Factors Influencing Dementia Care Competence among Care Staff: A Mixed-Methods Systematic Review Protocol

BACKGROUND

Dementia care competence is defined as the ability, acquired through practical experience, to deliver high-quality care services to persons with dementia (PWD). However, many studies only focus on one aspect of competence using qualitative or quantitative research design and have small sample sizes of care staff with dementia. This study aims to conduct a mixed-methods systematic review of the factors influencing the competence of dementia care staff, and explore the relationship between these factors and competence.

METHODS

This review was designed following the PRISMA-P 2015 statement and methodological guidance for the conduct of mixed-methods systematic reviews from the Joanna Briggs Institute (JBI). Seven English and four Chinese databases will be searched to systematically review the existing eligible studies. JBI Critical Appraisal Checklist for Qualitative Research and Analytical Cross-Sectional Studies will be used to assess the methodological quality of each study. A JBI Mixed-Methods Data Extraction Form will be applied for data extraction. The JBI convergent integrated approach will be used for data synthesis and integration. The synthesized findings will be graded according to the JBI ConQual approach as high, moderate, low, or very low. The protocol was registered with PROSPERO in October 2023 (CRD42023474093).

Utilization of Job Demands-Resources (JD-R) Theory to Evaluate Workplace Stress Experienced by Health Care Assistants in a UK In-Patient Dementia Unit after 10 Years of National Financial Austerity (2008-2018)

AIMS

Workplace stress for support workers in UK hospitals (Health Care Assistants; HCAs) is poorly understood. This study explores experiences of HCAs working in a National Health Service in-patient dementia unit after 10 years of national financial austerity (2008-2018).

DESIGN

Qualitative evaluation.

METHODS

15 HCAs (42%) from a specialist dementia care Unit were interviewed. Interviews were guided by UK Health & Safety Executive published dimensions of work stress. Framework analysis was applied to interview transcriptions, corroborated by a follow-up focus group (6 HCAs). Post hoc interviews with 10 nurses were later introduced to obtain a balanced view of teamwork on the Unit.

RESULTS

Health care assistants were altruistic regarding demands of dementia care but otherwise negative of most aspects of their work environment. Staff shortages had increased job demands: workload, poor shift rotas, and excessive reliance on inexperienced agency staff. According to HCAs, job resources of the care team were in significant deficit: nurses in charge were perceived as poor team leaders, had poor interpersonal skills, lacked respect for experienced HCAs, and deemed to be frequently absent from the ward so failing to support carers. HCAs' lack of decision-latitude exacerbated the situation. In contrast, nurses interviewed did not recognise the teamwork issues raised by HCAs, who were considered obstructive, unsupportive, lacked awareness of nurses' responsibilities, and of insights how understaffing meant excessive administration and time required to support patients' relatives. Such dissonant inter-group views caused considerable friction and exacerbated the work pressure.

CONCLUSION

Study outcomes spotlighted impacts of socioeconomic issues for HCAs. Staff shortage, exacerbated by financial austerity measures (pre-COVID pandemic), increased job demands for HCAs but their psychosocial job resources were in serious deficit, so putting them at risk of burnout. Inter-group relations are key for a collaborative ethos, and are amenable to interventions. Such difficulties should not be allowed to fester.

Quality home care for persons living with dementia: Personal support workers' perspectives in Ontario, Canada

There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi-structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person-centered; (2) provided by PSW with dementia-specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia-specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front-line workers' perspectives and how they can help revise current healthcare policies and inform future policy development.

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review

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.

