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Welch DL. Improving Safety and Satisfaction in the Safety Monitoring Unit. J Neurosci Nurs 2024:01376517-990000000-00091. [PMID: 38884457 DOI: 10.1097/jnn.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
ABSTRACT BACKGROUND: The safety monitoring unit (SMU) is a 4-bed unit designated for patients who require continual observation. Most experience some form of dementia, and agitation and aggression are not uncommon. When deescalation techniques do not work, request for help may be necessary. Referred to as Security Alert: Behavioral Assist (SABA), this system-wide message requires response from designated personnel. An increase in SABA events prompted this quality improvement project. METHODS: A survey sent to all unit staff members identified a need for specialized training on the care and management of SMU patients. Education on dementia care and deescalation techniques was provided by a certified dementia specialist and a psychiatry advanced practice registered nurse. Staff expressed a need for defined SMU admission criteria and the establishment of patient care guidelines. Patient care guidelines were developed. A structured schedule was implemented, and dedicated staff were hired to provide familiarity for patients. RESULTS: A postproject survey indicated a nonsignificant increase in staff satisfaction. Security Alert: Behavioral Assist events in the SMU decreased from an average of 3.6 to 1.75 episodes per month. CONCLUSION: Caring for SMU patients creates unique challenges to staff. Staff confidence and satisfaction were higher after implementing new SABA policies. This project could be replicated on similar units with ongoing leadership support and staff education.
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Tol S, de Haan GA, Postuma EMJL, Jansen JL, Heutink J. Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions. Neuropsychol Rev 2024:10.1007/s11065-024-09636-4. [PMID: 38639880 DOI: 10.1007/s11065-024-09636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.
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Affiliation(s)
- S Tol
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - G A de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
| | - E M J L Postuma
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J L Jansen
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
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Prendergast LM, Davies CT. 'A lot of people think it's just a Mickey Mouse role': Role ambiguity among dementia support workers within secondary care and community hospital settings. DEMENTIA 2024; 23:191-209. [PMID: 38100306 PMCID: PMC10807186 DOI: 10.1177/14713012231220461] [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] [Indexed: 12/17/2023]
Abstract
Purpose: Dementia support workers (DSWs) are employed to improve the hospital care for patients living with dementia. An evaluation sought to understand the perspectives and experiences of DSWs and related healthcare practitioners within one health board, to identify any role ambiguity and inform future role development.Design/methodology/approach: Framework analysis was used to synthesise data from semi-structured interviews and focus groups with dementia support workers, and a wider group of related healthcare practitioners.Findings: Thirteen semi-structured interviews were conducted with DSWs. Two focus groups were held with DSWs (n = 2 and 4) and two with associated healthcare practitioners (n = 3 and 5). Participants described inconsistencies in the understanding and delivery of the DSW role. Role ambiguity was identified as a key theme.Originality/value: This paper offers insight into challenges experienced by DSWs and addresses factors that could help improve and support the DSW role, and potentially the experience of other staff, and patients/people living with dementia. Overall, this evaluation highlights both the value of the DSW role in supporting the needs of patients/people living with dementia and the potential for person-centred activities to be used as therapeutic interventions.
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Adlbrecht L, Karrer M, Helfenberger N, Ziegler E, Zeller A. Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation. BMC Geriatr 2024; 24:29. [PMID: 38184542 PMCID: PMC10771665 DOI: 10.1186/s12877-023-04612-8] [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: 06/06/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital. METHODS We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz's content-structuring analysis scheme. RESULTS We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups' motivation and competence of managing change facilitated the implementation. CONCLUSIONS The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.
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Affiliation(s)
- Laura Adlbrecht
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland.
| | - Melanie Karrer
- University of Applied Sciences for Health Professions Upper Austria, Semmelweisstraße 34/D, Linz, 4020, Austria
| | - Nicole Helfenberger
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Eva Ziegler
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
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Chenoweth L, Burley C, Cook J, Cheah SL, Reyes P, Maiden G, McGuire J, McCade D, Brodaty H, Sukhapure M, Harrison F, Williams A. Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice. J Alzheimers Dis 2024; 98:619-628. [PMID: 38427481 DOI: 10.3233/jad-231056] [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] [Indexed: 03/03/2024]
Abstract
Background Person-centered care is considered beneficial for persons with dementia. Objective To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Methods Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Results Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). Conclusions When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Claire Burley
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Jacquelene Cook
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
- Department of Aged Health, Chronic Care and Rehabilitation, Concord Hospital, Sydney, Australia
| | - Seong-Leang Cheah
- Research Unit, Justice Health and Forensic Mental Health Network, AGSM (G27), UNSW, Sydney, Australia
| | - Patricia Reyes
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
- Discipline of Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Genevieve Maiden
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Jane McGuire
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Donna McCade
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Mayouri Sukhapure
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, NSW, Penrith, Australia
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von der Lühe V, Roos M, Löbberding M, Scholten N, Müller W, Hellmich M, Simic D, Köpke S, Dichter MN. Expanded nursing roles to promote person-centred care for people with cognitive impairment in acute care (ENROLE-acute): study protocol for a controlled clinical trial, process and economic evaluation. BMC Geriatr 2023; 23:858. [PMID: 38097987 PMCID: PMC10722805 DOI: 10.1186/s12877-023-04560-3] [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: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND For people with cognitive impairment, hospitalisation is challenging and associated with adverse events as well as negative outcomes resulting in a prolonged hospital stay. Person-centred care can improve the quality of care and the experience of people with cognitive impairment during hospitalisation. However, current care processes in German hospitals are rarely person-centred. To enable successful implementation of person-centred care on hospital wards, change agents within the interprofessional team are key. The aim of this study is to test the feasibility and initial effects of a newly developed complex person-centred care intervention for people with cognitive impairment provided by expanded practice nurses in acute care. METHODS We will conduct an exploratory non-randomised controlled clinical trial with accompanying process and cost evaluation with three intervention and three control wards at one university hospital. The person-centred care intervention consists of 14 components reflecting the activities of expanded practice nurses within the interprofessional team on the intervention wards. The intervention will be implemented over a six-month period and compared with optimised care on the control wards. We will include people aged 65 years and older with existing cognitive impairment and/or at risk of delirium. The estimated sample size is 720 participants. The primary outcome is length of hospital stay. Secondary outcomes include prevalence of delirium, prevalence of agitation, sleep quality, and person-centred care. We will collect patient level data at six time points (t1 admission, t2 day 3, t3 day 7, t4 day 14, t5 discharge, t6 30 days after discharge). For secondary outcomes at staff level, we will collect data before and after the intervention period. The process evaluation will examine degree and quality of implementation, mechanisms of change, and the context of the complex intervention. The economic evaluation will focus on costs from the hospital's perspective. DISCUSSION The ENROLE-acute study will provide insights into the effectiveness and underlying processes of a person-centred care intervention for people with cognitive impairment provided by expanded practice nurses on acute hospitals wards. Results may contribute to intervention refinement and evidence-based decision making. TRIAL REGISTRATION Current controlled trials: ISRCTN81391868. Date of registration: 12/06/2023. URL: https://doi.org/10.1186/ISRCTN81391868.
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Affiliation(s)
- Verena von der Lühe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Marcelina Roos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany.
