged care policy makers to examine their own setting, compare it to other approaches to aged care provision and assist in identifying alternatives and important considerations, when undertaking aged care reform.
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Affiliation(s)
- Jenni Suen
- Flinders University, Bedford Park, AU-SA, Australia
| | - Suzanne Dyer
- Flinders University, Bedford Park, AU-SA, Australia
| | | | - Tyler Ross
- Flinders University, Bedford Park, AU-SA, Australia
| | - Maria Crotty
- Flinders University, Bedford Park, AU-SA, Australia
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Hoben M, Dymchuk E, Doupe MB, Keefe J, Aubrecht K, Kelly C, Stajduhar K, Banerjee S, O'Rourke HM, Chamberlain S, Beeber A, Salma J, Jarrett P, Arya A, Corbett K, Devkota R, Ristau M, Shrestha S, Estabrooks CA. Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia. BMC Geriatr 2024; 24:177. [PMID: 38383339 PMCID: PMC10880372 DOI: 10.1186/s12877-024-04710-1] [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] [Received: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap. METHODS We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants. DISCUSSION This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Room 301E Stong College, 4700 Keele StreetON, Toronto, M3J 1P3, Canada.
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Emily Dymchuk
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Malcolm B Doupe
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Canada
| | - Katie Aubrecht
- Department of Sociology, Faculty of Arts, St. Francis Xavier University, Antigonish, NS, Canada
| | - Christine Kelly
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Kelli Stajduhar
- School of Nursing, Faculty of Human & Social Development, University of Victoria, Victoria, BC, Canada
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jordana Salma
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pamela Jarrett
- Faculty of Medicine, Dalhousie University, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Amit Arya
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
- Specialist Palliative Care in Long-Term Care Outreach Team, Kensington Gardens Long-Term Care, Kensington Health, Toronto, ON, Canada
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Kyle Corbett
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Rashmi Devkota
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Melissa Ristau
- Dr. Gerald Zetter Care Centre, The Good Samaritan Society, Edmonton, AB, Canada
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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4
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Wu SA, Morrison-Koechl JM, McAiney C, Middleton L, Lengyel C, Slaughter S, Carrier N, Yoon MN, Keller HH. Multi-Level Factors Associated with Relationship-Centred and Task-Focused Mealtime Practices in Long-Term Care: A Secondary Data Analysis of the Making the Most of Mealtimes Study. Can J Aging 2023; 42:696-709. [PMID: 37278323 DOI: 10.1017/s0714980823000156] [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] [Indexed: 06/07/2023] Open
Abstract
Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.
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Affiliation(s)
- Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura Middleton
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
| | - Christina Lengyel
- Department of Food and Human Nutrition Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Susan Slaughter
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Université de Moncton, Moncton, NB, Canada
| | - Minn-Nyoung Yoon
- Department of Dentistry & Dental Hygiene, University of Alberta, Calgary, AB, Canada
| | - Heather H Keller
- Kinesiology and Health Sciences, University of Waterloo, Waterlo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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5
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Cain P, Chejor P, Porock D. Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety. BMC Geriatr 2023; 23:444. [PMID: 37468889 DOI: 10.1186/s12877-023-04116-5] [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: 04/08/2023] [Accepted: 06/17/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care. METHODS Publicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken. RESULTS Four key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family's fight for liberty. Triangulation across the data and academic literature supports the findings. CONCLUSION Our findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a "first resort" care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.
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Affiliation(s)
- Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia.
| | - Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, 6027, Joondalup, WA, Australia
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Dokos M, Schultz R, Gossner JD, Fauth EB. Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants. Innov Aging 2023; 7:igad049. [PMID: 37476503 PMCID: PMC10355141 DOI: 10.1093/geroni/igad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 07/22/2023] Open
Abstract
Background and Objectives Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.
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Affiliation(s)
- Malinda Dokos
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Rebecka Schultz
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Jacob D Gossner
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
- Alzheimer’s Disease and Dementia Research Center, Utah State University, Logan, Utah, USA
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Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Koh RTG, Thirumanickam A, Attrill S. How are the mealtime experiences of people in residential aged care facilities informed by policy and best practice guidelines? A scoping review. BMC Geriatr 2022; 22:737. [PMID: 36085034 PMCID: PMC9463738 DOI: 10.1186/s12877-022-03340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mealtimes are embedded routines of residents living in residential aged care facilities (RACFs) that directly impact their health and quality of life. Little is known about how mealtime experiences are informed and affected by structures such as government and organisational policies and processes. This scoping review used Giddens' (The constitution of society: outline of the theory of structuration, 1984) Structuration Theory to investigate how governance structures related to mealtime practices inform residents' mealtime experiences. METHODS Using Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) scoping review framework, a systematic database, grey literature and policy search was completed in May 2020 and updated in July 2021. From 2725 identified articles, 137 articles were included in data charting and deductive analysis, and 76 additional Australian government policy papers were used interpretatively. RESULTS Data charting identified that the included studies were prominently situated in Western countries, with a progressive increase in publication rate over the past two decades. Qualitative findings captured structures that guide RACF mealtimes, how these relate to person-centred mealtime practices, and how these facilitate residents to enact choice and control. CONCLUSIONS Current policies lack specificity to inform the specific structures and practices of RACF mealtimes. Staff, residents, organisational and governance representatives possess different signification, legitimation and domination structures, and lack a shared understanding of policy, and how this influences processes and practices that comprise mealtimes.
