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de Lange S, Heyns T, Filmalter C. A concept analysis of person-centred handover practices: The meaning in emergency departments. Int Emerg Nurs 2024; 74:101446. [PMID: 38677057 DOI: 10.1016/j.ienj.2024.101446] [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] [Received: 07/29/2023] [Revised: 02/22/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Transfer of patients from the prehospital to the in-hospital environment is a frequent occurrence requiring a handover process. Habitually, emergency care practitioners and healthcare professionals focus on patient care activities, not prioritising person-centred handover practices and not initiating person-centred care. AIM The aim of this concept analysis was to define the concept person centred handover practices. METHODS The eight steps for Walker and Avant's method of concept analysis. RESULTS Thirty-one articles were included for final review including qualitative and quantitative studies, literature reviews and audits. This concept analysis guided the development of an concept definition of person-centred handover practices between emergency care practitioners and healthcare professionals in the emergency department as person- centred handover practices are those handovers being performed while including all identified defining attributes such as structure, verbal, and written information transfer, interprofessional process, inclusion of the patient and/ or family, occurs at the bedside, without interruption. CONCLUSIONS Results suggested that person-centred handover practices involve verbal and non- verbal interprofessional communication within a specific location in the emergency department. It requires mutual respect from all professionals involved, experience and training, and the participation of the patient and / or family to improve patient outcomes and quality patient care. A definition for the concept may encourage the implementation of person-centred handover practices in emergency departments.
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Affiliation(s)
- Santel de Lange
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
| | - Celia Filmalter
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Private Bag x 323 Arcadia, Pretoria, 0007, South Africa.
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Kim D, Choi YR, Lee YN, Chang SO. Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes. J Nurs Res 2024; 32:e330. [PMID: 38727209 DOI: 10.1097/jnr.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches. PURPOSE This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC. METHODS Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data. RESULTS Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.
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Affiliation(s)
- Dayeong Kim
- MSN, RN, Doctoral Student, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
| | - Young-Rim Choi
- PhD, RN, Research Professor, College of Nursing, Korea University, Republic of Korea
| | - Ye-Na Lee
- PhD, RN, Assistant Professor, Department of Nursing, The University of Suwon, Republic of Korea
| | - Sung Ok Chang
- PhD, RN, Professor, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
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Leibing A, Katz S. Dilemmas of intervention: From person-centred to alienation-centred dementia care. J Aging Stud 2024; 69:101224. [PMID: 38834244 DOI: 10.1016/j.jaging.2024.101224] [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] [Received: 08/30/2023] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 06/06/2024]
Abstract
Discussions regarding personhood and dementia care are often based on practices of recognition; on notions of being-or not being- 'one of us'. This article provides a short overview of personhood as articulated in dementia care, especially in the assemblage of practices known as 'person-centred care' (PCC), and in post-human approaches that developed following the critique of PCC. This article posits an alternative framework, based on a rereading of the concept of alienation, that we want to call 'alienation-centred care'. It considers the extent to which dynamic prosthetic networks can be adapted to the lives of people with dementia, rather than only examining the individual's reactivity to dementia interventions that define traditional approaches. It further urges us to understand the multiple origins of alienating states. Conclusions explore how this framework might address some of the limitations identified in both humanist and post-human approaches to personhood and dementia.
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Affiliation(s)
- Annette Leibing
- Medical anthropology, Faculté des sciences infirmières, Université de Montréal, CP 6128, succ. Centre-ville, Montreal, QC H3C 3J7, Canada.
| | - Stephen Katz
- Department of sociology, Trent University, 1600 West Bank Drive, Peterborough, ON K9L 0G2, Canada
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Montesinos R, Custodio B, Malaga M, Chambergo-Michilot D, Verastegui-Aranda G, Agüero K, Alejos-Zirena J, Andamayo-Villalba L, Seminario G W, Custodio N. Influence of Behavioral and Psychological Symptoms on Caregiver Burden for Different Types of Dementia: Clinical Experience in Lima, Peru. Dement Geriatr Cogn Disord 2024:1-8. [PMID: 38768581 DOI: 10.1159/000539335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia. METHODS A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation. RESULTS DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively. CONCLUSION Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Belen Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Marco Malaga
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de Investigación Neurociencia Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Graciet Verastegui-Aranda
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Katherine Agüero
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | | | | | - Wendy Seminario G
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Hospital IV EsSalud Augusto Hernández Mendoza, Ica, Peru
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
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Berkovic D, Macrae A, Gulline H, Horsman P, Soh SE, Skouteris H, Ayton D. The Delivery of Person-Centered Care for People Living With Dementia in Residential Aged Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2024; 64:gnad052. [PMID: 37144737 PMCID: PMC11020247 DOI: 10.1093/geront/gnad052] [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: 08/10/2022] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Person-centered care is the gold standard of care for people living with dementia, yet few systematic reviews have detailed how it is delivered in practice. This mixed-methods review aimed to examine the delivery of person-centered care, and its effectiveness, for people living with dementia in residential aged care. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis. Eligible studies were identified across 4 databases. Quantitative and qualitative studies containing data on person-centered care delivered to people with dementia living in residential aged care were included. Meta-analysis using a random-effects model was conducted where more than 3 studies measured the same outcome. A narrative meta-synthesis approach was undertaken to categorize verbatim participant quotes into representative themes. Risk of bias was undertaken using quality appraisal tools from the Joanna Briggs Institute. RESULTS 41 studies were identified for inclusion. There were 34 person-centered care initiatives delivered, targeting 14 person-centered care outcomes. 3 outcomes could be pooled. Meta-analyses demonstrated no reduction in agitation (standardized mean difference -0.27, 95% confidence interval [CI], -0.58, 0.03), improvement in quality of life (standardized mean difference -0.63, 95% CI: -1.95, 0.70), or reduced neuropsychiatric symptoms (mean difference -1.06, 95% CI: -2.16, 0.05). Narrative meta-synthesis revealed barriers (e.g., time constraints) and enablers (e.g., staff collaboration) to providing person-centered care from a staff perspective. DISCUSSION AND IMPLICATIONS The effectiveness of person-centered care initiatives delivered to people with dementia in residential aged care is conflicting. Further high-quality research over an extended time is required to identify how person-centered care can be best implemented to improve resident outcomes.
