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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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Chen KX, Pai MC, Hong WP, Wang CJ, Wang JJ. Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward. Nurs Health Sci 2024; 26:e13119. [PMID: 38626947 DOI: 10.1111/nhs.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.
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Affiliation(s)
- Ko-Xin Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Min-Chi Pai
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, Tainan City, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chi-Jane Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Bashian HM, Boyle JT, Correa S, Driver J, Madrigal C, Desroches I, Farrell M, Eiten O, Flanagan K, Shahal T, O'Malley KA. Implementation of STAR-VA for behavioral symptoms of dementia in acute care: Lessons learned. Geriatr Nurs 2024; 57:17-22. [PMID: 38452494 DOI: 10.1016/j.gerinurse.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
As the population grows, the incidence of dementia will increase. A common occurrence in people with dementia is behavioral and psychological symptoms of dementia (BPSD). BPSD can include apathy, aggression, resistance to care, and agitation. BPSD can start or worsen during an acute hospitalization, but these units are not well-equipped to handle BPSD, often relying on pharmacological interventions to address distress behaviors. One known behavioral intervention for BPSD is STAR-VA, an interdisciplinary approach to managing these behaviors. However, this intervention has not been utilized in acute care. Our team implemented STAR-VA in acute care at a Veterans Affairs hospital in the northeastern United States. Using the VA's Quality Enhancement Research Initiative (QUERI) implementation roadmap to guide our work, we first outlined the problem, completed a needs assessment with staff, and began implementation. Results from this quality improvement project demonstrated the feasibility and efficacy of STAR-VA in an acute care setting.
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Affiliation(s)
- Hannah M Bashian
- VA Boston Healthcare System, United States; Harvard Medical School, United States.
| | - Julia T Boyle
- VA Boston Healthcare System, United States; New England Geriatric Research Education and Clinical Center, United States; Harvard Medical School, United States
| | | | - Jane Driver
- VA Boston Healthcare System, United States; Harvard Medical School, United States
| | | | | | | | | | | | - Talya Shahal
- VA Boston Healthcare System, United States; Boston University Chobanian & Avedisian School of Medicine, United States; Harvard Medical School, United States
| | - Kelly A O'Malley
- VA Boston Healthcare System, United States; New England Geriatric Research Education and Clinical Center, United States; Harvard Medical School, United States
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Shi J, Jiang C. Exploring the associations between competence in dementia care and work attitudes among formal caregivers in nursing homes. J Clin Nurs 2024. [PMID: 38590040 DOI: 10.1111/jocn.17157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
AIMS Based on the two-factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations. DESIGN A cross-sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study. METHODS Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China. RESULTS The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction. CONCLUSIONS The results demonstrate that the two-factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Jiaming Shi
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China
| | - Chaoxin Jiang
- School of Social Development, East China Normal University, Shanghai, China
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Iwamoto Y, Fujino N, Furuno T, Fujimoto Y, Kamada Y. Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses. J Rural Med 2024; 19:92-104. [PMID: 38655229 PMCID: PMC11033672 DOI: 10.2185/jrm.2023-046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 04/26/2024] Open
Abstract
Objective Many patients with dementia experience sleep-related problems. However, there is a lack of clarity regarding nursing practices that can address these issues. Thus, we developed a self-assessment scale for nursing practices to improve sleep quality among patients with dementia taking sleep medication and confirmed its validity and reliability. This study aimed to test the validity and reliability of this scale for adaptability to general nurses and test its applicability. Participants and Methods The survey included basic attributes and questionnaire items related to nursing practices to improve sleep quality in patients with dementia taking sleeping pills. Data from 477 participants with no missing values in the survey items were used in the analysis. The self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills was based on a three-factor model, and confirmatory factor analysis was performed using structural equation modeling. Results Goodness-of-fit indices were satisfactory, supporting the construct validity of the scale. Cronbach's α coefficients for the total score and the three factors of the self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills exceeded 0.7. Conclusion The development of this scale can improve the quality of nursing practice for patients with dementia who take sleeping pills. Moreover, it can serve as evidence for general nurses to participate in drug treatment and can be considered as basic research for appropriate drug treatment in nursing practice.
