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Fernandes S, von Gunten A, Verloo H. Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review. JMIR Nurs 2024; 7:e54496. [PMID: 38805252 PMCID: PMC11167323 DOI: 10.2196/54496] [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: 11/12/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early. OBJECTIVE The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early. METHODS A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach. RESULTS A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD. CONCLUSIONS Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.
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Affiliation(s)
- Sofia Fernandes
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Les Maisons de la Providence Nursing Home, Le Châble, Switzerland
- Faculty of Biology and Medicine, Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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2
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Kim D, Choi YR, Lee YN, Chang SO. How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study. Nurs Health Sci 2024. [PMID: 38163765 DOI: 10.1111/nhs.13079] [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: 07/05/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.
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Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Young-Rim Choi
- Research professor, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
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3
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Ng L, Oliver E, Laver K. Beyond garden design: A review of outdoor occupation in hospital and residential care settings for people with dementia. Aust Occup Ther J 2023; 70:97-118. [PMID: 35773964 DOI: 10.1111/1440-1630.12826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Access to outdoor space is widely recommended for people with dementia. However, there is limited information on the occupations of people with dementia within these spaces. We sought to review the research literature to identify the occupations of people with dementia in outdoor spaces in residential aged care and/or hospitals and report on features that support occupational participation as well as the benefits of occupational participation in these spaces. METHODS Scoping review. We searched electronic databases involving health, design, and horticulture literature. Studies were included if they involved people with dementia and considered occupations within gardens or garden-like spaces of hospitals, subacute rehabilitation facilities, or residential aged care. RESULTS We identified 19 articles meeting the review criteria. Outdoor spaces for people with dementia varied in design and supported a range of occupations with the most common being social occupations, gardening, and physical activities. Quantitative studies suggested that benefits of outdoor occupations for people with dementia were improvements in activity participation, social connection, mood, agitation, light exposure, and sleep. Qualitative studies supported these findings and identified additional perceived benefits such as engagement, maintaining identity, health, and reduced levels of distress. Benefits were also reported for families and staff. CONCLUSIONS Current literature shows that many occupations can be done outside and that these are beneficial for people with dementia. Despite the wide range of benefits, multiple studies reported that outdoor spaces remain under-utilised. More work is required to design spaces for occupational engagement, support access to outdoor spaces, and promote occupational participation.
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Affiliation(s)
- Lorraine Ng
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia
| | - Eliza Oliver
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
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Maddox A, Mackenzie L. Occupational Violence Experienced by Care Workers in the Australian Home Care Sector When Assisting People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:438. [PMID: 36612758 PMCID: PMC9819805 DOI: 10.3390/ijerph20010438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND People with advancing dementia may be dependent on community services from home care workers and nurses to be supported at home. However, these care workers face difficulty undertaking their roles due to challenging behaviours or occupational violence. This study aimed to explore the challenges faced by home care workers and nurses working with people diagnosed with dementia in the community, to identify job demands contributing to their vulnerability to occupational violence, and to determine ways to help manage occupational violence. METHODS A qualitative descriptive study was conducted by interviewing 10 homecare workers and six registered nurses from agencies in South Australia and New South Wales, Australia. Interviews were audiotaped, transcribed and inductive thematic data analysis was conducted. RESULTS The following themes were identified: (i) sources of threats; (ii) categories of violent, threatening or challenging behaviour; (iii) aggravating factors; (iv) early warning signs; (v) education and training; (vi) managing occupational violence, (vii) resources, (viii) outcomes associated with exposure to occupational violence. CONCLUSION Serious issues were identified by participants, yet very little is known about occupational violence for these community care workers. Findings can inform what aspects of work design can be improved to moderate the effects of occupational violence exposure or mitigate rates of exposure, to enable long-term services for people with dementia.
