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Du H, Wang X, Lai X, Wang W, Huo X. Nurses' knowledge, attitude and practice regarding non-pharmacologic interventions for behavioral and psychological symptoms of dementia. BMC Psychiatry 2024; 24:528. [PMID: 39048967 PMCID: PMC11267692 DOI: 10.1186/s12888-024-05962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND To evaluate the knowledge, attitude and practice of nurses regarding non-pharmacologic therapies for behavioral and psychological symptoms of dementia (BPSD). METHODS This cross-sectional, questionnaire-based study enrolled nurses at Peking Union Medical College Hospital (Beijing, China) between September 2022 and October 2022. Correlations between knowledge, attitude and practice scores were evaluated by Pearson correlation analysis. Factors associated with knowledge, attitude and practice scores were identified by multivariable linear regression. Based on a cross-sectional questionnaire survey, this study designed a questionnaire according to the Guidelines for Diagnosis and Treatment of Dementia in China, and randomly selected nurses from Peking Union Medical College Hospital to fill in the questions through the Wen-Juan-Xing online platform from September 2022 to October 2022. RESULTS The analysis included 210 nurses (202 females). The average knowledge, attitude and practice scores were 11.06±2.61 (total score: 18), 53.51±5.81 (total score: 60) and 64.66 ± 10.35 (total score: 80) points, respectively. Knowledge score was positively correlated with attitude score (r = 0.416, P < 0.001) and practice score (r = 0.389, P < 0.001); attitude and practice scores were also positively correlated (r = 0.627, P < 0.001). Multivariable analysis demonstrated that age ≥ 40 years-old (vs. ≤30 years-old) was associated with higher knowledge score (β = 1.48, 95% confidence interval [95%CI] = 0.42-2.54, P = 0.006). Age ≥ 40 years-old (β = 1.43, 95%CI = 0.35-2.51, P = 0.010 vs. ≤30 years-old) and bachelor's degree or higher (β = 1.11, 95%CI = 0.12-2.10, P = 0.028 vs. college degree or lower) were associated with higher practice score. CONCLUSIONS Older age and higher education level were associated with higher knowledge, attitude and/or practice scores. The findings of this study may help guide the development and implementation of education and training programs to improve the management of BPSD by nurses in China.
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Affiliation(s)
- Hongdi Du
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Wang
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxing Lai
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- Department of health care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaopeng Huo
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Duan Y, Wang J, Lanham HJ, Berta W, Chamberlain SA, Hoben M, Choroschun K, Iaconi A, Song Y, Perez JS, Shrestha S, Beeber A, Anderson RA, Hayduk L, Cummings GG, Norton PG, Estabrooks CA. How context links to best practice use in long-term care homes: a mixed methods study. Implement Sci Commun 2024; 5:63. [PMID: 38849909 PMCID: PMC11157780 DOI: 10.1186/s43058-024-00600-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements interrelate and influence best practice use by LTC care aides. METHODS In this secondary analysis study, we combined coincidence analysis (a configurational comparative method) and qualitative analysis to examine data collected through the Translating Research in Elder Care (TREC) program. Coincidence analysis of clinical microsystem (care unit)-level data aggregated from a survey of 1,506 care aides across 36 Canadian LTC homes identified configurations (paths) of context elements linked consistently to care aides' best practices use, measured with a scale of conceptual research use (CRU). Qualitative analysis of ethnographic case study data from 3 LTC homes (co-occurring with the survey) further informed interpretation of the configurations. RESULTS Three paths led to very high CRU at the care unit level: very high leadership; frequent use of educational materials; or a combination of very high social capital (teamwork) and frequent communication between care aides and clinical educators or specialists. Conversely, 2 paths led to very low CRU, consisting of 3 context elements related to unfavorable conditions in relationships, resources, and formal learning opportunities. Our qualitative analysis provided insights into how specific context elements served as facilitators or barriers for best practices. This qualitative exploration was especially helpful in understanding 2 of the paths, illustrating the pivotal role of leadership and the function of teamwork in mitigating the negative impact of time constraints. CONCLUSIONS Our study deepens understanding of the complex interrelationships between context elements and their impact on the implementation of best practices in LTC homes. The findings underscore that there is no singular, universal bundle of context-related elements that enhance or hinder best practice use in LTC homes.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health, San Antonio, TX, USA
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | | | - Alba Iaconi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yuting Song
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Janelle Santos Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Hayduk
- Sociology Department, Faculty of Arts, University of Alberta, Edmonton, AB, Canada
| | - Greta G Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Ayeno HD, Kassie GM, Atee M, Nguyen T. PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: A systematic review and qualitative evidence synthesis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1393. [PMID: 38524867 PMCID: PMC10958098 DOI: 10.1002/cl2.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
This is a protocol for a Cochrane Review. The objectives are as follows. This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.
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Affiliation(s)
- Hunduma Dinsa Ayeno
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Department of PharmacyAmbo UniversityAmboEthiopia
| | - Gizat M. Kassie
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Mustafa Atee
- The Dementia Centre, HammondCareOsborne ParkWestern AustraliaAustralia
- Sydney Pharmacy School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- School of Nursing and Midwifery, Centre for Research in Aged CareEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Curtin Medical School, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
| | - Tuan Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- School of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
- National Ageing Research InstituteMelbourneVictoriaAustralia
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Stuart-Röhm K, Baker FA, Clark I. Training formal caregivers in the use of live music interventions during personal care with persons living with dementia: a systematic mixed studies review. Aging Ment Health 2023; 27:1876-1886. [PMID: 36803176 DOI: 10.1080/13607863.2023.2180485] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To examine research on the training of formal caregivers in live music interventions within care situations with persons with dementia. METHODS This review was registered with PROSPERO (CRD42020196506). PubMed, PsycINFO (Ovid), MEDLINE, Discovery EBSCO, Embase, CINAHL (Complete), AMED and ProQuest Dissertations and Theses Global were searched in September 2020 and again in October 2022. English, peer-reviewed studies on formal caregivers trained in using live music when caring one-on-one with persons with dementia were included. The Mixed Methods Assessment Tool (MMAT) was employed to assess quality, and narrative synthesis with effect sizes (Hedges-g) and thematic analysis were used for quantitative and qualitative studies respectively. RESULTS Nine studies (four qualitative, three quantitative, two mixed methods studies) were included. Quantitative studies demonstrated significant differences for music training on outcomes measuring agitation and emotional expression. Thematic analysis yielded five themes: emotional wellbeing; mutual relationship; shifts in caregivers' experiences; care environment; and insights into person-centered care. CONCLUSION Training for staff in live music interventions may benefit the delivery of person-centered care by supporting communication, easing care, and capacitating caregivers to meet the needs of persons with dementia. Findings appeared context specific due to high heterogeneity and small sample sizes. Further research on quality of care and caregiver outcomes, and sustainability of training is recommended.
