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Antipas H. Interventions for mitigating occupational stress for professional dementia caregivers in residential aged care: A systematic review with meta-analysis. DEMENTIA 2024; 23:292-311. [PMID: 38069510 PMCID: PMC10807264 DOI: 10.1177/14713012231220963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Occupational stress in professional dementia caregivers in residential aged care facilities has adverse effects on care quality, caregivers' health, and workforce sustainability. The purpose of this study was to examine the evidence regarding interventions to mitigate occupational stress for this population. METHODS A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original RCT research reporting on stress interventions, published in English between 1995 and March 2022. Search results were screened by two independent reviewers. Quality and risk of bias were appraised using the Downs and Black Checklist and Risk of Bias by two reviewers. Meta-analysis and subgroup analysis examined the pooled intervention effects on stress compared to control. RESULTS 10 studies met the inclusion criteria, and these reported on 15 interventions and 28 outcomes from 92 facilities, involving 1,397 caregivers. We found a small and insignificant effect of interventions on caregiver stress (g = -.27, p = .16). Heterogeneity was partially explained by subgroup analysis. Interventions can mitigate stress and burden not attributed to client behaviour (n = 3) (g = -.85, p < .001), and improve caregivers' self-efficacy (n = 4) (g = -.35, p = .07). We were unable to determine the most effective type of intervention, although organisation focused interventions showed the greatest potential (g = -.58, p = .08). CONCLUSION Interventions that improve caregivers' personal and organisational resources can reduce non-client associated stress and burden and increase self-efficacy. Aged care providers are recommended to prioritise education with organisational support interventions. Research on longitudinal effects and high-risk caregivers is required. Limitations are discussed. PROSPERO REGISTRATION NUMBER CRD42022313715 (registered April 2022).
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Affiliation(s)
- Hayley Antipas
- Creative Arts and Music Therapy Research Unit, Faculty of Fine Arts and Music, The University of Melbourne, Australia
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Chen HC, Wang JY, Lee YC, Yang SY. Examining the Predictors of Turnover Behavior in Newly Employed Certified Nurse Aides: A Prospective Cohort Study. Saf Health Work 2023; 14:185-192. [PMID: 37389317 PMCID: PMC10300465 DOI: 10.1016/j.shaw.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/07/2023] [Accepted: 04/26/2023] [Indexed: 07/01/2023] Open
Abstract
Background The turnover rate of nurse aides in Taiwan is high. However, the predictors of turnover behavior in the newly employed are still unclear. Objective To examine the predictors of turnover behavior in newly employed licensed nurse aides. Methods A longitudinal study design was used and subjects were newly employed certified nurse aides from a nurse aid training association in Taiwan. A total of five questionnaire surveys were conducted. The questionnaire was mainly used to collect information on turnover behavior, personal socioeconomic background, workplace psychosocial hazards, worker health hazards, and musculoskeletal disorders. Results A total of 300 participants were recruited in the study. Cox regression analysis results showed that short working experience (hazard ratio [HR] = 0.21, p < 0.01), work as non-home nurse aides (HR = 0.58, p = 0.01), low monthly salary (HR = 0.68, p < 0.01), high work mental load (HR = 1.01, p = 0.01), low workplace justice (HR = 0.97, p < 0.01), high workplace violence (HR = 1.60, p < 0.01), high burnout (HR = 1.01, p = 0.04), poor mental health (HR = 1.06, p = 0.04), and high total number of musculoskeletal disorder sites (HR = 1.08, p = 0.01) contribute to a higher risk of turnover. Conclusion The results indicated that employment period, work as a home nurse aide, monthly salary, work mental load, workplace justice, workplace violence, work-related burnout, mental health, and total number of musculoskeletal disorder sites are predictors of turnover behavior in newly employed certified nurse aides.
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Affiliation(s)
- Hsiao-Ching Chen
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Shang-Yu Yang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Berry K, Wright J, Sprange K, Cooper C, Courtney‐Walker R, Mountain G. The implementation of Journeying through Dementia: Strategies to run a successful pragmatic multicenter trial of a complex intervention. Brain Behav 2021; 11:e2436. [PMID: 34775690 PMCID: PMC8671795 DOI: 10.1002/brb3.2436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A key challenge in delivering pragmatic trials of complex interventions is effective implementation within the study period and beyond. We describe a trial of an intervention to improve quality of life in mild dementia (Journeying through Dementia), describe some of the challenges raised in terms of implementation, and illustrate the methods used to ensure effective implementation. METHOD The intervention was delivered by staff within local services and supervised by more experienced clinicians within those services in order to test the intervention in real-world settings and establish the potential for future embedding into practice. Researchers delivered training sessions for all facilitators and supervisors, met at regular intervals with intervention supervisors, and provided feedback on summaries of intervention sessions created by facilitators. We conducted a thematic analysis of the content of meetings and written correspondence between the researchers and intervention supervisors regarding implementation issues. RESULTS Key themes relating to difficulties with implementation were: staff absences and staff leaving posts; participant lack of engagement with intervention; difficulties with delivery of supervision; difficult group dynamics; lack of time to deliver the intervention; and lack of adherence to the intervention and its ethos. CONCLUSION We provide guidance for researchers involved in the trialing of other complex interventions in how these challenges might be overcome. These include: recruiting additional staff to deliver the intervention; having clear protocols in place for managing staff absences; using supervision to problem solve participant attendance at intervention sessions and difficult group dynamics; monitoring staff engagement in supervision and addressing problems with engagement with staff and managers when this occurs; giving staff ring-fenced time to deliver the intervention and engage in supervision; and regular monitoring and feedback in relation to the content of the intervention to ensure that it is consistent with ethos and content of the intervention manual.