| | - Mareike Löbberding
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Eupener Straße 129, Cologne, Germany
| | - Wiebke Müller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Martin Hellmich
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Robert-Koch-Straße 10, Cologne, Germany
| | - Dusan Simic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, Cologne, Germany
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
| | - Martin N Dichter
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Nursing Science, Gleueler Straße 176-178, Cologne, Germany
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Yong A, Zhao Y, Xu H, Liu Q, Huang C. Effects of specialized nursing intervention based on quantitative assessment strategy on psychological state and quality of life of patients with senile dementia. Acta Neurol Belg 2023; 123:2213-2220. [PMID: 36991296 DOI: 10.1007/s13760-023-02247-5] [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: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To explore the effects of specialized nursing intervention based on quantitative evaluation strategy on the psychological state and quality of life of senile dementia patients. METHODS 92 senile dementia patients were divided into the control and intervention groups (n = 46 each). Control group was given routine nursing intervention, while intervention group was given specialized nursing intervention based on the quantitative evaluation strategy. Patients' self-care ability, cognitive function, nursing compliance, psychological state, quality of life, and patient satisfaction indexes were measured. RESULTS After nursing interventions, the self-care ability (71.73 ± 4.31 vs 63.82 ± 3.97 points) and cognitive functions such as orientation (7.96 ± 1.02 vs 6.53 ± 1.15), memory (2.16 ± 0.39 vs 1.69 ± 0.31), visual-spatial copying (3.78 ± 0.53 vs 3.02 ± 0.65), language skills (7.49 ± 1.26 vs 6.05 ± 1.28), and recall ability (2.13 ± 0.26 vs 1.75 ± 0.28) were significantly improved in the intervention group compared to the control group (P ˂ 0.05). The patient's compliance in the intervention group (95.65%) was prominently higher than the control group (80.43%) (P < 0.05). Notably, patient's psychological state (anxiety and depression) in the intervention group (47.42 ± 3.12 vs 51.39 ± 3.16, 48.52 ± 2.51 vs 52.83 ± 2.49) was better than the control group (P < 0.05). Furthermore, the quality of life was significantly improved in the intervention group (88.11 ± 1.11 vs 71.52 ± 1.24) compared to the control group (P < 0.05). Also, patients' satisfaction with nursing services in the intervention group (97.83%) was higher than the control group (78.26%) (P < 0.05). CONCLUSIONS Specialized nursing intervention based on quantitative evaluation strategy can effectively improve patients' self-care ability, and cognitive function, reduce anxiety and depression and enhance the quality of life, which is worthy of clinical promotion and application.
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Affiliation(s)
- Angel Yong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Ying Zhao
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai'e Xu
- Department of Clinical Nutrition, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Liu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chuanying Huang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Gulou District, Nanjing, 210029, China.
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Sutton E, Armstrong N, Locock L, Conroy S, Tarrant C. Visual identifiers for people with dementia in hospitals: a qualitative study to unravel mechanisms of action for improving quality of care. BMJ Qual Saf 2023; 32:600-607. [PMID: 37230759 PMCID: PMC10511993 DOI: 10.1136/bmjqs-2022-015162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Hospitalised people with dementia (PwD) experience worse care and more patient safety incidents than non-dementia patients. Visual identifiers are commonly used to identify patients who have a diagnosis of dementia, with the aim of promoting more personalised care. However, little is known about how they work in practice, nor about the potential unintended consequences that might arise from their use. We aim to identify the mechanisms through which visual identifiers could support good care for PwD, how and why their use may have negative consequences and the conditions for their effective use. METHODS We conducted interviews with 21 dementia leads and healthcare professionals, 19 carers and two PwD, and produced case studies of visual identification systems in four UK acute hospital trusts between 2019 and 2021. Analysis drew on the concept of classification to identify and explore mechanisms of action. RESULTS We identified four mechanisms through which visual identifiers could help towards providing good care for PwD: enabling coordination of care at organisational level; signalling eligibility for dementia-specific interventions; informing prioritisation of resources on wards; and acting as a quick reference cue for staff. But identifier effectiveness could be undermined by: lack of standardisation and consistency; a lack of closely coupled information about individual needs; and stigma associated with a dementia diagnosis. Identifier effectiveness was dependent on their implementation being supported through staff training, resources directed and efforts to develop a supportive culture for caring for this patient group. CONCLUSION Our research highlights the potential mechanisms of action of visual identifiers and their possible negative consequences. Optimising the use of identifiers requires consensus on the rules of classification and the symbols used, and closely coupled patient information. Organisations need to provide support, offer the right resources and training and engage meaningfully with carers and patients about the use of identifiers.
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Affiliation(s)
| | | | - Louise Locock
- HSRU, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Van Graas R, Gobbens RJ. Learning and Developing Together for Improving the Quality of Care in a Nursing Home, Is Appreciative Inquiry the Key? Healthcare (Basel) 2023; 11:1840. [PMID: 37444674 PMCID: PMC10340465 DOI: 10.3390/healthcare11131840] [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: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
To investigate the impact of Appreciative Inquiry (AI) on learning and developing together for improving the quality of care in a nursing home, and to explore experiences following the four phases of the AI cycle, an AI was performed as part of participative action research. Interviews, group discussions, creative methods of storytelling, and reflections were used in the AI sessions. Staff members were interviewed to evaluate the AI process. All of the interviews were recorded and transcribed. Data were analyzed thematically using Maxqda and were discussed by the interviewers until consensus was reached. The sessions resulted in ten action proposals to improve healthcare. One proposal was worked out in agreements on cooperation. The evaluation revealed that the sessions have given a boost to the team spirit, and involvement at the location leading to more cooperation and communication during the shifts. The evaluation indicated that it is important to convert the action plans of the sessions into actions, which are then evaluated. AI was advised as a way of learning where everyone is involved, and mutual agreements are made. This study has shown that AI can be a valuable way to support learning and development to promote the quality of care in a nursing home.
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Affiliation(s)
- Regula Van Graas
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
| | - Robbert J. Gobbens
- Faculty of Health, Sports, and Well-Being, Inholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
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Hunter S, Callisaya M, Lawler K. Physiotherapy students' experiences of working with people with dementia during their clinical placements: a qualitative study. Physiother Theory Pract 2023; 39:794-802. [PMID: 35042447 DOI: 10.1080/09593985.2022.2028324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To explore the experiences of physiotherapy students on working with people with dementia during their clinical placements. METHODS Qualitative study using a Web-based survey of students in a 2-year entry-level Masters of Physical Therapy (MPT) program. Students were asked to reflect on their experiences during clinical placements within the MPT program. Qualitative content analysis was used to analyze the survey responses. RESULTS A total of 55 students (93%) completed the survey. Two overarching themes were mastery and inequity. Mastery described dementia care physiotherapy as a complex and potentially rewarding area of practice, requiring education and development throughout the professional continuum from student to expert. Inequity captured the barriers people with dementia experience to receiving excellent physiotherapy care. Six categories supported the themes: 1) physiotherapist characteristics for a successful therapeutic relationship; 2) communication strategies; 3) best practice physiotherapy skills and knowledge; 4) education strategies; 5) desire to work with people living with dementia; and 6) equity. CONCLUSIONS The study found physiotherapy students' experiences were informed by the preceptors' approach to delivery of care for people living with dementia. The students also articulated areas they wish they had known before placement and provided suggestions for teaching development in this area.
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Affiliation(s)
- Susan Hunter
- School of Physical Therapy, Elborn College, University of Western Ontario, London, ON, Canada
| | - Michele Callisaya
- Peninsula Clinical School, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
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García-Sanjuán S, Esteve-Ríos A, Fernández-Alcántara M, Valero-Soriano M. Experience of Operating Room Health Care Providers in the Management of Patients With Dementia. Res Gerontol Nurs 2023; 16:125-133. [PMID: 36881009 DOI: 10.3928/19404921-20230301-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The management of hospitalized patients with dementia is more complicated compared to patients without dementia, specifically in the surgery ward. The aim of the current study was to explore the experiences of operating room health care providers in the management of patients with dementia. A descriptive qualitative study was designed. Twenty semi-structured interviews were conducted with surgical professionals. Content analysis was performed. Four main themes emerged: Communication Issues, Experience-Based Protocol, Emotions, and Perceived Needs. Health care providers in a surgical ward face numerous challenges when attending to patients with dementia and tend to use strategies based on their own experience due to lack of specific action protocols. Therefore, specific training of the surgical team and protocols are needed to ensure quality care. [Research in Gerontological Nursing, xx(x), xx-xx.].
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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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13
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Ferreira AR, Gonçalves-Pinho M, Simões MR, Freitas A, Fernandes L. Dementia-related agitation: a 6-year nationwide characterization and analysis of hospitalization outcomes. Aging Ment Health 2023; 27:380-388. [PMID: 35466829 DOI: 10.1080/13607863.2022.2065663] [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 characterize all hospitalizations held in mainland Portugal (2010-2015) with dementia-related agitation based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding, and to investigate whether there is a relationship between agitation and hospitalization outcomes. METHODS A retrospective observational study was conducted using an administrative dataset containing data from all mainland Portuguese public hospitals. Only hospitalization episodes for patients aged over 65 years who have received a dementia diagnosis ascertained by an ICD-9-CM code of dementia with behavioral disturbance (294.11 and 294.21) and dementia without behavioral disturbance (294.10 and 294.20) were selected. Episodes were further grouped according to the presence of an agitation code. For each episode, demographic data and hospitalization outcomes, including length of stay (LoS), in-hospital mortality, discharge destination and all-cause hospital readmissions, were sourced from the dataset. Comparative analyses were performed and multivariable logistic methods were used to estimate the adjusted associations between agitation (exposure) and outcomes. RESULTS Overall, 53,156 episodes were selected, of which 6,586 had an agitation code. These were mostly related to male, younger inpatients (mean 81.19 vs. 83.29 years, p < 0.001), had a higher comorbidity burden, stayed longer at the hospital (median 9.00 vs. 8.00 days, p < 0.001) and frequently ended being transferred to another facility with inpatient care. Agitation was shown to independently increase LoS (aOR = 1.385; 95%CI:1.314-1.461), but not the risk of a fatal outcome (aOR = 0.648; 95%CI:0.600-0.700). CONCLUSION These results support the importance of detecting and managing agitation early on admission, since its prompt management may prevent lengthy disruptive hospitalizations.
