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Quick SM, Lawler K, Shannon MM, Soh SE, McGinley JL, Peiris CL, Snowdon DA, Callisaya ML. Physiotherapy students are underprepared to work with people living with dementia: a qualitative study. Physiotherapy 2024; 123:47-55. [PMID: 38271742 DOI: 10.1016/j.physio.2023.09.004] [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: 09/05/2022] [Revised: 05/08/2023] [Accepted: 09/19/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVES To 1) explore physiotherapy students' experience in caring for people with dementia; 2) develop a rich understanding of their perceived preparedness to work with people with dementia upon graduation; and 3) identify opportunities to improve dementia education from the perspectives of students. DESIGN A qualitative study comprised of semi-structured interviews via web conferencing software. Thematic analysis was undertaken, with themes/subthemes derived and a qualitative framework generated. SETTING Three Victorian Universities in Australia. PARTICIPANTS Physiotherapy students of entry-to-professional practice education programs (n = 17; mean age 23.7 years, 65% female), having completed at least 15 weeks of clinical placements. RESULTS The overarching theme was that students' experience of providing care for people with dementia was variable. The three sub-themes were: 1) students experience significant challenges when working with people with dementia, 2) students experience a range of emotions when working with people with dementia, and 3) the quality of dementia learning experiences during entry-to-professional practice training is mostly inadequate. Students described the importance of the supervisor during clinical placements, and suggested incorporating 'real-life' scenario training in the classroom to assist them learn to manage the challenging symptoms of dementia. CONCLUSION Physiotherapy students believe that entry-to-practice dementia education is insufficient. These findings have important implications for the future planning and delivery of physiotherapy dementia education. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Stephen M Quick
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia; National Centre for Healthy Ageing, Melbourne, Victoria, Australia; Academic Unit, Peninsula Health, Melbourne, Victoria, Australia.
| | - Katherine Lawler
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia.
| | | | - Sze-Ee Soh
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Jennifer L McGinley
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
| | - David A Snowdon
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia; National Centre for Healthy Ageing, Melbourne, Victoria, Australia; Academic Unit, Peninsula Health, Melbourne, Victoria, Australia.
| | - Michele L Callisaya
- Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia; National Centre for Healthy Ageing, Melbourne, Victoria, Australia; Academic Unit, Peninsula Health, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Evans CJ, van den Berg MEL, Lewis LK. Physiotherapy for people with dementia: a Call to Action for the development of clinical guidelines. Physiotherapy 2024; 122:27-29. [PMID: 38241940 DOI: 10.1016/j.physio.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 01/21/2024]
Affiliation(s)
- C J Evans
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, PO Box 2100, Sturt Rd, Bedford Park, SA 5042, Australia.
| | - M E L van den Berg
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, PO Box 2100, Sturt Rd, Bedford Park, SA 5042, Australia
| | - L K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, PO Box 2100, Sturt Rd, Bedford Park, SA 5042, Australia
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Scerri A, Innes A, Scerri C. Healthcare professionals' perceived challenges and solutions when providing rehabilitation to persons living with dementia-A scoping review. J Clin Nurs 2023; 32:5493-5513. [PMID: 36710398 DOI: 10.1111/jocn.16635] [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: 09/08/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
AIM This review aimed to map studies related to healthcare professionals' perceptions and attitudes towards the rehabilitation for persons living with dementia and extract what they perceive are the barriers and solutions. BACKGROUND Rehabilitation can improve the quality of life and integration of persons living with dementia into society. However, there are several barriers to accessing rehabilitation services. Healthcare professionals are a source of information to understand the challenges and provide solutions to improve these services. DESIGN Arksey and O' Malley (International Journal of Social Research Methodology, 8, 2005 and 19) five-step framework for scoping reviews and the PRISMA-ScR checklist was used. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework was used to identify research and practice recommendations. METHOD Seven databases including Medline Complete, Academic Search Ultimate, Ageline, CINAHL, PsycInfo, Pubmed and Google Scholar were searched. The healthcare professionals' perceived challenges and solutions were categorised using Braun & Clarke (Qualitative Research in Psychology, 3, 2006 and 77) thematic analysis. RESULTS Fifteen articles were selected for review. The challenges and solutions were organised according to their association with three stakeholders; the persons living with dementia/informal caregivers, healthcare professionals and the organisation providing the service. Nine of the studies focused on persons living with dementia following a fall or a hip fracture. Most of the studies focused on the perceptions of allied healthcare professionals, with nurses working in rehabilitation settings being underrepresented. CONCLUSION Healthcare professionals have to consider the complexity of rehabilitating persons living with dementia irrespective of the rehabilitation speciality. Moreover, more studies are needed that focus on the views of rehabilitation nurses. RELEVANCE TO CLINICAL PRACTICE This review provides further evidence of the healthcare professionals' misconceptions about the rehabilitation potential of persons living with dementia. There is a need to educate healthcare professionals about the societal, attitudinal and environmental barriers faced by persons living with dementia and their caregivers. PATIENT CONTRIBUTION No Patient or Public Contribution-scoping review.