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Affiliation(s)
| | - Abirami Thirumanickam
- School of Allied Health Science and Practice, University of Adelaide, Frome Road, Adelaide, SA, 5000, Australia
| | - Stacie Attrill
- School of Allied Health Science and Practice, University of Adelaide, Frome Road, Adelaide, SA, 5000, Australia.
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9
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Villar F, Silva-Cavero A, Serrat R, Celdrán M. Long-term care staff 's positive experiences of caring for people living with dementia: Narratives' content and lessons learned. DEMENTIA 2022; 21:2553-2568. [PMID: 36081334 DOI: 10.1177/14713012221126298] [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: 11/15/2022]
Abstract
Research on caregiving for persons with dementia has mainly focused on its negative impact on caregivers. However, while some studies have found that positive aspects of care can also be found among informal caregivers, little attention has been paid to these positive aspects among staff working in long-term care facilities. The aim of this is study is to explore what kind of positive stories of caring for a person living with dementia staff working in long-term care facilities recall, and what kind of lessons they extracted from these experiences. Forty-two staff members currently working in four Spanish long-term care facilities (21 nursing assistants; 21 technical staff) were interviewed. They were asked about positive stories related to caring for people living with dementia. Data were analyzed using content analysis, aimed at identifying common ideas in the responses. Results showed that the type of stories were quite diverse, but can be grouped into three main themes: attachment, awakening, and mastery. The stories imply different lessons learned, including the importance of individualized care, the value of persistence and patience, and the relevance of technical knowledge and strategies to provide good care. The articles discusses how recording, reflecting on and discussing positive experiences that care staff encounter in their daily practice, may be key to skill development, reinforce job satisfaction, and improve quality of care in a person-centered care direction.
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Affiliation(s)
| | - Ana Silva-Cavero
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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Choi YR, Lee YN, Kim DY, Chang SO. For the interprofessional management of the discomfort of long-term care facility residents with dementia. J Interprof Care 2022; 37:371-382. [PMID: 35687038 DOI: 10.1080/13561820.2022.2071242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.
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Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Gyeonggi-do, Republic of Korea
| | - Da-Yeong Kim
- College of Nursing, Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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11
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Brennan S, Doan T. Small-Scale Living Environments' Impact on Positive Behaviors and Quality of Life for Residents with Dementia. JOURNAL OF AGING AND ENVIRONMENT 2022. [DOI: 10.1080/26892618.2022.2030845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sumiyo Brennan
- Institute for Gerontology, J.F. Oberlin University, Tokyo, Japan
| | - Therese Doan
- School of Nursing, San Francisco State University, San Francisco, CA, USA
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12
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Lignos N, McCloskey R, Donovan C, Ellis K, Herrington M, Kanik M. Use of an Ambient Activity Technology for Long-Term Care Residents With Dementia. J Gerontol Nurs 2022; 48:35-41. [PMID: 34978492 DOI: 10.3928/00989134-20211206-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current pilot study was to determine the impact of an ambient activity technology, ABBY®, on responsive behavior and family visiting in a long-term care (LTC) home. We were also interested in family and staff perceptions of the technology. A mixed methods research study was conducted over a 6-month period and data were collected using standardized measures and focus groups. Although no significant differences were noted in responsive resident behaviors, focus group data showed the ABBY enriched the care environment and provided additional opportunities for families and staff to engage residents. Although the introduction of a new technology can create challenges for staff, with time, these challenges can be overcome. [Journal of Gerontological Nursing, 48(1), 35-41.].
