1
|
Lu JY, Lee YH, Wang YF. Dilemmas and support strategies in dementia care: Experiences of case managers in Taiwan. DEMENTIA 2024; 23:234-250. [PMID: 38055838 DOI: 10.1177/14713012231221025] [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: 12/08/2023]
Abstract
Objective: This study aimed to examine the dilemmas encountered and the countermeasures adopted by case managers, who care for individuals with dementia. The study also aimed to identify the types of support and assistance case managers require.Methods: In this qualitative study, the researchers conducted semi-structured interviews with 10 case managers, six from integrated dementia care centers and four from community-based dementia care centers in Taiwan.Results: The results are as follows: (1) Case managers providing services for individuals with dementia primarily encountered two major dilemmas, including cognitive differences (such as a lack of understanding of dementia, differences in ideas about dementia care, and distrust of the professionalism of case managers) with family members and their own insufficient professional capabilities, which made it difficult to reach a consensus on caregiving with family members and address the diverse conditions of individuals with dementia. (2) In response to these dilemmas, case managers adopted various approaches to enhance families' understanding of dementia and facilitate reaching a consensus on care. They also improved their professional capabilities through team discussions and resource networking. (3) The support and assistance required by case managers are continuous learning, the enhancement of their professional competencies, organizational support, and workload management.Conclusion: The findings of this study contribute to an understanding of the dilemmas faced by case managers in Taiwan's centers for integrated dementia care and community-based dementia care centers during policies implementation, as well as the strategies they adopted and the assistance they required. These results can also offer recommendations for policies, professional training, dementia services, and resources to reduce the disparity between policy and practice.
Collapse
Affiliation(s)
- Jing-Yi Lu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Ya-Hui Lee
- Department of Adult and Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan, Taiwan
| |
Collapse
|
2
|
Bilski PB, Hudson S, MacLellan M. Building Clinical Leadership Competencies When Caring for Hospitalized Adults Experiencing Dementia. CLIN NURSE SPEC 2024; 38:25-33. [PMID: 38079142 DOI: 10.1097/nur.0000000000000792] [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: 12/18/2023]
Abstract
PURPOSE AND OBJECTIVES Attempting to improve the experience of hospitalized adults with dementia and reduce patient attendant costs, we addressed hospital nursing staff confidence managing responsive behaviors through education, mentorship, and individualized patient care planning for adults with dementia.Responsive behaviors (such as pacing, calling out) is a term used to describe behaviors demonstrated by a person with dementia as a way of responding to something negative, frustrating, or confusing in their social and physical environment. DESCRIPTION OF PROJECT Under time restraints, we performed a rapid environmental scan and developed internal clinical resources and a learning strategy that informed a quality improvement initiative that focused on dementia care of hospitalized patients. OUTCOME Using quantitative and qualitative evaluation methods, the interventions increased confidence, competency, and leadership in clinical nursing leaders and improved person-centered care planning practices. The cost of patient attendant usage for this patient population decreased by 28% in 1 year. CONCLUSION This intervention, which was not a copyrighted program associated with administration costs, improved hospital-based dementia care and staff confidence in dementia care and reduced annual costs associated with patient attendant useage.
Collapse
Affiliation(s)
- Patricia B Bilski
- Author Affiliations: Professional Practice Leader (Ms Bilski), Professional Practice Leader (Ms Hudson), and Research Project Coordinator (Ms MacLellan), Nova Scotia Health, Halifax, Canada
| | | | | |
Collapse
|
3
|
Adewuyi M, Kimble L, Caruso D. Development and Validation of Dementia Care Content in Nursing Curricula Instrument-Revised. J Nurs Meas 2022; 30:762-777. [PMID: 36526416 DOI: 10.1891/jnm-d-21-00028] [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: 12/23/2022]
Abstract
Background: Understanding the extent to which dementia care content is integrated into curricula is vital to prepare the nursing workforce to provide quality dementia care. Purpose: To revise and examine the content validity of the Dementia Care Content in Nursing Curricula Instrument (DCCNCI), an instrument for assessing dementia care content in prelicensure nursing curricula. Method: We generated additional items and refined the original DCCNCI. Ten recruited expert reviewers rated each item for relevancy and assessed their clarity, meaningfulness, and completeness. Results: 39 of 47 items on the DCCNCI-Revised indicated significant content validity (cut-off value: 0.62, as calculated by applying Lawshe's formula for calculating content validity ratio). Conclusion: The DCCNCI-Revised demonstrated acceptable content validity for assessing dementia care content and its integration into prelicensure nursing curricula.