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Affiliation(s)
- Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthea Innes
- Gilbrea Chair Aging and Mental Health (Health, Aging and Society), McMaster University, Hamilton, Ontario, Canada
| | - Charles Scerri
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Hall AJ, Manning F, Goodwin V. Qualitative study exploring health care professionals' perceptions of providing rehabilitation for people with advanced dementia. BMJ Open 2023; 13:e072432. [PMID: 37524545 PMCID: PMC10391829 DOI: 10.1136/bmjopen-2023-072432] [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] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore healthcare professionals' principles for providing and delivering rehabilitation interventions for people with advanced dementia. DESIGN This was a qualitative study with three focus groups undertaken virtually. The data were analysed using a process of reflexive thematic analysis in order to gain an in-depth understanding of rehabilitation principles for this population. SETTING AND PARTICIPANTS 20 healthcare professionals who were specialists in treating and rehabilitating people with advanced dementia were recruited. These healthcare professionals had a wide range of experience in a variety of different settings including primary care, secondary care as well as specialist mental health teams. Purposive sampling focused on the requirement for participants to have significant experience of treating people with dementia. Participants were from the UK and Denmark. Data collection was undertaken during August and September 2022. RESULTS Three overarching themes were developed following analysis-organisational culture, knowledge and personal values of the healthcare professional. The first explored how the culture of an organisation affects a person with advanced dementia as well as the healthcare professional. The organisation needed to promote positive approaches to person-centred care and provide effective situational leadership to embed such approaches. Knowledge was a key consideration and was closely linked to the personal values of the healthcare professional, which formed the final theme. This study suggests that the interrelationship of these three factors influences the outcomes for the person with dementia and effective outcomes required consideration of all domains. CONCLUSIONS Effective interventions for people with advanced dementia require the healthcare professional to have the knowledge about dementia and positive personal values, but the culture of the organisation is also key to ensure that the healthcare professional is able to deliver successful interventions.