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13
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Cheung G, Bala S, Lyndon M, Ma'u E, Rivera Rodriguez C, Waters DL, Jamieson H, Nada-Raja S, Chan AHY, Beyene K, Meehan B, Walker X. Impact of the first wave of COVID-19 on the health and psychosocial well-being of Māori, Pacific Peoples and New Zealand Europeans living in aged residential care. Australas J Ageing 2021; 41:293-300. [PMID: 34855238 DOI: 10.1111/ajag.13025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Māori, Pacific Peoples and NZ Europeans in aged residential care (ARC). METHODS interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses. RESULTS A total of 538 Māori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID-19, while there were 549 Māori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Māori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID-19. Lower rates of hospitalisation were observed in Māori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID-19. CONCLUSIONS We found a lower rate of loneliness in Māori but a higher rate of depression in NZ European ARC populations during the first wave of COVID-19. Further research, including qualitative studies with ARC staff, residents and families, and different ethnic communities, is needed to explain these ethnic group differences. Longer-term effects from the COVID-19 pandemic on ARC populations should also be investigated.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Sharmin Bala
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Mataroria Lyndon
- The Centre for Medical and Health Sciences Education, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Debra L Waters
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shyamala Nada-Raja
- Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kebede Beyene
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brigette Meehan
- interRAI Services, Technical Advisory Services (TAS), Wellington, New Zealand
| | - Xaviour Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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Pringle J, Mellado ASAV, Haraldsdottir E, Kelly F, Hockley J. Pain assessment and management in care homes: understanding the context through a scoping review. BMC Geriatr 2021; 21:431. [PMID: 34275442 PMCID: PMC8286436 DOI: 10.1186/s12877-021-02333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, 2–5% of people live in residential or nursing homes, many with multi-morbidities, including severe cognitive impairment. Pain is frequently considered an expected part of old age and morbidity, and may often be either under-reported by care home residents, or go unrecognized by care staff. We conducted a systematic scoping review to explore the complexity of pain recognition, assessment and treatment for residents living in care homes, and to understand the contexts that might influence its management. Methods Scoping review using the methodological framework of Levac and colleagues. Articles were included if they examined pain assessment and/or management, for care or nursing home residents. We searched Medline, CINAHL, ASSIA, PsycINFO, EMBASE, Cochrane Library, and Google Scholar; reference lists were also screened, and website searches carried out of key organisations. Conversations with 16 local care home managers were included to gain an understanding of their perspective. Results Inclusion criteria were met by 109 studies. Three overarching themes were identified: Staff factors and beliefs - in relation to pain assessment and management (e.g. experience, qualifications) and beliefs and perceptions relating to pain. Pain assessment – including use of pain assessment tools and assessment/management for residents with cognitive impairment. Interventions - including efficacy/effects (pharmaceutical/non pharmaceutical), and pain training interventions and their outcomes. Overall findings from the review indicated a lack of training and staff confidence in relation to pain assessment and management. This was particularly the case for residents with dementia. Conclusions Further training and detailed guidelines for the appropriate assessment and treatment of pain are required by care home staff. Professionals external to the care home environment need to be aware of the issues facing care homes staff and residents in order to target their input in the most appropriate way. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02333-4.
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Affiliation(s)
- Jan Pringle
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK.
| | | | | | - Fiona Kelly
- School of Health Sciences, Queen Margaret University, Edinburgh, East Lothian, UK
| | - Jo Hockley
- Usher Institute, University of Edinburgh, Edinburgh, UK
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15
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Moir C, Lesa R, Ritchie L. A unique disaster response in aged residential dementia care: Can the experience inform future care models? J Clin Nurs 2021. [PMID: 34041801 DOI: 10.1111/jocn.15862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To understand how staff who chose to live-in with residents in a level 3 dementia care unit perceived the experience, in particular, their perceptions of how residing on site affected resident well-being. BACKGROUND COVID-19 has been especially devastating in aged residential care (ARC) facilities. In March 2020, when the threat became realised in New Zealand, one residential dementia care facility implemented a unique response to the imminent threat of COVID-19. Eight staff members made the decision to live on site during the lockdown, ensuring residents' risk of contracting the virus was significantly reduced as carers would not go outside of the facility. DESIGN A qualitative descriptive inquiry. METHODS Seven staff who chose to live-in, and the facility manager, participated in semi-structured, face-to-face interviews at the ARC. Audio-recorded interviews were transcribed verbatim and analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. RESULTS An overarching motif which emerged from the findings was the articulation of an 'all in this together' attitude which fostered feelings of camaraderie and collaboration which enhanced the experience for staff individually, and as a group. Themes identified were as follows: (a) A 'safe' but challenging choice, (b) Benefits for the staff and (c) Positive outcomes for the residents. CONCLUSION This crisis inadvertently brought about an enhanced 'dementia-friendly', person-centred communal environment. RELEVANCE TO CLINICAL PRACTICE This study identified themes that deepen our understanding of caring for vulnerable populations during a pandemic and beyond. Given the success of this 'live-in' innovation, consideration must be given to applying these findings more generally when planning care models for best outcomes for residents receiving rest home level dementia care. How we care for people in disaster situations reflects the heart of the caring workforce, but such innovation may be extended to usual care where indicated.
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Affiliation(s)
- Chris Moir
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Raewyn Lesa
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Lorraine Ritchie
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
- Southern District Health Board, Dunedin, New Zealand
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Anderson K, Blair A. What have staff got to do with it? Untangling complex relationships between residential aged care staff, the quality of care they provide, and the quality of life of people with dementia. Arch Gerontol Geriatr 2021; 94:104378. [PMID: 33631693 DOI: 10.1016/j.archger.2021.104378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the integral role residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia. METHOD Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of NSW/ACT. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors. RESULTS Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables. CONCLUSIONS The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals.