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Affiliation(s)
- Ana Rita Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Gonçalves-Pinho
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Mário R Simões
- University of Coimbra, CINEICC, PsyAssessmentLab, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Alberto Freitas
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.,Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal
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14
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Sinvani L, Strunk A, Ardito S, Gordon S, Liu Y, Schantz E, Arroon A, Ilyas A, Gromova V, Polokowski A, Levin J, Makhnevich A, D’Angelo S, Boltz M. Reducing Behavioral and Psychological Symptoms of Dementia in Acutely Ill Patients via Patient Engagement Specialists: A Pilot Feasibility Study. Gerontol Geriatr Med 2023; 9:23337214231192162. [PMID: 37601321 PMCID: PMC10439723 DOI: 10.1177/23337214231192162] [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: 06/02/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common in hospitalized persons living with dementia (PLWD). This pilot aimed to test the feasibility of an innovative model of care, PES-4-BPSD (a dementia unit staffed with Patient Engagement Specialists, PES). Non-randomized pilot feasibility trial was conducted, enrolling N = 158 patients to the intervention unit (n = 79, a 10-bed dementia unit, staffed with nursing assistants, NAs, with mental health backgrounds, PES) and an enhanced control unit (n = 79, 40-bed medicine unit, staffed with NAs). All NAs/PES (N = 63) received dementia training, with completion rate of 82.5%. Overall, patients had ~1 NPI-Q (Neuropsychiatric Inventory Questionnaire) assessment/48 hr. 97% (n = 153) of PLWD exhibited at least one behavior. Average NPI-Q scores did not differ across intervention (5.36) and control (3.87) units (p = .23). Patients on the intervention unit had 88% (p = .002) shorter duration of constant observation. A dementia care unit staffed by PES is an innovative model requiring further research.
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Affiliation(s)
- Liron Sinvani
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Andrew Strunk
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
| | - Suzanne Ardito
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Samantha Gordon
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Yan Liu
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Emily Schantz
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
| | - Asma Arroon
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
| | - Anum Ilyas
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Valeria Gromova
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ashley Polokowski
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
| | - Jessy Levin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alex Makhnevich
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Stefani D’Angelo
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Marie Boltz
- The Pennsylvania State University, University Park, USA
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15
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Kuberska K, Dixon‐Woods M, Martin G. Visual identifier systems for patients with cognitive impairment in healthcare settings: A survey of practice in UK hospitals. Int J Older People Nurs 2022; 17:e12472. [PMID: 35576107 PMCID: PMC9786885 DOI: 10.1111/opn.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND People with dementia and other forms of cognitive impairment form a substantial proportion of patients admitted to hospitals, but problems in their care are persistent. One widely proposed improvement approach involves the use of systems using visual identifiers to help staff quickly recognise people with suspected dementia, with the goal of supporting more personalised care. The aim of this paper is to identify the identifier systems in use and staff perceptions of their strengths and weaknesses. METHODS We undertook an online survey of staff providing care for people with dementia in acute and mental health hospitals across the United Kingdom. The questionnaire covered different types of visual identifier systems for dementia. It used categorical and open-response questions to access staff views of their use in practice. Responses were analysed using descriptive statistics, and the Framework approach for free-text answers. RESULTS 162 responses were received from staff in at least 48 hospitals. Of these, 128 had direct experience of using visual identifier systems. They reported that multiple identifier systems are in use, including schemes with national scope and locally developed approaches. Most respondents reported that more than one system is in use in their hospital. Different types of identifier were seen to have different strengths and weaknesses. Respondents had a broadly positive view of identifiers, but highlighted risks including lack of reliable and consistent use (linked to competing pressures on staff time), lack of staff training, uncertainty about patient and family views, and unclear consent processes. CONCLUSIONS Our study suggests that a wide range of identifier systems is in use in UK hospitals, with many hospitals using more than one. Further consideration should be given to ensuring that multiple perspectives-including those of patients and carers-are drawn on in optimising their design, resolving ethical issues and supporting implementation.
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Affiliation(s)
- Karolina Kuberska
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
| | - Mary Dixon‐Woods
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
| | - Graham Martin
- THIS Institute (The Healthcare Improvement Studies Institute)University of Cambridge, Cambridge Biomedical Campus, Clifford Allbutt BuildingCambridgeUK
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16
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McLaughlin D, Hasson F, Reid J, Brazil K, Rutherford L, Stone C, van der Steen JT, Ballentine J. Evaluating a partnership model of hospice enabled dementia care: A three-phased monitoring, focus group and interview study. Palliat Med 2022; 36:1351-1363. [PMID: 36065098 PMCID: PMC9606481 DOI: 10.1177/02692163221116763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with dementia and their caregivers often lack equitable access to hospice care which is a concern internationally. Domains of best practice in palliative care for this population exist and hospices are urged to become dementia friendly. AIM This study aimed to evaluate the model of 'Hospice Enabled Dementia Partnership' mapped to international domains of best practice. DESIGN Three-phased monitoring, group interview and individual interview study using a formative evaluation framework. SETTINGPARTICIPANTS The partnership model was a collaboration between a large specialist palliative care hospice, a dementia charity and a Health Care Trust in the United Kingdom. Service documents were subjected to documentary review of monitoring activity and key indicators of service success. Group interviews and individual interviews took place with family carers (n = 12), health care professionals involved in delivering the service (n = 32) and senior professionals (n = 5) responsible for service commissioning in palliative or dementia care. RESULTS One hundred people with dementia were referred to the service between May 2016 and December 2017. Thirty-eight of the 42 people who died, achieved their preferred place of care and died at home. Four themes were derived from the data 'Impact of Dementia', 'Value of the Service', 'Information and Learning Needs' and 'Working in Partnership'. CONCLUSIONS Positive outcomes resulted from this best practice model; achievement of preferred place of care and death at home, dual benefits of therapies for patients and families and partnership in cross working and learning between services. Replication of this model should be considered internationally.
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Affiliation(s)
- Dorry McLaughlin
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Kevin Brazil
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Lesley Rutherford
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland.,Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Carol Stone
- Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Zisberg A, Lickiewicz J, Rogozinski A, Hahn S, Mabire C, Gentizon J, Malinowska-Lipień I, Bilgin H, Tulek Z, Pedersen MM, Andersen O, Mayer H, Schönfelder B, Gillis K, Gilmartin MJ, Squires A. Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study. Int J Nurs Stud 2022; 134:104283. [DOI: 10.1016/j.ijnurstu.2022.104283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
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18
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Spencer L. Epistemic Injustice in Late-Stage Dementia: A Case for Non-Verbal Testimonial Injustice. SOCIAL EPISTEMOLOGY 2022; 37:62-79. [PMID: 36816431 PMCID: PMC9928428 DOI: 10.1080/02691728.2022.2103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression is a common feature of some forms of neurocognitive disorders such as 'intellectual disabilities', autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society.
