An educational programme to improve acute care nurses' knowledge, attitudes and family caregiver involvement in care of people with cognitive impairment

Understanding family carer experiences and perceptions of engagement in delirium prevention and care for adults in hospital: Qualitative systematic review

AIM

To identify, describe and synthesise what is known about family carers' experiences and perspectives of engagement in delirium prevention and care for adults in hospital.

DESIGN

Systematic review and synthesis of qualitative evidence.

DATA SOURCES

Comprehensive literature search within PubMed, CINAHL, EMBASE, Scopus, Cochrane Central and PsycInfo databases to August 2022. Peer reviewed original qualitative research published in English.

METHODS

Data were extracted using Covidence systematic review software. Methodological quality was reviewed against the Critical Appraisal Skills Program (CASP) Qualitative Checklist. Thematic synthesis was used to develop analytical themes. Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) framework was applied to findings.

RESULTS

Of 3429 records identified, 29 met criteria for final inclusion. Studies included a range of settings (intensive care, medical and surgical wards) and family carer types (spouse, daughter, parent and friend). Three primary themes Shared Caregiving, Partnership and Support, Communication for Shared Understanding and three cross-cutting contextual themes Care Transitions, Family Carer Context and Hospital Context were identified. Family carers have mixed experiences of involvement in delirium care and prevention. Family carer engagement in care impacted perceptions of care quality and their own self-efficacy. Where person-centred care expectations were not met, some family carers adopted compensatory or care contingency strategies. Information sharing and timely support from hospital staff who understood the carer context supported carer involvement. Supportive physical environments and addressing power imbalances allowed greater engagement.

CONCLUSION

Family carers often wish to be involved in delirium prevention and care, but need to be recognised as individuals, listened to, informed and supported to optimise their contribution.

IMPACT

The review findings can guide health professional and decision makers to optimise family carer involvement in delirium care programs.

PROTOCOL REGISTRATION

PROSPERO [CRD42020221854].

REPORTING

ENTREQ. No Patient or Public Contribution.

Ageism in the Nursing Care of Older Adults: A Concept Analysis

Despite the high prevalence of ageism worldwide, it is still underestimated and unrecognized by many nurses. Concept clarification is required to delineate the meaning of the word "ageism" in nursing. The purpose of this concept analysis is to clearly define the concept of ageism relative to nursing discipline using the Walker and Avant method. Defining the concept of ageism will provide nurses with a better understanding of its causes and consequences. It will aid policy makers in developing policies and interventions to help decrease ageism in health care environments.

Association of Ageism With Death Anxiety, Self-Esteem, Interpersonal Reactivity, and Symbolic Immortality Among Nurses

According toterror management theory (TMT), older adults may often be a reminder of death for younger adults. Therefore, dealing with older adults may be associated with increased levels of death anxiety and decreased levels of self-esteem, interpersonal reactivity, and symbolic immortality, leading younger adults to develop ageist attitudes and behaviors in defense. However, to date, these associations have not been empirically examined, especially among nurses. Self-report questionnaires were used on a sample of 163 nurses to explore the issue of ageism among nurses from the TMT perspective. The results indicated that, after controlling for sociodemographic variables, high levels of death anxiety and low levels of self-esteem, interpersonal reactivity, and symbolic immortality were associated with increased levels of ageism among nurses. Thus, the current study uses TMT to explain ageism among nurses, and the study findings may contribute to the development of psychological interventions aimed at reducing nurses' ageism.

Radiographers' knowledge and attitudes toward dementia

INTRODUCTION

Dementia is a syndrome associated with a decline in brain function, impacting how we speak, think, feel, and behave. Misunderstanding of dementia and how it affects patients and their carers is common. There is limited research on how radiographers provide adequate care to those with dementia. Radiographers with knowledge and positive attitudes can reduce stigma and fear, improving the quality of care. This study aimed to assess radiographers' knowledge and attitudes towards dementia.

