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Liu T, Nakatani H, Chen H, Gao N. Development and psychometric testing of the nursing practice difficulty scale for nurses caring for patients with dementia in general hospitals. Int J Nurs Sci 2024; 11:357-365. [PMID: 39156679 PMCID: PMC11328995 DOI: 10.1016/j.ijnss.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/14/2024] [Accepted: 06/06/2024] [Indexed: 08/20/2024] Open
Abstract
Objective As aging in the Chinese population increases, the hospitalization rates of patients with dementia have also risen. Research on the difficulties of nurses who care for patients with dementia in Chinese general hospitals is limited. This study aimed to develop a scale to measure the difficulties nurses face in nursing patients with dementia in Chinese general hospitals and to verify its reliability and validity. Methods Guided by the biopsychosocial theory, an initial scale was created through a literature review, qualitative interviews, and expert consultation. A web-based survey for psychometric testing was conducted with 394 nurses from 11 general hospitals during September to November 2021. Validity was verified using content validity, exploratory factor analysis, the known-groups method, and concurrent validity. Cronbach's α coefficient and split-half reliability were used to assess reliability. Results The Item-level Content Validity Index was 0.833-1.000. The Scale-level Content Validity Index was 0.929. Twenty-one items with four factors were extracted from the item analysis and exploratory factor analysis. According to the known-groups method, the difficulty of the experienced group and the group with training experience was significantly lower than that of the less experienced group and the group without training experience. Based on external standards, the correlation coefficient was 0.387 with the Nursing Job Stress Scale and -0.239 with the Dementia Care Attitude Scale. Cronbach's α coefficient for each factor ranged from 0.889 to 0.905, and the total was 0.959. The split-half reliability for each factor ranged from 0.814 to 0.894, and the total was 0.911. Conclusion This study discovered a four-factor structure related to the difficulty scale of dementia nursing practice, and the scale's reliability and validity were confirmed. The scale can be utilized to assess the difficulty of dementia nursing practice in general hospitals and may be employed in future research to improve dementia nursing practices.
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Affiliation(s)
- Ting Liu
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Hisae Nakatani
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Huifang Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nan Gao
- Operating Room, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
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Adam E, Meiland F, Frielink N, Meinders E, Smits R, Embregts P, Smaling H. User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study. JMIR Form Res 2024; 8:e52248. [PMID: 38905626 PMCID: PMC11245304 DOI: 10.2196/52248] [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: 08/29/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. OBJECTIVE This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. METHODS A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. RESULTS The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. CONCLUSIONS The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.
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Affiliation(s)
- Esmee Adam
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Franka Meiland
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine for Older people, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Noud Frielink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Reon Smits
- Mentech Innovation B.V., Eindhoven, Netherlands
| | - Petri Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hanneke Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
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Verhees LHF, Banning LCP, Stalman H, Koopmans RTCM, Gerritsen DL. Transferring people with dementia to severe challenging behavior specialized units, an in-depth exploration. Aging Ment Health 2024; 28:838-848. [PMID: 37993411 DOI: 10.1080/13607863.2023.2280673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES One of the main reasons for people with dementia to move to a dementia special care unit of a nursing home is challenging behavior. This behavior is often difficult to manage, and in the Netherlands, residents are sometimes relocated to a severe challenging behavior specialized unit. However, relocation often comes with trauma and should be prevented if possible. This study aimed to investigate the patient- and context-related reasons for these relocations. METHODS Qualitative multiple case study using individual (n = 15) and focus group interviews (n = 4 with n = 20 participants) were held with elderly care physicians, physician assistants, psychologists, nursing staff members, and relatives involved with people with dementia and severe challenging behavior who had been transferred to a severe challenging behavior specialized unit. Audio recordings were transcribed and analyzed with thematic analysis, including directed content analysis. RESULTS After five cases, data-saturation occurred. The thematic analysis identified three main processes: increasing severity of challenging behavior, increasing realization that the clients' needs cannot be met, and an increasing burden of nursing staff. The interaction between these processes, triggered mainly by a life-threatening situation, led to nursing staff reaching their limits, resulting in relocation of the client. CONCLUSION Our study resulted in a conceptual framework providing insight into reasons for relocation in cases of severe challenging behavior. To prevent relocation, the increasing severity of challenging behavior, increasing burden on nursing staff, and increasing realization that the clients' needs cannot be met need attention.
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Affiliation(s)
- Leon H F Verhees
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
- Center for Specialized Psychiatric Care, Vincent van Gogh Institute, Venray, Netherlands
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Leonie C P Banning
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Hester Stalman
- De Zorggroep, Center for Specialized Geriatric Care, Venlo, Netherlands
| | - Raymond T C M Koopmans
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
- Center for Specialized Geriatric Care, Joachim en Anna, Nijmegen, Netherlands
| | - Debby L Gerritsen
- Radboudumc Alzheimer Center, Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
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Rom Y, Morag I, Palgi Y, Isaacson M. The Architectural Layout of Long-Term Care Units: Relationships between Support for Residents' Well-Being and for Caregivers' Burnout and Resilience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:575. [PMID: 38791789 PMCID: PMC11120887 DOI: 10.3390/ijerph21050575] [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: 01/10/2024] [Revised: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
With a growing need for long-term care facilities in general, and for specialized dementia units in particular, it is important to ensure that the architectural layouts of such facilities support the well-being of both the residents and the unit caregivers. This study aimed to investigate correlations between the support provided by the architectural layout of long-term care units for enhancing residents' well-being and for decreasing unit caregivers' burnout and increasing their resilience-as layouts may impact each party differently. The Psycho Spatial Evaluation Tool was utilized to assess the support provided by the layouts of seventeen long-term care units (ten regular nursing units and seven specialized dementia units) for the residents' physical and social well-being (five dimensions); a questionnaire was used to measure the unit caregivers' burnout and resilience. When analyzing layouts' support for residents' physical and social well-being, inconsistencies emerged regarding correlations with caregivers' burnout and resilience across the two types of long-term care units. Supporting residents' physical well-being was correlated with increased caregiver resilience in dementia units, and with increased burnout and decreased resilience in regular nursing units. Layouts supporting social well-being showed inconsistent correlations with caregivers' resilience indexes in dementia units, and with burnout and resilience indexes in regular nursing units. The findings underscore the role of the architectural layout of long-term care units in enhancing residents' well-being; the results also highlight the possible unintentional yet negative impact of the layout on the caregivers' burnout and resilience. This study emphasizes the need to identify and rectify design shortcomings as a means of enhancing residents' well-being, while increasing the unit caregivers' resilience and decreasing their burnout. These insights should be addressed when developing strategies and interventions for ensuring optimal care environments for all parties involved.
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Affiliation(s)
- Yifat Rom
- Department of Gerontology, University of Haifa, Abba Khushi Ave. 199, Haifa 3498838, Israel; (Y.P.); (M.I.)
| | - Ido Morag
- Shenkar College of Engineering and Design, School of Industrial Engineering and Management, Ramat-Gan 5252626, Israel;
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Abba Khushi Ave. 199, Haifa 3498838, Israel; (Y.P.); (M.I.)
| | - Michal Isaacson
- Department of Gerontology, University of Haifa, Abba Khushi Ave. 199, Haifa 3498838, Israel; (Y.P.); (M.I.)