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Affiliation(s)
- Lucienne Spencer
- Institute for Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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19
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Abraham J, Hirt J, Richter C, Köpke S, Meyer G, Möhler R. Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. Cochrane Database Syst Rev 2022; 8:CD012476. [PMID: 36004796 PMCID: PMC9404383 DOI: 10.1002/14651858.cd012476.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Physical restraints, such as bedrails, belts in chairs or beds, and fixed tables, are commonly used for older people in general hospital settings. Reasons given for using physical restraints are to prevent falls and fall-related injuries, to control challenging behavior (such as agitation or wandering), and to ensure the delivery of medical treatments. Clear evidence of their effectiveness is lacking, and potential harms are recognised, including injuries associated with the use of physical restraints and a negative impact on people's well-being. There are widespread recommendations that their use should be reduced or eliminated. OBJECTIVES To assess the best evidence for the effects and safety of interventions aimed at preventing and reducing the use of physical restraint of older people in general hospital settings. To describe the content, components and processes of these interventions. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register the International Clinical Trials Registry Portal on 20 April 2022. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials that investigated the effects of interventions that aimed to prevent or reduce the use of physical restraints in general hospital settings. Eligible settings were acute care and rehabilitation wards. We excluded emergency departments, intensive care and psychiatric units, as well as the use of restrictive measures for penal reasons (e.g. prisoners in general medical wards). We included studies with a mean age of study participants of at least 65 years. Control groups received usual care or active control interventions that were ineligible for inclusion as experimental interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected the articles for inclusion, extracted data, and assessed the risk of bias of all included studies. Data were unsuitable for meta-analysis, and we reported results narratively. We used GRADE methods to describe our certainty in the results. MAIN RESULTS We included four studies: two randomised controlled trials (one individually-randomised, parallel-group trial and one clustered, stepped-wedge trial) and two controlled clinical trials (both with a clustered design). One study was conducted in general medical wards in Canada and three studies were conducted in rehabilitation hospitals in Hong Kong. A total of 1709 participants were included in three studies; in the fourth study the number of participants was not reported. The mean age ranged from 67 years to 84 years. The duration of follow-up covered the period of patients' hospitalisation in one study (21 days average length of stay) and ranged from 4 to 11 months in the other studies. The definition of physical restraints differed slightly, and one study did not include bedrails. Three studies investigated organisational interventions aimed at implementing a least-restraint policy to reduce physical restraints. The theoretical approach of the interventions and the content of the educational components was comparable across studies. The fourth study investigated the use of pressure sensors for participants with an increased falls risk, which gave an alarm if the participant left the bed or chair. Control groups in all studies received usual care. Three studies were at high risk of selection bias and risk of detection bias was unclear in all studies. Because of very low-certainty evidence, we are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on our primary efficacy outcome: the use of physical restraints in general hospital settings. One study found an increase in the number of participants with at least one physical restraint in the intervention and control groups, one study found a small reduction in both groups, and in the third study (the stepped-wedge study), the number of participants with at least one physical restraint decreased in all clusters after implementation of the intervention but no detailed information was reported. For the use of bed or chair pressure sensor alarms for people with an increased fall risk, we found moderate-certainty evidence of little to no effect of the intervention on the number of participants with at least one physical restraint compared with usual care. None of the studies systematically assessed adverse events related to use of physical restraint use, e.g. direct injuries, or reported such events. We are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on the number of participants with at least one fall (very low-certainty evidence), and there was no evidence that organisational interventions or the use of bed or chair pressure sensor alarms for people with an increased fall risk reduce the number of falls (low-certainty evidence from one study each). None of the studies reported fall-related injuries. We found low-certainty evidence that organisational interventions may result in little to no difference in functioning (including mobility), and moderate-certainty evidence that the use of bed or chair pressure sensor alarms has little to no effect on mobility. We are uncertain about the effect of organisational interventions on the use of psychotropic medication; one study found no difference in the prescription of psychotropic medication. We are uncertain about the effect of organisational interventions on nurses' attitudes and knowledge about the use of physical restraints (very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether organisational interventions aimed at implementing a least-restraint policy can reduce physical restraints in general hospital settings. The use of pressure sensor alarms in beds or chairs for people with an increased fall risk has probably little to no effect on the use of physical restraints. Because of the small number of studies and the study limitations, the results should be interpreted with caution. Further research on effective strategies to implement a least-restraint policy and to overcome barriers to physical restraint reduction in general hospital settings is needed.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), St. Gallen, Switzerland
| | - Christin Richter
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
- School of Public Health, Bielefeld University, Bielefeld, Germany
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20
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Carpenter CR, Leggett J, Bellolio F, Betz M, Carnahan RM, Carr D, Doering M, Hansen JC, Isaacs ED, Jobe D, Kelly K, Morrow-Howell N, Prusaczyk B, Savage B, Suyama J, Vann AS, Rising KL, Hwang U, Shah MN. Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review. J Am Med Dir Assoc 2022; 23:1313.e15-1313.e46. [PMID: 35940681 PMCID: PMC10802113 DOI: 10.1016/j.jamda.2022.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWD and their care partners in the ED setting. METHODS Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for PLWD compared with persons without dementia? Are there specific communication strategies that improve the outcomes of ED care? Future research areas were prioritized. RESULTS From 5451 studies identified for PICO-1, 21 were abstracted. From 2687 studies identified for PICO-2, 3 were abstracted. None of the included studies directly evaluated communication differences between PLWD and other populations, nor the effectiveness of specific communication strategies. General themes emerging from the scoping review included perceptions by PLWD/care partners of rushed ED communication, often exacerbated by inconsistent messages between providers. Care partners consistently reported limited engagement in medical decision-making. In order, the research priorities identified included: (1) Barriers/facilitators of effective communication; (2) valid outcome measures of effective communication; (3) best practices for care partner engagement; (4) defining how individual-, provider-, and system-level factors influence communication; and (5) understanding how each member of ED team can ensure high-quality communication. CONCLUSIONS AND IMPLICATIONS Research exploring ED communication with PLWD is sparse and does not directly evaluate specific communication strategies. Defining barriers and facilitators of effective communication was the highest-ranked research priority, followed by validating outcome measures associated with improved information exchange.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA.
| | - Jesseca Leggett
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - David Carr
- Department of Medicine and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michelle Doering
- Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Eric D Isaacs
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Jobe
- Person Living with Dementia, 2021-2022 Alzheimer's Association National Early Stage Advisory Group, St. Louis MO, USA
| | | | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Beth Prusaczyk
- Department of Medicine, Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bob Savage
- Person Living with Dementia, LiveWell Alliance, Plantsville, CT, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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21
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Wolverson E, Dunning R, Crowther G, Russell G, Underwood BR. The Characteristics and Outcomes of People with Dementia in Inpatient Mental Health Care: A Review. Clin Gerontol 2022:1-20. [PMID: 35897148 DOI: 10.1080/07317115.2022.2104145] [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: 11/03/2022]
Abstract
OBJECTIVES Inpatient mental health beds for people with dementia are a limited resource. Practitioners need an understanding of this population to provide high-quality care and design services. This review examines the characteristics, care, and outcomes of people with dementia admitted to inpatient mental health services. METHODS Systematic searches of key databases were undertaken up to November 2021. Findings were grouped into categories and then synthesized into a narrative review. RESULTS The review identified 36 international papers, the majority of which were retrospective audits. The literature describes significant psychiatric and medical comorbidity and significant risk of change in residence and death associated with admission. CONCLUSIONS We found a limited literature describing the characteristics, care, and outcomes of people with dementia in inpatient mental health services. The lack of research is striking given the complexity and vulnerability of this client group. More research is needed to describe the needs of this group, current and best practice to optimize care. CLINICAL IMPLICATIONS Professionals working in inpatient mental health services need to be aware of the evidence base available, consider how they evaluate patient outcomes, review their staffing and skills mix, and seek the views of patients and relatives in improving services.
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Affiliation(s)
- Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom of Great Britain and Northern Ireland
- Department of Clinical Psychology for Older People, Humber Teaching NHS Foundation Trust, Willerby Hill, Hull, United Kingdom of Great Britain and Northern Ireland
| | - Rebecca Dunning
- Department of Clinical Psychology for Older People, Humber Teaching NHS Foundation Trust, Willerby Hill, Hull, United Kingdom of Great Britain and Northern Ireland
| | - George Crowther
- Department of Clinical Psychology for Older People, Leeds and York Partnership NHS Foundation Trust, Century Way, Leeds, United Kingdom of Great Britain and Northern Ireland
- Department of Clinical Psychology for Older People, Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Gregor Russell
- Department of Clinical Psychology for Older People, Leeds Institute of Health Science, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
- Department of Clinical Psychology for Older People, Bradford District Care NHS Foundation Trust, Osprey House, Lynfield Mount Hospital, Hull, United Kingdom of Great Britain and Northern Ireland
| | - Benjamin R Underwood
- Department of Clinical Psychology for Older People, Cambridgeshire and Peterborough NHS Foundation Trust, Windsor Unit, Fulbourn Hospital, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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22
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Chenoweth L, Williams A, Fry M, Endean E, Liu Z. Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. Clin Gerontol 2022; 45:983-997. [PMID: 34229578 DOI: 10.1080/07317115.2021.1946233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This pilot study assessed clinical outcomes and quality care for persons with dementia in an acute hospital with PCC, compared with usual care. METHODS Forty-seven consented persons 60 years and over with dementia were assigned to PCC (n = 26) or usual care (control) (n = 21). Hospital nurses and allied health staff received 3 h of face-to-face education in PCC, and practice support by four PCC-trained nurse champions. Control group staff received 3 h of face-to-face education on dementia and delirium care clinical guidelines. Primary outcomes behavioral/neuropsychiatric symptoms and care quality were analyzed based on repeated measures at baseline (Time 1), 4-5 days after baseline (Time 2) and day 8-10 after baseline (Time 3) where available. RESULTS Compared with controls, at Time 2 PCC produced statistically significant improvements in behavioral/neuropsychiatric symptoms (adjusted p = .036) and care quality (adjusted p = .044). Where length of stay exceeded 8 days after baseline (Time 3), there was a sustained improvement in quality care (p = .007), but not in behavioral/neuropsychiatric symptoms (p = .27). CONCLUSIONS PCC can improve care quality for persons with dementia; nursing; agitation; paid caregivers with dementia and reduce behavioral/neuropsychiatric symptoms during short hospital stays. CLINICAL IMPLICATIONS Hospital systems need to support PCC to reduce behavioral/neuropsychiatric symptoms in dementia during long hospital stays.