METHODS

A cohort of registered radiographers in Ireland participated in an online survey. Two pre-existing validated questionnaires: The Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitudes Scale (DAS), assessed radiographers' knowledge and attitudes towards dementia and people with dementia. Scores were compared across variables such as gender, age, grade, qualification, work setting, and the number of years qualified.

RESULTS

A total of 123 radiographers responded. Knowledge scores did not significantly differ across demographic groups (p > 0.05). Total knowledge scores ranged from 60% to 100%. Total attitude scores ranged from 50% to 100%. Participants with a BSc, MSc, and other post-graduate degrees scored higher on the attitude scale than those with a diploma qualification (p = 0.027). Those with less than 20 years' experience scored higher than those with more. Knowledge had little correlation with attitude (r = 0.0522; p = 0.5667).

CONCLUSION

Findings indicate variations in attitudes linked to age and experience, and some misconceptions can be observed across varying groups. Interventions to improve attitudes and raise awareness are needed.

IMPLICATIONS FOR PRACTICE

There is a need for further research and education on dementia care in the imaging department. We have identified areas requiring further education.

Effect of a culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in China: A quasi-experimental study

BACKGROUND

Existing educational programmes for building capacity in dementia care are developed in the Western culture; their applicability and cultural relevancy to other cultures is questionable. There is a dearth of culturally specific dementia-care educational programme for Chinese communities.

OBJECTIVES

To evaluate a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China.

DESIGN

A multi-site quasi-experimental study.

METHODS

Nursing homes were pair-matched and allocated into intervention (n = 5) and control group (n = 5). The DECENT programme was delivered face-to-face using multiple pedagogies for 60-90 min per session by a trained educator once per week over 8 weeks. The primary outcome was the sense of competence in dementia care. The secondary outcomes were dementia knowledge, attitudes towards people with dementia, person-centred care in nursing homes and the severity of behavioral and psychological symptoms of dementia of residents with dementia and staff-perceived disturbance. They were measured at baseline (T0), immediately post-intervention (T1) and 3 months after the intervention (T2).

RESULTS

The intervention group has significantly greater improvement than control group in sense of competence both at T1 (B = 5.24, p < .001) and T2 (B = 4.43, p = .013). Regarding dementia knowledge and person-centred care, intervention group only showed greater improvement than control group at T1 (B = 3.18, p = .001; B = 5.75, p = .018, respectively), but not at T2 (p = .089 and .104, respectively). Group differences in attitudes and severity of behavioral and psychological symptoms of dementia and staff-perceived disturbance were not significant at both time points.

CONCLUSIONS

The DECENT programme is applicable and beneficial in improving staff's sense of competence in dementia care in Chinese communities, but reinforcement strategies are needed to sustain the effect for maintaining the learnt knowledge and changed person-centred care practice.

An analysis of nursing and medical students' attitudes towards and knowledge of Alzheimer's Disease (AD)

OBJECTIVES

Little is known about how Jordanian undergraduate medical and nursing students perceive Alzheimer's disease (AD) care. This study aimed to investigate nursing and medical students' AD knowledge, attitudes, and associated factors with their knowledge to inform reforms to multidisciplinary AD education undergraduate programs in Jordan.

METHODS

Cross-sectional research was carried out using a self-administered questionnaire. Students' knowledge was measured using the Alzheimer's Disease Knowledge Scale (ADKS) and attitudes were measured using the Dementia Care Attitude Scale (DCAS). The survey was completed by 423 nursing and medical students.

RESULTS

The overall mean score on the ADKS for students' AD knowledge was 17.50 (SD=3.08) out of 30 and the DCAS for students' attitudes toward AD was 26.76 (SD=6.19) out of 40.

CONCLUSIONS

Medical students had a higher level of AD knowledge and a lower level of positive attitude than nursing students (p<0.05).

Using an E-learning activity to enhance student nurses' understanding of cognitive impairment

BACKGROUND

Nurses often lack the knowledge and expertise to work with older people with cognitive impairment, which includes dementia, delirium and depression. This is due in part to deficits in their basic nursing education related to older people and managing the care needs of people with cognitive impairment. We developed an e-learning activity to facilitate student nurses' knowledge of cognitive impairment.