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Affiliation(s)
- Katrina Anderson
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia; NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia; Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Annaliese Blair
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia; NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia; Australian National University, Canberra, Australian Capital Territory, Australia
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Han A, Kim TH. A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study. Psychiatry Investig 2021; 18:132-139. [PMID: 33517619 PMCID: PMC7960746 DOI: 10.30773/pi.2020.0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Studies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes. METHODS 104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis. RESULTS Care providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program. CONCLUSION This study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Sadarangani T, Chong S, Park S, Missaelides L, Johnson J, Trinh-Shevrin C, Brody A. A Qualitative Analysis of the Delivery of Person-Centered Nutrition to Asian Americans With Dementia in the Adult Day Health Care Setting. J Appl Gerontol 2021; 40:179-188. [PMID: 32129126 PMCID: PMC7483203 DOI: 10.1177/0733464820910030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Adult day service centers (ADSCs) provide community-based long-term care, including meals, to racially diverse older adults, 47% of whom have dementia and consequently experience elevated nutritional risk. We examine nutritional behaviors for Chinese and Vietnamese persons living with dementia (PLWD) in ADSCs and evaluate the extent to which ADSCs provide person-centered nutritional care. Multi-stakeholder interviews were conducted. Data were coded using Dedoose and analyzed using Braun and Clarke's six-step method. The Model for the Provision of Good Nutritional Care in Dementia guided analysis. Barriers to food intake included distracting meal environment, rigid mealtimes, and excessively restrictive diets. Conversely, peer relationships, culturally tailored meals and celebrations, and consistent staff assisting with feeding benefited PLWD. ADSCs can support healthy nutritional behaviors and quality of life among PLWD through person-centered nutritional care. To optimize nutritional services, further exploration is needed with respect to the ADSC environment, users' culture and ethnicity, and liberalized diets for PLWD.
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Affiliation(s)
- Tina Sadarangani
- New York University Rory Meyers College of Nursing, New York, New York, United States
| | - Stella Chong
- New York University Langone Health, New York, New York
| | - Susie Park
- New York University Rory Meyers College of Nursing, New York, NY
| | | | | | | | - Abraham Brody
- New York University School of Medicine, New York, New York
- Hartford Institute for Geriatric Nursing, New York University Rory Meyers College of Nursing, New York, New York
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19
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Liu W, Kim S, Alessio H. Mealtime caregiving knowledge, attitudes, and behaviors for persons living with dementia: A systematic review of psychometric properties of instruments. Int J Nurs Stud 2020; 114:103824. [PMID: 33352436 DOI: 10.1016/j.ijnurstu.2020.103824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Using valid instruments to assess caregiving knowledge, attitudes, skills, and behaviors in mealtime care for people living with dementia is critical to evaluate the process and effects of mealtime assistance interventions. Yet, the quantity and psychometric quality of such instruments are unknown. OBJECTIVES This systematic review described and evaluated psychometric properties of instruments that were developed and used to assess mealtime caregiving knowledge, attitudes, skills, and behaviors for people with dementia. METHODS We searched Pubmed, CINAHL, AgeLine, PsychINFO, and Cochrane Library for records published between January 1st, 1980 and June 31st, 2019, with follow-up searches by December 20th, 2019. Records were eligible if they included any instrument developed, tested, and/or used to measure the concepts of interest, including mealtime caregiving knowledge, attitudes, skills, and/or behaviors. After eligible records were identified, instruments that were reported in the eligible records were identified and extracted. Instruments were eligible if they were originally developed to measure the concepts of interest or developed in non-mealtime activities and later used or tested to measure the concepts of interest. From eligible records, eight characteristics of eligible instruments were extracted: (1) development process, (2) the concept/construct the instrument operationalizes, (3) sample and setting the instrument was used/tested in, (4) administration method, (5) description of items, (6) scoring format/interpretation, (7) reliability, and (8) validity. The psychometric quality of eligible instruments was evaluated using a newly developed psychometric quality assessment tool. RESULTS A total of 9438 records were retrieved and 19 eligible instruments were identified. Ten instruments assessed mealtime caregiving skills or behaviors; 5 assessed attitudes, intention, self-efficacy, empathy; and 4 assessed knowledge. All instruments were scored as having low psychometric quality, except for Mealtime Engagement Scale with moderate psychometric quality in assessing mealtime engagement toward people with dementia. Reasons for low psychometric quality included limited psychometric testing, inadequate estimates of psychometric properties, and use of small sample size. CONCLUSIONS While all instruments warrant further testing, Mealtime Engagement Scale demonstrated moderate psychometric quality with preliminary evidence of reliability and validity to assess mealtime engagement toward people with dementia. Future testing of Mealtime Engagement Scale is needed in larger diverse samples in different care settings to accumulate psychometric evidence and expand the use.