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Affiliation(s)
| | - Felicity A Baker
- The University of Melbourne, Melbourne, VIC, Australia
- Norwegian Academy of Music, Oslo, Norway
| | - Imogen Clark
- The University of Melbourne, Melbourne, VIC, Australia
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Eikelboom WS, Koch J, Beattie E, Lautenschlager NT, Doyle C, van den Berg E, Papma JM, Anstey KJ, Mortby ME. Residential aged care staff perceptions and responses towards neuropsychiatric symptoms: a mixed methods analysis of electronic healthcare records. Aging Ment Health 2023; 27:243-250. [PMID: 35100918 DOI: 10.1080/13607863.2022.2032597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate electronic care notes to better understand reporting and management of neuropsychiatric symptoms (NPS) by residential aged care (RAC) staff. METHODS We examined semi-structured care notes from electronic healthcare notes of 77 residents (67% female; aged 67-101; 79% with formal dementia diagnosis) across three RAC facilities. As part of standard clinical practice, staff documented the NPS presentation and subsequent management amongst residents. Using a mixed-method approach, we analyzed the type of NPS reported and explored care staff responses to NPS using inductive thematic analysis. RESULTS 465 electronic care notes were recorded during the 18-month period. Agitation-related behaviors were most frequently reported across residents (48.1%), while psychosis (15.6%), affective symptoms (14.3%), and apathy (1.3%) were less often reported. Only 27.5% of the notes contained information on potential causes underlying NPS. When faced with NPS, care staff responded by either providing emotional support, meeting resident's needs, removing identified triggers, or distracting. CONCLUSION Results suggest that RAC staff primarily detected and responded to those NPS they perceived as distressing. Findings highlight a potential under-recognition of specific NPS types, and lack of routine examination of NPS causes or systematic assessment and management of NPS. These observations are needed to inform the development and implementation of non-pharmacological interventions and care programs targeting NPS in RAC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2032597 .
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Affiliation(s)
- Willem S Eikelboom
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jana Koch
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Colleen Doyle
- National Aging Research Institute, Parkville, VIC, Australia
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kaarin J Anstey
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
| | - Moyra E Mortby
- Neuroscience Research Australia, Randwick Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Kensington Sydney, NSW, Australia
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Kim D, Choi YR, Lee YN, Park WH, Chang SO. How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10493. [PMID: 36078209 PMCID: PMC9518535 DOI: 10.3390/ijerph191710493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.
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Affiliation(s)
- Dayeong Kim
- College of Nursing, Korea University, Seoul 02841, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
| | - Young-Rim Choi
- College of Nursing, Korea University, Seoul 02841, Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong 18323, Korea
| | - Won-Hee Park
- College of Nursing, Korea University, Seoul 02841, Korea
| | - Sung-Ok Chang
- College of Nursing, Korea University, Seoul 02841, Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
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Kolanowski A, Zhu S, Van Haitsma K, Resnick B, Boltz M, Galik E, Behrens L, Eshraghi K, Ellis J. 12-month trajectory and predictors of affect balance in nursing home residents living with dementia. Aging Ment Health 2022; 26:1686-1692. [PMID: 34253099 PMCID: PMC8752645 DOI: 10.1080/13607863.2021.1947964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
Objectives:Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The purpose of this study was to extend prior research by examining the pattern of well-being using affect balance, the ratio of positive to negative affect, in nursing home residents living with dementia over 12 months and its association to factors that could potentially influence resident well-being.Method:This study was a secondary analysis of baseline, 4 and 12-month data from a pragmatic clinical trial. A total of 536 residents with moderate to severe cognitive impairments from 55 nursing homes were included in the multivariable linear mixed model regression analyses.Results:Resident function, the number of registered nurse hours devoted to care in the facility, and the quality of staff interaction predicted higher affect balance over time after controlling for other variables.Conclusion:The findings provide support for the utility of affect balance as a meaningful outcome measure of well-being for persons living with dementia. In addition, results point to specific interventions (i.e. maintaining/improving resident function, providing adequate nurse staffing levels, and improving staff communications skills) that can serve as the focus for both research and practice to help residents live well with dementia. Clinicaltrials.gov (NCT03014570).