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Affiliation(s)
- Danielle Berkovic
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ann Macrae
- Mission & Corporate Development, Baptcare, Melbourne, Victoria, Australia
| | - Hannah Gulline
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Horsman
- Service Strategy Manager, Baptcare, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Konno R, Suzuki M, Hosomi A, Lizarondo L, Stern C. Assisted bathing of older adults with dementia: a mixed methods systematic review update. JBI Evid Synth 2024; 22:518-559. [PMID: 38054221 DOI: 10.11124/jbies-23-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This review update aimed to determine the best strategies for assisted bathing or showering for older adults with dementia. INTRODUCTION Assisted bathing is a high-risk activity, as it can trigger agitated behaviors. Assisted bathing of older adults with dementia can create caregiver challenges and stress. INCLUSION CRITERIA This review update considered quantitative, qualitative, and mixed methods studies that investigated, firstly, older adults with dementia who required assistance with bathing and, secondly, their caregivers and family members who provided this assistance. The quantitative component considered randomized controlled trials and quasi-experimental studies testing interventions for reducing agitated behaviors in older adults with dementia during bathing, as well as perceived confidence or satisfaction in caregivers. The qualitative component considered studies that reported on experiences of clients or caregivers during the bathing process. METHODS A JBI mixed methods review was conducted following the convergent segregated approach. The review considered studies published between 1990 and March 11, 2022. The databases searched were PubMed, CINAHL, and Embase. Gray literature was also searched. Two independent reviewers screened titles and abstracts. Full texts were retrieved for studies that met the inclusion criteria and were assessed further for eligibility. Two reviewers independently assessed the quality of included studies and extracted data using the standardized JBI tools. Due to methodological and clinical heterogeneity, the results were presented narratively in the quantitative section. For the qualitative component, meta-synthesis was conducted following the JBI approach of meta-aggregation. Finally, evidence from the 2 components was integrated following the convergent segregated approach. RESULTS Ten quantitative and 4 qualitative studies were included. The methodological quality was poor to moderate in the quantitative studies and moderate to high in the qualitative studies. Results from 3 quantitative studies suggested that providing training to caregivers on person-centered bathing reduced agitated behaviors in older adults with dementia. Other interventions did not show conclusive evidence of their effectiveness in any outcomes of interest. Two synthesized findings highlighted i) the importance of working within each person's reality by having the skills and knowledge required to deliver person-centered assistance and ii) the challenges experienced by caregivers, such as lack of support, time pressure, and safety-related fears. The integrated evidence showed that the quantitative and qualitative components complemented each other to promote the training of caregivers to deliver person-centered bathing. DISCUSSION Integrated findings can help inform an evidence-based strategy utilizing a person-centered bathing approach to reduce agitated behaviors in older adults with dementia. Due to the limited number of eligible studies, and the clinical and methodological heterogeneity of included quantitative studies, no statistical pooling was possible. More studies are needed, particularly intervention studies with high methodological quality. CONCLUSIONS This review update suggests that providing caregivers with person-centered bathing training should be encouraged prior to bathing older adults with dementia. Caregivers should have the knowledge and skills, such as relevant assessment and communication skills, enabling them to provide effective bathing experiences to older adults living with dementia. Organizations should provide caregivers with appropriate resources and training for bathing older adults with dementia. REVIEW REGISTRATION PROSPERO CRD42020208048. SUPPLEMENTAL DIGITAL CONTENT A Japanese-language version of the abstract of this review is available as supplemental digital content 1: http://links.lww.com/SRX/A37 .
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Affiliation(s)
- Rie Konno
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Miyuki Suzuki
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Akiyo Hosomi
- School of Nursing, Hyogo Medical University, Hyogo, Japan
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Kung PC, Huang HL, Hsu WC, Huang HL, Chang HJ, Shyu YIL. Coexisting with anomie: Experiences of persons living with early-stage dementia: A grounded theory study. Int J Ment Health Nurs 2024; 33:452-462. [PMID: 37985929 DOI: 10.1111/inm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
Individuals in the early stages of dementia often endure elevated levels of stress and anxiety, which can hinder their ability to adapt to the progression of dementia. To mitigate the negative impacts of dementia more effectively, it is necessary to explore the trajectory of the adaptation process of persons living with dementia. This study aimed to construct a theoretical framework for the adaptation process of individuals in the early stages of dementia. Participants were dyads of persons diagnosed with mild dementia or mild cognitive impairment (≥ 60 years of age) and their primary family caregivers. This longitudinal study used a grounded theory approach to explore the adaptation trajectory changes in persons with mild dementia over a 3-year period. Data were collected from dyads with face-to-face interviews. Analysis of the interview data revealed the core category was 'Coexisting with anomie: Progressive disappointment and striving', which was comprised of three categories: awareness of alienation, unsettled feelings, and restorative avoidance coping. Categories changed depending on levels of cognition and constituted progressive and cyclical dynamic processes. Four contextual factors positively or negatively influenced adaptation: level of insight about dementia, personal traits, caregiving style of the caregiver, and level of social interactions. These findings provide a new perspective about the mental health of persons in early-stage dementia. Understanding coexisting with anomie and related influencing factors could facilitate the development of support interventions by mental health nursing staff, which could improve emotional safety, promote psychological well-being, and increase quality of life for persons living with dementia.