OBJECTIVES

To test if the e-learning activity could improve student nurses' knowledge of cognitive impairment and whether they would find the style of learning beneficial.

DESIGN

A quasi-experimental pre-post-test design was used to test if the cognitive impairment e-learning activity could improve student nurses' knowledge about assessing and managing the needs of older people who are experiencing cognitive impairment. A 12-item true/false quiz was completed by participants.

SETTINGS

One large Western Canadian university.

PARTICIPANTS

Second year nursing students in the four-year baccalaureate degree program, second year nursing students in the bilingual four-year baccalaureate degree program, and first year nursing students in the two-year after-degree nursing program were invited to participate. Data from 166 students were included in the analysis (n = 166).

RESULTS

Based on the results of a paired t-test (p < 0.001 and an average score increase of 1.12 out of nine), we conclude that students' knowledge about cognitive impairment in older people increased following the e-learning activity. Students also offered qualitative feedback that identified the activity as both helpful and as an enjoyable way to learn and provided suggestions for improvement.

CONCLUSIONS

This e-learning activity was effective in helping students learn about how to work with older people experiencing cognitive impairment. This mode of learning might be useful for other difficult-to-teach content areas.

Family participation in the care of older hospitalised patients: Patients', family caregivers' and nurses' preferences on family caregivers performing care tasks

BACKGROUND

It is estimated that there are 101 million older care-dependent people (60+). This group is expected to double by 2050 due to the ageing of the world's population and the rise in life expectancy. Although people tend to live longer, there is little evidence that they live their later years in better health. In the future, this might put even more stress on an already overburdened acute care health system. Hospitals therefore need to focus on preventive measures to avoid rehospitalisation of older people. Family participation could be part of the solution.

OBJECTIVES

This study aimed to gain insight into the preferences of family caregivers, patients and nurses towards family caregivers taking up care tasks during hospitalisation, after receiving education.

METHODS

Data were collected using a cross-sectional survey of nursing staff, family caregivers and older patients in nine wards for older people within three hospitals. Data collection ran from October 2019 till March 2020 using a questionnaire of 25 care tasks with three answer options (perform alone, together with a nurse, do not perform). A consecutive sample of 330 patients and 133 family caregivers (81 dyads could be formed) next to a convenience sample of 67 nurses was obtained.

RESULTS

Patients (65%) are more prepared to let their family caregiver perform tasks alone than family caregivers (59%) and nurses (52%). Only few patients (3.8%) and family caregivers (13%) prefer the family caregiver to perform a task together with a nurse. The latter answer thus rather dichotomously, while nurses answer more dynamically over the three answer options. Of all family caregivers, 50% indicate willingness and ability to perform tasks on a regular basis. Significant correlations indicate that patients, family caregivers and nurses agree on which care tasks would be more preferable to be performed by a family caregiver. Looking at the dyads, preferences of a patient are not suspected to be more similar with his family caregiver than with a random family caregiver.

CONCLUSIONS

Patients, FCGs and nurses indicate to be prepared to engage in family participation. Further research needs to concentrate on the different attitudes and perceptions towards performing care tasks through qualitative research and how a successful implementation can be set up.

IMPLICATIONS FOR PRACTICE

Our study indicates that implementation of family participation in physical care within the hospital could be viable.

TRIAL REGISTRATION

The study protocol was approved by the ethical committee of the Ghent University Hospital (B670201940430).

Impact of settings and culture on nurses' knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review

BACKGROUND

Well-trained nurses are required to support dementia patients; however, the quality of the provided dementia nursing care can be impacted by nurses' knowledge, attitudes and perceptions towards people with dementia.

AIM

To obtain an overview of the current nursing practice towards people with dementia around the world.

DESIGN

An integrated literature review was conducted based on Whittemore and Knafl's method.

RESULTS

A total of 72 articles met the inclusion criteria. Three main themes were identified: (1) nurses' knowledge, attitudes and perceptions towards dementia; (2) nursing experience of caring for people with dementia in acute and community care settings; and (3) dementia nursing care across health regions.