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Affiliation(s)
- Katherine Berry
- Manchester Academic Health Science CentreThe University of ManchesterManchesterEngland
- Greater Manchester Mental Health NHS Foundation TrustThe University of ManchesterManchesterEngland
| | - Jessica Wright
- Sheffield Clinical Trials Research UnitSchool of Health and Related ResearchUniversity of SheffieldSheffieldEngland
| | - Kirsty Sprange
- Nottingham Clinical Trials UnitFaculty of MedicineUniversity of NottinghamNottinghamEngland
| | - Cindy Cooper
- Sheffield Clinical Trials Research UnitSchool of Health and Related ResearchUniversity of SheffieldSheffieldEngland
| | - Rebecca Courtney‐Walker
- CumbriaNorthumberlandTyne and Wear NHS Foundation TrustSt. Nicholas HospitalNewcastle upon TyneEngland
| | - Gail Mountain
- The Centre for Applied Dementia Studies, Faculty of Health StudiesUniversity of BradfordBradfordEngland
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Effects on staff outcomes and process evaluation of the educating nursing staff effectively (TENSE) program for managing challenging behavior in nursing home residents with dementia: A cluster-randomized controlled trial. Int J Nurs Stud 2021; 120:103982. [PMID: 34171518 DOI: 10.1016/j.ijnurstu.2021.103982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Challenging behavior is prevalent in people with dementia residing in nursing homes and places a high burden on the nursing staff of dementia special care units. This study evaluates an educational program for nursing staff for managing challenging behavior: The Educating Nursing Staff Effectively (TENSE) program. This program can be tailored to care organizations' wishes and needs and combines various learning styles. OBJECTIVE The aim of this cluster-randomized controlled trial was to examine the short-term (3 months) and long-term (9 months) effects of the TENSE training program on experienced stress, work contentment, and stress reactions at work in nursing staff working in dementia special care units. DESIGN Cluster-randomized controlled trial. METHODS Nursing staff members of 18 dementia special care units within nine nursing homes from different Netherlands regions were randomized into an intervention (n = 168) or control (n = 129) group. The TENSE program consisted of a three-day training course and two follow-up sessions after three and six months, respectively. The primary outcome was stress experienced by nursing staff measured with the Utrecht Burnout Scale - C. Secondary outcomes were work contentment and stress reactions at work. Furthermore, process evaluation data on the reach of and compliance with the program and the program's feasibility and relevance were collected. Data were collected between November 2012 and November 2014. RESULTS In general, the participants appreciated the quality and relevance of the TENSE training and evaluated the content of the training as beneficial. The TENSE training had no effect on the components of experienced stress, i.e., emotional exhaustion (p = 0.751), depersonalization (p = 0.701), and personal accomplishment (p = 0.182). Furthermore, no statistically significant effects of the intervention on work contentment and stress reactions at work were found. CONCLUSIONS The TENSE training program did not have an effect on experienced stress, work contentment, nor stress reactions at work of nursing staff working in dementia special care units. In future studies, more focus on practicing new skills seems needed. TRIAL REGISTRATION NTR (Dutch Trial Registration) number NTR3620.
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Pousa PCP, Lucca SRD. Psychosocial factors in nursing work and occupational risks: a systematic review. Rev Bras Enferm 2021; 74:e20200198. [PMID: 33503207 DOI: 10.1590/0034-7167-2020-0198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify, in international scientific production, the main psychosocial factors in nursing work, found through the Copenhagen Psychosocial Questionnaire (COPSOQ) application. METHODS a systematic review study of psychosocial factors at work among nursing professionals, who used COPSOQ in the assessment of work environments. RESULTS fifteen articles were identified, which highlighted as main psychosocial dimensions of nursing work demands, work organization, social relationships and leadership, work-home interface, workplace health and well-being and offensive behaviors. CONCLUSION the high demands for cognitive, emotional work and work pace were identified in the nursing routine. Management support had a positive impact. Physical and psychological violence and shift work interfere in family life, aggravating the fatigue of these professionals. Interventions for reducing work stress presuppose the identification of psychosocial factors involved in nursing work.