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Affiliation(s)
- Pen-Chen Kung
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Huei-Ling Huang
- Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Wen-Chuin Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Li Huang
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hong-Jer Chang
- National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology, Dementia Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Moermans VRA, Hamers JPH, Verbeek H, de Casterlé BD, Milisen K, Bleijlevens MHC. District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study. BMC Nurs 2023; 22:394. [PMID: 37853344 PMCID: PMC10585764 DOI: 10.1186/s12912-023-01553-w] [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: 01/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.
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Affiliation(s)
- Vincent R A Moermans
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Ma J, Wang Q, Lang Y, Lv S, Xu Y, Wei B. Effectiveness of creative story therapy for dementia: a systematic review and meta-analysis. Eur J Med Res 2023; 28:342. [PMID: 37705077 PMCID: PMC10500921 DOI: 10.1186/s40001-023-01337-7] [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: 07/25/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE To conduct a meta-analysis of the effectiveness of creative story therapy versus routine nursing alone for the treatment of dementia. METHODS We manually searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), China Biomedical Literature Database (CBM), and Wanfang Data up to May 2023. Randomized controlled trials (RCTs) of creative story therapy combined with routine nursing versus routine nursing for the treatment of dementia were included. RESULTS A total of 597 participants were enrolled in the 9 RCTs. Among them, 296 were in the creative story therapy group, and 301 were in the routine nursing group. We found statistically significant effects of creative story therapy combined with routine nursing on cognitive function [standardized mean difference (SMD) = 0.99, 95% CI 0.57, 1.41, P < 0.00001], CSDD score [mean difference (MD) = - 1.71, 95% CI - 3.27, - 0.14, P < 0.00001], quality of life [SMD = 0.97, 95% CI 0.04, 1.90, P = 0.04], and social communication [MD = 0.46, 95% CI 0.17, 0.74, P < 0.00001] between the creative story therapy group and routine nursing groups; no significant difference in change in basic needs communication [MD = 0.09, 95% CI - 0.58, 0.76, P < 0.00001]. CONCLUSION This meta-analysis shows that creative story therapy combined with routine nursing has significant effectiveness in improving cognitive function and depression in people with dementia. More high-quality RCTs are required to validate these results.
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Affiliation(s)
- Jinlong Ma
- School of Nursing, Yanbian University, Yanji, Jilin, China
| | - Qian Wang
- Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian, Shandong, China
| | - Yanmei Lang
- School of Nursing, Yanbian University, Yanji, Jilin, China
| | - Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China.
| | - Baojian Wei
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China.
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10
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Salis F, Pili D, Collu M, Serchisu L, Laconi R, Mandas A. Six-item cognitive impairment test (6-CIT)'s accuracy as a cognitive screening tool: best cut-off levels in emergency department setting. Front Med (Lausanne) 2023; 10:1186502. [PMID: 37547596 PMCID: PMC10401263 DOI: 10.3389/fmed.2023.1186502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Nowadays, elderly patients represent a significant number of accesses to the Emergency Department (ED). Working rhythms do not allow to perform complete cognitive analysis, which would, however, be useful for the health care. This study aims to define the optimal cut-off values of the six-item Cognitive Impairment Test (6-CIT) as a cognitive screening tool in ED. Methods This study included 215 subjects, evaluated at the Emergency Department of the University Hospital of Monserrato, Cagliari, Italy, from July to December 2021. The accuracy of 6-CIT as a cognitive screening tool was assessed by comparison with Mini Mental State Examination (MMSE). Results The correlation coefficient between the two tests was -0.836 (CI: -0.87 to -0.79; p < 0.0001), and 6-CIT showed AUC = 0.947 (CI: 0.908-0.973; p < 0.0001). The 8/9 6-CIT cut-off score presented 86.76% sensitivity (CI: 76.4-93.8) and 91.84% specificity (CI: 86.2-95.7), and Youden index for this score was 0.786. Conclusion Our study demonstrates that 6-CIT is a reliable cognitive screening tool in ED, offering excellent sensitivity and specificity with a 8/9 points cut-off score.
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Affiliation(s)
- Francesco Salis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Pili
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Manuel Collu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Serchisu
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Rosanna Laconi
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
| | - Antonella Mandas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- University Hospital “Azienda Ospedaliero-Universitaria” of Cagliari, Cagliari, Italy
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11
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Britt KC, Boateng ACO, Zhao H, Ezeokonkwo FC, Federwitz C, Epps F. Spiritual Needs of Older Adults Living with Dementia: An Integrative Review. Healthcare (Basel) 2023; 11:1319. [PMID: 37174861 PMCID: PMC10178032 DOI: 10.3390/healthcare11091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Older adults living with dementia experience progressive decline, prompting reliance on others for spiritual care and support. Despite a growing interest in studying persons living with dementia (PLwDs), empirical evidence on the spiritual needs of PLwDs has not been synthesized. Using the Whittemore and Knafl method, this integrative review examined the literature from 2000 to 2022 on the spiritual care needs of PLwDs. We sought to identify characteristics of the spiritual needs of PLwDs and ways to address them. The ATLA Religion, CINAHL, PsycINFO, PubMed, and Socindex databases were used to search the literature, and 12 peer-reviewed articles met the inclusion criteria. Spiritual care needs varied across studies. Overall, findings support the importance of identifying PLwDs' religious and spiritual backgrounds to inform person-centered care. Spiritual needs were identified as verbal and non-verbal expressions related to past meaning and religious and spiritual background and were not consistently addressed in care. Providers reported observing spiritual distress in the mild stage prompting the need for spiritual care. There is a great need for dementia-specific spiritual assessment tools and spiritual care interventions to support spiritual well-being in dementia care. Spiritual care involves facilitating religious rituals and providing spiritual group therapy and religious and spiritual activities.