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Affiliation(s)
- Ann Kolanowski
- Professor Emerita, College of Nursing, Penn State, University Park, Pa. 16802
| | - Shijun Zhu
- Associate Professor & Statistician, University of Maryland School of Nursing, 655 West Lombard Street, Suite 402K, Baltimore, MD 21201
| | | | - Barbara Resnick
- Sonya Ziporkin Gershowitz Chair in Gerontology, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Marie Boltz
- Professor and Elouise Ross Eberly and Robert Eberly Endowed Chair, College of Nursing, Penn State, University Park, Pa. 16802
| | - Elizabeth Galik
- Professor, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Liza Behrens
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Karen Eshraghi
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Jeanette Ellis
- Project Director, School of Nursing, University of Maryland, Baltimore MD 21218
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O’Donnell E, Holland C, Swarbrick C. Strategies used by care home staff to manage behaviour that challenges in dementia: a systematic review of qualitative studies. Int J Nurs Stud 2022; 133:104260. [DOI: 10.1016/j.ijnurstu.2022.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/14/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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9
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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Abstract
BACKGROUND This paper describes barriers to engagement in the context of group activities attended by nursing home residents with dementia. OBJECTIVE The goal is to clarify the presence and types of barriers to group activities for persons with dementia. METHODS Therapeutic recreation staff (TRs) who conducted the group activities, and trained research observers (ROs) independently identified barriers occurring during group activity sessions through ratings and open-ended comments, which were analyzed via a mixed-method approach. RESULTS Barriers were related to specific participant, environmental, and group session characteristics. Most frequently noted barriers were participant-related, pertaining to apathy and challenging behavior. Noise was the most frequent environmental barrier. Overall, ROs reported more barriers than TRs, yet TRs reported the barrier of inappropriate topic more frequently than ROs. CONCLUSIONS The study suggests that the number and specific types of barriers are associated with negative engagement outcomes. Insight into these barriers is the first step toward addressing them and minimizing their effects.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine and Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel,Jiska Cohen-Mansfield, School of Public Health, Tel Aviv University, Tel Aviv 6997801, Israel.
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities. Nurs Outlook 2021; 69:1058-1071. [PMID: 34332762 PMCID: PMC8678150 DOI: 10.1016/j.outlook.2021.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Federal regulations stipulate that behavioral interventions be used for behavioral and psychological symptoms of distress in dementia (BPSD). Care community staff have difficulty implementing these approaches. PURPOSE This study tested an implementation strategy, the Evidence Integration Triangle for BPSD (EIT-4-BPSD), for assisting staff in the use of evidence-based behavioral approaches for BPSD. METHODS About 55 care communities were randomized to EIT-4-BPSD or usual care; 553 residents were enrolled. The implementation strategy was delivered by research facilitators, staff, stakeholders, and champions over 12 months. It involved four components: Environment and policy assessments; Staff education; Establishment of person-centered care plans; and Mentoring and motivating staff. The implementation strategy was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance model. FINDINGS There was no evidence for resident or care community effectiveness. There was evidence of adoption and implementation. DISCUSSION EIT-4-BPSD was helpful as an implementation strategy and staff altered how care was provided.
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Affiliation(s)
| | | | | | | | - Marie Boltz
- Pennsylvania State University, University Park, PA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD
| | | | - Liza Behrens
- Pennsylvania State University, University Park, PA
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Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
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Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
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13
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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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Strøm BS, Engedal K. Ethical aspects in dementia care - The use of psychosocial interventions. Nurs Ethics 2020; 28:435-443. [PMID: 34032153 DOI: 10.1177/0969733020952121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of psychosocial interventions for people with dementia is common and recommended because they focus on the underlying problem and well-being of the person. The promotion of well-being is a relevant dimension in person-centred care, where the aim is to confirm the person's 'personhood'. Most literature about ethics in dementia care instructs us on how and when to include people with dementia in our research. Little is written about the ethical aspects regarding the use of psychosocial interventions in daily care. In clinical practise, several challenges arise about the use of psychosocial interventions. Those include questions about the person's ability to participate in decision-making and how we know what is best for them. Furthermore, we must consider what kinds of psychosocial interventions are best for everybody, or if intervention causes discomfort for the person. This article emphasizes the necessity to consider the ethical aspects of the implementation of psychosocial interventions while taking into consideration the persons individual needs. A particular ethical challenge arises when a person with dementia is unable to express themselves verbally. Therefore, it is essential that the staff know the history and preferences of each person with dementia. The ethical aspects of psychosocial interventions for people with dementia will be discussed using Beauchamp and Childress four ethical principles: respect for autonomy, beneficence, non-maleficence and justice. The person-centred approach proposed by Kitwood's and Brooker.
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Affiliation(s)
| | - Knut Engedal
- Vestfold Hospital HF, Norway; Oslo University Hospital, Norway
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Rosenthal M, Poling J, Wec A, Connolly E, Angell B, Crystal S. "Medication Is Just One Piece of the Whole Puzzle": How Nursing Homes Change Their Use of Antipsychotic Medications. J Appl Gerontol 2020; 41:62-72. [PMID: 32996374 DOI: 10.1177/0733464820958919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals' experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia. Interviews with 40 nursing home physicians and staff in seven states found that reducing antipsychotics is more time and resource-intensive than relying on medication, because it requires a person-centered approach. However, respondents supported reductions in antipsychotic use, and indicated that with sufficient staffing, effective communications, and training, they could create or implement individualized treatments. Their positive attitudes suggest that the National Partnership has been a catalyst in reducing antipsychotic medications, and their perspectives can inform further research, policy and practice in nursing homes toward achieving quality dementia care.
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Ballard C, Orrell M, Moniz-Cook E, Woods R, Whitaker R, Corbett A, Aarsland D, Murray J, Lawrence V, Testad I, Knapp M, Romeo R, Zala D, Stafford J, Hoare Z, Garrod L, Sun Y, McLaughlin E, Woodward-Carlton B, Williams G, Fossey J. Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.
Objective
The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.
Design
This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.
Setting
This programme was carried out in care homes in the UK.
Participants
Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.
Results
Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities.
Limitations
Residents with dementia were not involved in the qualitative work.
Conclusions
The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual.
Future work
It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation.