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Affiliation(s)
- Yuichi Iwamoto
- School of Nursing, Faculty of Medicine, Oita University,
Japan
| | - Narumi Fujino
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Takaomi Furuno
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Yuji Fujimoto
- Department of Nursing, Faculty of Medicine, Saga University,
Japan
| | - Yuki Kamada
- The Japanese Red Cross Kyushu International College of
Nursing, Japan
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Rhinehart DM, Gatmaitan DL, Spivack E, Chung PC, Aronow HU, Tan ZS. Intervention to improve acute care nurses confidence and knowledge in hospital dementia care. Geriatr Nurs 2023; 54:144-147. [PMID: 37782977 DOI: 10.1016/j.gerinurse.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
PROBLEM Acute care nurses are the front line of hospital care for persons with dementia (PwD), yet many have inadequate dementia education and lack the confidence to appropriately manage PwD in the hospital setting. IMPLEMENTATION Two acute care units with high rates of PwD in a large tertiary-care hospital were provided an education intervention involving interactive case-based discussion of the challenges of inpatient dementia care. RESULTS Out of 190 nurses, 171 completed a one-hour virtual educational session, 142 completed pre/post-session confidence surveys, and 123 completed pre/post-session knowledge tests. There was a statistically significant improvement in knowledge scores from 75.8% pre-session to 88.4% post-session (p < 0.001), and pre/post-session dementia care confidence increased from 3.49 to 4.44 ( + 27.22%; p < 0.001) CONCLUSION: An interactive virtual education intervention improves acute care nurses' confidence and knowledge in managing PwD in the acute care setting and may improve hospital outcomes for this population.
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Affiliation(s)
- Deana M Rhinehart
- Jona Goldrich Center for Alzheimer's & Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
| | - Dyane L Gatmaitan
- Jona Goldrich Center for Alzheimer's & Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Erica Spivack
- Jona Goldrich Center for Alzheimer's & Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Phong Chip Chung
- Department of Quality Improvement, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Harriet U Aronow
- Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zaldy S Tan
- Jona Goldrich Center for Alzheimer's & Memory Disorders, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Huijten DCM, Bolt SR, Meesterberends E, Meijers JMM. Nurses' support needs in providing high-quality palliative care to persons with dementia in the hospital setting: A cross-sectional survey study. J Nurs Scholarsh 2023; 55:405-412. [PMID: 36218182 DOI: 10.1111/jnu.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 07/18/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since dementia is an irreversible progressive disease characterized by a decline in mental functions and overall health, a palliative care approach is recommended. Nevertheless, many persons with dementia experience burdensome hospitalizations in end-of-life care. Their quality of life during hospitalization can be improved by palliative nursing care that suits their fragile health. AIM To explore hospital nurses' perceived support needs while providing high-quality palliative care for persons with dementia and to identify differences between nurses in different ward types and at different educational levels. DESIGN Cross-sectional, multicenter survey study. METHOD Between January 2021 and April 2021, a convenience sample of Dutch hospital nurses received a web-based questionnaire on the topics of palliative caregiving, communication, collaboration, and hospital admissions. The data were analyzed using descriptive statistics. RESULTS The survey was completed by 235 nurses. The most frequently endorsed support needs were "communicating with persons with severe dementia" (58.3%), "appointing a permanent contact person in the care for persons with dementia" (53.6%), and "dealing with family disagreement in end-of-life care" (53.2%). If nurses had more time to provide care, 66.4% of them would prioritize providing personal attention. Most support needs identified by nurses were similar. CONCLUSION A heterogeneous group of nurses demonstrates overall similar support needs in providing palliative care for persons with dementia and their families in the hospital setting. CLINICAL RELEVANCE Nursing practices should implement dementia-friendly interventions to improve the quality of dementia care in the hospital.
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Affiliation(s)
| | - Sascha R Bolt
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Judith M M Meijers
- Zuyderland, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.,Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Soun S, Hunter KF, Dahlke S. Nursing Care Management of Responsive Behaviors for Persons Living With Dementia in Acute Care Settings: An Integrative Review. J Gerontol Nurs 2023; 49:19-25. [PMID: 36719660 DOI: 10.3928/00989134-20230106-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The current integrative review was performed to understand how acute care nurses manage responsive behaviors among persons living with dementia (PLWD) in acute care settings. Eight studies were included, and three themes were developed: Person-Centered Approach, Non-Person-Centered Approach, and Facilitators and Barriers to Care Approaches. Nurses expressed difficulties in caring for hospitalized PLWD due to lack of knowledge of dementia care, pressure to work more efficiently, and prioritization of acute medical concerns. Nurses frequently used nonpharmacological approaches that required less time spent with patients. Results suggest that nurses in acute care settings require further education regarding dementia and person-centered care approaches for PLWD. Nursing management can support nurses' learning needs through education and policies to improve patient outcomes. [Journal of Gerontological Nursing, 49(2), 19-25.].
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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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