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Brimelow R, Beattie E, Byrne G, Dissanayaka N. Frequency of changed behaviours in residential aged care and common mitigation strategies - A retrospective review of behavioural report logs. J Clin Nurs 2022. [PMID: 36168200 DOI: 10.1111/jocn.16531] [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: 04/19/2022] [Revised: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Changed behaviours in residential aged care facilities (RACF) are frequently reported in the literature. How RACF staff routinely respond to these observed changed behaviours represents a significant gap. OBJECTIVE To analyse the frequency of changed behaviour reported within RACF behavioural report logs and to ascertain how staff typically manage these behaviours. METHODS Residents (N = 25) with varying levels of cognitive function were recruited from a 160 bed RACF in Queensland, Australia. A retrospective analysis of behavioural report logs was conducted to elucidate prevalence of reported changed behaviours as categorised by RACF staff. Thematic analysis of staff recorded behavioural mitigation strategies was used to categorise staff actions. A case analysis was also conducted to highlight the challenges faced by RACF staff managing persistent acute changed behaviours using identified common mitigation strategies. The STROBE guidelines were followed for reporting. RESULTS There were 395 behaviours recorded in a two-month period. Physical agitation, interfering while wandering, trying to get to inappropriate places, verbal refusal of care, physical aggression, and verbal disruption were most frequently reported by staff. Management strategies included redirection, PRN psychotropic medication, reassurance, routine care practices, offering of beverages, repositioning, and rarely analgesia. A 24-h case analysis highlighted how staff utilised redirection and multiple doses of a PRN benzodiazepine with limited effectiveness. CONCLUSION This study reveals current mitigation strategies employed by RACF staff in response to acute changed behaviours often associated with dementia. Agitation and wandering are prevalent and are difficult for staff to manage effectively. RELEVANCE TO CLINICAL PRACTICE This study highlights that careful consideration should be taken to avoid overuse of PRN benzodiazepines in management of changed behaviours. Short-term mitigation strategies, such as redirection, may not be effective if underlying causes such as pain, physiological, mental, emotional, or social needs are not met. PATIENT AND PUBLIC CONTRIBUTION A RACF participated in project design and review.
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Affiliation(s)
- Rachel Brimelow
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health and Biomedical Innovation, Kelvin Grove, Queensland, Australia
| | - Gerard Byrne
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,Royal Brisbane Clinical Unit, Royal Brisbane & Woman's Hospital, Queensland, Australia
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia.,The University of Queensland School of Psychology, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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O’Donnell E, Holland C, Swarbrick C. Strategies used by care home staff to manage behaviour that challenges in dementia: a systematic review of qualitative studies. Int J Nurs Stud 2022; 133:104260. [DOI: 10.1016/j.ijnurstu.2022.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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Piirainen P, Pesonen HM, Kyngäs H, Elo S. Challenging situations and competence of nursing staff in nursing homes for older people with dementia. Int J Older People Nurs 2021; 16:e12384. [PMID: 34075711 DOI: 10.1111/opn.12384] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require. METHODS Data were collected using mixed methods in a cross-sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open-ended questions. Quantitative data acquired were analysed statistically, and responses to the open-ended question were analysed using content analysis methodology. RESULTS Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self-management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia. CONCLUSION Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.
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Affiliation(s)
- Paula Piirainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | | | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Satu Elo
- Lapland University of Applied Sciences, Kemi, Finland
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Schmüdderich K, Holle D, Ströbel A, Holle B, Palm R. Relationship between the severity of agitation and quality of life in residents with dementia living in German nursing homes - a secondary data analysis. BMC Psychiatry 2021; 21:191. [PMID: 33849487 PMCID: PMC8042694 DOI: 10.1186/s12888-021-03167-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe agitation and its relation to single dimensions of quality of life are not well understood. The aim of this study was to gain more knowledge about severe agitation and to examine the relationships between the severity of agitation and single dimensions of quality of life among residents with dementia living in German nursing homes. METHODS This exploratory secondary analysis included data from 1947 residents of 66 German nursing homes from the DemenzMonitor study. The construct of agitation was defined as a composite score of the items agitation/aggression, irritability/lability and disinhibition from the Neuropsychiatric Inventory Questionnaire (NPI-Q); the resident was classified as severely agitated if at least one of these symptoms was rated as 'severe'. The single dimensions of quality of life were measured with the short version of the QUALIDEM instrument. To avoid selection bias, two controls with mild or no agitation were selected for each resident with severe agitation using propensity score matching. Mixed linear regression models were then generated to determine the differences in the dimensions of quality of life for the severity of agitation and the defining items. RESULTS For four out of five dimensions of quality of life of the short version of QUALIDEM, residents with severe agitation had significantly lower values than residents without severe agitation. Converted to scale size, the greatest difference between both groups was found in the dimension social isolation with 23.0% (-2.07 (95% CI: -2.57, -1.57)). Further differences were found in the dimensions restless tense behaviour with 16.9% (-1.52 (95% CI: -2.04, -1.00)), positive affect with 14.0% (-1.68 (95% CI: -2.28, -1.09)) and social relations with 12.4% (-1.12 (95% CI: -1.54, -0.71)). CONCLUSIONS Severe agitation is a relevant phenomenon among nursing home residents with dementia and is associated with lower values of quality of life in the dimensions social isolation, restless tense behaviour, positive affect and social relations from the QUALIDEM instrument. Therefore, more attention should be paid to severe agitation in nursing practice and research. Moreover, care strategies used to reduce severe agitation should be considered in terms of their impact on the dimensions of quality of life.