Collapse
Affiliation(s)
| | | | - Diane Caruso
- Lenoir-Rhyne University, Hickory, North Carolina
| |
Collapse
|
4
|
Hu R, Zhang F, Zhang Y, Lai B, Ma W, Xu X, Ye H, Lv Z, Chan C, Tao Q. Development and Validation of a Knowledge Scale About the Behavioral and Psychological Symptoms of Dementia (KS-BPSD) Among Chinese Formal Caregivers. Clin Gerontol 2022:1-9. [PMID: 35957605 DOI: 10.1080/07317115.2022.2111290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The current study aimed to develop a scale assessing knowledge about behavioral and psychological symptoms of dementia (KS-BPSD) among Chinese formal caregivers and to investigate its psychometric properties and factorial structure. METHODS The scale was generated with a systematic development process, and 229 formal caregivers working at nursing homes were recruited to construct and assess the psychometric properties of the scale. The preliminary scale was reviewed by an expert panel and items were selected based on item discrimination, difficulty, and item-total correlation. RESULTS The final KS-BPSD version consisted of 12 items, loaded into three factors (i.e., Disease Characteristics, Care and Risks, and Treatment Needs) following principal component analysis (PCA). The KS-BPSD showed good test-retest reliability, internal consistency, as well as construct and concurrent validity. CONCLUSIONS The 12-item KS-BPSD was found to have high reliability and preliminary validity in assessing the level of knowledge about patient's BPSD among formal Chinese caregivers in nursing homes. CLINICAL IMPLICATIONS KS-BPSD is a reliable tool to address the knowledge discrepancies and support needs among dementia caregivers, helping to develop and evaluate educational programs in the management of patient's BPSD.
Collapse
Affiliation(s)
- Rui Hu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China
| | - Fan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China
| | - Yuan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China
| | - Bingbing Lai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China
| | - Wenhao Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaohua Xu
- Department of Rehabilitation, Psychiatric Hospital of Guangzhou Civil Affairs Bureau, Guangzhou, China
| | - Hua Ye
- Department of Dementia Care, Home for the Aged Guangzhou, Guangzhou, China
| | - Zeping Lv
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, China
| | - Chetwyn Chan
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Qian Tao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.,Division of Medical Psychology and Behavior Science, School of Medicine, Jinan University, Guangzhou, China.,Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China.,Neuroscience and Neurorehabilitation Institute, University of Health and Rehabilitation Science, Qingdao, China
| |
Collapse
|
5
|
Yoon JM, Trinkoff AM, Galik E, Storr CL, Lerner NB, Brandt N, Zhu S. Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia. J Am Med Dir Assoc 2022; 23:1772-1779. [PMID: 35568094 DOI: 10.1016/j.jamda.2022.04.006] [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: 11/17/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. DESIGN A mixed-methods study was performed. SETTING AND PARTICIPANTS During the first quarter of 2018 (January-March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. METHODS Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ2 tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. RESULTS Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on PRN psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P < .001), attempt gradual drug reduction (P < .001), and provide adequate indications for psychotropics use (P < .001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P < .001) and provide nonpharmacologic interventions (P < .001). CONCLUSIONS AND IMPLICATIONS This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions.
Collapse
Affiliation(s)
- Jung Min Yoon
- Stony Brook University School of Nursing, Stony Brook, NY, USA.
| | | | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L Storr
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nancy B Lerner
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| |
Collapse
|
6
|
Abstract
Health care providers do not always possess the knowledge and skills necessary to optimally manage behavioral symptoms in patients with Alzheimer's disease (AD). The purpose of the current project was to evaluate the use of a simulated virtual reality AD experience on nursing staff sensitivity, awareness, and perceptions of caring for patients with AD. A quasi-experimental design was used. The Long Tour Survey and Approaches to Dementia Questionnaire were administered pre and post simulation and the Perceptions of Caring surveys were administered 3 to 6 weeks post-intervention. Total scores, although not statistically significant, revealed a slight change in the total score and hope subscale, representing more optimism toward people with dementia. The virtual reality AD simulation was a beneficial experience but unable to demonstrate a real change for the majority of participants. [Journal of Gerontological Nursing, 47(11), 39-47.].
Collapse
|
7
|
Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Viviano N, Madrigal C. Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test. J Nurs Meas 2020; 28:472-488. [PMID: 33067367 DOI: 10.1891/jnm-d-19-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. METHODS This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. RESULTS A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. CONCLUSIONS Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.