CONCLUSION

Nurses play the role of facilitators in the efficient delivery of quality care for dementia patients. A variety of attitudes and perceptions towards people with dementia were found to be triggered by the severity of dementia, religion, ethnicity and gender.

IMPLICATIONS FOR PRACTICE

Healthcare organisations and educational settings need to coordinate and function together to improve nurses' knowledge and encourage positive attitudes towards people with dementia.

Experiential Learning Through a Dementia Simulation

Health care providers do not always possess the knowledge and skills necessary to optimally manage behavioral symptoms in patients with Alzheimer's disease (AD). The purpose of the current project was to evaluate the use of a simulated virtual reality AD experience on nursing staff sensitivity, awareness, and perceptions of caring for patients with AD. A quasi-experimental design was used. The Long Tour Survey and Approaches to Dementia Questionnaire were administered pre and post simulation and the Perceptions of Caring surveys were administered 3 to 6 weeks post-intervention. Total scores, although not statistically significant, revealed a slight change in the total score and hope subscale, representing more optimism toward people with dementia. The virtual reality AD simulation was a beneficial experience but unable to demonstrate a real change for the majority of participants. [Journal of Gerontological Nursing, 47(11), 39-47.].

Nursing students' knowledge about behavioral and biopsychosocial domains of dementia: A cross-sectional survey study

PURPOSE

The purpose of this study was to investigate nursing students' knowledge about behavioral and biopsychosocial domains of dementia and the factors associated with nurses' knowledge.

METHODS

A cross-sectional, predictive study was conducted using a web-based survey. A convenience sample of 356 nursing students from a large public university completed an anonymous online survey comprising 25 Likert-scale items. Univariate analyses (two-sample t tests and one-way ANOVA) were used for model selection at the cutoff level of 0.20 in producing a multivariate linear regression model. Multiple linear regression analysis was conducted to predict a given student's score using the demographic variables selected. The regression model was used to infer pairwise demographic group comparisons while controlling for other demographic variables.

FINDINGS

The mean score of students' knowledge about dementia was 24.53 ± 7.81 out of 48 (52%). Students scored the lowest scores on knowledge about communication with and behaviors of people with dementia and the risk factors and health promotion areas in dementia care. Students' gender, current grade point average (GPA), family history with dementia, and education level had statistically significant effects on the mean total dementia knowledge score and respective subscales (p < 0.05). The model predicting the total dementia knowledge score explained the most variation among all five models conducted (29%).

CONCLUSIONS

The findings indicate that nursing curricula should introduce educational programs related to all aspects of dementia knowledge earlier on.

IMPLICATIONS FOR NURSING PRACTICE

The survey findings suggest raising standards of dementia knowledge and implementing educational strategies in clinical settings that adequately prepare nurses to interact with or care for people with dementia.

Effects of case-based confusion assessment methods for intensive care unit training on delirium knowledge and delirium assessment accuracy of intensive care units: A quasi-experimental study

BACKGROUND

Delirium evaluation is important because the development of delirium in critically ill patients negatively affects their progress and prognosis. Although delirium assessment tools have been developed, nurses have insufficient experience using these tools in clinical practice.

OBJECTIVES

This study examined the effects of case-based confusion assessment methods for intensive care unit education on delirium knowledge and assessment accuracy for intensive care nurses.

DESIGN

This study adopted a pre- and post-test non-equivalent control group design.

SETTINGS AND PARTICIPANTS

The study participants were 122 general nurses (61 participants each in the experimental and control groups) working in the intensive care unit of one university hospital in South Korea.

METHODS

Case-based confusion assessment methods for intensive care unit education comprised lectures on delirium and confusion assessment methods for intensive care unit tools and delirium assessment education using standardized patients. The experimental group received 80-min case-based confusion assessment methods for intensive care unit training, whereas the control group received no intervention.

