Care Intervention for Older Adults with Alzheimer's Disease and Related Dementias: Effect of Family Involvement on Cognitive and Functional Outcomes in Nursing Homes

Family Involvement in the Care of Nursing Home Residents With Dementia: A Scoping Review

Family members are involved in the lives of older adults with dementia in complex ways. This scoping review synthesizes existing research on family involvement in the care of nursing home residents with advanced dementia. Using the Arksey and O'Malley scoping review framework, electronic searches of PubMed, EBSCO's CINAHL Complete, and APA PsychInfo on the Ovid platform were conducted. Twenty-eight studies met inclusion criteria. Emergent themes and definitions of involvement were obtained through thematic analysis, including: (1) contact (through visitation, calling, or writing letters); (2) engagement in care activities (instrumental/activities of daily living); (3) planning and monitoring care (being aware of health and treatment changes, partnership with care staff, ensuring adequate care, and decision-making); and (4) supporting the resident (advocacy, socioemotional support, and financial support). Moreover, limited psychometrically sound instruments exist to measure family involvement. These limitations stall the progression of research targeting family involvement.

A family carer decision support intervention for people with advanced dementia residing in a nursing home: a study protocol for an international advance care planning intervention (mySupport study)

Background

Where it has been determined that a resident in a nursing home living with dementia loses decisional capacity, nursing home staff must deliver care that is in the person's best interests. Ideally, decisions should be made involving those close to the person, typically a family carer and health and social care providers. The aim of the Family Carer Decisional Support intervention is to inform family carers on end-of-life care options for a person living with advanced dementia and enable them to contribute to advance care planning. This implementation study proposes to; 1) adopt and apply the intervention internationally; and, 2) train nursing home staff to deliver the family carer decision support intervention.

Methods

This study will employ a multiple case study design to allow an understanding of the implementation process and to identify the factors which determine how well the intervention will work as intended. We will enrol nursing homes from each country (Canada n = 2 Republic of Ireland = 2, three regions in the UK n = 2 each, The Netherlands n = 2, Italy n = 2 and the Czech Republic n = 2) to reflect the range of characteristics in each national and local context. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. Our mixed methods study design has three phases to (1) establish knowledge about the context of implementation, (2) participant baseline information and measures and (3) follow up evaluation.

Discussion

The use of a multiple case study design will enable evaluation of the intervention in different national, regional, cultural, clinical, social and organisational contexts, and we anticipate collecting rich and in-depth data. While it is hoped that the intervention resources will impact on policy and practice in the nursing homes that are recruited to the study, the development of implementation guidelines will ensure impact on wider national policy and practice. It is our aim that the resources will be sustainable beyond the duration of the study and this will enable the resources to have a longstanding relevance for future advance care planning practice for staff, family carers and residents with advanced dementia.

Family member roles in long term care: Lessons for the future from COVID-19

This study investigates nursing home residents' and care partners' experiences during COVID-19 visitation restrictions. A nonprobability purposive sample of care partners was recruited via social media and email listservs. Care partners completed surveys (N = 30) and follow-up interviews (n = 17). Before COVID-19, care partners visited residents 3+ times per week for socialization and care. After restrictions, communication between care partners and nursing homes deteriorated. Families experienced reduced communication about residents' health statuses and little COVID-19 case information. Care partners expanded their advocacy roles, proposing policies to protect residents' rights. Care partners reported losing irreplaceable time with residents during restrictions. In future emergencies, we must balance the value of family visits with public health protection such as personal protective equipment (PPE).