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Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA 52242, USA.
| | - Sohyun Kim
- The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA 52242, USA
| | - Holly Alessio
- The University of Iowa, College of Nursing, 432 CNB, 50 Newton Road, Iowa City, IA 52242, USA
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20
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Liu W, Perkhounkova E, Williams K, Batchelor M, Hein M. Food intake is associated with verbal interactions between nursing home staff and residents with dementia: A secondary analysis of videotaped observations. Int J Nurs Stud 2020; 109:103654. [PMID: 32535342 PMCID: PMC7540727 DOI: 10.1016/j.ijnurstu.2020.103654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nursing home residents with dementia commonly experience low food intake, leading to negative functional and nutritional consequences. While the importance of staff-resident (dyadic) interactions during mealtime is acknowledged, little research has examined the role of dyadic verbal interactions on food intake. OBJECTIVES This study aimed to examine the relationship between food intake and dyadic verbal interactions. METHODS This study was a secondary analysis of 110 videotaped observations of mealtime care interactions among 25 residents with dementia and 29 staff (42 unique dyads) in 9 nursing homes. Staff positive utterances and resident positive and negative utterances (independent variables) and food intake (dependent variable) were coded from the videotaped observations using the Cue Utilization and Engagement in Dementia video coding scheme. A linear mixed model was fit to the data. The two-way interaction effects of food type and video duration with each independent variable as well as two-way interaction effects among the independent variables were tested. Covariates included in the model were the number of years staff worked as a caregiver, and resident age, gender, and eating function. RESULTS The model included three significant interaction effects involving verbal variables: the interaction effect of staff positive utterances with resident positive utterances (p=.030), the interaction effect of staff positive utterances with food type (p=.027), and the interaction effect of resident negative utterances with video duration (p=0.002). Increased number of intakes of liquid food per minute was associated with increased number of staff positive utterances per minute when residents did not make positive utterances. Decreased number of intakes of solid food per minute was associated with increased number of staff positive utterances per minute, especially when residents made between 0 and 3 positive utterances per minute. As the duration of the videos increased, the number of intakes per minute increased for residents who made one or more negative utterances and decreased for residents who made no negative utterances in the videos. The number of intakes per minute was associated with resident gender in that male residents had increased number of intakes per minute compared with female residents (p=.017), and was not associated with other participant characteristics. CONCLUSION Intake was associated with dyadic verbal interactions, and such relationship was complex in that it was moderated by food type and video duration. Findings support the significant role of dyadic verbal interactions on intake, and inform the development of effective, tailored mealtime care interventions to promote intake.
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Affiliation(s)
- Wen Liu
- The University of Iowa, College of Nursing, Iowa City, IA, USA.
| | | | | | - Melissa Batchelor
- George Washington University, School of Nursing, Washington, D.C., USA
| | - Maria Hein
- The University of Iowa, College of Nursing, Iowa City, IA, USA
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21
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Anderson K, Blair A. Why we need to care about the care: A longitudinal study linking the quality of residential dementia care to residents' quality of life. Arch Gerontol Geriatr 2020; 91:104226. [PMID: 32950909 DOI: 10.1016/j.archger.2020.104226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Residential dementia care staff are often the most important people in a resident's social world. It is a symbiotic relationship and the work can involve highly emotional interactions as well as physical and technical demands. This study focused on narrowing down the most useful targets for intervention in quality of care (QOC) in order to improve quality of life (QOL) for people with dementia in residential care. METHOD Over six months we followed: 247 older adults with dementia from 12 residential care facilities, their families/care partners (n = 225), managers (n = 12) and staff (n = 232). Facilities ranged from 10 to 137 beds, located across remote, rural and metropolitan areas. MEASURES Staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. RESULTS The QOC provided had an immediate impact on resident's pain, depression, QOL scale score, Body Mass Index, ease/engagement with staff, and food and fluid intake. This influence was still evident six months later, with baseline QOC leading to improved ease and engagement with staff, QOL scores, and fluid intake. Restraint use featured heavily as a predictor of poor outcomes for residents. QOC did not significantly impact agitated behaviours, frailty, nor physical/verbal expressions of well-being. CONCLUSIONS What staff do and the way they do it has a real and lasting impact on the QOL of residents. The most useful targets for improving QOL are: eradicating physical restraint and supporting and upskilling care staff so that they treat and interact empathetically and humanely with residents.
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Affiliation(s)
- Katrina Anderson
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia; NHMRC Cognitive Decline Partnership Centre, Sydney, Australia; Australian National University, Canberra, Australia.
| | - Annaliese Blair
- Aged Care Evaluation Unit, Southern NSW Local Health District, Queanbeyan, New South Wales, Australia; NHMRC Cognitive Decline Partnership Centre, Sydney, Australia; Australian National University, Canberra, Australia
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22
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Kim EM, Shin JH. Factors Influencing Patient-Centered Care by Nursing Staff in Nursing Homes. ACTA ACUST UNITED AC 2020. [DOI: 10.17079/jkgn.2020.22.1.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bailly N, Sanchez S, Ferrand C, Souesme G, Giraudeau C, Agli O. The impact of street clothes among caregivers on residents with dementia in special care units: The STRECLO study. J Clin Nurs 2020; 29:1723-1732. [PMID: 32043688 DOI: 10.1111/jocn.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/26/2019] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To examine the impact of caregivers' street clothes on people living in special care units (SCUs). We hypothesised that caregivers wearing street clothes would improve residents' relationships with other residents and caregivers and, as a consequence, would improve their quality of life. BACKGROUND Environmental factors have been recognised as important elements in the care of people with dementia. Among these factors, the importance of the caregivers' appearance and more particularly their street clothes has been raised. DESIGN The Street Clothes study (STRECLO) was designed as a multicentre crossover observational study. METHOD This study was conducted in two volunteer nursing homes. It involved videotaping residents (N = 24) over a 6-month period: caregivers wore uniform and then street clothes for two consecutive three-month periods. Three outcome measures were observed as follows: (a) behaviours of residents, (b) contents of conversations and (c) proximal interactions between residents and caregivers. The STROBE checklist was used to ensure quality reporting during this observational study. RESULTS When caregivers wore street clothes, we observed the following: (a) greater solicitation and less anxiety in residents, (b) content of conversations between residents and caregivers included more personal and less health information, and (c) more proximal interaction between caregivers and residents. CONCLUSION To our knowledge, this is the first study which investigated the long-term effects on residents of SCU caregivers wearing street clothes. Our study demonstrated the potential benefit of not wearing uniform on the quality of life of institutionalised people with dementia. RELEVANCE TO CLINICAL PRACTICE Given the budgetary constraints faced by nursing homes, wearing street clothes for caregivers could be readily applied to clinical practice and represents a promising way to increase the quality of life of dementia residents and their families.