RESULTS

Differences in the degree of pre- and post-knowledge in subcategories between the experimental and control groups were the cause, symptom, and management. The delirium assessment accuracy score of the experimental group changed from 2.89 ± 1.61 points before training to 8.11 ± 1.23 points after training, whereas that of the control group changed from 2.92 ± 1.94 points before training to 3.05 ± 2.99 points after training (Z = -9.668, p < .001).

CONCLUSIONS

The case-based confusion assessment methods for intensive care unit educational program developed in this study is effective for improving delirium knowledge and delirium assessment accuracy in intensive care nurses. Based on the study results, various cases can be developed for the education of intensive care nurses.

Training Program for Care Professionals in Nursing Homes: Effectiveness and Feasibility

The aim of the current study was to analyze the effectiveness and feasibility of a training program for care professionals at two nursing homes, investigating the impact on their beliefs, attitudes, and knowledge regarding aging. Twenty-three formal caregivers at a private nursing home and 10 formal caregivers at a philanthropic nursing home participated in the training program, which consisted of five weekly meetings, each lasting 1.5 hours. Characterization of the sample was performed and effectiveness and feasibility of the intervention were analyzed. The training program improved participants' knowledge about older adults; however, their attitudes and beliefs regarding old age were not affected. Results also indicated that the intervention program was feasible at both nursing homes. The positive results of the study underscore the importance of training and continuing education of professionals who work with older adults, especially staff at nursing homes. [Journal of Gerontological Nursing, 46(11), 37-47.].

Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units

Introduction

Delirium is a fluctuating cognitive disorder that occurs in admitted patients, especially in patients who are in intensive care units. Nurses due to persistent contact with patients and direct observation of their mental changes play an essential role in delirium evaluation. Early detection of delirium, identification of risk factors, and its prevention methods are critical to reducing complications, mortality, and treatment costs. This study aimed to determine the perception and the practices of nurses in intensive care units to assess delirium and its barriers.

Study design

A cross-sectional study.

Materials and methods

All nurses working in the intensive care unit (neurology, trauma, surgery, general, and heart) of educational hospitals in Kerman, Iran, were the study population. The data gathering tool was a questionnaire consisting of four sections: demographic information, nurses’ perception, practices, and perceived barriers in delirium assessment.

Results

The total score of nurses’ perception in delirium assessment was 19.47 ± 3.36, which was higher than the medium score of the questionnaire (estimated score = 16). In all, 45.5% of nurses reported having delirium treatment protocol in their units, and 12.1% of the nurses considered delirium as a priority of evaluating the patient's condition. The most important barrier to delirium assessment was the difficulty of assessing delirium in intubated patients. There was no association between nurses’ perception and practices (p value > 0.05).

Conclusion

Designing and implementing educational programs for improving nurses’ practices in this field is necessary.

Clinical significance

Healthcare providers, especially nurses, should be aware of the delirium assessment of the ICU patients to provide better care.

How to cite this article

Biyabanaki F, Arab M, Dehghan M. Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units. Indian J Crit Care Med 2020;24(10):955–959.

Facilitators for person-centred care of inpatients with dementia: A meta-synthesis of registered nurses’ experiences

Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent in the hospital setting. Moreover, whilst registered nurses often wish to improve the in-hospital care of patients with dementia, there is evidence of experienced barriers. This study aimed to describe registered nurses’ experiences of facilitators for the delivery of person-centred care to inpatients with dementia. By way of systematic searches in the databases PubMed, CINAHL and PsycINFO, qualitative studies (n = 19) reporting registered nurses experience of caring for inpatients with dementia were identified. Relevant content was analysed using a method of thematic synthesis. Three main categories and nine subcategories were presented, internal facilitators (experience and knowledge; values and beliefs; professional identity; empathy), external facilitators (physical environment; organisational culture and structure) and facilitating actions (forming a holistic picture; establishing trust; adjusting routines and interventions). While facilitators did exist in the hospital setting, the findings indicate that care received by inpatients with dementia is dependent on individual registered nurses knowledge, personal aptitude and ability to compensate for structural flaws. In order to minimise arbitrary outcomes of care for patients with dementia, consistent organisational support in the form of educational interventions and allocation of resources is crucial.