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van Diepen C, Fors A, Ekman I, Hensing G. Association between person-centred care and healthcare providers' job satisfaction and work-related health: a scoping review. BMJ Open 2020; 10:e042658. [PMID: 33293327 PMCID: PMC7722824 DOI: 10.1136/bmjopen-2020-042658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This scoping review aimed to explore and describe the research on associations between person-centred care (PCC) and healthcare provider outcomes, for example, job satisfaction and work-related health. DESIGN Scoping review. ELIGIBILITY CRITERIA Studies were included if they were empirical studies that analysed associations between PCC measurement tools and healthcare providers outcomes. SEARCH STRATEGY Searches in PubMed, CINAHL, Psychinfo and SCOPUS databases were conducted to identify relevant studies published between 2001 and 2019. Two authors independently screened studies for inclusion. RESULTS Eighteen studies fulfilled the inclusion criteria. Twelve studies were cross-sectional, four quasi-experimental, one longitudinal and one randomised controlled trial. The studies were carried out in Sweden, The Netherlands, the USA, Australia, Norway and Germany in residential care, nursing homes, safety net clinics, a hospital and community care. The healthcare provider outcomes consisted of job satisfaction, burnout, stress of conscience, psychosocial work environment, job strain and intent to leave. The cross-sectional studies found significant associations, whereas the longitudinal studies revealed no significant effects of PCC on healthcare provider outcomes over time. CONCLUSION Most studies established a positive association between PCC and healthcare provider outcomes. However, due to the methodological variation, a robust conclusion could not be generated. Further research is required to establish the viability of implementing PCC for the improvement of job satisfaction and work-related health outcomes through rigorous and consistent research.
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Affiliation(s)
- Cornelia van Diepen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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What kind of home is your care home? A typology of personalised care provided in residential and nursing homes. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.
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Researchers, please take due care of the formal caregivers in nursing homes. Int Psychogeriatr 2020; 32:311-313. [PMID: 32192558 DOI: 10.1017/s1041610220000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Specific components of a complex depression care program can affect staff outcomes differently: post-hoc analyses of a stepped-wedge cluster-randomized trial in nursing homes. Int Psychogeriatr 2020; 32:371-380. [PMID: 31948507 DOI: 10.1017/s1041610219002151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The Act in case of Depression program showed effects on the quality of life and depression in nursing home (NH) residents. We aimed to explore the effects of this complex multidisciplinary program on job satisfaction, job demands, and autonomy in nursing home staff. DESIGN Four data points from a stepped-wedge cluster-randomized trial on patient outcomes were used for secondary analyses on staff outcomes. SETTING Sixteen dementia special care and 17 somatic care units in Dutch NHs.Participants were 717 (90.1%) care staff or trainees, 34 (4.3%) paramedical staff, and 45 (5.7%) other staff members.Intervention describes procedures for nursing staff, activity therapists, psychologists, and physicians. It contains evidence-based pathways for depression assessment, treatment, and monitoring treatment results. RESULTS Mixed models for intention-to-treat analyses showed no significant changes in job demands, job satisfaction, or autonomy. Models corrected for the ratio of unit residents who received, when indicated, a specific program component revealed reduced job demands and improved job satisfaction and autonomy when treatment procedures were used. A better use of assessment procedures was associated with increased job demands, while conducting monitoring procedures was associated with increased job demands and decreased autonomy. CONCLUSIONS Components of complex care programs may affect the staff outcomes in opposite directions and, taken together, produce a zero-sum or a statistically insignificant effect. While implementing treatment protocols affecting patients directly can also improve job outcomes such as satisfaction and autonomy and decrease job demands, it is possible that other procedures of complex programs may have unfavorable effects on job outcomes. It is important to account for specific components of complex interventions when evaluating intervention effects.
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Krohne K, Døble B, Johannessen A, Thorsen K. "We feel included": education and inclusion of health care staff with minority language in elder care. J Multidiscip Healthc 2018; 12:9-19. [PMID: 30588006 PMCID: PMC6304238 DOI: 10.2147/jmdh.s178458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In Norwegian elder care, an increasing percentage of the health care staff has a migrant background. “The aging and nursing care ABC” educational program offers multi-component training for municipal care staff to systematically improve their competence in elder care. The program consists of written material organized into booklets, regular multidisciplinary reflection group meetings, and a full-day workshop in each semester. In 2017, a Norwegian municipality included migrant health care personnel in an educational Minority ABC-model (Min. ABC), systematically focusing on processes relevant for interaction between majority and minority health care staff. Aim To investigate the experiences of the participants in the Min. ABC-model, focusing on the processes and relationships between native participants with Norwegian language and migrants with other lingual backgrounds. Method The study has a qualitative design, and draws on four focus group interviews, one group interview, and four individual interviews with a total of 23 female Min. ABC-model participants. Data were analyzed using an approach outlined by Corbin and Strauss. Results Our analysis resulted in six main themes: 1) reaching equality, 2) sharing experiences, 3) communication and language, 4) relations to the elderly, 5) differences and discrimination, and 6) lessons learnt. Conclusion Our findings indicate that the Min. ABC-model of the ABC program contributes to better the competence and interaction among personnel with migrant and native lingual backgrounds. The participants describe increased inclusion at work, as well as integration into a more holistic form of teamwork in elder care.
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Affiliation(s)
- Kariann Krohne
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway,
| | - Betty Døble
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway,
| | - Aud Johannessen
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, .,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Vestfold, Norway
| | - Kirsten Thorsen
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway, .,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway, .,Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
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