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Affiliation(s)
- Katherine Carroll Britt
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Augustine C. O. Boateng
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hui Zhao
- School of Nursing, James Madison University, Harrisonburg, VA 22807, USA
| | | | - Chad Federwitz
- Gerontology, Western Colorado Community College, Grand Junction, CO 81505, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
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12
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Doménech S, Rojano I Luque X, Sánchez-Martínez I, Fernández I, Solé M, Palacios F, Alsina M, Heras E. [Comparison of digital and conventional life story books on mood, communication, cognition and quality of life in people with dementia in nursing homes: A pilot study]. Rev Esp Geriatr Gerontol 2023; 58:141-147. [PMID: 37208276 DOI: 10.1016/j.regg.2023.04.005] [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] [Received: 10/13/2022] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Person-centered care (PCC) includes life story, a form of reminiscence therapy that can be useful in the treatment of dementia. We compared the efficacy of using a digital or conventional life story book (LSB) on depressive symptoms, communication, cognition, and quality of life. MATERIAL AND METHODS Thirty one persons with dementia living in 2 PCC nursing homes were randomly assigned to receive reminiscence therapy based on the Neural Actions digital LSB (n=16) or a conventional LSB (n=15). Both groups performed 2 weekly sessions of 45min for 5 weeks. Depressive symptoms were evaluated with the Cornell scale (CSDD); communication with the Holden scale (HCS), cognition with the Mini Mental State Examination (MMSE) and quality of life with the quality of life scale for Alzheimer's (QoL-AD). The results were analyzed using ANOVA of repeated measures with the jamovi 2.3 program. RESULTS Both LSB improved communication skills (η2=0.115; p<0.001), with no differences between groups. No effects on quality of life, cognition, or mood were found. CONCLUSIONS In PCC centres digital or conventional LSB can be useful in the treatment of people with dementia by facilitating communication. Its role on quality of life, cognition or mood is uncertain.
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Affiliation(s)
- Sara Doménech
- Fundació Salut i Envelliment, Universitat Autònoma de Barcelona, Barcelona, España.
| | | | - Iván Sánchez-Martínez
- Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), Vic, Barcelona, España
| | | | | | | | | | - Eva Heras
- Servei Andorrà d'Atenció Sanitària, Andorra
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13
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de Melo RC, Schutz V, Wachholz PA, Villalonga-Olives E, Myer D, Corazzini K, Lepore M. Long-Term Care Staff Perspectives on the Care of Persons Living With Dementia During the COVID-19 Pandemic in São Paulo State, Brazil. J Gerontol Nurs 2023; 49:45-52. [PMID: 37126010 DOI: 10.3928/00989134-20230414-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the Brazilian long-term care (LTC) sector faced many challenges, which accentuated other common issues experienced by persons living with dementia (PLWD). The current pilot study evaluated staff perspectives regarding the care of institutionalized PLWD during the COVID-19 pandemic. Using an online survey, we collected the perspectives of 24 workers from seven long-term care facilities (LTCFs) located in São Paulo State, Brazil, about the impact of COVID-19 in caring for PLWD. Results highlight concerns about challenges related to following precautionary measures and the negative effects of social distancing on PLWD. Aspects related to workforce and staffing and person-centered care approaches were recognized by staff as important to provide good care for PLWD. Future research is needed to consider how to support LTCFs in achieving a balance between the protection and well-being of PLWD. [Journal of Gerontological Nursing, 49(5), 45-52.].
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Metzger L, Henley L, Smallfield S, Green M, Rhodus EK. Interventions Within the Scope of Occupational Therapy to Improve Cognitive Performance for Individuals with Dementia and Mild Cognitive Impairment (2018-2022). Am J Occup Ther 2023; 77:7710393260. [PMID: 37695992 PMCID: PMC10995912 DOI: 10.5014/ajot.2023.77s10026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to interventions to improve cognitive function for individuals living with Alzheimer's disease and related dementias and mild cognitive impairment.
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Affiliation(s)
- Lizabeth Metzger
- Lizabeth Metzger, OTD, OTR/L, is home health therapist, InHome Therapy
| | - Laura Henley
- Laura Henley, MS, OTR/L, CDP, is Rehabilitation Program Manager, HealthPro Heritage
| | - Stacy Smallfield
- Stacy Smallfield, DrOT, OTR/L, BCG, FAOTA, is Associate Professor, Occupational Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health, University of Nebraska Medical Center
| | - Melissa Green
- Melissa Green, OT, OTD, OTR, is Assistant Professor, Occupational Therapy Program, Bay Path University
| | - Elizabeth K Rhodus
- Elizabeth K. Rhodus, PhD, MS, OTR/L, is Assistant Professor, Sanders-Brown Center on Aging, Department of Behavioral Science, College of Medicine, University of Kentucky
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15
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Smallfield S, Green M, Metzger L, Henley L, Rhodus EK. Interventions Within the Scope of Occupational Therapy Addressing Behavioral and Psychological Symptoms of Dementia (2018-2022). Am J Occup Ther 2023; 77:7710393240. [PMID: 37695990 DOI: 10.5014/ajot.2023.77s10024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents finding related to interventions within the scope of occupational therapy that address behavioral and psychological symptoms of dementia.
