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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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Petry H, Ernst J, Naef R. Participatory development and implementation of a dementia care pathway with intervention bundles in acute care during the coronavirus pandemic: A process evaluation study. J Clin Nurs 2023; 32:7193-7208. [PMID: 37317613 DOI: 10.1111/jocn.16799] [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: 10/12/2022] [Revised: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
AIMS To explore the implementation of a dementia care pathway in an acute care setting. BACKGROUND Dementia care in acute settings is often constrained by contextual factors. We developed an evidence-based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care. DESIGN Process evaluation using quantitative and qualitative methods. METHODS Pre-implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence-based dementia care. Post-implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR). REPORTING GUIDELINE Standards for Reporting Qualitative Research Checklist. RESULTS Pre-implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence-based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational- and process-related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines. CONCLUSIONS Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process. RELEVANCE TO CLINICAL PRACTICE Our study provides important learning around improving care for persons with dementia and their families in hospitals. PATIENT OR PUBLIC CONTRIBUTION A family caregiver was involved in the development of the education and training programme.
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Affiliation(s)
- Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
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Rommerskirch-Manietta M, Manietta C, Purwins D, Braunwarth JI, Quasdorf T, Roes M. Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia-a scoping review. Implement Sci Commun 2023; 4:104. [PMID: 37641142 PMCID: PMC10463361 DOI: 10.1186/s43058-023-00486-4] [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: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. METHODS We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). RESULTS We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. CONCLUSIONS We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. TRIAL REGISTRATION The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany.
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Alhalaiqa F, Masa’Deh R, Al Omari O, Shawashreh A, Khalifeh AH, Gray R. The Impact of an Educational Programme on Jordanian Intensive Care Nurses' Knowledge, Attitudes, and Practice Regarding Delirium and their Levels of Self-Efficacy: A Quasi-Experimental Design. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:312-319. [PMID: 37575493 PMCID: PMC10412801 DOI: 10.4103/ijnmr.ijnmr_437_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/06/2021] [Accepted: 09/21/2022] [Indexed: 08/15/2023]
Abstract
Background Delirium is a common problem among patients in Intensive Care Units (ICUs); however, it remains underdiagnosed. We aimed to determine the impact of a nursing education program on Jordanian nurses' knowledge, practice, attitudes, self-efficacy, and ability to detect delirium among ICU patients. Materials and Methods We conducted a nonequivalent, quasi-experimental design from January 2019 to January 2020. A total of 175 nurses who work in an ICU were included at the baseline and divided into two groups: (1) intervention (86 nurses), who received education for 6 hours each day across two different days and (2) a control group (89 nurses), who maintained their usual routine of care. Data were collected by means of a booklet of questionnaires about the nurses' knowledge and practice, attitudes, and self-efficacy. Results Data from 160 nurses were included in the analysis. The education program intervention (n = 81) significantly increased nurses' knowledge and practice, positive attitudes, and self-efficacy compared with the control group (n = 79, p < 0.001). In addition, nurses who received the educational intervention were able to detect more cases of delirium (28%, from a total of 51 patients) than the controls, who detected three (6.50%) out of a total of 31 patients (p = 0.003). Conclusions The ICU nurses who received the delirium-focused educational program increased their knowledge and practice, positive attitudes, and their self-efficacy; in addition, their ability to detect delirium was increased. The implementation of such a program is recommended for the health policymakers and stakeholders.
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Affiliation(s)
- Fadwa Alhalaiqa
- Professor Psychiatric Mental Health Nursing, Faculty of Nursing, Dean of Allied Medical Sciences, Oman
| | - Rami Masa’Deh
- School of Nursing, Applied Science Private University, Jordan, Philadelphia University, Jordan
| | - Omar Al Omari
- Professor, Fundamentals and Administration, Faculty of Nursing, Sultan Qaboos University, Oman
| | - Atef Shawashreh
- Training and Consultation Unit, Institute of Family Health, Noor Al-Hussein Foundation, Amman, Jordan
| | | | - Richard Gray
- Professor of Clinical Nursing Practice and Director, The La Trobe Alfred Clinical School, The Alfred Centre, 99 Commercial Rd, Melbourne VIC 3004, Australia
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Gaudet JG, Kull C, Eskenazi ML, Diaper J, Maillard J, Mollard F, Marti C, Marcantonio ER, Courvoisier DS, Walder B. Three-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM): French translation and cultural adaptation. Can J Anaesth 2022; 69:726-735. [PMID: 35338453 PMCID: PMC9132814 DOI: 10.1007/s12630-022-02232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The routine use of validated diagnostic instruments is key to identifying delirious patients early and expediting care. The 3-Minute Diagnostic Assessment for Delirium using the Confusion Assessment Method (3D-CAM) instrument is a brief, easy to use, sensitive, and specific delirium assessment tool for hospitalized patients. We aimed to translate the original English version into French, and then adapt it to older high-risk patients. METHODS Translation and adaptation of the questionnaire were guided by an expert committee and the 3D-CAM instrument developer. During the translation phase, we achieved semantic and conceptual equivalence of the instrument by conducting forward and backward translations. During the adaptation phase, we assessed the face validity, clarity of wording, and ease of use of the translated questionnaire by administering it to 30 patients and their caregivers in peri-interventional and medical intermediate care units. During both phases, we used qualitative (goal and adequacy of the questionnaire) and quantitative (Sperber score, clarity score) criteria. RESULTS Translation: four items were judged inadequate and were revised until all reached a Sperber score of < 3/7. Face validity: 91% of patients thought the questionnaire was designed to assess memory, thoughts, or reasoning. Clarity: eight items required adjustments until all scored ≥ 9/10 for clarity. Ease of use: all bedside caregivers reported that the questionnaire was easy to complete after receiving brief instructions. CONCLUSIONS We produced a culturally adapted French version of the 3D-CAM instrument that is well understood and well-received by older high-risk patients and their caregivers.