- MIT AgeLab-Massachusetts Institute of Technology, Cambridge, MA 02142, USA
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Tabatabaei-Jafari H, Furst MA, Bagheri N, D’Cunha NM, Bail K, Sachdev PS, Salvador-Carulla L. The Integrated Atlas of Dementia Care in the Australian Capital Territory: A Collective Case Study of Local Service Provision. Health Serv Insights 2024; 17:11786329241232254. [PMID: 38348356 PMCID: PMC10860480 DOI: 10.1177/11786329241232254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nathan M. D’Cunha
- School of Rehabilitation and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Garcia L, Robitaille A, Bouchard S, Rivard MC, McCleary L. The usability of virtual reality to train individuals in responding to behaviors related to dementia. FRONTIERS IN DEMENTIA 2024; 2:1237127. [PMID: 39081984 PMCID: PMC11285664 DOI: 10.3389/frdem.2023.1237127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/11/2023] [Indexed: 08/02/2024]
Abstract
Introduction Dementia is associated with several behavioral changes globally referred to as Behavioral and Psychological Symptoms of Dementia (BPSD) of which many are recognized to be the expression of unmet needs triggered by environmental factors. BPSD are an extreme source of stress for family care partners and health care providers alike and can be the reason why people living with dementia (PLWD) are placed in long-term care homes (LTCH). The overall goal of this project was to examine whether a virtual environment that includes a virtual LTCH resident with dementia in a lifelike situation could be useful and usable for health care providers and care partners to identify potential triggers to BPSDs while being engaged emotionally with the scenario. Methods Twenty-three health care professionals working with PLWD, 25 care partners to PLWD, 27 students in a health-related field, and 11 university/community college faculty members teaching courses relevant to gerontology tested the application which depicted a meal-time scenario. In addition to being asked about the behavioral triggers in the scene, participants were asked about the usefulness and usability of the tool for training. Presence and simulator sickness were also measured. Results Results suggest that participants generally felt present and emotionally engaged. They could identify the potential triggers for the observed behaviors in the virtual human with dementia as well as suggest some solutions. The majority (87% of participants) found the tool easy to use. Many participants identified the inability to interact with the virtual humans as a shortfall, and few reported mild to moderate levels of simulator sickness. Discussion As the behavioral changes associated with dementia can cause extreme stress for those interacting with PLWD, developing an effective and efficient training tool could significantly improve well-being for all involved. The investigators see the development and testing of an interactive version of this virtual environment as a next step in making this a clinically relevant training tool.
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Affiliation(s)
- Linda Garcia
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Annie Robitaille
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
| | - Marie-Christine Rivard
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, St. Catharines, ON, Canada
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Chen YR, Huang WY, Lee TY, Chu H, Chiang KJ, Jen HJ, Liu D, Chen R, Kang XL, Lai YJ, Chou KR. Efficacy of Blue LED Phototherapy on Sleep Quality and Behavioral and Psychological Symptoms of Dementia: A Double-Blind Randomized Controlled Trial. Gerontology 2023; 69:1175-1188. [PMID: 37527625 DOI: 10.1159/000531968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION People with dementia often experience behavioral and psychological symptoms of dementia (BPSD), which are a major cause of caregiver burden and institutionalization. Therefore, we conducted a double-blind, parallel-group randomized controlled trial to examine the efficacy of blue-enriched light therapy for BPSD in institutionalized older adults with dementia. METHODS Participants were enrolled and randomly allocated into blue-enriched light therapy (N = 30) or the conventional light group (N = 30) for 60 min in 10 weeks with five sessions per week. The primary outcome was sleep quality measured by actigraphy and Pittsburgh Sleep Quality Index (PSQI). The secondary outcome was overall BPSD severity (Cohen-Mansfield Agitation Inventory [CMAI] and Neuropsychiatric Inventory [NPI-NH]). The outcome indicators were assessed at baseline, mid-test, immediate posttest, 1-month, 3-month, and 6-month follow-up. The effects of the blue-enriched light therapy were examined by the generalized estimating equation model. RESULTS Blue-enriched light therapy revealed significant differences in the objective sleep parameters (sleep efficiency: β = 5.81, Waldχ2 = 32.60, CI: 3.82; 7.80; sleep latency: β = -19.82, Waldχ2 = 38.38, CI:-26.09; -13.55), subjective sleep quality (PSQI: β = -2.07, Waldχ2 = 45.94, CI: -2.66; -1.47), and overall BPSD severity (CMAI: β = -0.90, Waldχ2 = 14.38, CI: -1.37; -0.44) (NPI-NH: β = -1.67, Waldχ2 = 30.61, CI: -2.26; -1.08) compared to conventional phototherapy immediate posttest, 1-month, 3-month, and 6-month follow-up. Furthermore, the effects for sleep efficiency and sleep latency lasted for up to 6 months. In the subscale analysis, the differences of the behavioral symptoms changed significantly between the groups in physical/nonaggressive (CI: -1.01; -0.26) and verbal/nonaggressive (CI: -0.97; -0.29). CONCLUSIONS Blue-enriched light therapy is a feasible low-cost intervention that could be integrated as a comprehensive therapy program for BPSD among older adults with dementia.
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Affiliation(s)
- Ying-Ren Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yu Huang
- Department of Nursing, Taipei Veterans General Hospital, Yuanshan Branch, I-lan, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kai-Jo Chiang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Philadelphia, USA
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
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Chen Z, Highfill C. Emotional Stress Experience of Care Professionals for Older Adults with Dementia: A Qualitative Interpretive Meta-synthesis. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:235-247. [PMID: 36166601 DOI: 10.1080/19371918.2022.2128138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Emotional stress is a common problem for many professionals in dementia care. Although a plethora of quantitative studies have examined the factors that affect care professionals' emotional stress, little qualitative research has provided in-depth understanding of professional stress experiences. To magnify the voices of professionals who share their experiences of stress in caring for older adults with dementia, a qualitative interpretive meta-synthesis of five qualitative studies was conducted. Guided by Pearlin's stress process model, four themes were identified: (1) emotional attachments to older adults with dementia; (2) difficulties in dementia care; (3) stressful working environment; and (4) conflicts with family members of older adults with dementia. Findings further highlighted that professionals' genuine concern for the well-being of older adults with dementia reinforced the perception of stressors identified in each of the preceding themes. These results could inform the improvements of emotional support for care professionals in practice and policy arenas.