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Affiliation(s)
- Stacy Smallfield
- Stacy Smallfield, DrOT, OTR/L, BCG, FAOTA, is Associate Professor, Occupational Therapy Program, Department of Health and Rehabilitation Sciences, College of Allied Health, University of Nebraska Medical Center
| | - Melissa Green
- Melissa Green, OT, OTD, OTR, is Assistant Professor, Occupational Therapy Program, Bay Path University
| | - Lizabeth Metzger
- Lizabeth Metzger, OTD, OTR/L, is home health therapist, InHome Therapy
| | - Laura Henley
- Laura Henley, MS, OTR/L, CDP, is Rehabilitation Program Manager, HealthPro Heritage
| | - Elizabeth K Rhodus
- Elizabeth K. Rhodus, PhD, MS, OTR/L, is Assistant Professor, Sanders-Brown Center on Aging, Department of Behavioral Science, College of Medicine, University of Kentucky
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Sousa L, Oliveira C, Tomás M, Pires MDC, Almeida A, Oliveira H, García-Navarro EB, José H. Effectiveness of Music Therapy in People Living with Dementia: An Umbrella Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3200. [PMID: 36833896 PMCID: PMC9961781 DOI: 10.3390/ijerph20043200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Dementia stands out as a neurological disorder which constitutes a progressive decline in cognitive, behavioral, emotional, and social functioning. However, non-pharmacotherapy, such as music therapy, can be combined with pharmacological treatment as a possible strategy to improve functionality regarding the cognitive and non-cognitive dimensions of people diagnosed with dementia. OBJECTIVES To analyze and synthesize published evidence regarding the effectiveness of music therapy in people diagnosed with dementia, concerning cognitive and non-cognitive outcomes. DESIGN Descriptive study protocol of an umbrella review. METHODS AND ANALYSIS An umbrella review method will guide this study, focusing on an extensive search of published systematic reviews and meta-analyses reviews that include randomized controlled trials and other types of trials. Databases for the article search include ISI Web of Knowledge, Scopus, and Joanna Briggs Institute (JBI) EBP database, and EBSCO Host platform (Cochrane Database of Systematic Reviews, MEDLINE, and CINAHL). Two reviewers will independently review all titles and abstracts and identify articles considering the inclusion criteria. Afterward, two reviewers will independently extract relevant information from each article for the characterization table, and evaluate the quality of selected articles using the Measurement Tool for Evaluating Systematic Reviews (AMSTAR) 2 guideline. RELEVANCE TO CLINICAL PRACTICE Data from this study will aid in designing healthcare workers' training courses, clinical intervention guidelines, and specific intervention protocols that support pharmacological interventions in treating dementia.
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Affiliation(s)
- Luís Sousa
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Comprehensive Health Research Centre (CHRC), 7000-811 Evora, Portugal
| | - Cláudia Oliveira
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Research in Education and Community Intervention, Piaget Agency for Development, 4410-372 Vila Nova de Gaia, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 3045-043 Coimbra, Portugal
| | - Margarida Tomás
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
| | - Maria do Céu Pires
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 3045-043 Coimbra, Portugal
| | - António Almeida
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
| | - Helga Oliveira
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
| | | | - Helena José
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 3045-043 Coimbra, Portugal
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17
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Omotunde M, Agholme F, Böhling A, Huige N, Schweigel H, Hayder-Beichel D, Reidy R, Wagg A. A post-market cluster randomized controlled trial of the effect of the TENA SmartCare Change Indicator™ on urinary continence care efficiency and skin health in older nursing home residents. Trials 2023; 24:80. [PMID: 36737838 PMCID: PMC9895969 DOI: 10.1186/s13063-022-07031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Urinary continence care for residents of nursing homes who are unable to communicate their toileting needs usually involves care aides manually checking continence products (pads) to determine the level of urine saturation prior to changing. The TENA SmartCare Change Indicator is a medical device which estimates urine saturation and notifies caregivers of the optimal time for pad changes. This study will seek to examine the effect of the TENA SmartCare Change Indicator on urinary continence care efficiency and skin health, in comparison to usual care. METHODS This cluster randomized controlled trial (NCT05247047) involving older nursing home residents with urinary incontinence unable to consistently indicate their toileting needs, and their care aides, will compare technology-based and usual continence care over a period of 8 weeks. Co-primary endpoints of superiority in continence care efficiency and non-inferiority in the maintenance of skin health will be assessed. Secondary outcomes will examine the resident quality of life, sleep quality, responsive behaviours, changes in pad use and leakage episodes outside the pad. Change in care aide work engagement, job satisfaction and rushed tasks will be assessed. Benefits and challenges with the use of the device for continence care will be identified from the perspectives of the care staff. DISCUSSION Urinary continence assessment and care in nursing homes is reported as suboptimal and threatening to dignity. Data on the utility and effect of technological solutions for improving urinary continence care are few and conflicting. If shown effective, this technological solution has the potential to improve the care for older residents and improve the working lives of caregiving staff who look after this most vulnerable section of the population. TRIAL REGISTRATION ClinicalTrials.gov NCT05247047. Registration date is Feb 18, 2022.
