Social Network Analysis of Dementia Wards in Psychiatric Hospitals to Explore the Advancement of Personhood in Patients with Alzheimer's Disease

Background:

Little is known on investigating how healthcare teams in dementia wards act for promoting personhood in persons with Alzheimer’s disease (PWA).

Objective:

The current research aimed to identify the social networks of dementia health carers promoting the personhood of PWA in acute or long-term dementia wards in public and private psychiatric hospitals.

Methods:

We used a mixed-method research approach. Ethnographic observations and two-mode Social Network Analysis (SNA) captured the role and social networks of healthcare professionals promoting PWA personhood, using SocNetv version 2.4. The social network graphs illustrated how professionals participated in PWA care by computing the degree of centrality (%DC) for each professional; higher values indicated more statistical significance of a professional role compared to others in the provision of personhood care. The categories of personhood were biological, individual, and sociologic. Nurses, doctors, ward managers, hospital managers, clinical psychologists, occupational therapists, care coordinators, physiotherapists, healthcare assistants, and family members were observed if they were promoting PWA personhood.

Results:

The highest %DC in SNA in biological personhood was held by the ward nurses (36%), followed by the ward doctors (20%) and ward managers (20%). All professional roles were involved in 16% of cases in the promotion of individual personhood, while the hospital managers had the highest %DC (33%) followed by the ward managers and nurses (27%) in the sociologic personhood.

Conclusion:

All professional roles were deemed to promote PWA personhood in dementia wards, although some limitation exists according to the context of the assessment.

Spring EngAGEment: An Interprofessional Collaboration to Enhance Community Interaction and University Education

Purpose

Interprofessional education and practices are increasingly recognized as vital to addressing complex health needs, including individuals living with Alzheimer's disease or other associated dementias (AD/OAD). An innovative approach to meet this need is to create a meaningful engagement experience, Spring EngAGEment, following a multidisciplinary patient-centered model to serve individuals with AD/OAD and their care partners in the community and to offer new interprofessional collaboration opportunities for college students and faculty across disciplines in nursing, recreation, and speech-language pathology. The Spring EngAGEment program was developed by lead undergraduate students in an outcome-based program planning course from the Department of Recreation, Parks & Leisure Services and implemented by student volunteers and faculty across the disciplines with ongoing mentorship from the author team and feedback from the local ACT on Alzheimer's team. The program offered community resource booths, gardening, music therapy, and physical activity education as a way to inform individuals with AD/OAD and their care partners on available community resources, increase their mental outlook, and help reduce their isolation and stress.

Conclusions

This interprofessional practice/interprofessional education experience not only allowed college students to facilitate collaboration with future health care professionals from a variety of disciplines but also provided the participants living with AD/OAD and their care partners with new ideas and strategies to help adjust to their life changes. Program outcomes from event participants with AD/OAD and student volunteers were reported. Lessons identified by the author team are discussed.

Employee attitudes towards aggression in persons with dementia: Readiness for wider adoption of person-centered frameworks

WHAT IS KNOWN ON THE SUBJECT

Person-centered care, as compared to standard approaches, is a widely accepted, evidence-based approach for managing aggressive behaviour in persons with dementia. The attitudes, beliefs and values of long-term care and mental health nursing employees are important prerequisites to implementing person-centered practices. Research shows that nursing employees typically support person-centered approaches; however, less is known about the attitudes of non-nursing employee groups.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Nurse managers and administrators tended to agree with person-centered approaches for managing aggression in dementia, suggesting some prerequisites are in place to support wider adoption of person-centered frameworks. Employees with more resident contact tended to support person-centered approaches the least, suggesting discipline-specific trainings may not be adequate for preparing frontline staff to use person-centered techniques. Attitudes towards aggressive behaviour may be especially varied and contradictory within certain employee groups, providing implications for facility-wide initiatives.

IMPLICATIONS FOR PRACTICE

Person-centered values and practices should be monitored and reinforced across the organization. Person-centered trainings should be interdisciplinary in nature and focused on care areas, such as mealtime or bathing. Long-term care facilities should consider allowing nurse management and registered nurses to share the burden of direct resident care with frontline employees on a more regular basis.

ABSTRACT

Introduction Implementing person-centered care requires shared attitudes, beliefs and values among all care employees. Existing research has failed to examine the attitudes of non-nursing employees. Aim This study examined attitudes towards aggression among nursing and non-nursing employees to address gaps in existing research and assess readiness for wider adoption of person-centered frameworks. Method The Management of Aggression in People with Dementia Attitude Questionnaire was used to survey attitudes of employees in Michigan-based nursing homes. Results Overall, employees preferred person-centered over standard approaches. Job title was a significant predictor of paradigm support. Frontline employees were found to support person-centered attitudes the least. Wide-ranging responses were noted within employee groups. Discussion Job title may influence the degree to which an employee supports and utilizes person-centered approaches. Employees with the most contact with persons with dementia may be the least likely to implement person-centered approaches. In contrast to prior studies, years of experience was not a significant predictor of attitude towards aggressive behaviour. Wide-ranging responses indicate that employee attitudes are varied and complex. Implications Person-centered approaches should be trained within care areas rather than individual employee groups. Programs should be interdisciplinary and seek to establish a shared understanding of person-centered beliefs and values.