Trial registration
Current Controlled Trials ISRCTN40313497 and ISRCTN62237498.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, Centre of Psychological Care and Ageing, University of Hull, Hull, UK
| | - Robert Woods
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- Centre for Age-related Medicine, Stavanger University Hospital, University of Stavanger, Stavanger, Norway
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Renee Romeo
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darshan Zala
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health & Social Care, Institute of Medical & Social Care Research, Bangor University, Bangor, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Yongzhong Sun
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | | | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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Inker J, Jensen C, Barsness S, Stewart MM. Implementing Microlearning in Nursing Homes: Implications for Policy and Practice in Person-Centered Dementia Care. J Appl Gerontol 2020; 40:1062-1070. [PMID: 32525436 DOI: 10.1177/0733464820929832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to develop and pilot a 52-week Microlearning curriculum on person-centered dementia care in nine nursing homes. The goal was to evaluate the usability and application of Microlearning as a tool to increase staff knowledge and improve perceptions of people with dementia, thus increasing their ability to deliver person-centered care and their job satisfaction. Findings indicate that participants enjoyed the flexible, 24/7 access to training and found that the immediacy of the format encouraged them to apply their learning directly to practice. Staff knowledge and attitudes toward people with dementia were positively impacted by the training, as was job satisfaction. Further research to test the efficacy of Microlearning compared to usual training is warranted, as are coordinated policy development efforts that can guide the implementation of best practices in the use of Microlearning as an innovative training modality in nursing homes.
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Affiliation(s)
- Jenny Inker
- Virginia Commonwealth University, Richmond, USA
| | - Christine Jensen
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, VA, USA
| | | | - Mary Martha Stewart
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, VA, USA
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/02763893.2019.1683670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, PA, USA
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, PA, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Liza Behrens
- School of Nursing, Pennsylvania State University, PA, USA
| | - Karen Eshraghi
- School of Nursing, Pennsylvania State University, PA, USA
| | - Nicole Viviano
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ying-Ling Jao
- School of Nursing, Pennsylvania State University, PA, USA
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Sefcik JS, Ersek M, Harnett SC, Cacchione PZ. Integrative review: Persistent vocalizations among nursing home residents with dementia. Int Psychogeriatr 2019; 31:667-683. [PMID: 30303058 PMCID: PMC6458099 DOI: 10.1017/s1041610218001205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBackground:Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia. METHODS We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs. RESULTS Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs. CONCLUSION The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.
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Affiliation(s)
- Justine S. Sefcik
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Mary Ersek
- Professor of Palliative Care, University of Pennsylvania School of Nursing,
418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Sasha C. Harnett
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia,
PA 19104, USA
| | - Pamela Z. Cacchione
- Ralston House Term Chair in Gerontological Nursing, Associate Professor of
Geropsychiatric Nursing Clinician Educator, University of Pennsylvania School of
Nursing, 418 Curie Blvd, Philadelphia, PA 19104, USA
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Impact of brief education on healthy seniors' attitudes and healthcare choices about Alzheimer's disease and associated symptoms. Int Psychogeriatr 2018; 30:1889-1897. [PMID: 29720286 DOI: 10.1017/s1041610218000479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTObjective:The primary objective of this study was to determine whether a brief education session about Alzheimer's disease (AD) stages and associated behavioral and psychological symptoms of dementia (BPSD) changes healthy seniors' treatment choices. A secondary objective was to determine whether pharmacotherapy to reduce BPSD would be preferred over other potentially more restrictive interventions. METHODS Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session. RESULTS Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints. CONCLUSIONS Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.
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21
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Chiberska D. The use of robotic animals in dementia care: challenges and ethical dilemmas. ACTA ACUST UNITED AC 2018. [DOI: 10.7748/mhp.2018.e1342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Flanagan NM, Eshraghi KJ, Zhu S. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial. Res Nurs Health 2018; 41:228-242. [PMID: 29485197 DOI: 10.1002/nur.21866] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, University Park, Pennsylvania
| | - Nina M Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | | | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
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Bodner E, Palgi Y, Wyman MF. Ageism in Mental Health Assessment and Treatment of Older Adults. INTERNATIONAL PERSPECTIVES ON AGING 2018. [DOI: 10.1007/978-3-319-73820-8_15] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Does working with the Veder Contact Method influence the job satisfaction of caregivers? A non-randomized controlled trial in nursing homes for people with dementia. Int Psychogeriatr 2017; 29:2017-2032. [PMID: 28829005 DOI: 10.1017/s1041610217001582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Person-centered care interventions can improve the quality of life and decrease behavioral problems of people with dementia. Although not convincingly proven, person-centered care interventions may benefit the caregivers as well. This study aims to gain insight into how working with the Veder Contact Method (VCM) - a new person-centered care method - influences the job satisfaction of caregivers. METHODS Within a quasi-experimental study, the job satisfaction of caregivers of six experimental wards (n = 75) was compared with caregivers of six control wards (n = 36) that applied Care-As-Usual. The Leiden Quality of Work Questionnaire (LQWQ) was filled in by caregivers in both conditions. Additionally, on the experimental wards, qualitative research, i.e. focus groups with 42 caregivers and interviews with 11 managers, was conducted to obtain a deeper understanding of the influence of applying VCM on caregivers' job satisfaction. The transcripts were analyzed using deductive analysis. RESULTS No quantitatively significant differences were found on the subscales of the LQWQ: work and time pressure, job satisfaction, autonomous decision making, social support from colleagues, and social support from supervisors. From the qualitative research, some caregivers and managers reported that implementing VCM contributed to their job satisfaction and that applying VCM supported handling difficult behavior and depressed mood of residents and contributed to team building. CONCLUSIONS No significant effects on job satisfaction were demonstrated. Qualitative findings indicate that VCM positively influences the daily work performances of nursing home caregivers. The relation between the experience of offering quality care and job satisfaction of caregivers needs further investigation.