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Affiliation(s)
- Kathrin Schmüdderich
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Daniela Holle
- University of Applied Sciences (hsg Bochum), Department of Nursing Science, Gesundheitscampus 6-8, Bochum, 44801 Germany
| | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Universitätsklinikum Erlangen, Center for Clinical Studies, Krankenhausstraße 12, Erlangen, 91054 Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
| | - Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, Witten, 58453 Germany
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, Witten, 58453 Germany
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Kunkle R, Chaperon C, Hanna KM. Formal Caregiver Burden in Nursing Homes: A Concept Analysis. J Gerontol Nurs 2020; 46:19-24. [DOI: 10.3928/00989134-20200706-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
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10
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Palm R, Sorg CGG, Ströbel A, Gerritsen DL, Holle B. Severe Agitation in Dementia: An Explorative Secondary Data Analysis on the Prevalence and Associated Factors in Nursing Home Residents. J Alzheimers Dis 2019; 66:1463-1470. [PMID: 30412491 PMCID: PMC6294574 DOI: 10.3233/jad-180647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: The phenomena of severe agitation is not well understood and often not adequately treated. Objective: This article determines the prevalence and associated factors of severe agitation in nursing home residents with dementia. Methods: Secondary data analysis within an observational study in German nursing homes with n = 1,967 participants. We assessed severity of agitation with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and defined the construct of agitation as a composite score of the NPI-Q items agitation/aggression, disinhibition, and irritability/lability; the dependent variable of severe agitation was considered as being present in residents who scored ‘severe’ in at least one of these symptoms. A binary logistic regression model was calculated to estimate associations. Results: The prevalence of severe agitation was 6.3% (n = 124). The strongest associations were found for elation/euphoria (OR 7.6, CI 3.1–18.5), delusions (OR 7.3, CI 4.0–13.2), apathy/indifference (OR 2.8, CI 1.7–4.7), anxiety (OR 2.2, CI 1.2–3.8), nighttime behaviors (OR 2.4, CI 1.4–4.2), motor disturbances (OR 2.4, CI 1.4–4.1), and male sex (OR 2.4. CI 1.3–4.2). Conclusion: Severe agitation in nursing home residents with dementia is a relevant clinical issue as approximately 70% of residents have a dementia. Residents with elation/euphoria and delusions may have a stronger risk of showing severe agitation. We consider delusions as a possible cause of agitation and therefore a prelude to agitation. Although it might be possible that elation/euphoria follows from agitation, we hypothesize that the residents first experience elation/ euphoria and exhibit agitation afterwards.
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Affiliation(s)
- Rebecca Palm
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
| | | | - Armin Ströbel
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany
| | - Debby L Gerritsen
- Department of Primary and Community Care and Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.,School of Nursing Science, University Witten/Herdecke, Witten, Germany
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11
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Gaviola MA, Inder KJ, Dilworth S, Holliday EG, Higgins I. Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials. Australas J Ageing 2019; 39:10-20. [PMID: 30912616 DOI: 10.1111/ajag.12642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To summarise the evidence regarding the impact of individualised music listening on persons with dementia. METHODS Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions. RESULTS Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. CONCLUSIONS The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.