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Affiliation(s)
- Zhirui Chen
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Christine Highfill
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
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Abstract
In health care, well-being is considered to be composed of multiple interacting dimensions and to regard the subjective (affective and cognitive) evaluation of these dimensions. These dimensions are often referred to as physical, psychological, and social domains of life. Although there are various disease-specific and group-specific conceptual approaches, starting from a universal perspective provides a more inclusive approach to well-being. Indeed, universal approaches to well-being have striking overlaps with dementia-specific approaches. Although many initiatives have been launched to promote person-centered care and attention for well-being in recent decades, the current COVID pandemic showed that the primary focus in (Dutch) long-term care was still on physical health. However, a well-being perspective can be a central base of care: it is a means to include positive aspects, and it can be applied when addressing problems such as challenging behavior in the sense that both are about needs. Furthermore, providing care from this perspective is not only about the well-being of frail people and their loved ones but also about the well-being and needs of the involved professionals. Increasingly, research shows the importance of the quality of the resident-carer relationship, the carer's behavior, and their well-being for improving the well-being of residents. Applying the care approaches 'attentiveness in care' and relationship-centered care can contribute to the well-being of all involved stakeholders as these uphold the reciprocity of care relationships and take the values and attitudes, but also the vulnerability of those involved, into account.
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Affiliation(s)
- Debby L Gerritsen
- Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Department of Primary and Community care, Radboud University Medical Center, Nijmegen, The Netherlands
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Hamouda I, Rousseau MC, Beltran Anzola A, Aim MA, de Villemeur TB, Auquier P, Baumstarck K, de Villemeur TB, Rousseau MC, Khaldi-Cherif S, Maincent K, Felce A, Baumstarck K, Auquier P, Dany L, Beltran A, Hamouda I, Aim MA, Boutalbi N, Kemlin I, Roger J, Julien P, Heng P, Willocq D, Valkov M, Pietra S, Lenormand S, Lind K. The French EVAL-PLH cohort of persons with polyhandicap. Sci Rep 2022; 12:12512. [PMID: 35869128 PMCID: PMC9305042 DOI: 10.1038/s41598-022-16596-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Polyhandicap is characterized by a combination of profound intellectual disability and serious motor deficit, resulting in the extreme restriction of autonomy and communication. The aim of the EVAL-PLH (EVALuation PoLyHandicap) study is to identify the impact of socioeconomic, environmental, and epidemiological determinants on the health status of the persons with polyhandicap and the daily lives of their caregivers. EVAL-PLH is a prospective cohort study. The study involved persons with severe polyhandicap (who were cared for at reeducation centers, residential facilities, and one specialized pediatric/neurological department of a university hospital), their familial caregivers and the institutional caregivers. Data collection included sociodemographics, heath status, and psychocomportemental information. Data have been collected at 2 points (2015-2016 and 2020-2021). The French EVAL-PLH cohort is the first cohort study focusing on persons with polyhandicap, their families, and the health care workers caring for them. The sustainability of the device is essential to assist patients, families, clinicians, and health decision-making authorities in the optimization of care management.
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Molteni V, Vaccaro R, Ballabio R, Ceppi L, Cantù M, Ardito RB, Adenzato M, Poletti B, Guaita A, Pezzati R. Doll Therapy Intervention Reduces Challenging Behaviours of Women with Dementia Living in Nursing Homes: Results from a Randomized Single-Blind Controlled Trial. J Clin Med 2022; 11:jcm11216262. [PMID: 36362489 PMCID: PMC9654994 DOI: 10.3390/jcm11216262] [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: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Doll therapy (DT) is a non-pharmacological intervention for the treatment of the behavioural and psychological symptoms of dementia (BPSD). We designed a single-blind randomized controlled trial of the 30-day efficacy of DT in reducing the BPSD, professional caregivers’ distress and patients’ biomarkers of stress, and in improving the exploration and caregiving behaviours. Methods: We randomly assigned 134 women with moderate-to-severe dementia living in nursing homes (NHs) to a DT intervention (DTI, 67) or a sham intervention with a cube (SI, 67). Results: From the first to the 30th session, the DTI group showed a significant decrease in the Neuropsychiatric Inventory-NH (NPI-NH) total score and in the NPI-NH-Distress score compared to the SI group (both p < 0.001). We observed a greater interest in the doll than in the cube, a greater acceptance of a separation from the nurse among DTI participants, and caregiving and exploratory behaviours towards the doll. There were no differences between the groups in the stress biomarkers. Conclusions: Consistent with attachment theory, our findings support the 30-day efficacy of DT, as this non-pharmacological intervention promotes perceptions of security by creating a situation in which patients feel confident and engaged in a caregiving relationship with the doll and reduces the challenging behaviours that are stressful for professional caregivers.
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Affiliation(s)
- Valentina Molteni
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
| | - Roberta Vaccaro
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- Golgi Cenci Foundation, 20081 Abbiategrasso, Italy
| | - Roberta Ballabio
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
| | - Laura Ceppi
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- School of Cognitive Therapy, 22100 Como, Italy
| | - Marco Cantù
- Ente Ospedaliero Cantonale, Istituto di Medicina di Laboratorio (EOLAB), 6500 Bellinzona, Switzerland
| | - Rita B. Ardito
- Department of Psychology, University of Turin, 10124 Turin, Italy
- Correspondence:
| | - Mauro Adenzato
- Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Barbara Poletti
- Laboratory of Neuroscience, Department of Neurology, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | | | - Rita Pezzati
- Dipartimento di Economia Aziendale e Socio Sanitaria (SUPSI), Centro Competenza Anziani, 6928 Manno, Switzerland
- GINCO Ticino Association, 6802 Monteceneri, Switzerland
- School of Cognitive Therapy, 22100 Como, Italy
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12
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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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13
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Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Persoon A, Koopmans RTCM, Gerritsen DL. Losing hope or keep searching for a golden solution: an in-depth exploration of experiences with extreme challenging behavior in nursing home residents with dementia. BMC Geriatr 2022; 22:758. [PMID: 36114482 PMCID: PMC9479311 DOI: 10.1186/s12877-022-03438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Situations of extreme challenging behavior such as very frequent and/or severe agitation or physical aggression in nursing home residents with dementia can be experienced as an impasse by nursing home staff and relatives. In this distinct part of our WAALBED (WAAL-Behavior-in-Dementia)-III study, we aimed to explore these situations by obtaining the experiences and perspectives of nursing home staff and relatives involved. This can provide a direction in providing tools for handling extreme challenging behavior of nursing home residents with dementia and may improve their quality of life. Methods Qualitative multiple case study with individual interviews and focus group discussions. Interviewees were elderly care physicians, psychologists, care staff members, unit managers and relatives (n = 42). They were involved with nursing home residents with dementia and extreme challenging behavior living on dementia special care units in the Netherlands. For these residents, external consultation by the Centre for Consultation and Expertise was requested. Audio-recordings of the interviews were transcribed verbatim and analyzed with thematic analysis, including conventional content analysis. Results Seven cases were included. Forty-one individual interviews and seven focus group discussions were held. For six stakeholder groups (resident, relative, care staff, treatment staff, nursing home staff, and the organization), three main factors could be identified that contributed to experiencing a situation of extreme challenging behavior as an impasse: 1) characteristics and attitudes of a stakeholder group, 2) interaction issues within a stakeholder group and 3) interaction issues among (groups of) stakeholders. The experienced difficulties with the resident’s characteristics, as well as suboptimal interdisciplinary collaboration and communication among the nursing home staff are remarkable. Nursing home staff kept searching for a golden solution or lost hope. Conclusions This study offers important insights into situations of extreme challenging behavior in nursing home residents with dementia and offers caregivers targets for improving care, treatment and interdisciplinary collaboration, such as working uniformly and methodically. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03438-0.