Interventions promoting family involvement with care homes following placement of a relative with dementia: A systematic review

There is a wealth of literature investigating the role of family involvement within care homes following placement of a relative with dementia. This review summarises how family involvement is measured and aims to address two questions: (1) which interventions concerning family involvement have been evaluated? And (2) does family involvement within care homes have a positive effect on a resident’s quality of life and behavioural and psychological symptoms of dementia? After searching and screening on the three major databases PsycINFO, MEDLINE and CINAHL Plus for papers published between January 2005 and May 2021, 22 papers were included for synthesis and appraisal due to their relevance to family involvement interventions and or family involvement with resident outcomes. Results show that in 11 interventions designed to enhance at least one type of family involvement, most found positive changes in communication and family–staff relationships. Improvement in resident behavioural and psychological symptoms of dementia was reported in two randomised controlled trials promoting partnership. Visit frequency was associated with a reduction of behavioural and psychological symptoms of dementia for residents with moderate dementia. Family involvement was related to positive quality of life benefits for residents. Contrasting results and methodological weaknesses in some studies made definitive conclusions difficult. Few interventions to specifically promote family involvement within care homes following placement of a relative with dementia have been evaluated. Many proposals for further research made over a decade ago by Gaugler (2005) have yet to be extensively pursued. Uncertainty remains about how best to facilitate an optimum level and type of family involvement to ensure significant quality of life and behavioural and psychological symptoms of dementia benefits for residents with dementia.

Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review

BACKGROUND

Family inclusion in nursing homes is central to the provision of individualized care for people with dementia. Although positive effects can be recognized, barriers have been identified that hamper family inclusion in nursing homes. Specifically for people with dementia, insight into the content of interventions to foster family inclusion is lacking.

METHODS

A systematic review was performed by systematically searching the databases PubMed, Cinahl, PsycInfo and Embase. Studies were eligible if they examined (1) nursing home settings, (2) interventions to foster the inclusion of family members from people with dementia, (3) were original research articles in which effects/experiences of/with these interventions were evaluated, and (4) were written in English, Dutch or German. Findings were summarized systematically.

RESULTS

Twenty-nine studies were included. Two interventions were targeted at creating family-staff partnerships from a two-way perspective. Other interventions focused on single components, such as including family members in formal decisions (n = 9), enabling them to make better informed decisions and/or participate more actively (n = 7), or providing psychoeducation for family members (n = 3). Within the interventions, family and staff members are often treated differently. Effects on actual increase in family inclusion remain unclear.

CONCLUSIONS

Very few interventions exist that try to enhance equal family-staff partnerships in nursing homes. Future interventions should pay specific attention to mutual exchange and reciprocity between family and staff. As little is known about promising (components of) interventions to foster family inclusion in nursing homes for people with dementia, more effectiveness research is needed.

Influence of social interaction on behavioral and psychological symptoms of dementia over 1 year among long-term care facility residents

This study investigated the effect of social interaction including activity participation, relationships with residents, and communication with family/relatives and friends at baseline on the behavioral and psychological symptoms of dementia (BPSD) among long-term care facility residents over 1 year. This follow-up study was conducted among older adult residents with dementia or similar symptoms. Generalized linear mixed effect models were used to examine associations between social interaction and changes in the number and severity of BPSD symptoms over 1 year. Among 220 participants, rare participation in activities and poor relationships with other residents at baseline were associated with greater baseline BPSD. Less communication with family/relatives at baseline was associated with increased severity of BPSD over 1 year. Active interaction with family and relatives may prevent progression of BPSD severity among long-term care facility residents for at least 1 year.

Preferred Music Listening Intervention in Nursing Home Residents with Cognitive Impairment: A Randomized Intervention Study

BACKGROUND

The current trend in addressing symptoms of dementia comprises non-pharmacological strategies such as music interventions for the management and improvement of cognitive function, memory, agitation, depression, or anxiety.

OBJECTIVE

To determine the impact of a preferred music listening group intervention upon the functional, cognitive, and emotional dimensions in nursing home residents.

METHODS

A randomized intervention study was carried out. The study was conducted from June to August 2015, and involved a preferred music listening group intervention lasting 60 minutes, 5 days/week during 8 weeks. A total of 119 adults aged ≥65 years, with annual permanent residence in the nursing home (Málaga, Spain) were included in the study. 47 (39.5%) subjects were randomized to the music group intervention. The nurses and physiotherapists were blinded to the assessments.