Collapse
Affiliation(s)
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, PA
| | | | | | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, PA
| | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Caroline Madrigal
- Pennsylvania State University College of Nursing, University Park, PA
| |
Collapse
|
8
|
A communication model for nursing staff working in dementia care: Results of a scoping review. Int J Nurs Stud 2020; 113:103776. [PMID: 33120133 DOI: 10.1016/j.ijnurstu.2020.103776] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/04/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking. OBJECTIVES To identify and visualize factors associated with communication between nursing staff and people with dementia. DESIGN A scoping review of scientific literature. DATA SOURCES Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO. REVIEW METHODS The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model. RESULTS The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed. CONCLUSIONS The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.
Collapse
|
9
|
Chan HYL, Ho FKY, Chui KCM, Hui EYS, Wong B, Chong YY, Bowes A, Kwok TCY. Capacity building for dementia care in community care services: a mixed methods approach. BMC Geriatr 2020; 20:122. [PMID: 32228475 PMCID: PMC7106768 DOI: 10.1186/s12877-020-01517-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prevalence of dementia is surging that results in huge service demand in the community care services. Dementia care competence of staff working in these settings is fundamental of the care quality. This project aims to examine the effects of staff training on their competence for the anticipated challenges in dementia care and explore how the training influence their care practices. METHODS This study adopted a mixed methods triangulation design, including a prospective multi-center study with pre-test post-test evaluations and a narrative analysis of the participants' reflective essays. Seventeen experienced health and social care professionals were trained as trainers at the Dementia Services Development Centre of the University of Stirling, UK. The trainers provided local facilitator training to staff members by using training materials that were culturally adapted to the local context. The facilitators were required to deliver 12 two-hour in-service training sessions for 6 months to their colleagues in a small group format in their respective workplace. Eventually a total of 1347 staff members from community care centers, day care centers, outreach teams and care homes of 70 non-government organizations in Hong Kong participated in the study between April 2017 and December 2018. Validated instruments were used to measure knowledge, attitude, sense of competence in dementia care and job satisfaction at the baseline and at 12-month follow-up. All participants were required to write a reflective essay to describe their experiences in dementia care by the end of the training. RESULTS A total of 1264 participants, including 195 facilitators and 1069 learners, completed all assessment were included for analysis. Significant improvements were observed in all outcomes at the 12-month follow-up assessment (Ps ≤ .001). The magnitude of improvements in attitudes was the largest. The findings also showed that the effects of the training program significantly varied across different groups of learners in terms of age, occupation, work and training experience. CONCLUSIONS This community-wide large-scale project provided evidence that the train-the-trainer model and reflective learning are effective means to facilitate situated learning that promote awareness and understanding of dementia, and consequently enhance sustainability of changes in care practices.
Collapse
Affiliation(s)
- Helen Y L Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence K Y Ho
- Jockey Club Centre for Positive Ageing, 27 A Kung Kok Street, Shatin, New Territories, Hong Kong SAR, China
| | - Kenny C M Chui
- Jockey Club Centre for Positive Ageing, 27 A Kung Kok Street, Shatin, New Territories, Hong Kong SAR, China
| | - Eunice Y S Hui
- Jockey Club Centre for Positive Ageing, 27 A Kung Kok Street, Shatin, New Territories, Hong Kong SAR, China
| | - Bel Wong
- Jockey Club Centre for Positive Ageing, 27 A Kung Kok Street, Shatin, New Territories, Hong Kong SAR, China
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alison Bowes
- Dementia Services Development Centre, University of Stirling, Stirling, UK
| | - Timothy C Y Kwok
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Jockey Club Centre for Positive Ageing, 27 A Kung Kok Street, Shatin, New Territories, Hong Kong SAR, China.