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14
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Villar F, Silva-Cavero A, Serrat R, Celdrán M. Long-term care staff 's positive experiences of caring for people living with dementia: Narratives' content and lessons learned. DEMENTIA 2022; 21:2553-2568. [PMID: 36081334 DOI: 10.1177/14713012221126298] [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: 11/15/2022]
Abstract
Research on caregiving for persons with dementia has mainly focused on its negative impact on caregivers. However, while some studies have found that positive aspects of care can also be found among informal caregivers, little attention has been paid to these positive aspects among staff working in long-term care facilities. The aim of this is study is to explore what kind of positive stories of caring for a person living with dementia staff working in long-term care facilities recall, and what kind of lessons they extracted from these experiences. Forty-two staff members currently working in four Spanish long-term care facilities (21 nursing assistants; 21 technical staff) were interviewed. They were asked about positive stories related to caring for people living with dementia. Data were analyzed using content analysis, aimed at identifying common ideas in the responses. Results showed that the type of stories were quite diverse, but can be grouped into three main themes: attachment, awakening, and mastery. The stories imply different lessons learned, including the importance of individualized care, the value of persistence and patience, and the relevance of technical knowledge and strategies to provide good care. The articles discusses how recording, reflecting on and discussing positive experiences that care staff encounter in their daily practice, may be key to skill development, reinforce job satisfaction, and improve quality of care in a person-centered care direction.
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Affiliation(s)
| | - Ana Silva-Cavero
- Departament of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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15
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Backman A, Sjögren K, Lövheim H, Lindkvist M, Edvardsson D. The influence of nursing home managers' leadership on person-centred care and stress of conscience: A cross-sectional study. BMC Nurs 2021; 20:200. [PMID: 34654423 PMCID: PMC8518168 DOI: 10.1186/s12912-021-00718-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience. Methods This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. Results Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders. Conclusion Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.
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Affiliation(s)
- Annica Backman
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
| | - Karin Sjögren
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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16
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Adams AMN, Chamberlain D, Grønkjær M, Thorup CB, Conroy T. Caring for patients displaying agitated behaviours in the intensive care unit - A mixed-methods systematic review. Aust Crit Care 2021; 35:454-465. [PMID: 34373173 DOI: 10.1016/j.aucc.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient agitation is common in the intensive care unit (ICU), with consequences for both patients and health professionals if not managed effectively. Research indicates that current practices may not be optimal. A comprehensive review of the evidence exploring nurses' experiences of caring for these patients is required to fully understand how nurses can be supported to take on this important role. OBJECTIVES The aim of this study was to identify and synthesise qualitative and quantitative evidence of nurses' experiences of caring for patients displaying agitated behaviours in the adult ICU. METHODS A mixed-methods systematic review was conducted. MEDLINE, CINAHL, PsycINFO, Web of Science, Emcare, Scopus, ProQuest, and Cochrane Library were searched from database inception to July 2020 for qualitative, quantitative, and mixed-methods studies. Peer-reviewed, primary research articles and theses were considered for inclusion. A convergent integrated design, described by Joanna Briggs Institute, was utilised transforming all data into qualitative findings before categorising and synthesising to form the final integrated findings. The review protocol was registered with PROSPERO CRD42020191715. RESULTS Eleven studies were included in the review. Integrated findings include (i) the strain of caring for patients displaying agitated behaviours; (ii) attitudes of nurses; (iii) uncertainty around assessment and management of agitated behaviour; and (iv) lack of effective collaboration and communication with medical colleagues. CONCLUSIONS This review describes the challenges and complexities nurses experience when caring for patients displaying agitated behaviours in the ICU. Findings indicate that nurses lack guidelines together with practical and emotional support to fulfil their role. Such initiatives are likely to improve both patient and nurse outcomes.
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Affiliation(s)
- Anne Mette N Adams
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia.
| | - Diane Chamberlain
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia
| | - Mette Grønkjær
- Alborg University Hospital & Department of Clinical Medicine, Aalborg University, Denmark
| | - Charlotte Brun Thorup
- Department of Intensive Care and Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Tiffany Conroy
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, 5042 SA, GPO Box 2100, Adelaide 5001, SA, Australia
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17
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Veldwijk-Rouwenhorst AE, Zuidema SU, Smalbrugge M, Bor H, Wetzels R, Gerritsen DL, Koopmans RTCM. Very frequent physical aggression and vocalizations in nursing home residents with dementia. Aging Ment Health 2021; 25:1442-1451. [PMID: 32602746 DOI: 10.1080/13607863.2020.1786799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. METHOD/DESIGN This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. RESULTS We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)=1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR = 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR = 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR = 2.75, 95% CI: 1.34-5.68) and euphoria (OR = 2.01, 95% CI: 1.22-3.31). CONCLUSION Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.
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Affiliation(s)
- Annelies E Veldwijk-Rouwenhorst
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Roland Wetzels
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Center for Specialized Geriatric Care, De Waalboog "Joachim en Anna", Nijmegen, the Netherlands
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18
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Groot Kormelinck CM, van Teunenbroek CF, Zuidema SU, Smalbrugge M, Gerritsen DL. Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia. BMC Geriatr 2021; 21:414. [PMID: 34217230 PMCID: PMC8254904 DOI: 10.1186/s12877-021-02357-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. METHODS We used Leontjevas' model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. RESULTS The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations' readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. CONCLUSIONS Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.
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Affiliation(s)
- Claudia M. Groot Kormelinck
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 253, 9700 AD Groningen, the Netherlands
| | - Charlotte F. van Teunenbroek
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 253, 9700 AD Groningen, the Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 253, 9700 AD Groningen, the Netherlands
| | - Martin Smalbrugge
- Department of medicine for older people, Amsterdam Public Health research institute, Amsterdam UMC - Vrije Universiteit, Amsterdam, the Netherlands
| | - Debby L. Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Nijmegen, the Netherlands
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Ibenthal E, Kehmann M, Backhaus C. Feasibility of a Music System Intervention to Affect Mental Stress and Strain of Employees in Inpatient Dementia Care. Ann Work Expo Health 2021; 65:591-604. [PMID: 33787833 DOI: 10.1093/annweh/wxaa120] [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: 05/05/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES If family caregivers participate with people with dementia in group music therapies, their mental stress can be reduced. The interventions investigated this context are often limited to active music therapies in groups, which do not consider the inclusion of formal caregivers. In the presented study, a music system was implemented in the routine nursing care of a dementia residential community. Aiming to investigate the use and the effects of the music system on employees' mental stress and strain, hypotheses were derived, which, for the first time, qualitatively describe this connection. METHODS A controlled feasibility study with pretests and posttests was conducted. Two residential areas of an inpatient care facility for people with dementia participated as an intervention and control groups-these included 28 residents and 18 employees. In the intervention phase, the employees of the intervention group used the music systems during nursing activities and the operations were saved in log files. Mental stress and strain were recorded six times using the BGWmiab questionnaire. In the questionnaire part on mental stress, typical stress factors were assessed, while the part on mental strain records the extent of seven typical symptoms of overstrain. RESULTS The music systems were used 1.6 (±1.3) times per day and per resident, dependent on the residents (P < 0.05, n = 13). Changes in total mental stress and strain scores could not be determined. Regarding the strain symptoms, scores of work motivation, fatigue, and aversions decreased. Seventy-one percent of the employees stated an improved daily work routine. The strain changes in employees of the intervention group correlated significantly with their work experience (r = 0.73, P = 0.04, n = 8). CONCLUSIONS Eight hypotheses on the usage and effect of music systems were generated. These did not represent an additional stress factor and affected single strain symptoms. In addition, the study highlighted a positive impact that the music systems had on the employees' perception of stress. This is the first time that the positive effects of receptive music interventions on mental stress and strain of formal caregivers are described. Further investigations with an increased frequency of use of the music systems should validate and specify the findings and hypotheses.