RESULTS

The sample had a mean age of 80.52 (SD7.44) years, with female predominance. The subjects presented dependency in Barthel, and cognitive impairment as determined by the MMSE. The Tinetti scores yielded fall risk and depression as evidenced by the Yesavage scale. The Cornell scores evidenced no depression in elderly people with dementia. Following the intervention, function improved significantly with a medium effect size, as did emotional state, with a large effect size. Cognitive function was seen to worsen in the control group, but remained stable in the intervention group, with a large effect size.

CONCLUSIONS

A preferred music listening group intervention among elderly people in nursing homes is effective, resulting in improvements in functional and emotional condition.

The Predictors of and Motivations for Increased Family Involvement in Nursing Homes

BACKGROUND AND OBJECTIVES

Quantitative and qualitative data from a statewide survey of family members of nursing home residents were analyzed to determine the predictors of, and motivations for, family involvement.

RESEARCH DESIGN AND METHODS

We examined 3 types of involvement: visiting, providing personal care, and family-staff communication. Our mixed methods approach used (a) multilevel regression models to examine predictors of family involvement, including family member perceptions and resident, family member, and facility characteristics, and (b) a thematic analysis of qualitative data regarding the experiences of family members and their motivations for involvement.

RESULTS

Families were more involved when a short-term stay (<3 months) was expected, and when residents were in poorer physical condition. Spouses and female family members were more involved than others, yet the effect of gender varied by relationship type. At the facility level, families of residents in rural facilities reported less family involvement. Aside from these commonalities, predictors of each type of involvement varied. Themes from the qualitative data identify unique motivations for each type of involvement-to enhance residents' identity, care, or quality of life.

DISCUSSION

Families visit more and provide more hands-on assistance when they are not confident in the care being provided or the well-being and stability of their resident loved one. Receiving adequate information, perceiving staff as friendly, and residents as looking well cared for promote greater family-staff communication.

IMPLICATIONS

Findings can inform strategies to increase meaningful family involvement in nursing homes.

A Pilot Study of An Intervention to Increase Family Member Involvement in Nursing Home Care Plan Meetings

BACKGROUND AND OBJECTIVES

Many family members struggle to negotiate their aging relative's care with nursing home staff, potentially leading to depression and other negative outcomes for residents' families. This pilot study tested an intervention designed to empower residents' family members to attend and participate in nursing home care plan meetings.

RESEARCH DESIGN AND METHODS

We conducted a small, randomized, controlled trial of the Families Involved in Nursing home Decision-making (FIND) intervention, which used web conferencing to facilitate family participation in care plan meetings.

RESULTS

Overall, FIND was feasible and acceptable. Family members who received the FIND intervention were more likely to experience decreased depressive symptoms than those who did not.

DISCUSSION AND IMPLICATIONS

FIND is a promising approach to reduce depression among family members of nursing home residents. Findings support the need for a follow-up clinical trial.

Communicating emotional support: family caregivers' visits with residents living with dementia in nursing homes

This study characterized emotional connections between largely female caregivers and female care recipients with dementia living in nursing homes with the research question: How does interpersonal communication between family caregivers and older adults with dementia convey enacted emotional support? Ten dyads (8 with at least one female) of regularly-involved family caregivers (7 female; 3 male) and their relatives with dementia (5 female; 5 male) were videotaped. Qualitatively, three themes emerged: 1) distinct conversational topics, 2) shared physical proximity and silence, and 3) catalysts for natural interaction. These findings may help improve the quality of life of these predominantly female dyads.