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Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales (Sydney), Sydney, NSW, Australia
| | - Anna Williams
- School of Nursing (Sydney), The University of Notre Dame Australia, Fremantle, NSW, Australia
| | - Margaret Fry
- Northern Sydney Local Health District, Sydney; Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Zhixin Liu
- Stats Central, University of New South Wales (Sydney), Sydney, NSW, Australia
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SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care. Contemp Clin Trials 2022; 119:106818. [PMID: 35690262 DOI: 10.1016/j.cct.2022.106818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care. METHODS We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care. SHARING Choices is a multicomponent intervention that aims to improve communication through patient and family engagement in ACP, agenda setting, and shared access to the patient portal for all patients over 65 years of age. The primary outcomes include documentation of an advance directive or medical orders for life-sustaining treatment in the electronic health record (EHR) at 12 months for all patients and receipt of potentially burdensome care within 6 months of death for the subgroup of patients with serious illness. We plan a priori sub-analysis for patients with dementia. Data sources include the health system EHRs and the Maryland health information exchange. We use a mixed-methods approach to evaluate uptake, fidelity and adaptation of the intervention and implementation facilitators and barriers. CONCLUSIONS This cluster-randomized pragmatic trial examines ACP with a focus on the key population of those with dementia, implementation in diverse settings and innovative approaches to trial design and outcome abstraction. Mixed-methods approaches enable understanding of intervention delivery and facilitators and barriers to implementation in rapidly changing health care systems. CLINICALTRIALS gov Identifier: NCT04819191.
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Marulappa N, Anderson NN, Bethell J, Bourbonnais A, Kelly F, McMurray J, Rogers HL, Vedel I, Gagliardi AR. How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review. BMC Health Serv Res 2022; 22:541. [PMID: 35459214 PMCID: PMC9034625 DOI: 10.1186/s12913-022-07875-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07875-w.
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Affiliation(s)
- Nidhi Marulappa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, PO Box 6128, Montreal, QC, H3C 3J7, Canada
| | - Fiona Kelly
- Division of Nursing, Queen Margaret University, Queen Margaret University Drive, Musselburgh, East Lothian, EH21 6UU, UK
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T 3Y3, Canada
| | - Heather L Rogers
- Biocruces Bizkaia Health Research Institute and Ikerbasque Basque Foundation for Science, Bilbao, Spain, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
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Clark E, Wood F, Wood S. Barriers and facilitators to the use of personal information documents in health and social care settings for people living with dementia: A thematic synthesis and mapping to the COM-B framework. Health Expect 2022; 25:1215-1231. [PMID: 35415955 PMCID: PMC9327869 DOI: 10.1111/hex.13497] [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: 05/18/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person-centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation-Behaviour (COM-B) model can be used to understand factors determining individuals' behaviours. OBJECTIVES This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology. METHODS A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high-income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM-B framework. RESULTS Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM-B domain. CONCLUSION This framework provides a starting point for evidence-informed initiatives to improve the use of personal information documents in the care of people with dementia. PATIENT AND PUBLIC CONTRIBUTION This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders).
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Affiliation(s)
- Emily Clark
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Cardiff and Vale Local Public Health Team, Public Health Wales, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Suzanne Wood
- Cardiff and Vale Local Public Health Team, Public Health Wales, Cardiff, UK
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Meyer K, James D, Amezaga B, White C. Simulation learning to train healthcare students in person-centered dementia care. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:209-224. [PMID: 33081626 PMCID: PMC8055727 DOI: 10.1080/02701960.2020.1838503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In coming decades, healthcare providers will treat a greater number of individuals living with Alzheimer's Disease and related dementias than ever. Simulation-based learning provides experiential learning opportunities to enhance clinical training, but little is known about how dementia simulation training improves understanding of dementia or how it changes in participants' ability to deliver high-quality healthcare to individuals living with dementia. In this study, we examine how a simulation training program may prepare healthcare trainees to treat individuals living with dementia. We conducted eight in-depth, one-on-one interviews with healthcare trainees who participated in the Virtual Dementia Tour (VDT) program and faculty who added VDT to their curricula, and also examined 20 reflection papers from students following participation in VDT. A thematic analysis of qualitative data led us to three themes: 1) dementia simulation complements and enhances traditional teaching methods, 2) dementia simulation helps students to understand the experiences of people living with dementia, and 3) experiential learning inspired students to reflect on actions they would take as clinicians and leaders to support individuals living with dementia and their families. Based on these findings, we propose a modified transformative learning process for dementia simulation training with healthcare students.
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Affiliation(s)
- Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Debbie James
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Braulio Amezaga
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Carole White
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Crandall J, Coatsworth-Puspoky R, Schlegel K, Beker L, McLelland VC, Martin LS. Implementing Gentle Persuasive Approaches dementia education for staff on in-patient medicine units: A program evaluation. DEMENTIA 2022; 21:1173-1199. [PMID: 35081811 PMCID: PMC9109211 DOI: 10.1177/14713012211070148] [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] [Indexed: 11/29/2022]
Abstract
Older adults with dementia, when hospitalised, frequently experience responsive behaviours. Staff struggle to manage responsive behaviours without specific education. We aimed to enhance staff knowledge and confidence with care for older adults with dementia and responsive behaviours on medicine units at a Canadian hospital. An online dementia education program was disseminated to staff as part of a broader quality improvement project. Gentle Persuasive Approaches (GPA) encourages staff to reframe responsive behaviours as self-protective expressions of unmet needs and learn to assess their meaning. Participants completed online quantitative and qualitative measures of self-efficacy, competence and knowledge in dementia care at three times: immediate pre-, immediate post- and six to eight weeks post-GPA eLearning. Immediately post-GPA, participants showed significant increases relative to baseline in dementia care self-efficacy, competence and knowledge. Self-efficacy scores increased further eight weeks post-GPA. Before GPA, few participants described dementia-specific strategies for de-escalating a patient’s agitation. Eight weeks post-GPA, participants described application of tailored, person-centred, non-pharmacological interventions and successful application of GPA strategies. GPA eLearning strengthened staff preparedness to interact with older adults experiencing responsive behaviours, thus enhancing their care.
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Affiliation(s)
| | - Robin Coatsworth-Puspoky
- School of Health, Community Services & Creative Design, 10028Lambton College, Sarnia, ON, Canada
| | | | - Lyndsay Beker
- 10033London Health Sciences Centre, London, ON, Canada
| | | | - Lori Schindel Martin
- 104269Advanced Gerontological Education, Hamilton, ON, Canada; Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
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Watson J, Darlington-Pollock F, Green M, Giebel C, Akpan A. The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002-2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13405. [PMID: 34949010 PMCID: PMC8708637 DOI: 10.3390/ijerph182413405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002-2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations-and for later-onset only dementia medications-are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes.