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Affiliation(s)
- Nathalie Bailly
- EA2114 Psychologie des Ages de la Vie et Adaptation, University of Tours, Tours, France
| | - Stéphane Sanchez
- Pôle Information Médicale, Hôpitaux Champagne Sud, Centre Hospitalier Troyes, Troyes, France
| | - Claude Ferrand
- EA2114 Psychologie des Ages de la Vie et Adaptation, University of Tours, Tours, France
| | - Guillaume Souesme
- EA2114 Psychologie des Ages de la Vie et Adaptation, University of Tours, Tours, France
| | - Caroline Giraudeau
- EA2114 Psychologie des Ages de la Vie et Adaptation, University of Tours, Tours, France
| | - Océane Agli
- EA2114 Psychologie des Ages de la Vie et Adaptation, University of Tours, Tours, France
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Boersma P, van Weert JCM, Lissenberg-Witte BI, van Meijel B, Dröes RM. Testing the Implementation of the Veder Contact Method: A Theatre-Based Communication Method in Dementia Care. THE GERONTOLOGIST 2020; 59:780-791. [PMID: 29319813 DOI: 10.1093/geront/gnx200] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of research on implementation of person-centered care in nursing home care. The purpose of this study was to assess the implementation of the Veder contact method (VCM), a new person-centered method using theatrical, poetic and musical communication for application in 24-hr care. RESEARCH DESIGN AND METHODS Caregivers (n = 136) and residents (n = 141) participated in a 1-year quasi-experimental study. Foundation Theater Veder implemented VCM on six experimental wards and rated implementation quality. Six control wards delivered care-as-usual. Before and after implementation, caregiver behavior was assessed during observations using the Veder-observation list and Quality of Caregivers' Behavior-list. Caregiver attitude was rated with the Approaches to Dementia Questionnaire. Quality of life, behavior, and mood of the residents were measured with QUALIDEM, INTERACT and FACE. Residents' care plans were examined for person-centered background information. RESULTS Significant improvements in caregivers' communicative behavior (i.e., the ability to apply VCM, establishing positive interactions) and some aspects of residents' behavior and quality of life (i.e., positive affect, social relations) were found on the experimental wards with a high implementation score, as compared to the experimental wards with a low implementation score, and the control wards. No significant differences were found between the groups in caregivers' attitudes, residents' care plans, or mood. DISCUSSION AND IMPLICATIONS The positive changes in caregivers' behavior and residents' well-being on the high implementation score wards confirm the partly successful VCM implementation. Distinguishing between wards with a high and low implementation score provided insight into factors which are crucial for successful implementation.
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Affiliation(s)
- Petra Boersma
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,VU University Medical Center, Department of Psychiatry, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- VU University Medical Center, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Berno van Meijel
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,VU University Medical Center, Department of Psychiatry, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.,Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Rose-Marie Dröes
- VU University Medical Centre, Department of Psychiatry, Alzheimer Centre, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands
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Harrison SL, Dyer SM, Milte R, Liu E, Gnanamanickam ES, Crotty M. Alternative staffing structures in a clustered domestic model of residential aged care in Australia. Australas J Ageing 2019; 38 Suppl 2:68-74. [PMID: 31496059 DOI: 10.1111/ajag.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A clustered domestic model of residential aged care has been associated with better consumer-rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. METHODS A cross-sectional study involving 541 individuals living in 17 Australian not-for-profit residential aged care homes. RESULTS Four of the homes offered dementia-specific clustered domestic models of care with higher personal care attendant (PCA) hours-per-resident-per-day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours-per-resident-per-day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hours-per-resident-per-day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. CONCLUSIONS An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models. Further research to determine optimal staffing structures within alternative models of care is warranted.