Eastern perspectives on roles, responsibilities and filial piety: A case study

INTRODUCTION

Broad issues relating to filial piety and ethical dilemmas of families and care practitioners in residential care were discussed as part of an international networking project. It is meaningful to explore the different roles and responsibilities of participants in residential care in the context of China's filial piety. Older residents and their children are part of this caring process, which might be significantly different from that in Western countries. However, only a little amount of research related to this topic has been conducted.

OBJECTIVE

This study aimed to identify and describe the roles and responsibilities of a nursing professional, manager, older person, and her children, as well as other mutual contacts in residential care, based on the context of Chinese filial piety culture.

METHODS

The study was conducted as a case study. The product of the analysis, themes, or categories that describe the phenomenon, content analysis method was applied. After a consultation with a group of experts on research on older adults, a specific nursing home was selected in Xiamen City, China. This case study emphasized the roles and responsibilities of a nursing professional, manager, the older resident, and her children as they related to the care of older adult. The data, which consisted of interviews with four participants, were collected using a semi-structured interview method. Inductive content analysis was applied to analyze data.

ETHICAL CONSIDERATIONS

Permission to conduct the interviews received ethical approval from the participating organization based on national standards. The elements of voluntary participation, anonymity, and confidentiality on the part of the respondent were explained.

FINDINGS

The analysis resulted in four participants, with some variation of roles and responsibilities, describing staffing level and competence and their behavior for reducing the accident of the older adult, and the children of older adult influencing the quality of taking care of the older adult, based on the filial piety. The nursing home residents were described as becoming increasingly complex with a subsequent demand for increased spiritual support. There was variation in roles and responsibilities among four participants, but their contributions adjusting was an overall focus. Manager plays a considerable role in the future development of the institution, as a resource allocator, and decision-maker. Nursing professional is the main personnel serving as a link among staffs. The older adult herself adjust mentally and actively with the aging process, and some of them can be able to burden in taking care of her grandchildren or can be rehired and still have a distinct role in society. Children are required to fulfill their obligations to their parents, which involves supports of care, spiritual and economy. Several factors such as managers and nursing professional competence and their cooperation, various aspects of supports from their children based on the filial piety, and adequate communication and self-adjusting of the older adult, were recognized as factors affecting the process of taking care of the older adult.

DISCUSSION

New information was produced to serve as theoretical guidelines in managing nursing homes, the training of nursing staff, preservation of the filial piety culture, and encouraging self-care among older people in the new era.

CONCLUSION

A variety of roles and responsibilities for a nursing professional, manager, MrsWang and her children was identified in the older adult care process. Several factors to manager's and nursing professional's experience of the resource situation and competence level, and also adequate communication and self-adjusting of the older adult were suggested to affect the effect of taking care of the older adult. The older adults were perceived as more complex with more physical and mental problems but inadequate care from family members forcing the older adult from home care to a nursing home. A nursing home seems to have a higher nursing competence and be well-suited for the needs of the older adult, on the other hand, filial piety and self-care are also needed to play an important role in taking care of the older adult.

Development and Validation of the Scale for Partnership in Care-for Family (SPIC-F)

This study aims to develop and validate the Scale for Partnership in Care between staff and families of older adult nursing home (NH) residents—for Family (SPIC-F). The components of partnership were identified on the basis of literature reviews and focus group interviews. The content validity of 41 preliminary items was verified by 10 experts, and a pilot study was conducted. The reliability and validity of the instrument was tested on 330 families of older adult NH residents. The final instrument comprised 20 items in three categories: professional caring and support, cooperative relationship and information sharing, and participation in care. Each item is rated on a four-point Likert scale, with total scores ranging from 20–80. The reliability of the instrument was 0.95, and test–retest ICC was 0.83. This instrument could be utilized to develop interventions to establish an efficient partnership and assess its outcomes.