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Affiliation(s)
- Minah Amor Gaviola
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sophie Dilworth
- Hunter Aged Care Assessment Team, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Elizabeth G Holliday
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Isabel Higgins
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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12
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Bickford B, Daley S, Sleater G, Hebditch M, Banerjee S. Understanding compassion for people with dementia in medical and nursing students. BMC MEDICAL EDUCATION 2019; 19:35. [PMID: 30683079 PMCID: PMC6347776 DOI: 10.1186/s12909-019-1460-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/09/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Compassion is an essential component of good quality care. Compassion towards people with dementia in health systems is often suboptimal, which can have negative impacts on clinical outcomes and patient experience. Attitudes are formed early in training and the literature on healthcare student compassion towards those with dementia is limited. This study aimed to understand how undergraduate medical and nursing students understand compassion towards people with dementia and factors influencing the delivery of compassionate care. METHODS Nine individual in-depth interviews and two focus groups were undertaken with 23 medical and nursing students. A topic guide was developed, and transcripts were analysed using thematic analysis. RESULTS The analysis identified three themes which students used to define compassion: (i) connection, (ii) care, and (iii) respect. Three factors were identified as being either facilitators or barriers to delivering compassionate care to people with dementia: (i) patient factors, (ii) student factors, and (iii) connection. Patient factors related to the presence of behaviours which might be challenging to manage. Student factors included student exposure to dementia, as well as student knowledge and skills. Connection focussed on whether there was an awareness and understanding of the person behind the diagnosis. CONCLUSION Undergraduate healthcare students are the future workforce for patients with dementia, and understanding how compassion develops within them is important. We found medical and nursing students had a broad understanding of compassion, and identified factors influence their compassion towards people with dementia. These novel data can be used to shape healthcare education programmes aimed at improving dementia care.
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Affiliation(s)
- Ben Bickford
- Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Univeristy of Sussex, Falmer, East Sussex BN1 9RY UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Univeristy of Sussex, Falmer, East Sussex BN1 9RY UK
| | - Gillian Sleater
- Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Univeristy of Sussex, Falmer, East Sussex BN1 9RY UK
| | - Molly Hebditch
- Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Univeristy of Sussex, Falmer, East Sussex BN1 9RY UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Trafford Centre, Univeristy of Sussex, Falmer, East Sussex BN1 9RY UK
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13
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Bolt SR, van der Steen JT, Schols JMGA, Zwakhalen SMG, Pieters S, Meijers JMM. Nursing staff needs in providing palliative care for people with dementia at home or in long-term care facilities: A scoping review. Int J Nurs Stud 2019; 96:143-152. [PMID: 30928183 DOI: 10.1016/j.ijnurstu.2018.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/23/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nursing staff caring for people with dementia have a crucial role in addressing palliative care needs and identifying changes in health status. Palliative care for people with dementia is complex and requires specific competences. A lack thereof may lead to unnecessary hospitalizations, poor symptom control and undesirable burdensome treatments. Understanding what nursing staff need to provide palliative care specifically for people with dementia facilitates the development of tailored and feasible interventions. OBJECTIVE To investigate what is known from the literature regarding the needs in providing palliative dementia care as perceived by nursing staff working in home care or in long-term care facilities and to establish an integrated conceptualization of these needs. DESIGN A scoping review method combined with thematic analysis methods. DATA SOURCES Bibliographic databases of PubMed, CINAHL and PsycINFO were searched for primary research studies. REVIEW METHODS Guidelines from the Joanna Briggs Institute were utilized as a framework for setting up and conducting the scoping review. Eligible articles considered nursing staff's perceived needs in providing palliative dementia care at home or in long-term care facilities. Two authors assessed eligibility based on title and abstract, assessed full texts for selected records and assessed the quality of included articles. Thematic analysis methods were used to identify themes from relevant study findings, which were integrated to form a conceptualization. RESULTS Of the 15 articles that were included, most used qualitative methods (N = 13) and were conducted in long-term care facilities (N = 14). Themes reflecting nursing staff needs on a direct care-level concern recognizing and addressing palliative care needs (such as comfort), verbal and non-verbal communication, challenging behaviour and familiarity: knowing and understanding the person with dementia. On more distant levels, themes involve a need for interdisciplinary collaboration, training and education and organizational support. CONCLUSION A comprehensive overview of nursing staff perspectives on providing palliative care for people with dementia demonstrates interdependent needs related to recognizing and addressing palliative care needs, communicating, handling challenging behaviour and building close care relationships. These care-related needs occur within workplace and organizational contexts. Organizational support is considered insufficient. Yet, healthcare organizations have the authority to fulfil a facilitating role in implementing nursing interventions tailored to nursing staff needs. Areas for further research include home care settings, the psychosocial and spiritual domains of palliative dementia care, advance care planning and family involvement.
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Affiliation(s)
- Sascha R Bolt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD, Leiden, the Netherlands; Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, the Netherlands.
| | - Jos M G A Schols
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Sandra M G Zwakhalen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Sabine Pieters
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Judith M M Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Lifesciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands; Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, the Netherlands.
