Italian Dementia-Friendly Hospital Trial (IDENTITÀ): efficacy of a dementia care intervention for hospital staff

Examination and testing of structural validity of the Confidence in Dementia Scale with nursing students. An international perspective

BACKGROUND

As the prevalence of dementia continues to rise globally, nurses are increasingly at the forefront of providing care. Effective dementia care relies on not just knowledge, but also the confidence to translate this knowledge into meaningful action. Enhancing nursing education programmes to build both knowledge and confidence is critical. As no studies have explored measuring confidence in dementia care over an extended period (beyond six months), there is a need for a rigorous and robust analysis of the Confidence in Dementia (CODE) Scale, to determine whether it is a psychometrically sound tool for assessing confidence over time.

METHODS

A cross-sectional series design was used to collect longitudinal data from a census of nursing students over a 3-year period. A standardized instrument, the Confidence in Dementia Scale was administered repeatedly to a sample (time 1 n = 247; time 2 n = 239; time 3 = n = 216). Analyses were performed using SPSS for descriptive statistics and JASP for structural equation modelling. An initial exploratory factor analysis was conducted using the first data set to explore the factor structure. A confirmatory factor analysis was performed (on the second and third data sets) to confirm the factor structure and assess the model's overall validity. COSMIN guidelines inform the analysis process, and the findings are reported using STROBE guidelines.

RESULTS

The factor structure replicated and confirmed the one factor structure identified by international findings. The findings confirm its usefulness of the Confidence in Dementia scale to gauge health professionals' confidence in dementia care before going into practice.

CONCLUSIONS

This study highlights the need for psychometrically valid tools that can measure confidence over an extended period, encompassing the three-year degree programme and beyond.

Drug prescriptions in elderly hospitalized patients with cognitive impairment in the Italian Dementia Friendly Hospital project

Objective

The aim of the study was to characterize drug prescription patterns in elderly patients hospitalized in acute wards as a function of cognitive status and staff training.

Methods

We recorded clinical parameters reflecting health status and drug prescriptions at admission, during hospital stay, and at discharge before and after a short staff training on the needs of aged cognitively impaired patients. Participants aged 65 and older had a Mini-Mental State Examination (MMSE) score ≥16. The number of prescriptions, sedative and anticholinergic load, and drug-drug interactions were evaluated. Of the 116 older patients analyzed, 59 patients were cognitively impaired, and 57 were cognitively normal with an MMSE value > 24. Fifty-nine patients (28 CN, 31 CI) were assisted by the hospital health staff after training.

Results

Participants presented a widespread polypharmacy. Cognitively impaired patients received more prescriptions, more inappropriate prescriptions, had a greater sedative load, and were exposed to more interactions. Staff training had no effect on the prescription pattern.

Conclusion

The results suggest that hospitalized cognitively impaired patients are overprescribed psychotropic drugs and have an excessive sedative and anticholinergic load. Interventions designed to improve dementia care practices in health staff that are not also designed to manage drug polypharmacy do not modify prescription patterns.

Improving Safety and Satisfaction in the Safety Monitoring Unit

ABSTRACT

BACKGROUND: The safety monitoring unit (SMU) is a 4-bed unit designated for patients who require continual observation. Most experience some form of dementia, and agitation and aggression are not uncommon. When deescalation techniques do not work, request for help may be necessary. Referred to as Security Alert: Behavioral Assist (SABA), this system-wide message requires response from designated personnel. An increase in SABA events prompted this quality improvement project. METHODS: A survey sent to all unit staff members identified a need for specialized training on the care and management of SMU patients. Education on dementia care and deescalation techniques was provided by a certified dementia specialist and a psychiatry advanced practice registered nurse. Staff expressed a need for defined SMU admission criteria and the establishment of patient care guidelines. Patient care guidelines were developed. A structured schedule was implemented, and dedicated staff were hired to provide familiarity for patients. RESULTS: A postproject survey indicated a nonsignificant increase in staff satisfaction. Security Alert: Behavioral Assist events in the SMU decreased from an average of 3.6 to 1.75 episodes per month. CONCLUSION: Caring for SMU patients creates unique challenges to staff. Staff confidence and satisfaction were higher after implementing new SABA policies. This project could be replicated on similar units with ongoing leadership support and staff education.

Measuring Dementia Knowledge in German: Validation and Comparison of the Dementia Knowledge Assessment Scale, the Knowledge in Dementia Scale, and the Dementia Knowledge Assessment Tool 2

BACKGROUND

Assessing dementia knowledge is critical for developing and improving effective interventions. There are many different tools to assess dementia knowledge, but only one has been validated in German so far.

OBJECTIVE

To validate two tools for assessing dementia knowledge-the Dementia Knowledge Assessment Scale (DKAS-D) and the Knowledge in Dementia Scale (KIDE-D) for the German general population-and compare their psychometric properties with the Dementia Knowledge Assessment Tool 2 (DKAT2-D).

METHODS

A convenience sample of 272 participants completed online surveys. Analyses included internal consistency, structural validity, construct validity through the known-groups method, retest-reliability with a subgroup of n = 88, and floor and ceiling effects. This study used the STROBE checklist.

RESULTS

Internal consistency was acceptable for DKAT2-D (α= 0.780), very good for DKAS-D (α= 0.873), and poor for KIDE-D (α= 0.506). Construct validity was confirmed for all questionnaires. Retest-reliability was good for DKAT2-D (0.886; 0.825-0.926) and KIDE-D (0.813; 0.714-0.878), while it was great for DKAS-D (0.928; 0.891-0.953). Trends toward ceiling effects were observed for DKAT2-D and KIDE-D, but not for DKAS-D. The principal component analysis did not reveal a coherent structure for DKAT2-D or KIDE-D, while the confirmatory factor analysis proposed the removal of 5 items for DKAS-D resulting in the shortened DKAS20-D, which had nearly identical properties.

CONCLUSION

Both DKAS-D and its shortened version, DKAS20-D, are reliable instruments for evaluating programs intended for the general population, as they were found to be convincing in all aspects.