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Affiliation(s)
- Elisabeth Ibenthal
- Münster University of Applied Sciences, Centre for Ergonomics and Medical Engineering, Bürgerkamp 3, 48565 Steinfurt, Germany
| | - Maximilian Kehmann
- Münster University of Applied Sciences, Centre for Ergonomics and Medical Engineering, Bürgerkamp 3, 48565 Steinfurt, Germany
| | - Claus Backhaus
- Münster University of Applied Sciences, Centre for Ergonomics and Medical Engineering, Bürgerkamp 3, 48565 Steinfurt, Germany
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Effects on staff outcomes and process evaluation of the educating nursing staff effectively (TENSE) program for managing challenging behavior in nursing home residents with dementia: A cluster-randomized controlled trial. Int J Nurs Stud 2021; 120:103982. [PMID: 34171518 DOI: 10.1016/j.ijnurstu.2021.103982] [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: 11/30/2020] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Challenging behavior is prevalent in people with dementia residing in nursing homes and places a high burden on the nursing staff of dementia special care units. This study evaluates an educational program for nursing staff for managing challenging behavior: The Educating Nursing Staff Effectively (TENSE) program. This program can be tailored to care organizations' wishes and needs and combines various learning styles. OBJECTIVE The aim of this cluster-randomized controlled trial was to examine the short-term (3 months) and long-term (9 months) effects of the TENSE training program on experienced stress, work contentment, and stress reactions at work in nursing staff working in dementia special care units. DESIGN Cluster-randomized controlled trial. METHODS Nursing staff members of 18 dementia special care units within nine nursing homes from different Netherlands regions were randomized into an intervention (n = 168) or control (n = 129) group. The TENSE program consisted of a three-day training course and two follow-up sessions after three and six months, respectively. The primary outcome was stress experienced by nursing staff measured with the Utrecht Burnout Scale - C. Secondary outcomes were work contentment and stress reactions at work. Furthermore, process evaluation data on the reach of and compliance with the program and the program's feasibility and relevance were collected. Data were collected between November 2012 and November 2014. RESULTS In general, the participants appreciated the quality and relevance of the TENSE training and evaluated the content of the training as beneficial. The TENSE training had no effect on the components of experienced stress, i.e., emotional exhaustion (p = 0.751), depersonalization (p = 0.701), and personal accomplishment (p = 0.182). Furthermore, no statistically significant effects of the intervention on work contentment and stress reactions at work were found. CONCLUSIONS The TENSE training program did not have an effect on experienced stress, work contentment, nor stress reactions at work of nursing staff working in dementia special care units. In future studies, more focus on practicing new skills seems needed. TRIAL REGISTRATION NTR (Dutch Trial Registration) number NTR3620.
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Ibenthal E, Kehmann M, Backhaus C. Effectiveness of personalized music systems to influence neuropsychiatric symptoms associated with dementia: A quasi-experimental study. Explore (NY) 2021; 18:319-326. [PMID: 33781719 DOI: 10.1016/j.explore.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Studies have shown that music can improve the neuropsychiatric symptoms in people with dementia. Personalized music has the greatest impact. However, people with dementia in residential care rarely listen to personalized music; in doing so, they themselves as well as their caregivers pass up the positive effects associated with it. As a result, customizable music systems have been developed that allow people with dementia to listen to their favorite music. AIM To determine the effectiveness of personalized music systems on the neuropsychiatric symptoms of people with dementia in residential care and the perceived distress of caregivers. METHOD 14 residents heard personalized music during personal care for eight weeks. Outcomes were derived from pre-post-follow up assessments of residents' neuropsychiatric symptoms and caregivers' distress using the Neuropsychiatric Inventory Questionnaire (NPI-Q). The frequency of the music systems' usage was recorded in log files. A control group of 14 residents received standard care. RESULTS Caregivers used the music systems among the residents with varying frequency. During the intervention, an increasing trend of the severity value of apathy was observed, while the severity values of delusions and nighttime disturbances tended to decrease. However, the trends did not reach statistical significance. Caregivers' perceived distress was not affected. CONCLUSION A practicable solution for providing personalized music to people with dementia in residential care was tested. Possible positive effects were observed for delusions and nighttime disturbances in people with dementia, but a larger study will be required to verify these observations.
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Affiliation(s)
- Elisabeth Ibenthal
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany.
| | - Maximilian Kehmann
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
| | - Claus Backhaus
- Münster University of Applied Sciences, Bürgerkamp 3, 48565 Steinfurt, Germany
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van Teunenbroek CF, Verhagen K, Smalbrugge M, Persoon A, Zuidema SU, Gerritsen DL. The construction of a conceptual framework explaining the relation between barriers to change of management of neuropsychiatric symptoms in nursing homes: a qualitative study using focus groups. BMC Geriatr 2020; 20:163. [PMID: 32375668 PMCID: PMC7201759 DOI: 10.1186/s12877-020-01569-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
Background Several efforts have been made to change management of neuropsychiatric symptoms (NPS) in nursing homes, however only few were successful. Numerous barriers to change in healthcare were identified, yet only one conceptual model is known to study their interrelationships. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in the management of NPS in nursing homes and to construct a conceptual framework providing insight into the relative importance and interrelationships of these barriers when improving quality of care. Methods Four focus groups were conducted in different dementia special care units of one Dutch nursing home. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases defined by Braun & Clarke. Finally, a conceptual framework showing the interrelations of barrier-themes was constructed using text fragments of the focus groups. Results We constructed a conceptual framework consisting of eight themes of barriers explaining the extent to which change in NPS-management can be achieved: ‘organizational barriers’, ‘personal barriers’, ‘deficiency of staff knowledge’, ‘suboptimal communication’, ‘inadequate (multidisciplinary) collaboration’, ‘disorganization of processes’, ‘reactive coping’ and ‘differences in perception’. Addressing ‘organizational barriers’ and ‘deficiency of staff knowledge’ is a precondition for change. ‘Suboptimal communication’ and ‘inadequate (multidisciplinary) collaboration’ play a key role in the extent of change achieved via the themes ‘differences in perception’ and ‘disorganization of processes’. Furthermore, ‘personal barriers’ influence all themes - except ‘organizational barriers’ - and may cause ‘reactive coping’, which in turn may lead to ‘difficulties to structure processes’. Conclusions A conceptual framework was created explaining the relationships between barriers towards achieving change focused on improving management of NPS in nursing homes. After this framework has been confirmed and refined in additional research, it can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing them for achieving change in the provided care.