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Affiliation(s)
- James Watson
- School of Environmental Sciences, The University of Liverpool, Liverpool L69 7ZT, UK; (F.D.-P.); (M.G.)
| | | | - Mark Green
- School of Environmental Sciences, The University of Liverpool, Liverpool L69 7ZT, UK; (F.D.-P.); (M.G.)
| | - Clarissa Giebel
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool L69 3GF, UK;
- NIHR ARC NWC, Liverpool L69 3GL, UK
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Cheong CY, Tay FHE, Choo J, Yap PLK. Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses Working in a Specialized Dementia Unit. Dement Geriatr Cogn Disord 2021; 50:250-257. [PMID: 34348291 DOI: 10.1159/000517536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]). METHOD This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data. RESULTS The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work. CONCLUSION Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.
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Affiliation(s)
- Chin Yee Cheong
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Felicia Hui En Tay
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | | | - Philip Lin Kiat Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
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Curnow E, Rush R, Gorska S, Forsyth K. Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks. BMC Geriatr 2021; 21:613. [PMID: 34717561 PMCID: PMC8556981 DOI: 10.1186/s12877-021-02546-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/12/2021] [Indexed: 02/04/2023] Open
Abstract
Background Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions. Methods Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined. Results Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others. Conclusions Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants’ needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.
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Affiliation(s)
- Eleanor Curnow
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Robert Rush
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Sylwia Gorska
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
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Comparison of Mini-Mental State Examination and Addenbrooke’s Cognitive Examination III in detection of cognitive impairment in patients with type 2 diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gkioka M, Schneider J, Kruse A, Tsolaki M, Moraitou D, Teichmann B. Evaluation and Effectiveness of Dementia Staff Training Programs in General Hospital Settings: A Narrative Synthesis with Holton's Three-Level Model Applied. J Alzheimers Dis 2021; 78:1089-1108. [PMID: 33104033 PMCID: PMC7739966 DOI: 10.3233/jad-200741] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: People with Dementia (PwD) are frequently admitted to hospital settings. The lack of proper dementia knowledge, poor communication skills, negative attitudes toward dementia, and lack of confidence affects the quality of care, thus development of dementia trainings has increased. Nevertheless, literature regarding the effectiveness of training implementation is limited. Objective: The aim of this narrative synthesis is to 1) identify the characteristics of training programs and 2) explore the effectiveness of these training programs in everyday clinical practice. Methods: A systematic search in PubMed, PsycINFO, CINAHL, and Cochrane was conducted, including qualitative and quantitative peer-reviewed studies. Holton’s evaluation model with its three outcome levels (learning, individual performance, and organizational results) was adopted. 14 studies were included. Results: The synthesis of the results was divided into two parts: 1) to describe the characteristics and content of trainings 2) to evaluate the effectiveness of training programs according to the three outcome levels of Holton’s model, taking into consideration its construct domains: ability, motivation, and environment. Learning outcomes were assessed in all selected studies: 13 studies observed changes in individual performance, four studies reported changes within the organizational level, and only five showed sustainable changes over time. Conclusion: Person-centered care (PCC) approaches, interactive and varied teaching methods, supporting conditions like champions, action plans, and setting care policies, are all characteristics of effective trainings. Successful programs should be sustainable over time, demonstrating positive outcomes across the organization. Based on current findings, there is a lack of adequate evaluation with regard to training programs on the organizational level.
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Affiliation(s)
- Mara Gkioka
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Julia Schneider
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Andreas Kruse
- Institute of Gerontology, Heidelberg University, Heidelberg, Germany
| | - Magda Tsolaki
- 1st Department of Neurology, AHEPA University Hospital, Thessaloniki, Greece
| | - Despina Moraitou
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Birgit Teichmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Chenoweth L, Cook J, Williams A. Perceptions of Care Quality during an Acute Hospital Stay for Persons with Dementia and Family/Carers. Healthcare (Basel) 2021; 9:1176. [PMID: 34574951 PMCID: PMC8469973 DOI: 10.3390/healthcare9091176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES to report on acute hospital care experiences for persons with dementia and family/carers in a pilot study (PiP) of person-centred care compared with usual care. METHODS participants were recruited from one acute aged care ward and one mixed medical/surgical ward. One-on-one interviews occurred soon after discharge using a semi-structured interview guide framed by person-centred principles whereby the person is: V-valued; I-treated as an individual; P-perceived as having a unique identity; and S-supported socially and psychologically. Data were analysed deductively with reference to these a priori principles. RESULTS 11 consented persons with dementia and 36 family/carers participated. A total of eight core VIPS concepts were derived from the data. While many occasions of person-centred care occurred, there was variability in staff expertise, interest and aptitude for dementia care work. Neglect of person-centred principles more frequently occurred for the usual care group, where staff failed to place the person and their family/carer at the centre of service. CONCLUSIONS person-centred services for persons with dementia requires that hospital executive equip staff with the relevant knowledge, skills and support to adhere to person-centred care guidelines. Hospitals must address workplace cultures and procedures that favour organisational systems over person-centred services.
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Affiliation(s)
- Lynette Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Janet Cook
- School of Nursing, University of Notre Dame Australia, Sydney, NSW 2010, Australia; (J.C.); (A.W.)
| | - Anna Williams
- School of Nursing, University of Notre Dame Australia, Sydney, NSW 2010, Australia; (J.C.); (A.W.)
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Riquelme-Galindo J, Lillo-Crespo M. Designing Dementia Care Pathways to Transform Non Dementia-Friendly Hospitals: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179296. [PMID: 34501886 PMCID: PMC8431306 DOI: 10.3390/ijerph18179296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
People with dementia (PwD) occupy around 25% of the hospital beds. Once PwD are admitted to hospitals, their cognitive impairment is not considered in most of the cases. Thus, it causes an impact on the development of the disease becoming a stressful situation as care plans are not adapted to PwD. The aim of this study was to explore the published core elements when designing a dementia care pathway for hospital settings. A scoping review was conducted to provide an overview of the available research evidence and identify the knowledge gaps regarding the topic. This review highlights person-centered care, compassionate care and end-of-life process as some of the key elements that should integrate the framework when designing a dementia care pathway. Architectonical outdoor and indoor hospital elements have also been found to be considered when adapting the healthcare context to PwD. Findings provide information about the key points to focus on to successfully design dementia interventions in hospital environments within available resources, mostly in those contexts in which national dementia plans are in its infancy. Hospitals should transform their patients’ routes and processes considering the increasing demographic changes of people with cognitive impairment.
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Affiliation(s)
- Jorge Riquelme-Galindo
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
- Correspondence:
| | - Manuel Lillo-Crespo
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- HLA Vistahermosa Hospital, 03015 Alicante, Spain
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Morita K, Fukahori H, Ogawara H, Iwagami M, Matsui H, Okura T, Itoh S, Fushimi K, Yasunaga H. Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals: A difference-in-differences analysis of a nationwide retrospective cohort study in Japan. Int J Geriatr Psychiatry 2021; 36:1386-1397. [PMID: 33733528 DOI: 10.1002/gps.5537] [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] [Received: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). DESIGN AND METHODS Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. RESULTS There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88-1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95-1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. CONCLUSIONS The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.
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Affiliation(s)
- Kojiro Morita
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hirofumi Ogawara
- Major in Nursing, Graduate School of Health Management, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toru Okura
- Yamato Homecare Clinic Osaki, Osaki-shi, Miyagi, Japan
| | - Sakiko Itoh
- Department of Gerontological Nursing and Care System Development, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Mann K, Gröschel S, Singer S, Breitmaier J, Claus S, Fani M, Rambach S, Salize HJ, Lieb K. Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics. BMC Psychiatry 2021; 21:419. [PMID: 34419009 PMCID: PMC8380405 DOI: 10.1186/s12888-021-03410-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. METHODS Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1-3.0 for patients < 65 years; OR 8.0, CI 3.1-20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7-3.9). CONCLUSIONS The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.