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Walsh KA, Dennehy R, Sinnott C, Browne J, Byrne S, McSharry J, Coughlan E, Timmons S. Influences on Decision-Making Regarding Antipsychotic Prescribing in Nursing Home Residents With Dementia: A Systematic Review and Synthesis of Qualitative Evidence. J Am Med Dir Assoc 2017; 18:897.e1-897.e12. [DOI: 10.1016/j.jamda.2017.06.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 01/21/2023]
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Myers DR, Rogers RK, LeCrone HH, Kelley K. The Behavioral Health Role in Nursing Facility Social Work. J Appl Gerontol 2017; 38:1063-1095. [DOI: 10.1177/0733464817733103] [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] Open
Abstract
Types of compromised resident behaviors licensed nursing facility social workers encounter, the behavioral health role they enact, and effective practices they apply have not been the subject of systematic investigation. Analyses of 20 in-depth interviews with Bachelor of Social Work (BSW)/Master of Social Work (MSW) social workers averaging 8.8 years of experience identified frequently occurring resident behaviors: physical and verbal aggression/disruption, passive disruption, socially and sexually inappropriateness. Six functions of the behavioral health role were care management, educating, investigating, preventing, mediating, and advocating. Skills most frequently applied were attention/affirmation/active listening, assessment, behavior management, building relationship, teamwork, and redirection. Narratives revealed role rewards as well as knowledge deficits, organizational barriers, personal maltreatment, and frustrations. Respondents offered perspectives and prescriptions for behavioral health practice in this setting. The findings expand understanding of the behavioral health role and provide an empirical basis for more research in this area. Recommendations, including educational competencies, are offered.
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Halek M, Holle D, Bartholomeyczik S. Development and evaluation of the content validity, practicability and feasibility of the Innovative dementia-oriented Assessment system for challenging behaviour in residents with dementia. BMC Health Serv Res 2017; 17:554. [PMID: 28806934 PMCID: PMC5557472 DOI: 10.1186/s12913-017-2469-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers’ management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes. Methods The development process and evaluation of the content validity were based on Lynn’s methodology (1998). A literature review (steps 1 + 2) provided the theoretical framework for the instrument and for item formation. Ten experts (step 3) evaluated the first version of the instrument (the Innovative dementia-oriented Assessment (IdA®)) regarding its relevance, clarity, meaningfulness and completeness; content validity indices at the scale-level (S-CVI) and item-level (I-CVI) were calculated. Health care workers (step 4) evaluated the second version in a workshop. Finally, the instrument was introduced to 17 units in 11 nursing homes in a field study (step 5), and 60 care staff members assessed its practicability and feasibility. Results The IdA® used the need-driven dementia-compromised behaviour (NDB) model as a theoretical framework. The literature review and expert-based panel supported the content validity of the IdA®. At the item level, 77% of the ratings had a CVI greater than or equal to 0.78. The majority of the question-ratings (84%, n = 154) and answer-ratings (69%, n = 122) showed valid results, with none below 0.50. The health care workers confirmed the understandability, completeness and plausibility of the IdA®. Steps 3 and 4 led to further item clarification. The carers in the study considered the instrument helpful for reflecting challenging behaviour and beneficial for the care of residents with dementia. Negative ratings referred to the time required and the lack of effect on residents´ behaviour. Conclusions There was strong evidence supporting the content validity of the IdA®. Despite the substantial length and time requirement, the instrument was considered helpful for analysing challenging behaviour. Thus, further research on the psychometric qualities, implementation aspects and effectiveness of the IdA® in understanding challenging behaviour is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2469-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margareta Halek
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany. .,School of Nursing Science, Witten/Herdecke University, Witten, Germany.
| | - Daniela Holle
- German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.,School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Strøm BS, Engedal K, Benth JS, Grov EK. Effect of the Sonas Programme on Communication in People with Dementia: A Randomized Controlled Trial. Dement Geriatr Cogn Dis Extra 2017; 7:122-135. [PMID: 28553314 PMCID: PMC5425769 DOI: 10.1159/000468147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Strategies to improve communication in people with dementia are warranted. We examined the effect of the Sonas programme on communication ability in persons with moderate to severe dementia. Methods A 24-week 3-armed (Sonas, reading, and control group) randomized controlled trial including 120 nursing home residents with dementia was conducted; 105 completed the follow-up assessments. The main outcome was change in communication abilities measured by the Holden Communication Scale (HCS). Results We found no overall significant effect of the Sonas programme with regard to communication ability as measured by the HCS. However, an effect between the Sonas group and the reading group and between the Sonas group and the control group from T0 to T1 and T2 was found, as well as a significant improvement in communication in the Sonas group. Among people with severe dementia, the Sonas group scored significantly better on the HCS compared to the reading group after 12 weeks, but not after 24 weeks. Conclusion This study failed to document an overall effect of the Sonas programme on communication; however, the findings indicate that the Sonas programme has a significant effect on communication among those with severe dementia.
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Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | | | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Quasdorf T, Riesner C, Dichter MN, Dortmann O, Bartholomeyczik S, Halek M. Implementing Dementia Care Mapping to develop person-centred care: results of a process evaluation within the Leben-QD II trial. J Clin Nurs 2016; 26:751-765. [DOI: 10.1111/jocn.13522] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE); Witten Germany
- Department für Pflegewissenschaft; Fakultät für Gesundheit; Universität Witten/Herdecke; Witten Germany
| | - Christine Riesner
- Department für Pflegewissenschaft; Fakultät für Gesundheit; Universität Witten/Herdecke; Witten Germany
- Referat “Grundsatzfragen Pflegewissenschaft und -pädagogik/Modellstudiengänge”; Ministerium für Gesundheit, Emanzipation, Pflege und Alter des Landes Nordrhein-Westfalen; Düsseldorf Germany
| | - Martin Nikolaus Dichter
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE); Witten Germany
- Department für Pflegewissenschaft; Fakultät für Gesundheit; Universität Witten/Herdecke; Witten Germany
| | - Olga Dortmann
- AOK Rheinland/Hamburg - Die Gesundheitskasse; Düsseldorf Germany
| | - Sabine Bartholomeyczik
- Department für Pflegewissenschaft; Fakultät für Gesundheit; Universität Witten/Herdecke; Witten Germany
| | - Margareta Halek
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE); Witten Germany
- Department für Pflegewissenschaft; Fakultät für Gesundheit; Universität Witten/Herdecke; Witten Germany
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Backhouse T, Killett A, Penhale B, Gray R. The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies. Age Ageing 2016; 45:856-863. [PMID: 27543054 DOI: 10.1093/ageing/afw136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AIM to explore the use of NPIs in care homes to manage BPSD. METHODS In-depth, ethnographic case studies were conducted in four care homes; in total, they included interviews with 40 care-home staff and 384 hours of participant observations. FINDINGS NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. CONCLUSIONS there is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.