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Affiliation(s)
- Muyibat Omotunde
- grid.17089.370000 0001 2190 316XDivision of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Fredrik Agholme
- grid.509222.eEssity Hygiene & Health AB, 405 03 Gothenburg, Sweden
| | - Arne Böhling
- Essity/BSN Medical GmbH, Schützenstraße 1-3, 22765 Hamburg, Germany
| | - Nicole Huige
- grid.509222.eEssity Hygiene & Health AB, 405 03 Gothenburg, Sweden
| | - Hardy Schweigel
- Essity/BSN Medical GmbH, Schützenstraße 1-3, 22761 Hamburg, Germany
| | - Daniela Hayder-Beichel
- Department of Health, Hochschule Neiderrhein-University of Applied Sciences, Reinarzstr 49, 47805 Krefeld, Germany
| | - Robert Reidy
- Staburo GmbH, Aschauer Strasse 26a, 81549 Munich, Germany
| | - Adrian Wagg
- grid.17089.370000 0001 2190 316XDivision of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, AB Canada
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18
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Lee JY, Yang E, Lee KH. Experiences of implementing person-centered care for individuals living with dementia among nursing staff within collaborative practices: A meta-synthesis. Int J Nurs Stud 2023; 138:104426. [PMID: 36584446 DOI: 10.1016/j.ijnurstu.2022.104426] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Person-centered care is considered standard care in long-term care for individuals living with dementia. However, qualitative reviews that synthesize the staff experiences of the implementation of person-centered care are lacking. OBJECTIVE This review aims to synthesize the experiences of nursing staff members after the implementation of person-centered care for individuals living with dementia. DESIGN A meta-synthesis was conducted. DATA SOURCES Overall, five electronic databases (i.e., PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, and Cochrane Library) were searched for the following terms: "dementia," "person-centered care," and "qualitative." The search was limited to articles published in English from January 1998 to December 2021, considering the period when person-centered care was applied in dementia care. REVIEW METHODS Qualitative content analysis was conducted using a person-centered nursing framework. Meta-data analysis, meta-method, and meta-theory analysis were used to synthesize the results of the included studies. The methodological quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) tool. RESULTS Altogether, 19 studies were included in this review. Through meta-synthesis, 12 themes, including professionally competent, perspective shift, shared decision-making among staff, appropriate supportive system, understanding and respecting individuals living with dementia, interaction with persons living with dementia and their family members, collaboration among staff members, concern about the well-being of an individual living with dementia, meaningful relationship between staff members and individuals living with dementia, quality care, reflections for maintenance, and barriers to overcome, emerged. CONCLUSIONS A person-centered nursing framework could be implemented in person-centered care for individuals living with dementia. However, the framework should be modified based on the characteristics of individuals living with dementia. Additionally, reflection strategies for maintenance and barriers are added to facilitate successful person-centered care implementation. REGISTRATION The study was registered with PROSPERO (International prospective register of systematic reviews) in May 2022 (registration number: CRD42022316097).
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Affiliation(s)
- Ji Yeon Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Eunjin Yang
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea
| | - Kyung Hee Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, South Korea.
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19
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Boafo J, David D, Wu B, Brody AA, Sadarangani T. "The Sun Came Up Because You Got Here…": A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia. J Appl Gerontol 2023; 42:147-159. [PMID: 36165422 DOI: 10.1177/07334648221128283] [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: 01/18/2023] Open
Abstract
In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.
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Affiliation(s)
| | - Daniel David
- 15935New York University College of Nursing, New York, NY, USA
| | - Bei Wu
- 5894New York University, New York, NY, USA
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20
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García-Alberca JM, de la Rosa MD, Solo de Zaldívar P, Ledesma M, Oltra E, Gris E, Ocejo O, Torrecilla J, Zafra C, Sánchez-Fernández A, Mancilla T, López-Romero M, Jerez R, Santana N, Lara JP, Barbancho MÁ, Blanco-Reina E. Effect of Nordic Sensi® Chair on Behavioral and Psychological Symptoms of Dementia in Nursing Homes Residents: A Randomized Controlled Trial. J Alzheimers Dis 2023; 96:1609-1622. [PMID: 38007648 PMCID: PMC10741310 DOI: 10.3233/jad-230391] [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] [Accepted: 09/29/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD. OBJECTIVE We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia. METHODS We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis. RESULTS Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003). CONCLUSIONS The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.
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Affiliation(s)
- José María García-Alberca
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - María Dolores de la Rosa
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Paloma Solo de Zaldívar
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - María Ledesma
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Estela Oltra
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Esther Gris
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Olga Ocejo
- Centro Residencial Almudena, Rincón de laVictoria, Spain
| | | | - Carmen Zafra
- Centro Residencial Almudena, Rincón de laVictoria, Spain
| | | | - Tomás Mancilla
- Residencia DomusVi Fuentesol, Alhaurín de la Torre, Spain
| | | | - Raquel Jerez
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - Nuria Santana
- Alzheimer Research Center and Memory Clinic, Instituto Andaluz de Neurociencia (IANEC), Málaga, Spain
| | - José Pablo Lara
- Brain Health Unit, School of Medicine, University of Málaga, Málaga, Spain
| | | | - Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, School of Medicine, University of Málaga, Málaga, Spain
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21
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Mroz EL, Shah M, Lan H, Duker A, Sperduto M, Levy BR, Monin JK. When Harry Met Sally: Older Adult Spouses' First Encounter Reminiscing and Well-Being. THE GERONTOLOGIST 2022; 62:1486-1495. [PMID: 35429275 PMCID: PMC9710240 DOI: 10.1093/geront/gnac053] [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: 01/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interest in reminiscence activities for older adults has grown in recent years, but the benefits of co-reminiscence are not well-known. Drawing from a narrative identity framework, this study examined older adult spouses' co-reminiscence about their first encounters. We hypothesized that perceived closeness and support increase when spouses co-reminisce and that greater perceptions of closeness and support after reminiscing relate to lower depressive symptoms and greater marital satisfaction in daily life. RESEARCH DESIGN AND METHODS One hundred and one couples completed questionnaires measuring marital satisfaction and depressive symptoms at home and then participated in a laboratory session in which they co-reminisced about their first encounters. Self-reported perceived support and relationship closeness were obtained before and after reminiscence. t Tests and the Actor Partner Interdependence Model were used to examine hypotheses. RESULTS As hypothesized, closeness and perceived support increased from pre- to postreminiscence for husbands and wives. In addition, one's own relationship closeness after reminiscence was positively associated with own marital satisfaction (actor effect). One's perceived support after reminiscence was positively related to spouse's marital satisfaction and negatively associated with their spouse's depressive symptoms (partner effects). DISCUSSION AND IMPLICATIONS Findings suggest that co-reminiscence about early relationship development can boost feelings of closeness and support for older adults. Benefiting from co-reminiscence in this way also appears to indicate broader relationship and individual well-being. Brief co-reminiscence activities may nurture late-life relational well-being.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maya Shah
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Hanzhen Lan
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ajua Duker
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Maria Sperduto
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Becca R Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joan K Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Huizenga J, Scheffelaar A, Fruijtier A, Wilken JP, Bleijenberg N, Van Regenmortel T. Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10828. [PMID: 36078544 PMCID: PMC9518176 DOI: 10.3390/ijerph191710828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.