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Affiliation(s)
- Klaus Mann
- Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Sonja Gröschel
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Department of Neurology, University Medical Center, Mainz, Germany
| | - Susanne Singer
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Jörg Breitmaier
- Department of Psychiatry and Psychotherapy, Krankenhaus Zum Guten Hirten, Ludwigshafen, Germany
| | - Sylvia Claus
- Department of Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Markus Fani
- Department of Geriatric Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Stephan Rambach
- Clinic for Psychiatry and Psychotherapy, Municipal Hospital, Pirmasens, Germany
| | - Hans-Joachim Salize
- grid.413757.30000 0004 0477 2235Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Verma S, Agarwal S, Tashok S, Verma A, Giri R. Cognitive impairment in type 2 diabetes and its impact on daily living and self-care: A case - Control study in Kanpur, North India. Diabetes Metab Syndr 2021; 15:102147. [PMID: 34186338 DOI: 10.1016/j.dsx.2021.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIM There have been few studies from South Asia which have shown increased prevalence of cognitive impairment (CI) in diabetes. CI may further hamper self-care and independent living. The present study was designed to evaluate the impairment in cognition and self-care among patients with type 2 diabetes. MATERIALS AND METHODS We assessed cognitive function in 54 type 2 diabetes participants and compared them with 54 healthy controls, using Addenbrooke's Cognitive Examination-III (ACE-III) test. Assessment of self-care was done by using Katz index of independence in activities of daily living and revised Summary of Diabetes Self-Care Activities (SDSCA) measures. RESULTS The mean age and HbA1c of cases was 64.5 ± 5.3 years and 8.8 ± 2.5%, respectively. Cognitive impairment was more prevalent among type 2 diabetes participants (Odds ratio 31.3, CI: 10-100, P < 0.0001) with mean Addenbrooke's score of 74.9 ± 11.2 compared to 86.9 ± 5.3 in controls (t-statistic = 7.09, 95% CI: 8.6 to 15.3, P < 0.0001). The adjusted Odds ratio for CI was 9.46 after adjustment for hypertension. All the sub-domains of cognition were affected. The burden of CI was more among females and in those with poor glycemic control (HbA1C > 7.5%) when compared to controls. The diabetic participants with CI had poor SDSCA scores compared to those with no CI. CONCLUSION Diabetes may cause CI and is related to poor self-care. Considering a high prevalence of CI in diabetes, cognitive assessment should be a part of overall evaluation. ACE-III is a sensitive and convenient tool for this purpose.
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Affiliation(s)
- Shivendra Verma
- Department of Medicine, GSVM Medical College, Kanpur, 208002, India.
| | - Saurabh Agarwal
- Department of Medicine, GSVM Medical College, Kanpur, 208002, India
| | - Sorang Tashok
- Department of Medicine, GSVM Medical College, Kanpur, 208002, India
| | - Alok Verma
- Department of Neurology, GSVM Medical College, Kanpur, 208002, India
| | - Richa Giri
- Department of Medicine, GSVM Medical College, Kanpur, 208002, India
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Abbott RA, Cheeseman D, Hemsley A, Thompson Coon J. Can person-centred care for people living with dementia be delivered in the acute care setting? Age Ageing 2021; 50:1077-1080. [PMID: 33890625 PMCID: PMC8244565 DOI: 10.1093/ageing/afab065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
The need to improve care for people living with dementia in the hospital setting has long been recognised. Person-centred care has the potential to improve the experience of care for persons living with dementia and their carers, and has been shown to improve the experiences of hospital staff caring for the persons living with dementia, however it remains challenging to deliver in a time- and task-focussed acute care setting. This commentary suggests that to embed person-centred care across the hospital environment, cultural changes are needed at organisational and ward levels. In particular there needs to be: leadership that supports and advocates for workforce capacity to recognise and meet both psychological and physical needs of people living with dementia, promotion of physical environments that support familiarisation and social interactions, an inclusive approach to carers and the development of a culture of sharing knowledge and information across hierarchies and roles. An evidence-based set of pointers for service change are described which highlight institutional and environmental practices and processes that need to be addressed in order for person-centred care to become part of routine care.
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Affiliation(s)
- Rebecca A Abbott
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
| | | | - Anthony Hemsley
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
| | - Jo Thompson Coon
- NIHR ARC South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK
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[Dental care for older people: opportunities and challenges]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:802-811. [PMID: 34156484 PMCID: PMC8241673 DOI: 10.1007/s00103-021-03358-1] [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: 01/22/2021] [Accepted: 05/20/2021] [Indexed: 11/12/2022]
Abstract
Die Mundgesundheit der Bevölkerung in Deutschland konnte in den letzten Jahren verbessert werden; allerdings profitierten ältere und insbesondere gebrechliche sowie pflegebedürftige Menschen nicht adäquat von dieser Entwicklung. Dabei kann eine gute Mundgesundheit relevant dazu beitragen, die Herausforderungen bei Gebrechlichkeit und Pflegebedürftigkeit besser zu bewältigen. Der eingeschränkte Zugang zur zahnmedizinischen Betreuung, die manchmal eingeschränkte Kooperativität sowie die schlechtere Mundpflege in dieser Bevölkerungsgruppe erhöhen das Risiko für Karies, Parodontalerkrankungen, Zahnverlust und Zahnlosigkeit im Vergleich zur Durchschnittsbevölkerung. Der vorliegende Beitrag gibt eine Übersicht über die zahnmedizinische Situation älterer Menschen anhand bereits publizierter Daten aus der bevölkerungsrepräsentativen Fünften Deutschen Mundgesundheitsstudie (DMS V), die im Jahr 2014 erhoben wurden. Die mittlere Anzahl der fehlenden Zähne betrug bei den 65- bis 74-Jährigen 11,1 Zähne. Bei älteren Seniorinnen und Senioren (75–100 Jahre) mit Pflegebedarf (äSmP) war die Mundgesundheit schlechter als bei denjenigen ohne Pflegebedarf (äSoP). So hatten äSoP durchschnittlich 11,8 Zähne, äSmP dagegen nur 5,7 Zähne. Der Anteil zahnloser 65- bis 74-Jähriger hatte sich seit 1997 halbiert auf 12,4 %. Bei den äS waren 32,8 % zahnlos (äSmP: 53,7 %, äSoP: 26,7 %). Mehr als 75 % der äSmP waren abnehmbar prothetisch versorgt (äSoP: 51,7 %). Vor diesem Hintergrund werden in diesem Beitrag Schnittstellen benannt, an denen eine chancengleiche Anbindung dieser Bevölkerungsgruppen an eine zahnmedizinische Versorgungsstruktur etabliert werden könnte. Diese beinhalten akutgeriatrische Krankenhausstationen und die Entwicklung weitergehender Konzepte in der aufsuchenden Versorgung zur besseren Versorgung der Betroffenen und zur Erleichterung der Pflege.
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Daniel Lai LL, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [PMID: 34368465 PMCID: PMC8311801 DOI: 10.12688/wellcomeopenres.16189.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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Affiliation(s)
- L L Daniel Lai
- Clinical Psychology, Kwong Wah Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Sebastian J Crutch
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, Royal Academy of Music, London, UK
| | - Emma Harding
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Rohan Takhar
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Nicholas Firth
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Paul M Camic
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
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Daniel Lai L, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [PMID: 34368465 PMCID: PMC8311801 DOI: 10.12688/wellcomeopenres.16189.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 08/08/2023] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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Affiliation(s)
- L.L. Daniel Lai
- Clinical Psychology, Kwong Wah Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Sebastian J. Crutch
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Julian West
- Open Academy, Royal Academy of Music, London, UK
| | - Emma Harding
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Emilie V. Brotherhood
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Rohan Takhar
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Nicholas Firth
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
| | - Paul M. Camic
- Dementia Research Centre, Queens Square Institute of Neurology, University College London, London, UK
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Daniel Lai L, Crutch SJ, West J, Harding E, Brotherhood EV, Takhar R, Firth N, Camic PM. Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia. Wellcome Open Res 2021; 5:230. [DOI: 10.12688/wellcomeopenres.16189.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals. However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.
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de la Perrelle L, Cations M, Barbery G, Radisic G, Kaambwa B, Crotty M, Fitzgerald JA, Kurrle S, Cameron I, Whitehead C, Thompson J, Laver K. How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation. BMJ Open Qual 2021; 10:bmjoq-2020-001147. [PMID: 33990392 PMCID: PMC8127967 DOI: 10.1136/bmjoq-2020-001147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246.
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Affiliation(s)
- Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Gaery Barbery
- Health Services Management School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Janna Anneke Fitzgerald
- Business Strategy and Innovation, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Susan Kurrle
- Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Jane Thompson
- NNIDR Consumer Involvement Reference Group, NHMRC CDPC, Hornsby, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
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Osuoha P, Masoud SS, Leibas M, Cleveland LM, Reed CC, Piernik-Yoder B, White CL. "Getting to Know Them": Person-Centered Care for Patients With Dementia in Acute Care. J Gerontol Nurs 2021; 47:37-44. [PMID: 34039092 DOI: 10.3928/00989134-20210408-01] [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: 11/20/2022]
Abstract
Older adults with dementia are reported to have twice as many hospital stays as their age-matched counterparts without dementia. Acute care hospitals are generally not equipped to provide best care for persons with dementia. The purpose of the current qualitative study was to gain an understanding of the needs and perspectives of nursing staff and patient care technicians regarding delivering person-centered care (PCC) to patients with dementia. Nine focus groups (N = 49) were conducted. Participants discussed the importance of "getting to know them" as the basis for their care. Several themes emerged that served to support or detract from providing PCC: (a) communication, (b) education, and (c) care environment. Findings from this study support the desire of nurses and patient care technicians to provide PCC, highlight challenges, and indicate needed system-level changes to education, communication, and the care environment to support best practices. [Journal of Gerontological Nursing, 47(5), 37-44.].