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Affiliation(s)
- Stephanie L Harrison
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne M Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Milte
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Enwu Liu
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Emmanuel S Gnanamanickam
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Health Economics and Social Policy, Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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Liu W, Williams K, Batchelor-Murphy M, Perkhounkova Y, Hein M. Eating performance in relation to intake of solid and liquid food in nursing home residents with dementia: A secondary behavioral analysis of mealtime videos. Int J Nurs Stud 2019; 96:18-26. [PMID: 30660444 PMCID: PMC6610782 DOI: 10.1016/j.ijnurstu.2018.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/25/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Persons with dementia commonly experience low food intake leading to negative nutritional and functional outcomes. While multilevel personal and environmental factors that influence intake are implicated, evidence is lacking on the role of characteristics of dynamic eating performance cycles. An eating performance cycle is defined as the process of getting food from the plate or container, transporting it into the mouth, and chewing and swallowing it. OBJECTIVE This study aimed to examine the association between intake and characteristics of eating performance cycles among nursing home residents with dementia. METHODS A secondary analysis of 111 mealtime video clips from a nursing home communication training study was conducted. The 111 videos involved 25 residents and 29 staff (N = 42 unique staff-resident dyads) in 9 nursing homes. The Cue Utilization and Engagement in Dementia Mealtime video-coding scheme was used to code the characteristics of eating performance cycles, including eating technique (resident-completed, staff-facilitated), type of food (solid, liquid), duration of each eating performance cycle, and intake outcome (intake, no intake). The Generalized Linear Mixed Model was used to examine the interaction effects of eating technique by type of food, eating technique by duration, and type of food by duration on intake outcome. RESULTS Totally 1122 eating performance cycles were coded from 111 video clips. The majority of the cycles (85.7%) resulted in intake. There were significant interactions for eating technique by duration, and type of food by duration. As the duration of the eating performance cycle increased, staff-facilitated cycles resulted in greater odds of intake than resident-completed cycles (OR = 17.80 vs. 2.73); and cycles involving liquid food resulted in greater odds of intake than cycles involving solid food (OR = 15.42 vs. 3.15). Though the interaction between eating technique and type of food was not significant, the odds of intake were greater for resident-completed cycles than for staff-facilitated cycles regardless of the type of food being involved in the cycle (OR = 3.60 for liquid food, OR = 10.69 for solid food). CONCLUSIONS The findings pointed out the importance of supporting resident independence in eating performance, providing liquid food when residents struggle with solid food, and provision of longer and continuous facilitation at mealtimes to improve intake. The findings inform the development and implementation of innovative mealtime assistance and staff training to promote eating performance and intake.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing, Iowa City, IA, USA.
| | | | | | | | - Maria Hein
- The University of Iowa College of Nursing, Iowa City, IA, USA
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Are Changes Needed for Therapeutic Recreation Undergraduate Curricula? Perceived Competencies of Therapeutic Recreationists and Recreation Staff Working with Seniors in Long Term Care Homes. Can J Aging 2019; 38:168-179. [DOI: 10.1017/s0714980818000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RÉSUMÉL’objectif de cette étude était d’identifier les lacunes dans les compétences gérontologiques autoperçues par le personnel en loisir dans les centres de soins de longue durée en Ontario. Deux séries de compétences gérontologiques ont été présentées dans un sondage en ligne qui a été distribué à du personnel en loisir œuvrant dans 500 centres de soins de longue durée. Parmi eux, 487 membres du personnel ont répondu au sondage. Ce sondage comportait des questions concernant les compétences actuelles du personnel et les compétences dont ils avaient eu connaissance avant d’entrer sur le marché du travail. Les facteurs perçus comme favorables à une plus grande confiance en ces compétences gérontologiques étaient l’expérience, la formation continue et les sessions de formation en cours d’emploi. Une meilleure compréhension des lacunes dans les compétences gérontologiques est nécessaire pour améliorer la formation en loisirs thérapeutiques, dont la formation continue dans ce domaine.
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Windle G, Algar-Skaife K, Caulfield M, Pickering-Jones L, Killick J, Zeilig H, Tischler V. Enhancing communication between dementia care staff and their residents: an arts-inspired intervention. Aging Ment Health 2019; 24:1306-1315. [PMID: 30884963 PMCID: PMC7446032 DOI: 10.1080/13607863.2019.1590310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: The arts are increasingly recognised as important and beneficial activities for people living with dementia. However, there is little peer-reviewed published research exploring arts-based learning for dementia care staff. In response, this paper explores (a) how dementia care staff describe forms of communication in care settings, and (b) the impact on communication following four sessions of 'Creative Conversations', an arts-based intervention for skills development.Method: Fourteen care homes received the intervention, delivered as 4 × 2 hour sessions. The intervention uses a range of activities (e.g. poetry, film, music, art making). Twenty-eight care staff were opportunistically sampled (mean age = 42.29), and provided pre-post qualitative data, obtained through interviews. Transcripts were analysed thematically.Results: At baseline, the dominant 'task-focussed' nature of care work was described as a barrier to communication, challenging opportunities for developing meaningful relationships with residents. Post-intervention, three primary themes were identified regarding improving communication: (1) learning through the arts (secondary themes: simplicity and subtlety, innovation in communication, and strengthening the role of non-verbal communication), (2) Enhancing creative approaches to care (secondary themes: element of surprise, confidence to experiment and catalyst for communication) and (3) professional introspection (secondary themes: development of empathy, sharing knowledge and experiences and a new appreciation).Conclusions: The intervention validated staff skills and confidence, enabling meaningful interactions that could be creative, 'in the moment', spontaneous and improvised. This arts-based intervention, which departs from formal education and fact-based learning may be particularly useful for the development of the dementia care workforce.