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Affiliation(s)
- Charlotte F van Teunenbroek
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, HPC FA21, the Netherlands.
| | - Kim Verhagen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, HPC FA21, the Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
| | - Anke Persoon
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, HPC FA21, the Netherlands
| | - Debby L Gerritsen
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands
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Process evaluation of the response of nursing homes to the implementation of the dementia-specific case conference concept WELCOME-IdA: A qualitative study. BMC Nurs 2020; 19:14. [PMID: 32095116 PMCID: PMC7026945 DOI: 10.1186/s12912-020-0403-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 01/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background The implementation of clearly structured dementia-specific case conferences could be an important tool to enable nursing staff to properly analyse and manage challenging behaviour in nursing home residents with dementia. A process evaluation of the responses of nursing homes to the implementation of WELCOME-IdA (Wittener model of case conferences for people with dementia - the Innovative dementia-oriented Assessment tool) was carried out to gain insight into which key elements of the intervention were adopted by the nursing homes and which elements were adapted. Methods This study was part of a larger process evaluation using a qualitative design. Thirty-four semi-structured telephone interviews and 15 focus group interviews were conducted in four nursing homes. The interviews were analysed using deductive content analysis, although inductive categories have been developed. Results Nursing home staff adopted the roles of moderator, case reporter, keeper of the minutes and reflection partner in WELCOME-IdA, but the selection of the staff members who filled these roles differed across nursing homes. The recommended group size of 5-8 participants per case conference was sometimes adopted. The key element of having core nursing teams who participated continuously in all case conferences was not adopted at all. Instead, there was a high level of rotation among staff members. The pre-defined process structure of WELCOME-IdA was adapted in such a way that the assessment of the residents' behaviour and the selection of the relevant domain for the behaviour analysis were conducted in advance of the case conference. The evaluation of the interventions was also organized differently. Conclusion The scope of the response implies that WELCOME-IdA requires further adaptation to the requirements of nursing processes in nursing homes. The results provide important information on the selection of role keepers and offer insights into a) how knowledge of the structured training was circulated and transformed into self-organized case conferences and b) how knowledge was circulated throughout the entire processing of one case. Thus, these results can be used to optimize intervention and implementation. Overall, the intervention should allow more possibilities for tailored adaptation than it currently does.
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van Duinen‐van den IJssel JC, Bakker C, Smalbrugge M, Zwijsen SA, Adang E, Appelhof B, Zuidema SU, de Vugt ME, Verhey FR, Koopmans RT. Cost-consequence analysis of an intervention for the management of neuropsychiatric symptoms in young-onset dementia: Results from the BEYOND-II study. Int J Geriatr Psychiatry 2020; 35:131-137. [PMID: 31657080 PMCID: PMC6916543 DOI: 10.1002/gps.5229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the cost-consequences of an intervention for the management of neuropsychiatric symptoms in nursing home residents with young-onset dementia. METHODS A stepped wedge design was used. The intervention consisted of an educational program and a multidisciplinary care program and was implemented in 13 nursing homes from September 2015 to March 2017. Costs' outcomes included the time investment of the elderly care physician and health care psychologists regarding the management of neuropsychiatric symptoms, residents' psychotropic drug use, nursing staff absenteeism, and costs of the educational program. Composite cost measure contained the sum of costs of staff absenteeism, costs on psychotropic drugs, and costs of the educational program. Costs of time investment were investigated by comparing means. Costs of psychotropic drug use were analyzed with mixed models at resident level and as part of the composite cost measure on unit level. Staff absenteeism was also analyzed at unit level. RESULTS Compared with care as usual, the mean costs of time invested decreased with €36.79 for the elderly care physician but increased with €46.05 for the health care psychologist in the intervention condition. Mixed model analysis showed no effect of the intervention compared with care as usual on the costs of psychotropic drug use, staff absenteeism, and the composite cost measure. The costs of the educational program were on average €174.13 per resident. CONCLUSION The intervention did not result in increased costs compared with care as usual. Other aspects, such as the lack of a structured working method, should be taken into account when considering implementation of the intervention.
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Affiliation(s)
- Jeannette C.L. van Duinen‐van den IJssel
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands
| | - Christian Bakker
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,Groenhuysen, Center for Geriatric CareRoosendaalThe Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamThe Netherlands
| | - Sandra A. Zwijsen
- Department of General Practice and Elderly Care Medicine/Amsterdam Public Health Research InstituteAmsterdam UMCAmsterdamThe Netherlands
| | - Eddy Adang
- Department for Health EvidenceRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Britt Appelhof
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,Archipel Care Group, Landrijt, Center for Specialized CareEindhovenThe Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Marjolein E. de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Frans R.J. Verhey
- School for Mental Health and Neuroscience, Alzheimer Center LimburgMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Raymond T.C.M. Koopmans
- Department of Primary and Community CareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,Radboud Alzheimer CenterRadboud University Medical CenterNijmegenThe Netherlands,De Waalboog, “Joachim en Anna”Center for Specialized Geriatric CareNijmegenthe Netherlands
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Goergen T, Gerlach A, Nowak S, Reinelt-Ferber A, Jadzewski S, Taefi A. Danger in Safe Spaces? Resident-to-Resident Aggression in Institutional Care. INTERNATIONAL PERSPECTIVES ON AGING 2020. [DOI: 10.1007/978-3-030-25093-5_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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O'Connell B, Guse L, Greenslade L. Does restructuring theory and clinical courses better prepare nursing students to manage residents with challenging behaviors in long-term care settings? GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:85-99. [PMID: 29381127 DOI: 10.1080/02701960.2018.1428573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bachelor of Nursing students (BN) placed in long-term care encounter residents who exhibit challenging behaviors. Students are often inadequately prepared to manage these behaviors, and this is a source of distress for students. This study explored whether enhancing and restructuring theoretical and clinical courses resulted in student nurses feeling better prepared to manage residents' challenging behaviors and improve their levels of distress. This study was conducted in two phases with 116 BN students (first phase) and 99 students (second phase) where the course on older adults was restructured. The findings of this study indicated that students who felt less prepared experienced greater distress by residents' behaviors than those who felt better prepared. Scheduling a theoretical course on the care of older adults prior to the clinical course placement, as well as offering an online learning module focused on responsive behaviors, significantly increased students' feelings of preparedness to manage residents' complex behaviors.