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Affiliation(s)
- Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Bridget Penhale
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Richard Gray
- Nurse Education and Research Department, Hamad Medical Corporation, Doha, Qatar
- Office Of Nursing And Midwifery, LaTrobe University, Melbourne, Australia
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Resnick B, Kolanowski A, Van Haitsma K, Boltz M, Galik E, Bonner A, Vigne E, Holtzman L, Mulhall PM. Pilot Testing of the EIT-4-BPSD Intervention. Am J Alzheimers Dis Other Demen 2016; 31:570-579. [PMID: 27609932 PMCID: PMC10852713 DOI: 10.1177/1533317516662337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | | | | - Marie Boltz
- William F. Connell School of Nursing, Boston College, Boston, MA, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Alice Bonner
- School of Nursing, Northeastern University, Boston, MA, USA
| | - Erin Vigne
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Lauren Holtzman
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Streater A, Aguirre E, Spector A, Orrell M. Cognitive stimulation therapy for people with dementia in practice: A service evaluation. Br J Occup Ther 2016. [DOI: 10.1177/0308022616659886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Cognitive stimulation therapy is a well-recognised evidence-based cognitive psychosocial intervention for people with mild to moderate dementia. Despite increased use of the programme, little is known about its implementation in practice. Method A service evaluation of care home staff that received cognitive stimulation therapy training was conducted, and on-going support to deliver the programme in practice was provided. Outcome measures collected at baseline and 6 month follow up included sense of competence, learning transfer, dementia knowledge, and approaches to dementia. Attendance records were also collected. Results Ten out of 12 care homes attempted to deliver the cognitive stimulation therapy programme after receiving training and support. Overall, a high number of sessions were delivered. In addition, the staff members demonstrated significant improvements in positive approaches to dementia care and sense of competence. Conclusions This article reports encouraging findings of training and outreach support with demonstrated improvements in staff outcomes and successful implementation of the cognitive stimulation therapy programme. These results support the current evidence base supporting the use of cognitive stimulation therapy in routine care. This is relevant to occupational therapy as the profession plays a crucial part in the implementation of psychosocial interventions for dementia in practice.
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Affiliation(s)
- Amy Streater
- Senior Researcher, Research and Development, Goodmayes Hospital, Essex, UK
| | - Elisa Aguirre
- Clinical Research Health Psychologist, Research and Development, Goodmayes Hospital, Essex, UK
| | - Aimee Spector
- Reader in Clinical Psychology, Research Department of Clinical, Education and Health Psychology, University College London, UK
| | - Martin Orrell
- Director of the Institute of Mental Health, University of Nottingham, UK
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Hallberg IR, Cabrera E, Jolley D, Raamat K, Renom-Guiteras A, Verbeek H, Soto M, Stolt M, Karlsson S. Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care. DEMENTIA 2016; 15:931-57. [DOI: 10.1177/1471301214548520] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.
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Affiliation(s)
| | | | - David Jolley
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Maria Soto
- University of Toulouse, Toulouse, France
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Galik E, Resnick B, Lerner N, Hammersla M, Gruber-Baldini AL. Function Focused Care for Assisted Living Residents With Dementia. THE GERONTOLOGIST 2016; 55 Suppl 1:S13-26. [PMID: 26055774 DOI: 10.1093/geront/gnu173] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. DESIGN AND METHODS A cluster-randomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. RESULTS There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. IMPLICATIONS The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy.
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Affiliation(s)
- Elizabeth Galik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland.
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Nancy Lerner
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Margaret Hammersla
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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Kolanowski A, Van Haitsma K, Penrod J, Hill N, Yevchak A. "Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care. THE GERONTOLOGIST 2016; 55 Suppl 1:S50-60. [PMID: 26055781 DOI: 10.1093/geront/gnv014] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored. DESIGN AND METHODS Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC. RESULTS To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times. IMPLICATIONS To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments.
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Affiliation(s)
- Ann Kolanowski
- Elouise Ross Eberly Professor, College of Nursing, Penn State, University Park, Pennsylvania.
| | | | - Janice Penrod
- College of Nursing, Penn State, University Park, Pennsylvania
| | - Nikki Hill
- Clare M. Fagin Fellow, College of Nursing, Penn State, University Park, Pennsylvania
| | - Andrea Yevchak
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
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Strøm BS, Ytrehus S, Grov EK. Sensory stimulation for persons with dementia: a review of the literature. J Clin Nurs 2016; 25:1805-34. [PMID: 27030571 DOI: 10.1111/jocn.13169] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To provide an overview of available sensory stimulation interventions, and their effect on persons with dementia and to present theoretical and methodological characteristics of the studies included. BACKGROUND Different sensory stimulation interventions are used for persons with dementia to increase alertness, reduce agitation and improve quality of life. However, the effect of these interventions is not clear, neither are their characteristics. DESIGN A systematic search and review of the literature with description of the content and an evaluation of theoretical and methodological approaches. METHODS Systematic searches in CINAHL, PubMed (Medline), The Cochrane library and PsycINFO. Studies included have been subject to quality assessment by means of Critical Appraisal Skills Programme. RESULTS Fifty-five studies were included and thirty of these documented significant effect. The effect of the sensory stimulation interventions mainly reported on negative behaviours, except from five studies assessing quality of life and well-being. The majority of the studies had methodological limitations. The different sensory stimulation interventions were organised into eight categories: music, light therapy, acupressure/reflexology, massage/aromatherapy and doll therapy/pet therapy/toy therapy, the Sonas programme and Snoezelen. CONCLUSIONS More studies are needed to clarify appropriate substantial background for the specific interventions. However, most of the studies based their interventions on a theoretical foundation. Furthermore, more research is needed to measure the effect of sensory stimulation on communication as well as quality of life. In addition, studies are to focus on whether the effect depends on the stage of dementia. RELEVANCE TO CLINICAL PRACTICE Nurses are to be aware of sensory stimulation as a possible intervention to improve persons' quality of life.