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Affiliation(s)
- Gill Windle
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales; ,CONTACT Gill Windle @victischler https://www.linkedin.com/in/victoriatischler/
| | - Katherine Algar-Skaife
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales;
| | - Maria Caulfield
- Ageing and Dementia@Bangor/DSDCWales, School of Health Sciences, Bangor University, Bangor, Wales;
| | | | - John Killick
- Dementia Positive, Yorkshire, United Kingdom of Great Britain and Northern Ireland;
| | - Hannah Zeilig
- University of the Arts London and University of East Anglia, London, England;
| | - Victoria Tischler
- College of Nursing, Midwifery and Healthcare, University of West London, London, England
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Han A, Kim TH, Hong H. Experiences of caregivers of people with dementia in a Korean dementia simulation program. DEMENTIA 2019; 19:2415-2429. [PMID: 30626192 DOI: 10.1177/1471301218823453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Experiencing dementia-related challenges in a dementia simulation program can be useful for caregivers to understand perspectives of people with dementia possibly leading to improvement in the quality of care and positive outcomes in caregivers and people with dementia. Previous studies about dementia simulation programs have been conducted in Western countries and no research has been conducted in Asian countries. The purpose of this qualitative study was to explore experiences of caregivers of people with dementia who participated in a Korean dementia simulation program. METHODS A descriptive phenomenological study using thematic analysis with ATLAS.ti 8 software was used. A total of 28 Korean caregivers were interviewed about two weeks after participating in the Korean dementia simulation program that was modified from a program developed in USA by considering Korean cultures. RESULTS Three key themes with seven subthemes emerged. The present study demonstrated that participation in the program helped caregivers have more empathy, affected their care strategies positively leading to emotional and social benefits on the care dyads, and increased awareness in possible changes due to aging and the risk of dementia. CONCLUSIONS The present study was the first study that demonstrated caregivers' positive experiences in and benefits from participation in a dementia simulation program in an Asian country. Caregivers in the other Asian countries may have similar benefits from participation in dementia simulation programs.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, College of Health Science, Yonsei University, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Republic of Korea
| | - Hyeon Hong
- Department of Occupational Therapy, Graduate School, Yonsei University, Republic of Korea
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Monfort E, Besse P, Bellet A, Fontaine AC. Perceptions de la qualité de vie et de la bientraitance par des personnes âgées résidant en institution gériatrique et par leurs proches. PRAT PSYCHOL 2018. [DOI: 10.1016/j.prps.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants’ perspectives. DEMENTIA 2018; 19:2090-2113. [DOI: 10.1177/1471301218815053] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Objectives Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.
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Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: a cross-sectional survey. Int Psychogeriatr 2018; 30:1279-1290. [PMID: 29198221 PMCID: PMC6190067 DOI: 10.1017/s1041610217002708] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED ABSTRACTBackground:Person-centered care (PCC) is regarded as good quality care for persons with dementia. This study aimed to explore and understand the association between PCC and organizational, staff and unit characteristics in nursing homes (NHs). METHODS Staff from 175 NH units in Norway (n = 1,161) completed a survey, including measures of PCC and questions about staff characteristics and work-related psychosocial factors. In addition, data about organizational and structural factors and assessment of the physical environment in the units were obtained. The distribution of these factors in regular units (RUs) and special care units (SCUs) is described, and the differences between the two types of units are analyzed. Furthermore, multilevel linear regression analyses explored the extent to which variables were associated with PCC. RESULTS Higher levels of PCC were associated with a greater job satisfaction, three years or more of health-related education, a lower level of quantitative demands and role conflict, a higher level of perception of mastery, empowering leadership, innovative climate and perception of group work, in addition to the type of unit and the physical environment in the NH unit designed for people with dementia. SCU and staff job satisfaction explained most of the variation in PCC. CONCLUSION This study shows an association between PCC and organizational, staff and unit characteristics in NH. These findings indicate that providing PCC in NH care is closely linked to how the staff experiences their job situation in addition to both organizational and structural factors and the physical environment. Attention needs to be given to such factors when planning NH care.
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Bird M, Anderson K, MacPherson S, Blair A. Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence. Int Psychogeriatr 2016; 28:1937-1963. [PMID: 27439660 DOI: 10.1017/s1041610216001083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL. METHODS A comprehensive search of 20 years' peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review. RESULTS Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3-4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change. CONCLUSION In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).
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Affiliation(s)
- Mike Bird
- Dementia Services Development Centre,Bangor University,Bangor,Gwynedd,UK
| | - Katrina Anderson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Sarah MacPherson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Annaliese Blair
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
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