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14
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Jain B, Willoughby M, Winbolt M, Lo Giudice D, Ibrahim J. Stakeholder perceptions on resident-to-resident aggression: implications for prevention. AUST HEALTH REV 2018; 42:680-688. [DOI: 10.1071/ah17282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/08/2018] [Indexed: 11/23/2022]
Abstract
Objective Resident-to-resident aggression (RRA) in nursing homes is a matter of serious and profound concern, yet action to eliminate or mitigate RRA is hampered by a paucity of research. The aim of this study was to explore key stakeholders’ knowledge and perceptions of RRA in Australian nursing homes. Methods A qualitative cross-sectional study design was used, and semistructured telephone interviews were conducted. Participants were purposively and conveniently sampled with replacement from a range of aged care, healthcare and legal professional bodies, as well as advocacy organisations. The interview contained 12 closed-ended questions and six open-ended questions about participants’ knowledge, experiences, perceptions and attitudes to RRA. Participant characteristics and responses to closed-ended questions were aggregated and proportions calculated, and thematic analysis was conducted by two independent researchers using a directed content approach. Results Fifteen participants (11 females; 73.3%) in senior management positions were interviewed. All were familiar with the concept of RRA and just over half (n=8; 53.3%) had witnessed an incident. Major themes included the nature and causes of RRA and attitudes and responses to RRA. Potential causes of RRA included maladaptation to nursing home life, transfer of pre-existing issues into the nursing home environment, physical environment and staffing-related issues. RRA was commonly viewed by participants as dangerous and unpredictable or, conversely, as expected behaviour in a nursing home setting. A person-centred care approach was considered most effective for managing and responding to RRA. Conclusion The research demonstrates that understanding perceptions of RRA among key stakeholders is critical to identifying the nature and scope of the problem and to developing and implementing appropriate prevention strategies. What is known about the topic? RRA is common in nursing homes, with potentially fatal consequences for residents involved, and has serious implications for nursing home staff, managers, providers, and regulators. Despite this, the prevalence, impact, and prevention of RRA remains under-recognised and under-researched in Australia. What does this paper add? This is the first Australian study to produce qualitative findings on the knowledge and perceptions of RRA in nursing homes among key stakeholders. This paper reports on the knowledge and perceptions of individuals in senior management and policy roles in aged care and related fields in relation to four themes: nature; causes; attitudes; and responses to RRA. Our findings highlight the complex and multifactorial nature of RRA. What are the implications for practitioners? A movement towards person-centred care that promotes understanding of individual care needs is favoured as an approach to reducing RRA. Increased reporting of both minor and major incidents of RRA will help to identify patterns and inform appropriate responses. However, a cultural shift is first required to recognise RRA as a manageable and preventable health care and adult safeguarding issue.
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15
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Gilbert J, Ward L, Gwinner K. Quality nursing care in dementia specific care units: A scoping review. DEMENTIA 2017; 18:2140-2157. [DOI: 10.1177/1471301217743815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
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Affiliation(s)
- Julia Gilbert
- School of Nursing and Midwifery, Federation University, Australia
| | - Louise Ward
- Mental Health Nursing, La Trobe University, Australia
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16
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Factors associated with aggressive behavior between residents and staff in nursing homes. Geriatr Nurs 2017; 38:398-405. [DOI: 10.1016/j.gerinurse.2017.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
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17
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Holst A, Skär L. Formal caregivers’ experiences of aggressive behaviour in older people living with dementia in nursing homes: A systematic review. Int J Older People Nurs 2017; 12. [DOI: 10.1111/opn.12158] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Adelheid Holst
- Faculty of Professional Studies; Nord University; Bodø Norway
| | - Lisa Skär
- Department of Health; Blekinge Institute of Technology; Karlskrona Sweden
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18
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Williams J, Hadjistavropoulos T, Ghandehari OO, Malloy DC, Hunter PV, Martin RR. Resilience and organisational empowerment among long-term care nurses: effects on patient care and absenteeism. J Nurs Manag 2015; 24:300-8. [DOI: 10.1111/jonm.12311] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jaime Williams
- Centre on Aging and Health; University of Regina; Regina SK Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology; University of Regina; Regina SK Canada
- Centre on Aging and Health; University of Regina; Regina SK Canada
| | - Omeed O. Ghandehari
- Department of Psychology and Centre on Aging and Health; University of Regina; Regina SK Canada
| | - David C. Malloy
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| | - Paulette V. Hunter
- Department of Psychology; St Thomas More College; University of Saskatchewan; Saskatoon SK Canada
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