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Affiliation(s)
- Abigail J Hall
- Public Health and Sports Science, University of Exeter, Exeter, UK
| | - Fay Manning
- Department of Medical Imaging, University of Exeter Medical School, Exeter, UK
| | - Victoria Goodwin
- Public Health and Sports Science, University of Exeter, Exeter, UK
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White LW, Dawson N, Saale BP, Lemley T. Physical Therapists' and Physical Therapist Students' Experiences and Views on the Provision of Physical Therapy Services to People With Dementia: A Scoping Review. J Geriatr Phys Ther 2022:00139143-990000000-00002. [PMID: 35420572 DOI: 10.1519/jpt.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Physical therapists (PTs) require specialized education and training to increase the capacity and competence of the dementia care workforce. Four areas of critical dementia workforce education and training gaps that apply to the physical therapy profession have been identified, including recruitment/retention, financing and cost of training, interprofessional education, and translation/implementation of effective dementia care. A critical step in developing effective training programs and educational curricula is to understand PTs' and PT students' experiences and views on working with people with dementia (PwD). Therefore, the purpose of this scoping review was to examine the extent and types of evidence that explore the experiences and views of PTs and PT students on the provision of physical therapy services to PwD. METHODS The Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, ERIC, PEDro, Web of Science, and Medline databases and sources of gray literature were searched for sources of evidence that met the inclusion criteria of the review protocol. The literature was mapped according to author, participant role, setting, publication type, study design, study aim, key findings, and dementia workforce training gaps addressed. RESULTS AND DISCUSSION A total of 552 sources of evidence were screened for eligibility, and 16 studies were selected for inclusion. Twelve studies included PTs as participants, and 5 included PT students. Included sources explored PTs' experiences, behaviors, knowledge, attitudes, and confidence in working with PwD and the influence of educational, organizational, and other factors on these domains. Challenges to and strategies for delivering effective care to PwD were examined in multiple sources. The 4 areas of critical dementia workforce education and training gaps were each addressed by at least 1 of the included studies. CONCLUSIONS The current body of literature identifies several gaps in both research and education that need to be addressed before our profession is truly prepared to effectively manage this challenging population of patients with specialized needs.
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Affiliation(s)
- Laura W White
- Department of Physical Therapy, University of South Alabama, Mobile
| | - Nicole Dawson
- School of Kinesiology and Physical Therapy, University of Central Florida, Orlando
| | - Blair P Saale
- Department of Physical Therapy, University of South Alabama, Mobile
| | - Trey Lemley
- Biomedical Library, University of South Alabama, Mobile
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Ries JD. A framework for rehabilitation for older adults living with dementia. Arch Physiother 2022; 12:9. [PMID: 35361283 PMCID: PMC8970689 DOI: 10.1186/s40945-022-00134-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/03/2022] [Indexed: 12/29/2022] Open
Abstract
Abstract
Introduction & Background
The aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.
Purpose
The purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.
Implications
This framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as “uncooperative” or “unable to participate” in PT.
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Quick SM, Snowdon DA, Lawler K, McGinley JL, Soh SE, Callisaya ML. Physical Therapist and Physical Therapist Student Knowledge, Confidence, Attitudes, and Beliefs About Providing Care for People With Dementia: A Mixed-Methods Systematic Review. Phys Ther 2022; 102:6527603. [PMID: 35157773 PMCID: PMC9155993 DOI: 10.1093/ptj/pzac010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine physical therapists' and physical therapist students' attitudes and beliefs, knowledge, and confidence in working with people with dementia. METHODS This was a mixed-methods systematic review. Participants included physical therapists working in any clinical specialty and physical therapist students who had completed at least 1 clinical placement. Eleven databases were searched. The evidence was evaluated using the Joanna Briggs Institute Critical Appraisal Checklists. Data synthesis followed a convergent integrated approach according to Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were "qualitized" using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS Fifteen studies were included (9 quantitative and 6 qualitative studies). Seven key themes evolved. Five related to the belief that (1) working with people with dementia is complex and challenging; (2) opportunities for education in dementia care are lacking; (3) working with people with dementia is a specialized area of practice; (4) there are unsupportive systems for working with people with dementia; and (5) people with dementia deserve rehabilitation, but their potential to improve is less certain. One theme related to knowledge (lack of knowledge in some areas of dementia care), and 1 theme related to confidence (lack of confidence in working with people with dementia). CONCLUSIONS Physical therapists and physical therapist students believe that working with people with dementia can be challenging. The low levels of knowledge and confidence in areas important to working with people who have dementia suggest that more education about dementia is needed. IMPACT This mixed-methods systematic review highlights that physical therapists and physical therapist students believe that working with people who have dementia is complex and challenging. Physical therapists want more training and support in this growing area of practice.
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Affiliation(s)
- Stephen M Quick
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia,Address all correspondence to Mr Quick at:
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | | | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Australia,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia,Academic Unit, Peninsula Health, Melbourne, Australia,Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
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