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Karrer M, Schnelli A, Zeller A, Mayer H. A systematic review of interventions to improve acute hospital care for people with dementia. Geriatr Nurs 2021; 42:657-673. [PMID: 33823424 DOI: 10.1016/j.gerinurse.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes. The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.
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Affiliation(s)
- Melanie Karrer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland.
| | - Angela Schnelli
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Hanna Mayer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria
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Mudge AM, Young A, McRae P, Graham F, Whiting E, Hubbard RE. Qualitative analysis of challenges and enablers to providing age friendly hospital care in an Australian health system. BMC Geriatr 2021; 21:147. [PMID: 33639854 PMCID: PMC7913259 DOI: 10.1186/s12877-021-02098-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system. METHODS In this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines. RESULTS Twenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce. CONCLUSIONS Progress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.
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Affiliation(s)
- Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia. .,University of Queensland School of Clinical Medicine, Brisbane, Australia.
| | - Adrienne Young
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Prue McRae
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Frederick Graham
- Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia
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Abley C. Developing a dementia care leaders' toolkit for older patients with cognitive impairment. Nurs Older People 2021; 33:14-19. [PMID: 32851821 DOI: 10.7748/nop.2020.e1250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
A recent review of the progress that has been made in meeting the government's Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The review also identified the need for improvements in assessing the individual needs of people with dementia while in hospital, including their emotional and social needs. This article focuses on the development and implementation of an evidence-based toolkit to improve the hospital care of older patients with cognitive impairment, including dementia and/or delirium. The toolkit's focus is on optimising the patient experience of people with cognitive impairment who have been admitted to hospital. The toolkit also promotes the importance of person-centred care and communication skills.
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Affiliation(s)
- Clare Abley
- vulnerable older adults and associate clinical researcher, The Newcastle upon Tyne Hospitals NHS Foundation Trust; honorary clinical senior lecturer, Newcastle University, Newcastle upon Tyne, England
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Keuning-Plantinga A, Finnema EJ, Krijnen W, Edvardsson D, Roodbol PF. Validation and psychometric evaluation of the Dutch person-centred care of older people with cognitive impairment in acute care (POPAC) scale. BMC Health Serv Res 2021; 21:59. [PMID: 33435963 PMCID: PMC7805135 DOI: 10.1186/s12913-020-06048-x] [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: 01/29/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Person-centred care is the preferred model for caring for people with dementia. Knowledge of the level of person-centred care is essential for improving the quality of care for patients with dementia. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale is a tool to determine the level of person-centred care. This study aimed to translate and validate the Dutch POPAC scale and evaluate its psychometric properties to enable international comparison of data and outcomes. Methods After double-blinded forward and backward translations, a total of 159 nurses recruited from six hospitals (n=114) and via social media (n=45) completed the POPAC scale. By performing confirmatory factor analysis, construct validity was tested. Cronbach’s alpha scale was utilized to establish internal consistency. Results The confirmatory factor analysis showed that the comparative fit index (0.89) was slightly lower than 0.9. The root mean square error of approximation (0.075, p=0.012, CI 0.057–0.092) and the standardized root mean square residual (0.063) were acceptable, with values less than 0.08. The findings revealed a three-dimensional structure. The factor loadings (0.69–0.77) indicated the items to be strongly associated with their respective factors. The results also indicated that deleting Item 5 improved the Cronbach’s alpha of the instrument as well as of the subscale ‘using cognitive assessments and care interventions’. Instead of deleting this item, we suggest rephrasing it into a positively worded item. Conclusions Our findings suggest that the Dutch POPAC scale is sufficiently valid and reliable and can be utilized for assessing person-centred care in acute care hospitals. The study enables nurses to interpret and compare person-centred care levels in wards and hospital levels nationally and internationally. The results form an important basis for improving the quality of care and nurse-sensitive outcomes, such as preventing complications and hospital stay length. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06048-x.
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Affiliation(s)
- Annette Keuning-Plantinga
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands. .,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands. .,University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelyn J Finnema
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands.,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands.,Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - Wim Krijnen
- Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Level 4, Austin Tower, PO BOX 55555, Heidelberg, Victoria, 3084, Australia.,Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Petrie F Roodbol
- Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
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"EduKation demenz® Nursing" in the acute hospital setting : Evaluation of a dementia training program: a pilot study. Z Gerontol Geriatr 2021; 54:659-666. [PMID: 33433665 DOI: 10.1007/s00391-020-01838-8] [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] [Received: 06/09/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND An increasing number of people with dementia (PwD) are being hospitalized due to acute conditions. The surrounding conditions and procedures in acute hospitals are not oriented to the special needs of this vulnerable patient group. The behavior of PwD poses particular challenges and burdens for nursing staff. OBJECTIVE The aim of this pilot study was to evaluate the effectiveness of a 2-day dementia training program with a self-reflection component compared to a standard 1.5‑h training of nursing staff caring for PwD in acute hospitals. METHODS A nonrandomized pretest-posttest study with a control group was conducted in three German acute hospitals. Through a questionnaire, nursing staff caring for PwD were examined for potential changes in attitude, strain and confidence levels. The intervention group (n = 32) received a 2-day training program, "EduKation demenz® Nursing", the control group (n = 36) participated in a short,1.5‑h dementia training. RESULTS Compared to the control group, the intervention group demonstrated statistically significant improvement in perceived strain (p = 0.007) and in confidence in caring for PwD (p < 0.001). There were positive but not significant changes in attitude (p = 0.176). CONCLUSION "EduKation demenz® Nursing", a 2-day training program with a self-reflection component, could provide more effective support for nursing staff in acute hospitals caring for PwD than a 1.5‑h training. Results indicate, however, that general conditions in acute hospitals should be changed to allow nursing staff to apply the knowledge gained.
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Aldridge Z, Oliver E, Gardener H, Dening KH. Admiral Nursing-A Model of Specialist Dementia Care in Acute Hospitals. SAGE Open Nurs 2021; 6:2377960820952677. [PMID: 33415301 PMCID: PMC7774376 DOI: 10.1177/2377960820952677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/26/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The rising prevalence of dementia has led to increased numbers of people with
dementia being admitted to acute hospitals. This demand is set to continue
due to an increasingly older population who are likely to have higher levels
of dependency, dementia, and comorbidity. If admitted to the hospital,
people with dementia are at higher risk of poor outcomes during and
following a hospital admission. Yet, there remains a significant lack of
specialist support within acute hospitals to support people with dementia,
their families and hospital staff. Methods Admiral Nurses are specialists that work with families affected by dementia
and provide consultancy and support to health and social care colleagues to
improve the delivery of evidenced based dementia care. Historically, Admiral
Nurses have predominantly been based in community settings. In response to
the increasing fragmentation of services across the dementia trajectory, the
Admiral Nurse model is evolving and adapting to meet the complex needs of
families impacted upon by dementia inclusive of acute hospital care. Results The Admiral Nurse acute hospital model provides specialist interventions
which improve staff confidence and competence and enables positive change by
improving skills and knowledge in the provision of person-centred dementia
care. The role has the capacity to address some of the barriers to
delivering person centred dementia care in the acute hospital and contribute
to improvements across the hospital both as a result of direct interventions
or influencing the practice of others. Conclusion Improving services for people with dementia and their families requires a
whole system approach to enable care coordination and service integration,
this must include acute hospital care. The increasing numbers of people with
dementia in hospitals, and the detrimental effects of admission, make
providing equitable, consistent, safe, quality care and support to people
with dementia and their families a national priority requiring immediate
investment. The inclusion of Admiral Nursing within acute hospital services
supports service and quality improvement which positively impacts upon the
experience and outcomes for families affected by dementia.
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Affiliation(s)
- Zena Aldridge
- Dementia UK, London, UK.,Health and Life Sciences, De Montfort University, Leicester, UK
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