Investigating Barriers to Family Visitation of Nursing Home Residents: A Systematic Review

Families are integral in helping nursing home residents maintain feelings of social inclusion and an overall sense of belonging, thus reducing consequences of social exclusion. Preliminary research, particularly of the culture change movement in long-term care, shows there are barriers to family engagement and visitation of residents. The objective of this study is to: (1) identify and summarize the barriers most reported to family visitation and (2) synthesize the findings to determine which barriers are most often reported in literature, and which may pose the greatest challenges to family involvement. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final sample of 15 articles across 11 databases report seven barriers to visitation: psychological, health, staff to family member relationship, employment/finances, travel time, access to transportation, and other. Findings suggest barriers to family visitation and point toward a need for further research as relationships between resident and family member is complex and warrants attention across professions. Interprofessional efforts between social work, allied professionals, and transportation planners are necessary to address this pressing concern experienced by residents in nursing homes, with the ultimate goal of lessening such barriers.

Experiences of family-staff relationships in the care of people with dementia in residential aged care: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, critically appraise and synthesize the best available literature regarding experiences and perceptions of family-staff relationships in the care of people with dementia living in residential aged care facilities.More specifically, the objectives are to identify family caregiver and healthcare staff experiences and perceptions of their own and each other's roles and responsibilities and the characteristics that facilitate or hinder a constructive family-staff relationship.

[The experience of adult Korean children caring for parents institutionalized with dementia]

PURPOSE

The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia.

METHODS

Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method.

RESULTS

From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life.

CONCLUSION

In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.

Nurse/family caregiver intervention for delirium increases delirium knowledge and improves attitudes toward partnership

Delirium is highly prevalent, especially in hospitalized older adults and is a costly, significant predictor of poor outcomes, including mortality and institutionalization. Partnership between family caregivers and staff nurses could be a cost-neutral preventive strategy. The Nurse/Family Caregiver Partnership for Delirium Prevention (NFCPM) is an innovative educational program that concurrently teaches family caregivers and nurses about delirium and partnering in prevention. The purpose of this feasibility study was to examine the effect of the NFCPM on knowledge of delirium, attitudes toward partnership, and satisfaction with the NFCPM. A quasi-experimental pretest-posttest design was used to enroll 28 patients, 28 family caregivers, and 28 staff nurses. The intervention group significantly improved knowledge of delirium and attitudes toward partnership. Key to satisfaction were participation in decision making, communication, and respect. The NFCPM appears feasible for clinical practice and provides an innovative strategy for family and nurses to improve hospital outcomes for older adults.

Family caregiver involvement for long-term care residents at the end of life

OBJECTIVES

To examine family caregiver involvement for long-term care (LTC) residents during the last month of life. Researchers examined direct (personal care and meals) and indirect (management and monitoring) types of caregiver involvement and the relationship between the type of involvement and predisposing, enabling, and need characteristics. Researchers also examined whether the frequency of involvement changed during the end-of-life (EOL) period.

METHOD

Researchers used an expanded version of Andersen's Behavioral Model to conceptualize predictors of family involvement for 438 residents in 125 residential care/assisted living and nursing home settings. Bivariate and multivariate analyses examined relationships among variables.

RESULTS

More than one-half of family caregivers monitored, managed care and assisted with meals, and 40% assisted with personal care tasks. The enabling characteristic of days visited and the need characteristic of caregiver role strain were related to each of the 4 types of involvement. However, the other correlates were distinct to the type of involvement.

DISCUSSION

Families are involved in EOL care in LTC settings. Higher role strain is related to more involvement in each of the 4 types of involvement, suggesting that whether involvement is by desire, perceived need, or both, there is cause to more critically examine the family caregiver's desired role and need for support.

A systematic mapping review of randomized controlled trials (RCTs) in care homes

Background

A thorough understanding of the literature generated from research in care homes is required to support evidence-based commissioning and delivery of healthcare. So far this research has not been compiled or described. We set out to describe the extent of the evidence base derived from randomized controlled trials conducted in care homes.