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Affiliation(s)
- Jacoba Huizenga
- Institute of Social Work, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Aukelien Scheffelaar
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Agnetha Fruijtier
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Jean Pierre Wilken
- Research Center Social Innovation, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Center Healthy & Sustainable Living, HU University of Applied Sciences Utrecht, 3507 LC Utrecht, The Netherlands
- Department Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tine Van Regenmortel
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands
- HIVA—Research Institute for Work and Society, Faculty of Social Sciences, University of Leuven, B-3000 Leuven, Belgium
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23
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Wallengren C, Billig H, Björkman I, Ekman I, Feldthusen C, Lindström Kjellberg I, Lundberg M. Person-centered care content in medicine, occupational therapy, nursing, and physiotherapy education programs. BMC MEDICAL EDUCATION 2022; 22:492. [PMID: 35739515 PMCID: PMC9229130 DOI: 10.1186/s12909-022-03502-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 05/20/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although person-centered care (PCC) ensures high-quality care for patients, studies have shown that it is unevenly applied in clinical practice. The extent to which future health care providers are currently offered education in PCC at their universities is unclear. We aimed to clarify the PCC content offered to students as a basis for their understanding by exploring the PCC content of Swedish national study programs in medicine, nursing, occupational therapy, and physiotherapy. METHODS Using a qualitative document analysis design, we sampled the steering documents from all higher education institutions (n = 48) with accreditation in medicine (n = 7), nursing (n = 25), occupational therapy (n = 8), or physiotherapy (n = 8) at a single time point. All national study programs (n = 4), local program syllabuses (n = 48), and local course syllabuses (n = 799) were reviewed using a 10-item protocol. RESULTS We found no content related to PCC in the steering documents at the national level. At the local level, however, signs of PCC were identified in local program syllabuses and local course syllabuses. Seven of the 48 local program syllabuses (15%) included PCC in their intended learning outcomes. Eight of the 799 local course syllabuses (1%) contained course titles that included the phrase 'person-centered care,' and another 101 listed 142 intended learning outcomes referring to PCC. A total of 21 terms connected to PCC were found, and the term 'person-centered care' was most commonly used in the nursing programs and least commonly in the medical programs. CONCLUSIONS There is a broad range in how the national study programs in Sweden have incorporated PCC. The implementation has been driven by a bottom-up strategy. A deliberate and standardized strategy is needed to ensure full implementation of PCC into clinical curricula in higher education.
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Affiliation(s)
- Catarina Wallengren
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden.
- Department of Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden.
| | - Håkan Billig
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ida Björkman
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Department of Life Context and Health Promotion, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Medicine/Geriatrics, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Caroline Feldthusen
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Irma Lindström Kjellberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Department of Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
| | - Mari Lundberg
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, P.O. Box 457, 40530, Gothenburg, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
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24
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Dys S, Tunalilar O, Hasworth S, Winfree J, White DL. Person-centered care practices in nursing homes: Staff perceptions and the organizational environment. Geriatr Nurs 2021; 43:188-196. [PMID: 34915418 DOI: 10.1016/j.gerinurse.2021.11.018] [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: 08/21/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
Person-centered care (PCC) is considered the standard to assure quality of care and quality of life in long-term care, benefiting both residents and staff. This study examines the associations between nursing home staff perceptions of person-centered care practices, the organizational system, and work-related attitudes in a sample of 340 nurses and direct care workers across 32 nursing homes in Oregon. Random-intercepts regression models were used to estimate within- and between-nursing home variation in staff perceptions of PCC practices as measured by the Staff Assessment of Person-Directed Care (SA-PDC), and identify characteristics associated with these perceptions. Staff in nursing homes that accept Medicaid reported lower SA-PDC scores, and higher scores were reported in nonprofit nursing homes. Staff perceptions varied extensively within nursing homes, suggesting a lack of staff cohesion regarding core aspects of PCC. Cultivating a supportive work environment is key to promoting person-centered care practices, increasing job satisfaction, elevating affective commitment, and reducing turnover intention.
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Affiliation(s)
- Sarah Dys
- School of Public Health, Oregon Health & Science University, Portland State University, Portland, Oregon, United States; Vital Research, LLC, Los Angeles, California, United States
| | - Ozcan Tunalilar
- Institute on Aging, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, Oregon 97207, United States; Nohad A. Toulan School of Urban Studies and Planning, College of Urban and Public Affairs, Portland State University, Portland, Oregon, United States
| | - Serena Hasworth
- Institute on Aging, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, Oregon 97207, United States
| | - Jaclyn Winfree
- Institute on Aging, College of Urban and Public Affairs, Portland State University, PO Box 751, Portland, Oregon 97207, United States
| | - Diana L White
- Vital Research, LLC, Los Angeles, California, United States.