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Affiliation(s)
- Beverly O'Connell
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Lorna Guse
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Loreley Greenslade
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Canada
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Röhrig G, Lindner R. [Survey on psychosomatic treatment options in geriatric clinical routine: state of the art]. Z Gerontol Geriatr 2019; 53:430-436. [PMID: 31720831 DOI: 10.1007/s00391-019-01658-5] [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: 07/18/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mental and physical disorders form a common body of experience and suffering in old age that can negatively influence aging. Experience and handling of age-associated functional impairments are challenging for multimorbid patients, their relatives and the healthcare providers involved. Among patients aged 70 years or older more than 50% suffer from psychopathological symptoms and 30-40% of geriatric inpatients have a psychosomatic or psychiatric comorbidity; however, despite this high prevalence of mental problems in older patients they are hardly ever treated and if treatment is offered it is carried out by specialists for somatic medicine. The aim of the present study of the working group on gerontopsychosomatics of the German Geriatric Society (DGG) was the evaluation of interdisciplinary co-management opportunities for geriatricians who treat inpatients with gerontopsychosomatic needs. METHOD Online survey among members of the DGG regarding experiences with interdisciplinary co-management of inpatients with gerontopsychosomatic needs. RESULTS The majority of the respondents were senior physicians in a department for geriatrics. While every second institution had access to a psychiatric consultation service, psychosomatic cooperation was only offered in every fifth department. Psychosomatic co-management was particularly required in connection with neurogeriatric problems. CONCLUSION There is need of gerontopsychosomatic co-management among geriatric inpatients; however, in comparison to gerontopsychiatric co-management the options are deficient and need to be strengthened.
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Affiliation(s)
- Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln-Ost, Johann Classen Straße 68, 51103, Köln, Deutschland.
| | - Reinhard Lindner
- Institut für Sozialwesen, Fachbereich Humanwissenschaften, FG Theorie, Empirie und Methoden der Sozialen Therapie, Universität Kassel, Kassel, Deutschland
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Nauta J, Mahieu C, Michiels C, Ongenae F, De Backere F, De Turck F, Khaluf Y, Simoens P. Pro-active positioning of a social robot intervening upon behavioral disturbances of persons with dementia in a smart nursing home. COGN SYST RES 2019. [DOI: 10.1016/j.cogsys.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kaasalainen S. Launching 'Namaste Care' in Canada: findings from training sessions and initial perceptions of an end-of-life programme for people with advanced dementia. J Res Nurs 2019; 24:403-417. [PMID: 34394554 PMCID: PMC7932258 DOI: 10.1177/1744987119832932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multisensory approaches and programmes have been developed to improve the quality of both life and dying for people with advanced dementia. However, little is known about the experiences of staff, family and others involved in the use of these programmes, and in the relevant education provided to improve the quality of life of residents living with advanced dementia in long-term care homes. AIM The aim of this study was to explore early experiences associated with the implementation of a new programme called 'Namaste Care' in two Canadian long-term care homes. METHODS A multiple methods design was used. This included a survey to evaluate a 2-day education programme and qualitative description of interview data that explored experiences during the first 3 months of implementation. RESULTS Survey respondents included 44 long-term care staff and 44 others (primarily family) who had attended a 2-day training session or public lecture. Interviews were undertaken with 18 staff, 5 family members and 2 volunteers to generate qualitative descriptions about the last 3 months of implementation of the 2-day education programme. The majority of those who attended training rated this as excellent and affirmed that they now understood the purpose of 'Namaste Care'. Most endorsed that they had learned some essentials of 'Namaste Care' delivery. The majority of those who attended the public lecture were very satisfied with the education, and better understood how this novel programme could be implemented in long-term care. Qualitative description of interview data revealed that participants were positive about 'Namaste Care' in long-term care, and identified both barriers and facilitators to implementation as well as recommendations to help with future implementation. CONCLUSIONS These study findings support the use of a facility-wide educational programme to help launch a new innovation in long-term care.
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van Duinen-van den IJssel JC, Bakker C, Smalbrugge M, Zwijsen SA, Appelhof B, Teerenstra S, Zuidema SU, de Vugt ME, Verhey FR, Koopmans RT. Effects on staff outcomes from an intervention for management of neuropsychiatric symptoms in residents of young-onset dementia care units: A cluster randomised controlled trial. Int J Nurs Stud 2019; 96:35-43. [DOI: 10.1016/j.ijnurstu.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
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Brooke J, Cronin C, Stiell M, Ojo O, Belcina MT, Smajlović SK, Slark J. Nursing students' cultural beliefs and understanding of dementia: A phenomenological study across three continents. NURSE EDUCATION TODAY 2019; 77:6-11. [PMID: 30878702 DOI: 10.1016/j.nedt.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/23/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse's cultural heritage on their beliefs and understanding of dementia. OBJECTIVES To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand. DESIGN An explorative hermeneutic phenomenology design. SETTINGS Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boškin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman). PARTICIPANTS Student nurses studying nursing in England (n = 81), Slovenia (n = 41), Philippines (n = 53) and New Zealand (n = 6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n = 100) and towards the end of their studies (n = 81) participated. METHODS Completion of focus groups (n = 23), in England (n = 10), Slovenia (n = 6), Philippines (n = 6), and New Zealand (n = 1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data. RESULTS Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: 'my granddad': familial experience, and 'better to be with her': familial home. Dementia discourse emerged from the terminology student nurses applied, such as: 'preconceptions and misconceptions' of aggression, and 'considered crazy' stigma of dementia due to a lack of awareness. CONCLUSIONS The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education.
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Affiliation(s)
- Joanne Brooke
- Centre for Social Care, Health and Related Research, Birmingham City University, Ravensbury House, City South Campus, Westbourne Road, Birmingham, B15 3TN, United Kingdom of Great Britain and Northern Ireland.
| | - Camille Cronin
- School of Health and Human Sciences, University of Essex, Elmer Approach, Southend-on-Sea SS1 1LW, United Kingdom of Great Britain and Northern Ireland.
| | - Marlon Stiell
- Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London. SE9 2UG, United Kingdom of Great Britain and Northern Ireland.
| | - Omorogieva Ojo
- Faculty of Education and Health, University of Greenwich, Avery Hill Campus, London. SE9 2UG, United Kingdom of Great Britain and Northern Ireland.
| | - Maria Theresa Belcina
- Silliman University, College of Nursing, 1 Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines
| | | | - Julia Slark
- University of Auckland, Level 2, Building 505, Grafton, Auckland 1142, New Zealand.