Methods

A systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for “Nursing Home”, “Residential Facilities” and “Homes for the Aged”; CINAHL for “nursing homes”, “residential facilities” and “skilled nursing facilities”; AMED for “Nursing homes”, “Long term care”, “Residential facilities” and “Randomized controlled trial”; and BNI for “Nursing Homes”, “Residential Care” and “Long-term care”. Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results.

Results

3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6 years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health.

Conclusions

This study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.

[Development of dementia care standards]

PURPOSE

This study was done to develop standards for dementia care as a baseline for professional nurses to provide a framework for dementia care evaluation.

METHODS

The dementia care standards were developed through a literature review and focus group discussions. According to the Delphi method, the data analysis was conducted using the Content Validity Index (CVI).

RESULTS

The final set of 18 standards on dementia care was developed through one round of CVI. The standards included four structural standards: 'Organization of nursing system', 'Operating system', 'Management of human resources', 'Management of material resources', 13 procedural standards: 'Advanced assessment', 'Nursing diagnosis', 'Nursing plan', 'Advanced nursing implementation', 'Evaluation', 'Education', 'Research', 'Consultation', 'Counseling and cooperation', 'Development of specialty', 'Utilizing resources', 'Nursing quality assurance', 'Ethics', and one standard concerning outcome ('Evaluation of nursing tasks in care of patients with dementia'). The final set of 55 criteria on care of patients with dementia was confirmed through two rounds of CVI. The final 171 indicators were confirmed through four rounds of CVI.

CONCLUSION

These dementia care standards provides a framework that allows registered nurses to clarify their roles and tasks in the care of patients with dementia and provides evaluation criteria.

Dementia in residential care: education intervention trial (DIRECT); protocol for a randomised controlled trial

Background

There is scope to improve the quality of life (QOL) of people with dementia living in residential care facilities (RCF). The DIRECT study will determine if delivery of education to General Practitioners (GPs) and care staff improves the quality of life of residential care recipients with cognitive impairment.

Methods/Design

A prospective randomised controlled trial conduced in residential aged care facilities in the metropolitan area of Perth, Western Australia. Participants are care facility residents, aged 65 years and older and with mini-mental state examination scores less than 25. GPs and care facility staff have been independently randomised to intervention or control groups. An education programme, designed to meet the perceived needs of learners, will be delivered to GPs and care staff in the intervention groups. The primary outcome of the study will be quality of life of the people with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) and Alzheimer Disease Related QOL Scale (ADRQL), 4 weeks and 6 months after the conclusion of the education intervention.

Results

Recruitment of 351 people with dementia, cared for by staff in 39 residential facilities and 55 GPs, was undertaken between May 2007 and July 2008. Collection of baseline data is complete. Education has been delivered to GPs and Care staff between September 2008 and July 2009. Follow- up data collection is underway.

Discussion

The study results will have tangible implications for proprietors, managers and staff from the residential care sector and policy makers. The results have potential to directly benefit the quality of life of both patients and carers.

Trial registration

These trial methods have been prospectively registered (ACTRN12607000417482).

Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

Background

Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education.

Methods

A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically.

Results

Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of person centred care, system factors and the multidisciplinary team were consistently and frequently cited. Small group education which is flexible, individualized, practical and case based was sought.

Conclusion

The effectiveness and sustainability of an educational intervention based on these findings needs to be tested. In addition, future interventions should focus on supporting cultural change to facilitate sustainable improvements in care.

Partners in caregiving in a special care environment: cooperative communication between staff and families on dementia units

PURPOSE

This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs.

DESIGN AND METHODS

Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents' family members, followed by a joint meeting with facility administrators.

RESULTS

Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs.

IMPLICATIONS

Effective staff and family partnerships are critical in caring for residents with dementia. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.

Seizing possibilities for positive family caregiving in nursing homes

AIMS

This paper explores the ways family members reconstruct meaning through seizing possibilities for positive caregiving in nursing homes.