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25
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Seok JW, Shin J, Kang B, Lee H, Cho E, Lee KH. Non-pharmacological interventions using information and communication technology for behavioral and psychological symptoms of dementia: A systematic review and meta-analysis protocol. J Adv Nurs 2021; 78:282-293. [PMID: 34812533 DOI: 10.1111/jan.15109] [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: 09/14/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
AIM To review and examine the effectiveness of non-pharmacological interventions on behavioural and psychological symptoms of dementia using information and communication technology. DESIGN This is a systematic review and meta-analysis. METHODS The databases including PubMed, CINAHL with Full Text (EBSCOhost), PsycINFO, Embase, and the Cochrane Library will be searched for all published studies. Studies will be screened and selected with criteria described in PICOS format. Risk of bias will be assessed by the National Institute for Health and Clinical Excellence checklist. Data will be extracted from eligible studies and used to perform a meta-analysis examining the overall effects and effects on individual outcomes. Additionally, we will conduct meta-regression to examine the association between explanatory variables and behavioural and psychological symptoms. This study has been funded since June 2020. DISCUSSION This study will be the first to reveal the effects of non-pharmacological interventions using information and communication technology on behavioural and psychological symptoms of dementia. Furthermore, this study will provide updated and valid evidence of interventions using this for managing behavioural and psychological symptoms of dementia. IMPACT Although non-pharmacological interventions using information and communication technology for older adults living with dementia are continuously developing, their direct effect remains unclear. This study will evaluate the effectiveness of these interventions on behavioural and psychological symptoms of dementia and provide the evidence to implement these interventions among older adults living with dementia. Thus, caregivers and nursing staff can manage behavioural and psychological symptoms of dementia more effectively by incorporating information and communication technology.
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Affiliation(s)
- Jo Woon Seok
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Jinhee Shin
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Bada Kang
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Hyangkyu Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Kyung Hee Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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26
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Thompson Z, Baker FA, Tamplin J, Clark IN. How Singing can Help People With Dementia and Their Family Care-Partners: A Mixed Studies Systematic Review With Narrative Synthesis, Thematic Synthesis, and Meta-Integration. Front Psychol 2021; 12:764372. [PMID: 34707550 PMCID: PMC8542693 DOI: 10.3389/fpsyg.2021.764372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Recent research on the efficacy of music-based interventions for people with dementia have focused on specific outcomes and methods, and singing has been noted as a particularly beneficial activity. However, due to heterogeneity of research methods, there is a need to synthesise the findings of both quantitative and qualitative research in order to better understand both the impact and potential mechanisms of singing for people in this population. Method: This systematic review included quantitative, qualitative and mixed-methods studies, and analysed these using a systematic mixed-studies synthesis (with a results-based convergent approach). Quantitative and qualitative data were initially synthesised using a narrative synthesis and thematic synthesis method, respectively, before a final meta-integration method was used to synthesise common themes across the two data forms. Results: Electronic and hand search strategies revealed 1,815 relevant studies, 40 of which met the full eligibility criteria. Narrative synthesis of quantitative data revealed six key outcome areas (quality of life; psychological well-being; cognition; engagement; activities of daily living; care-partner well-being), and thematic synthesis of qualitative data generated seven themes relating to the impact and mechanisms of singing (pragmatic elements; social benefits; mood; identity; memory; flow-on effects; and relationships). Meta-integration identified four key areas relating to the impact and mechanisms of singing for people with dementia and care-partners: psychological well-being, quality of life, cognition, and care-partner well-being. Conclusion: Results from the syntheses suggest that singing can positively impact the lives of people with dementia and their care-partners, although due to heterogeneity of study design and outcome measures, it is difficult to draw conclusions based on quantitative data alone. Qualitative data provides further context and insights from participant perspectives, and when integrated with quantitative data, contextual factors that may influence the benefits that participants experience from singing are revealed.
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Affiliation(s)
- Zara Thompson
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Felicity A Baker
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
| | - Imogen N Clark
- Faculty of Fine Arts and Music, University of Melbourne, Melbourne, VIC, Australia
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27
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Borbasi JAL, Tong A, Ritchie A, Poulos CJ, Clayton JM. "A good death but there was all this tension around"- perspectives of residential managers on the experience of delivering end of life care for people living with dementia. BMC Geriatr 2021; 21:306. [PMID: 33980152 PMCID: PMC8117498 DOI: 10.1186/s12877-021-02241-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND End of life care for residents with advanced dementia in the aged care setting is complex. There is prolonged and progressive cognitive decline, uncertain disease trajectory, significant symptom burden and infrequent access to specialist palliative care. Residential aged care managers offer a unique perspective in understanding the experience of providing end of life care for residents with advanced dementia. They bring insight from the coalface to the broader policy context. The aim of this study was to describe the experience and perspectives of residential aged care managers on providing end of life care for residents living with dementia. METHODS Focus groups and semi-structured interviews were conducted with residential or care managers from various care homes from one dementia specific aged care organisation in Australia. A comprehensive sampling strategy was used in participating care homes. Transcripts were analysed using thematic analysis. RESULTS 20 residential or care managers from 11 aged care homes in two states of Australia participated in two focus groups (total 16 participants) or individual interviews (4 participants). Six themes were identified: laying the ground work to establish what families understand about dementia, playing the peacemaker in the face of unrealistic family demands and expectations, chipping away at denial and cultivating a path towards acceptance of death, recruiting general practitioners as allies, supporting and strengthening the front line, and dedication to optimal care is relentless but rewarding. CONCLUSION Aged care manager participants described provision of end of life dementia care as a rewarding but sometimes fraught experience requiring persistent personalisation of care and communication to enable family acceptance of the resident's terminal condition. The findings suggest that continuous front line aged care staff skill development, iterative family discussions, and partnership building between aged care staff and general practitioners, are all required to promote optimal end of life dementia care in residential aged care settings.
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Affiliation(s)
- Jessica A L Borbasi
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia.
| | - Allison Tong
- The University of Sydney, School of Public Health, Faculty of Medicine and Health Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Hammondville, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, Australia
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