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Affiliation(s)
- Benedicte S Strøm
- Center of Diakonia and Professional Practice, VID Specialized University, Oslo, Norway
| | - Siri Ytrehus
- Department of Nursing and Health, VID Specialized University, Oslo, Norway
| | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Lawrence V, Fossey J, Ballard C, Ferreira N, Murray J. Helping staff to implement psychosocial interventions in care homes: augmenting existing practices and meeting needs for support. Int J Geriatr Psychiatry 2016; 31:284-93. [PMID: 26192078 DOI: 10.1002/gps.4322] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/10/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To contribute to an optimised training programme for care staff that supports the implementation of evidence-based psychosocial interventions in long-term care. METHODS Qualitative study that involved focus group discussions with 119 care home staff within 16 care homes in the UK. Part of wider clinical trial aimed at developing and evaluating an effective and practical psychosocial intervention and implementation approach for people with dementia in long-term care. Inductive thematic analysis was used to identify themes and interpret the data. RESULTS The findings highlighted that successful training and support interventions must acknowledge and respond to 'whole home' issues. Three overarching themes emerged as influential: the importance of contextual factors such as staff morale, interpersonal relationships within the home, and experience and perceived value of the proposed intervention. CONCLUSIONS Priority must be given to obtain the commitment of all staff, management and relatives to the training programme and ensure that expectations regarding interaction with residents, participation in activities and the reduction of medication are shared across the care home.
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Affiliation(s)
- Vanessa Lawrence
- Institute of Psychiatry, Psychology & Neurology, King's College London, London, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Clive Ballard
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Nicola Ferreira
- Institute of Psychiatry, Psychology & Neurology, King's College London, London, UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology & Neurology, King's College London, London, UK
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Raber C, Purdin S, Hupp A, Stephenson B. Occupational therapists’ perspectives on using the remotivation process with clients experiencing dementia. Br J Occup Ther 2016. [DOI: 10.1177/0308022615615892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This qualitative study systematically examined occupational therapists’ use of a model of human occupation intervention, the Remotivation Process, for individuals with dementia. Method An international sample of therapists participated in an on-line survey and in-depth interviews, resulting in 33 respondents and eight participants, respectively. The survey gathered general information regarding therapists’ use of the Remotivation Process with persons experiencing dementia, and was used to recruit interview participants. Interviews were conducted using SKYPE or telephone, and were audio-recorded and transcribed. Descriptive statistics were derived from the survey results, and van Manen’s phenomenological approach was used to describe therapists’ experiences using the intervention. Results Use of the Remotivation Process for this population was most common among mid-career therapists, and a majority of respondents had been using the intervention less than two years. Three themes identified from the interviews were: (1) Therapist beliefs: Commitment to the Remotivation process; (2) Does it work? Evaluating success; (3) It's more than me: External factors. Conclusion Survey and interview data revealed that use of the Remotivation Process intervention for persons experiencing dementia is fairly complex yet clinically applicable. Therapists’ experiences of using the Remotivation Process underscored the importance of therapist volition and clinical reasoning in achieving desired outcomes.
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Affiliation(s)
- Christine Raber
- Professor, Master of Occupational Therapy Program, Shawnee State University, Portsmouth, OH, USA
| | - Sarah Purdin
- Occupational Therapist, Springfield Regional Medical Center, Springfield, OH, USA
| | - Ashley Hupp
- Occupational Therapist, Pebble Creek Care Center, Advanced 360 Rehabilitation, Akron, OH, USA
| | - Brian Stephenson
- Occupational Therapist, Paige Smith Therapeutics, Grayson, KY, USA
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Van Mierlo LD, Bootsma-Van der Wiel A, Meiland FJM, Van Hout HPJ, Stek ML, Dröes RM. Tailored mental health care after nursing home admission: improving transfers of people with dementia with behavioral problems. An explorative study. Aging Ment Health 2015; 19:902-11. [PMID: 25564968 DOI: 10.1080/13607863.2014.977774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In the Netherlands, many community-dwelling people with dementia and behavioral disturbances and their family caregivers receive mental health care from a community psychiatric nurse (CPN). To promote continuity of care for these persons after moving to a nursing home, a transfer intervention was developed. The aim of this explorative study was to evaluate this intervention and its implementation. METHOD A qualitative explorative study design was used. CPNs visited professional nursing home carers, people with dementia and family caregivers six weeks after moving, advised on how to manage behavioral problems of their former clients and provided support to family caregivers. Twenty-two interviews were conducted with participants exposed to the intervention (5 CPNs, 5 family and 12 nursing home carers) and with 11 stakeholders (i.e., nursing home and mental health care managers, professional caregivers) to identify facilitators and barriers to the implementation. Data were collected in 2012 and 2013. RESULTS The follow-up visit at six weeks met the need for background information of new admitted patients and helped family caregivers close off the period prior to the move. It did not meet the original purpose of providing nursing home staff with advice about problem behaviors on time: six weeks after the move was experienced as too late. CONCLUSION The transfer intervention increased the awareness of nursing home staff about personal and behavioral characteristics of residents with dementia and supported caregivers in coping with the new situation. The timing of the intervention could be improved by scheduling it immediately after the move.