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Affiliation(s)
- John G Gaudet
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Corey Kull
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Marc L Eskenazi
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - John Diaper
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Julien Maillard
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Florence Mollard
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Christophe Marti
- Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Bernhard Walder
- Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Division of Anesthesiology, Geneva University Hospital, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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ten Ham-Baloyi W. Nurses' roles in changing practice through implementing best practices: A systematic review. Health SA 2022; 27:1776. [PMID: 35747507 PMCID: PMC9210184 DOI: 10.4102/hsag.v27i0.1776] [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: 08/12/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Nurses play an important role in the implementation of best practices. However, the role of nurses in changing practice by implementing best practices requires further exploration. No systematic review was found that summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. This study summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. A systematic review was used to search for studies in the English language, where a best practice was implemented in a clinical context and which included findings regarding the roles of nurses when implementing best practices. Scopus, EBSCOhost (Academic Search Ultimate, APA PsycInfo, CINAHL with Full Text, ERIC, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete), PUBMED, and ScienceDirect databases were searched from January 2013 to June 2021. The search generated 1343 citations. After removing duplicates and applying eligibility criteria, 27 studies were included. Five definite roles were identified as follows: leadership, education and training, collaboration, communication and feedback and development and tailoring of the best practice. These roles are interrelated, but equally crucial in order to implement best practices. This study found five interrelated but equally crucial nurse roles in changing practice through the implementation of best practices. Contribution The study's findings and gaps identified can be used for further nursing research, improving practice change and health outcomes through the implementation of best practices and the role nurses can play in this process.
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Affiliation(s)
- Wilma ten Ham-Baloyi
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
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Law J, Dahlke S, Butler JI, Hunter KF, Martin LS, Pietrosanu M. Improving practicing nurses' knowledge and perceptions of older people: a quasi-experimental study. Int J Nurs Educ Scholarsh 2022; 19:ijnes-2022-0090. [PMID: 36473144 DOI: 10.1515/ijnes-2022-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to determine if an e-learning module about understanding and communicating with older people can improve practicing nurses' ageist perceptions about older people. METHODS We used a quasi-experimental pre-post-test design. Participants completed a 13-item Ambivalent Ageism Scale before and after completing the Understanding and Communicating with Older People e-learning module as well as a Likert-style feedback survey with the option for written feedback on an open-ended question. RESULTS Pre-post-test comparisons indicated a statistically significant decrease in ageist attitudes and self-reported increases in knowledge and confidence in working with older people. Qualitative analysis of written feedback revealed that most participants felt the module enhanced their understanding of older people. CONCLUSIONS The e-learning activity has the potential to improve practicing nurses' knowledge and perceptions about working with older people and is likely to be associated with better patient-level outcomes.
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Affiliation(s)
- Joanna Law
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Jeffrey I Butler
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada.,School of Nursing, York University Centre for Aging Research and Education, Faculty of Health, York University, Toronto, ON, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Lori Schindel Martin
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
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Graham F, Eaton E, Jeffrey C, Secher-Jorgensen H, Henderson A. “Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care? Collegian 2021. [DOI: 10.1016/j.colegn.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schnitker L, Nović A, Arendts G, Carpenter CR, LoGiudice D, Caplan GA, Fick DM, Beattie E. Prevention of Delirium in Older Adults With Dementia: A Systematic Literature Review. J Gerontol Nurs 2020; 46:43-54. [PMID: 32852044 DOI: 10.3928/00989134-20200820-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Although dementia is the largest independent risk factor for delirium and leads to poor health outcomes, we know little about how to prevent delirium in persons with dementia (PWD). The purpose of the current systematic literature review was to identify interventions designed to prevent delirium in older PWD. Seven studies meeting inclusion criteria were extracted. Five studies were in the acute care setting and two were community settings. One study used a randomized controlled trial design. Five of the seven interventions comprised multiple components addressing delirium risk factors, including education. Two studies addressed delirium by administration of medication or vitamin supplementation. Using the GRADE framework for the evaluation of study quality, we scored three studies as moderate and four studies as low. Thus, high-quality research studies to guide how best to prevent delirium in PWD are lacking. Although more research is required, the current review suggests that multicomponent approaches addressing delirium risk factors should be considered by health care professionals when supporting older PWD. [Journal of Gerontological Nursing, 46(10), 43-54.].
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Hurst A, Coyne E, Kellett U, Needham J. Volunteering in dementia care in an Australian hospital: A phenomenological study. Collegian 2020. [DOI: 10.1016/j.colegn.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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