Feasibility of a Dementia-Focused Person-Centered Communication Intervention for Home Care Workers

Objectives: This study assessed the feasibility of Be EPIC, a dementia-focused, person-centered communication intervention for personal support workers (PSWs). Be EPIC's foci includes the environment, person-centered communication, client relationships, and clients' abilities, social history and preferences.Methods: Feasibility was assessed using semi-structured interviews and focus groups with PSWs. We used a phenomenological approach to assess: acceptability, implementation, practicality, demand, and limited efficacy.Results: The theme supporting the criterion of acceptability was helpful/relevant training. Themes supporting implementation included realistic simulations, interactive training, and positive learning experience at the adult-day center. The theme supporting practicality was support to attend training. Demand for Be EPIC revealed two themes: participants' personal motivation and barriers to applying newly learned knowledge and skills. The theme reflecting limited efficacy was applying newly learned knowledge and skills with home care clients. Four themes emerged that mapped onto Be EPIC's foci.Conclusions: The findings support Be EPIC's feasibility and highlight the need to address structural barriers from employers and government to ensure the delivery of person-centered dementia care.Clinical Implications: The findings highlight the need for and positive impact of person-centered communication training on home care workers, especially the value of learning by doing, reflective practice, and peer support.

A comparison of presentation methods for conducting youth juries

The 5Rights Youth Juries are an educational intervention to promote digital literacy by engaging participants (i.e. jurors) in a deliberative discussion around their digital rights. The main objective of these jury-styled focus groups is to encourage children and young people to identify online concerns and solutions with a view to developing recommendations for government policy-makers and industry chiefs. The methodology included a series of dramatized scenarios that encourage jurors to deliberate about their digital rights. This paper compares two formats for these scenarios: live actors and professionally recorded and edited videos of the same actors. Results failed to show any major differences between formats indicating the cost-effectiveness of the video-recorded format and the possibility for others to run the 5Rights Youth Juries with the support of an online open educational resource.

Nurses' perceptions of personal attributes required when working with people with a learning disability and an offending background: a qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Learning disability nursing in the area of people with a learning disability and an offending background has developed considerably over recent years, particularly since the publication of the Bradley (). There has been limited work into the competencies nurses require to work in this area, and even less about the personal attributes of learning disability nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Learning disability nursing's specific contribution to the care of this population lies in their knowledge of the interaction between the learning disability, an individual's, sometimes abusive, personal history and an understanding of the subsequent offending behaviour. The knowledge base of nurses working with people with learning disabilities and an offending background needs to reflect the changing service user group. This is particularly in relation to substance misuse, borderline personality disorder, and mental health and the way such factors inter-relate with the learning disability. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is required into the relationship among decision making, risk taking or reluctance to do this, and the personal attributes required by nurses to work in secure learning disability care. Learning disability secure services are likely to continue to undergo change as circumstances alter and the offending population demonstrate greater complexity; nursing competencies and personal attributes need similarly to adapt to such changes. Mental health nursing has a great deal to contribute to effective working with this population, specifically with regard to developing strong relationships when concerns around borderline personality disorder or substance misuse are particularly in evidence.

ABSTRACT

Aim To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background This study was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods A semi-structured interview schedule was devised and constructed, and 39 individual interviews were subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1 year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion Nursing of those with a learning disability and an offending background continues to develop. The interplay among personal history, additional background factors, nurses' personal attributes and learning disability is critical for effective relationship building.

Living with dementia in hospital wards: a comparative study of staff perceptions of practice and observed patient experience

AIMS AND OBJECTIVES

To ascertain the experiences, attitudes and knowledge of staff working in two Maltese hospital wards and the observed experiences of people with dementia living there. To examine the impact of recommendations made in October 2011 for improving the psychosocial and physical environments of the wards 1 year later.

BACKGROUND

There is an increasing policy recognition of the need for a better trained and educated dementia care workforce and of ensuring that the environmental design of care settings meets the needs of people with dementia.

DESIGN AND METHODS

At both time points, three established and validated data-collection methods evaluated (i) staff/patient interaction and patient experience, (ii) the extent to which the wards met dementia friendly principles and (iii) staff views about their work environment and their perceptions about their practice. Sixteen (five male and 11 female) patients with dementia and 69 staff in the two wards participated in the study.

RESULTS

We noted small but important changes; however, the physical and psychosocial environments of the wards did not always align to current recommendations for dementia care, with staff perceptions of care delivery not always reflecting the observed experiences of care of those living with dementia.

CONCLUSIONS

Comparing staff questionnaire data with observational methods offered a unique opportunity to understand multiple perspectives in a complex hospital setting. Incorporating these perspectives into staff and management feedback allowed for recommendations that recognised both patient-centred values and staff constraints.