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Affiliation(s)
- L D Van Mierlo
- a VU University Medical Centre , Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research , Amsterdam , The Netherlands
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Friedmann E, Galik E, Thomas SA, Hall PS, Chung SY, McCune S. Evaluation of a pet-assisted living intervention for improving functional status in assisted living residents with mild to moderate cognitive impairment: a pilot study. Am J Alzheimers Dis Other Demen 2015; 30:276-89. [PMID: 25118333 PMCID: PMC10852909 DOI: 10.1177/1533317514545477] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND In older adults with cognitive impairment (CI), decreased functional status and increased behavioral symptoms require relocation from assisted living (AL) to nursing homes. Studies support positive effects of pets on health/function. PURPOSE Evaluate the effectiveness of the Pet AL (PAL) intervention to support physical, behavioral, and emotional function in AL residents with CI. METHODS Cognitively impaired AL residents randomized to 60-90 minute sessions [PAL (n = 22) or reminiscing (n = 18)] twice/week for 12 weeks. PAL interventionist encourages residents to perform skills with the visiting dog; reminiscing interventionist encourages residents to reminisce. Monthly assessment of physical (energy expenditure, activities of daily living), emotional (depression, apathy), and behavioral (agitation) function. RESULTS In linear mixed models, physical activity depressive symptoms improved more with PAL. CONCLUSION Evidence supports that the PAL program helps preserve/enhance function of AL residents with CI. Additional study is required to evaluate the duration and predictors of effectiveness of the PAL intervention.
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Affiliation(s)
- Erika Friedmann
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sue A Thomas
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - P Sue Hall
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Seon Yoon Chung
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sandra McCune
- WALTHAM Centre for Pet Nutrition, Leicestershire, United Kingdom
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Chiu Y, Bero L, Hessol NA, Lexchin J, Harrington C. A literature review of clinical outcomes associated with antipsychotic medication use in North American nursing home residents. Health Policy 2015; 119:802-13. [PMID: 25791166 DOI: 10.1016/j.healthpol.2015.02.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 11/30/2022]
Abstract
The benefits and harms of antipsychotic medication (APM) use in nursing home residents need to be examined because, although commonly used, APMs are considered an off-label use by the Food and Drug Administration for residents with dementia and behavioral problems. The objective of this study was to provide a realist literature review, summarizing original research studies on the clinical effects of conventional and atypical APM use in nursing home residents. Searches of multiple databases identified 424 potentially relevant research articles, of which 25 met the inclusion criteria. Antipsychotic medication use in nursing home residents was found to have variable efficacy when used off-label with an increased risk of many adverse events, including mortality, hip fractures, thrombotic events, cardiovascular events and hospitalizations. Findings suggested certain APM dosing regimens (e.g. fixed-dose) and shorter duration of use might have fewer adverse events. Non-pharmacological interventions should still be considered the first-line treatment option for nursing home residents with dementia related behavioral disturbances, as more studies are needed to establish safer criteria for APM use in nursing homes residents.
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Affiliation(s)
- Yunwen Chiu
- School of Pharmacy, University of California, San Francisco, 513 Parnassus Ave., San Francisco, CA 94143, USA.
| | - Lisa Bero
- Department of Clinical Pharmacy, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA; Institute for Health Policy Studies, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA.
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 3333 California St. Suite 420, San Francisco, CA 94143, USA.
| | - Joel Lexchin
- School of Health Policy and Management, York University, 4700 Keele St., Toronto, ON, Canada M3J 1P3.
| | - Charlene Harrington
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 410, San Francisco, CA 94143, USA.
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Mellor D, McCabe M, Bird M, Davison T, MacPherson S, Hallford D, Seedy M. Staff Compliance With Protocols to Improve the Management of Behavioral and Psychological Symptoms of Dementia. J Gerontol Nurs 2015; 41:44-52. [DOI: 10.3928/00989134-20140701-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 06/03/2014] [Indexed: 12/20/2022]
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43
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Jeon YH, Govett J, Low LF, Chenoweth L, Mcneill G, Hoolahan A, Brodaty H, O’Connor D. Care planning practices for behavioural and psychological symptoms of dementia in residential aged care: A pilot of an education toolkit informed by the Aged Care Funding Instrument. Contemp Nurse 2014; 44:156-69. [DOI: 10.5172/conu.2013.44.2.156] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marx KA, Stanley IH, Van Haitsma K, Moody J, Alonzi D, Hansen BR, Gitlin LN. Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia. J Gerontol Nurs 2014; 40:26-34; quiz 36-7. [DOI: 10.3928/00989134-20140905-01] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/28/2014] [Indexed: 11/20/2022]
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McFadden G, Gillespie M. Application of reminiscence therapy for dementia in practice. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjmh.2014.3.6.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mark Gillespie
- Nursing Lecturer, School of Nursing and Midwifery, University of the West of Scotland
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Hill NL, Yevchak A, Gilmore-Bykovskyi A, Kolanowski AM. The Model of Care Partner Engagement: Use in delirium management. Geriatr Nurs 2014; 35:272-8. [DOI: 10.1016/j.gerinurse.2014.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 01/26/2023]
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A New Toolkit for Behavioral Health. J Am Med Dir Assoc 2014; 15:298-9. [DOI: 10.1016/j.jamda.2014.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 01/06/2023]
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Braun SM, Kleynen M, Bleijlevens MHC, Moser A, Beurskens AJ, Lexis MA. “Interactive surfaces” technology as a potential tool to stimulate physical activity in psychogeriatric nursing home residents. Disabil Rehabil Assist Technol 2014; 10:486-492. [DOI: 10.3109/17483107.2014.904449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sefcik JS, Kolanowski AM. A behavioral health toolkit that can support researchers and practitioners alike. Clin Nurs Res 2014; 23:115-8. [PMID: 24634362 DOI: 10.1177/1054773814528073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rice J, Humphreys C. Off-Label Use of Antipsychotic Drugs in Patients With Dementia. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2013.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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