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van Duinen-van den IJssel JC, Mulders AJ, Smalbrugge M, Zwijsen SA, Appelhof B, Zuidema SU, de Vugt ME, Verhey FR, Bakker C, Koopmans RT. Nursing Staff Distress Associated With Neuropsychiatric Symptoms in Young-Onset Dementia and Late-Onset Dementia. J Am Med Dir Assoc 2018; 19:627-632. [DOI: 10.1016/j.jamda.2017.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 01/30/2023]
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Lavallée JF, Gray TA, Dumville J, Cullum N. Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. Int J Nurs Stud 2018; 82:79-89. [DOI: 10.1016/j.ijnurstu.2017.12.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/07/2017] [Accepted: 12/30/2017] [Indexed: 11/25/2022]
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Delfino LL, Komatsu RS, Komatsu C, Neri AL, Cachioni M. Dementia management strategies associated with neuropsychiatric symptoms of elderly people with Alzheimer’s disease. DEMENTIA 2018; 18:2747-2759. [DOI: 10.1177/1471301218759233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to investigate the association between management and communication strategies and the presence of neuropsychiatric symptoms presented by elderly people with Alzheimer’s disease. One hundred and thirty-four family caregivers answered a questionnaire with socio-demographic data and questions regarding the care context, the Small Communication Strategies Scale, the Dementia Management Strategy Scale, and the Neuropsychiatric Inventory. Caregivers used the criticism management strategy more when the elderly presented hallucination, agitation, depression, anxiety, irritability, nighttime behavior, and appetite abnormalities. The encouragement strategy was more significantly used only in the presence of euphoria/elation. The caregivers who used the most active management strategy were those who cared for the elderly with delirium, hallucination, agitation, depression, anxiety, irritability, and appetite and eating abnormalities. The use of communication strategies did not differ between groups with or without neuropsychiatric symptoms. It is concluded that criticism management and active management strategies are strongly associated with neuropsychiatric symptoms. The results of this study may be useful for planning treatment interventions that aim to modify the use of management strategies used by caregivers.
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Palese A, Grassetti L, Bandera D, Zuttion R, Ferrario B, Ponta S, Hayter M, Watson R. High feeding dependence prevalence in residents living in Italian nursing homes requires new policies: Findings from a regionally based cross-sectional study. Health Policy 2018; 122:301-308. [PMID: 29409682 DOI: 10.1016/j.healthpol.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 01/05/2018] [Accepted: 01/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES An increased amount of functional dependence has been reported among residents living in nursing homes. Among others, feeding dependence is one of the most complex needs to satisfy: behind the attempt to personalise meals with individual preferences and clinical regimens, all residents require help at the same moment and for long periods of time, three or more times a day. With the intent of debating policy implications, the aims of this study were to advance the knowledge in the field of feeding dependence prevalence and predictors in Italy, a country where life expectancy is among the highest in the World. METHOD A large retrospective regionally-based study approaching all nursing homes (n = 105) was performed in 2014; all residents (n = 10,900) were eligible and those with a completed assessment recorded in the regional database and aged >65 years (n = 8875) were included. RESULTS 1839 residents (20.7%) were in total need of help in feeding on a daily basis. At the multilevel analysis, predictors were moderate/severe dementia (OR 4.044, CI 95% 3.213-5.090); dysphagia (OR 4.003 CI 95% 3.155-5.079); pressure sores (OR 2.317 CI 95% 1.803-2.978); unintentional weigh loss (OR 2.197 CI 95% 1.493-3.233); unsociability (OR 1.561 CI 95% 1.060-2.299); and clinical instability (OR 1.363 CI 95% 1.109-1.677). CONCLUSIONS The feeding dependence prevalence emerged seem to be unique compared to that documented at the international levels. Modifiable and unmodifiable predictors found require new policies regarding workforce skills-mix and shifts schedules; as well as alliances with families, associations and communities' stakeholders. According to the complexity of the resident profile emerged, staff education and training is also recommended.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, Udine University, Italy.
| | - Luca Grassetti
- Department of Economics and Statistics, Udine University, Italy
| | | | | | | | - Sandra Ponta
- Welfare Unit, Friuli Venezia Giulia Region, Italy
| | - Mark Hayter
- Faculty of Health Siences, Hull University, UK
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Griffiths AW, Wood AM, Tai S. The prospective role of defeat and entrapment in caregiver burden and depression amongst formal caregivers. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial. Int Psychogeriatr 2017; 29:1993-2006. [PMID: 28853389 DOI: 10.1017/s104161021700148x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Dementia Care Mapping (DCM) method is an internationally recognized complex intervention in dementia research and care for implementing person-centered care. The Leben-QD II trial aimed to evaluate the effectiveness of DCM with regard to caregivers. METHODS The nine participating nursing home units were allocated to three groups: (1) DCM method experienced ≥ 1 year, (2) DCM newly introduced during this trial, and (3) regular rating of residents' quality of life (control group). Linear mixed models were fit to cluster-aggregated data after 0, 6, and 18 months, adjusting for repeated measurements and confounders. The primary outcome was the Approaches to Dementia Questionnaire (ADQ) score; the secondary outcomes were the Copenhagen Psychosocial Questionnaire (COPSOQ) and the Copenhagen Burnout Inventory (CBI). RESULTS The analysis included 201 caregivers with 290 completed questionnaires (all three data collection time points). The ADQ showed a significant time and time*intervention effect. At baseline, the estimated least-square means for the ADQ were 71.98 (group A), 72.46 (group B), and 71.15 (group C). The non-linear follow-up of group A indicated an estimated-least square means of 69.71 (T 1) and 68.97 (T 2); for group B, 72.80 (T 1) and 72.29 (T 2); and for group C, 66.43 (T 1) and 70.62 (T 2). CONCLUSIONS The DCM method showed a tendency toward negatively affecting the primary and secondary outcomes; this finding could be explained by the substantial deviation in adherence to the intervention protocol.
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Rousseau MC, Baumstarck K, Leroy T, Khaldi-Cherif C, Brisse C, Boyer L, Resseguier N, Morando C, Billette De Villemeur T, Auquier P. Impact of caring for patients with severe and complex disabilities on health care workers' quality of life: determinants and specificities. Dev Med Child Neurol 2017; 59:732-737. [PMID: 28432687 DOI: 10.1111/dmcn.13428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
AIM Individuals with severe and complex disabilities, defined by a combination of profound intellectual impairment and serious motor deficit resulting in extreme dependence, often remain in hospital or at residential facilities. The aim of this study was to identify the determinants of quality of life (QoL) of 238 health care workers (HCWs) caring for individuals with severe and complex disabilities. METHOD We conducted a cross-sectional study. The recruitment of the HCWs was performed in five French centres specializing in patients with severe and complex disabilities. The selection criteria were age above 18 years, being an institutional referent HCW (a resource person coordinating various issues for or about the patient), and agreeing to participate. Sociodemographic, health, professional variables, and psycho-behavioural (QoL, burn-out, and coping strategies) data were collected. RESULTS Of the 362 eligible HCWs, 65.7% returned the questionnaires. The scores of the physical and social dimensions of QoL were significantly lower, and the score of the psychological dimension significantly higher, than those of a comparison group. The main factors modulating QoL were age, financial difficulties, nature of coping strategy, and burn-out. INTERPRETATION This research provides preliminary evidence that caring for patients with severe and complex disabilities affects the QoL of HCWs. These results support the need for optimization of the work environments for HCWs.
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, Hyères, France.,Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Karine Baumstarck
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Tanguy Leroy
- Groupe de Recherche de Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | | | - Catherine Brisse
- Comité d'Études, d'Éducation et de Soins Auprès des Personnes Polyhandicapées, Paris, France
| | - Laurent Boyer
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Noémie Resseguier
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Claire Morando
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
| | - Thierry Billette De Villemeur
- Service de Neuropédiatrie et Polyhandicap Pédiatrique, Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pascal Auquier
- Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France
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