BACKGROUND

The importance of the ability of family caregivers to adapt and accommodate has been well documented in international family caregiving research. Through engagement in caregiving activities, families learn to modify, adapt and accommodate to changes in their situation and relationships. The support family caregivers experience in learning to accommodate change is crucial in enabling them to reconstruct positive aspects of caregiving in a long-term aged care context.

METHOD

In this study, a hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collected by in-depth interviews and participant observations, from a purposeful sample of 14 family caregivers, underwent hermeneutic analysis.

RESULTS

Five shared meanings associated with seizing possibilities for positive caregiving were revealed: accommodating new and different ways of caring; feeling a part of the nursing home community; seeing the whole picture; learning to care in stress-reducing ways and learning to seize possibilities for self.

CONCLUSION

This paper illustrates how families, through caregiving experience in nursing homes, learn to become active managers, negotiating, accommodating and redeveloping a sense of future viewed with hope, strength and positive anticipation.

RELEVANCE TO CLINICAL PRACTICE

By highlighting what is attributed significance by families, a critical examination of the difficult issues which obstruct the development of meaningful partnerships among nurses, family and their relatives is facilitated. In particular, an examination of tensions at an ideological level supports the need for future research to focus its efforts on examining the ways of implementing nursing care that facilitates partnerships that incorporate and build upon positive and equal relations among staff, families and residents in the context of the nursing home setting.

Family Member Perception of Quality of Their Visits With Relatives With Dementia: A Pilot Study

OBJECTIVE

The purpose of the investigation was to identify factors influencing quality of visits with institutionalized patients suffering from dementia.

STUDY DESIGN

Two focus groups of family members of patients residing on a Dementia Special Care Unit.

SETTING

Dementia Special Care Unit in a Veterans Administration Hospital.

PARTICIPANTS

Spouses and adult children of institutionalized patients with dementia.

INTERVENTION

During the focus group the family members were asked to identify factors that contribute to the quality of their visits with loved ones suffering from dementia. The group sessions were recorded and transcribed verbatim. Data obtained during the sessions were analyzed and specific factors affecting the visiting experience were identified.

RESULTS

Numerous factors affecting the visiting experience were identified and were grouped into personal, interpersonal, and environmental domains.

CONCLUSIONS

The presence of visitors in the long-term care setting is very important. Visiting provides a link with the families and communities, and promotes the quality of life for patients with dementia. Satisfying experience during the visits helps the families to enjoy the interaction and promotes their involvement with their institutionalized relatives. Health care providers should make efforts to improve the quality of visits.

Nursing Staff and the Outcomes of Nursing Home Stays

BACKGROUND

Findings on the relationship between nurse staffing and nursing home outcomes (eg, dying vs. discharges to the community) have been inconsistent. Although some studies show outcomes related to staffing ratios, others do not. Subjects in studies showing staffing effects may have been primarily short-stay residents and longer stays in studies showing no staffing effects. Outcomes affected by staffing may vary by short and longer stays.

OBJECTIVE

The effect of staffing by duration of stay has not been studied explicitly. The purpose of this study was to discern whether the effect of nursing staffing on discharge status varies between short and longer stays.

METHOD

Data on discharges came from the 1999 National Nursing Home Survey (n = 6386). Models were constructed for short and longer stays applying multinomial logistic regression.

RESULTS

For stays less than 60 days, but not among longer stays, the probability of leaving the nursing home in recovered or stabilized condition increased, and that of dying decreased, with an increasing staffing ratio for registered nurses. Clinical condition was the major factor differentiating discharge status among short and longer stays.

CONCLUSION

Results indicate a likely reason for past inconsistent findings on staffing. Staffing ratios may affect discharge disposition more among short stays. Some discharge dispositions, such as death, may not be the most relevant outcomes to study to discern how staffing affects the care provided to longer-stay residents. More research is warranted on how the sensitivity of outcomes to staffing ratios varies across short- and longer-stay residents.