Nurses' knowledge and attitudes about dementia care: Systematic literature review

PURPOSE

To explore nurse's knowledge and attitudes toward the care of people with dementia.

DESIGN AND METHODS

A systematic review informed by the PRISMA-P (preferred reporting items for systematic reviews and meta-analyses protocols) guidelines in four databases (CINAHL, PsyINFO, Pubmed, Cohrane, EMBASE) using keywords "attitudes," "behaviors," "dementia," "knowledge," and "nurses." Predetermined inclusion criteria were selected. The review was conducted between January 1 and December 30, 2017.

FINDINGS

Sixteen quantitative studies, one qualitative, and two mixed methods studies were included. Nurses lack knowledge, communication skills, management strategies, and confidence in the provision of dementia care. Interventional studies suggested that knowledge and attitudes improved after training programs were implemented.

PRACTICE IMPLICATION

This review contributes to care advancement and practice development through the reinforcement of organizational support and educational opportunities for nurses.

Delirium Stigma Among Healthcare Staff

Older people with delirium occupy more than one third of acute medical beds and require increased medical attention, as care at present is suboptimal. In addition, since delirium is undetected, it should form a target for teaching in wards. Moreover, as people with delirium are largely dependent on daily interactions and care by inpatients professional staff, it is important to address stigmatisation of these vulnerable patients. This is especially important as previous studies have shown that negative staff attitudes towards these patients undermine good care. This single center cross-sectional study was designed to determine the extent of institutional stigma among health professionals involved in the care of people with delirium. For this, professional staff working on medical wards and in communities were approached to fill in a questionnaire containing the adapted Delirium Stigma Scale and the EuroQol five dimensions (EQ-5D-5L) questionnaire. Additional demographic information concerning their education and professional and personal experience with delirium was also collected. The characteristics associated with stigma were determined from the sample. The findings of our study provide an insight into the high level of stigmatisation of delirium patients among professionals (mean 11.66/18 points). This was not related to professionals' own experiences of delirium, their educational and professional backgrounds, or them having received formal delirium education. However, working closely with people with delirium seems to have a positive impact on the de-stigmatisation of this population among health professionals. Our findings that attitudes are not influenced by formal delirium teaching need to be incorporated into the design of interprofessional educational interventions. Accordingly, we advocate more direct patient-oriented and care delivered teaching interventions.

Educational benefits for nurses and nursing students of the dementia supporter training program in Japan

In Japan, which is thought to be a rapidly growing super-aging society, a national campaign named “the Dementia Supporter Caravan” has been deployed. The aim of this study was to assess the educational benefits of the dementia supporter training program for nurses and nursing students. We conducted dementia supporter training, and measured knowledge and attitudes regarding people with dementia as educational benefits pre- and post-training. Data sets of 134 nursing students and 63 nurses were analyzed. The results indicated that the two groups gained knowledge, understanding, and the confidence to care for people with dementia after attending the dementia supporter training program. Moreover, the two groups derived different benefits from the program. Nursing students gained substantial knowledge and learnt the importance of early detection and treatment, to levels similar to those of nurses prior to training. The training program reduced the difficulties of nurses to interact with and care for people with dementia. We can conclude that the dementia supporter training program has considerable educational benefits for nurses and nursing students.

Critical Contextual Elements in Facilitating and Achieving Success with a Person-Centred Care Intervention to Support Antipsychotic Deprescribing for Older People in Long-Term Care

Antipsychotic and other tranquilising medicines are prescribed to help care staff manages behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study was undertaken to address this issue with 139 people 60 years and over with behaviours of concern for staff living in 24 care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, dementia management education for visiting general practitioners (GP) and pharmacists, use of an individualised deprescribing protocol for residents, and awareness-raising for the resident's family. The HALT champions completed open-ended questionnaires and semistructured interviews to identify the contextual elements they considered most critical to facilitating, educating care staff, and achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in the absence of antipsychotic medicines; the champions considered that this required strong managerial support, champion empowerment to lead change, reeducation of care staff, and the cooperation of families and GPs.