| |
Collapse
|
10
|
Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. JOURNAL OF AGING AND ENVIRONMENT 2020. [DOI: 10.1080/02763893.2019.1683670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, PA, USA
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, PA, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Liza Behrens
- School of Nursing, Pennsylvania State University, PA, USA
| | - Karen Eshraghi
- School of Nursing, Pennsylvania State University, PA, USA
| | - Nicole Viviano
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ying-Ling Jao
- School of Nursing, Pennsylvania State University, PA, USA
| |
Collapse
|
11
|
Yang YY, Hsiao CH, Chang YJ, Ma SC, Wang JJ. Exploring dementia care competence of nurses working in acute care settings. J Clin Nurs 2020; 31:1972-1982. [PMID: 31971304 DOI: 10.1111/jocn.15190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/21/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To examine the current status of dementia care competence of nurses working in acute care settings as well as the relationship between competence and demographic attributes. BACKGROUND Most people with dementia are older individuals when they are admitted to unfamiliar acute care settings for treatment, and they are prone to displaying BPSD. If nurses working in acute care settings are not sufficiently competent in dementia care, providing proper patient care is difficult. DESIGN The study used a one-sample descriptive-correlation design. METHODS This study enrolled nurses at two medical centres in southern Taiwan as the research participants and performed a stratified random sampling according to the units where they served. The Dementia Care Competence Scale was used for data collection. An independent samples t test, ANOVA and Pearson's product-moment correlation were performed for data analysis (See STROBE). RESULTS A total of 308 valid questionnaires were collected. The results showed that dementia care competence of nurses working in acute care settings was moderate. In particular, they had insufficient knowledge of the special needs related to dementia and lacked the skills and patience necessary for identifying, preventing and managing BPSD. Additionally, although the nurses tended to have a positive attitude, they seldom communicated with people with dementia. This study also found that dementia care competence was better in nurses who were older, who had more seniority, who had taken care of people with dementia for a longer period of time and who had received training in dementia care. CONCLUSIONS Dementia care training topics for nurses working in acute care settings should include palliative care for dementia, skills for managing behavioural and psychological symptoms of dementia and communication techniques for improving person-centred care. Nurses should also be encouraged to maintain a warm, friendly attitude when providing patient care. RELEVANCE TO CLINICAL PRACTICE Continuing education in managing behavioural and psychological symptoms of dementia is necessary for currently practicing acute care nursing staff and should be developed according to the staff's educational background and needs.
Collapse
Affiliation(s)
- Yueh-Ying Yang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chun-Hui Hsiao
- Department of Nursing, Chi-Mei Hospital, Tainan City, Taiwan
| | - Ying-Ju Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Shu-Ching Ma
- Department of Nursing, Chi-Mei Hospital, Tainan City, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| |
Collapse
|
12
|
Yous ML, Ploeg J, Kaasalainen S, Martin LS. Healthcare professionals' perceptions of P.I.E.C.E.S. education in supporting care delivery for older adults with responsive behaviours of dementia in acute care. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:32-51. [PMID: 30704367 DOI: 10.1080/02701960.2019.1572011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction: In acute care settings persons with dementia often use responsive behaviours such as yelling and hitting as a meaningful mode of communication. Staff dementia care education programs such as P.I.E.C.E.S. may help to address these gaps in care. P.I.E.C.E.S. is a holistic clinical assessment framework that focuses on Physical, Intellectual, and Emotional health, Capabilities of an individual, and the living Environment of a person and the Social being.Aims: The aim of this interpretive descriptive study was to explore the perceptions of healthcare professionals of P.I.E.C.E.S. and recommendations to enhance its uptake.Methods: A total of 15 healthcare professionals from acute medical settings in a hospital in Ontario participated in face-to-face, semi-structured interviews. Experiential thematic and secondary data analyses were performed.Findings: P.I.E.C.E.S. had many positive perceived impacts such as promoting interdisciplinary collaboration. However, participants reported that it was challenging to sustain P.I.E.C.E.S. in practice which led to a tapering off of it approximately one year post-education. A barrier to applying P.I.E.C.E.S. was limited time.Conclusions: Findings indicate the need for educational reinforcements and sustainability strategies for dementia care programs in acute care settings. Organizations should implement regular interdisciplinary meetings to provide opportunities for staff to apply P.I.E.C.E.S.
Collapse
Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- School of Nursing, Scientific Director, Aging, Community and Health Research Unit, Faculty of Health Sciences and Associate Member, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | | | - Lori Schindel Martin
- Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| |
Collapse
|
13
|
Lee L, Hillier LM, Patel T, Weston WW. A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:131-140. [PMID: 32175933 DOI: 10.1097/ceh.0000000000000288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
Collapse
Affiliation(s)
- Linda Lee
- Dr. Lee: Lead Physician, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, Associate Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada, and Schlegel Research Chair in Primary Care for Elders, Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada. Ms. Hillier: Research Affiliate, Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, Ontario, Canada. Dr. Patel: Pharmacist, MINT Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada, and Assistant Clinical Professor, School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada, and Assistant Clinical Professor, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Weston: Professor Emeritus, Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | | | | |
Collapse
|
14
|
Brossard Saxell T, Ingvert M, Lethin C. Facilitators for person-centred care of inpatients with dementia: A meta-synthesis of registered nurses’ experiences. DEMENTIA 2019; 20:188-212. [DOI: 10.1177/1471301219871408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Person-centred care is widely advocated when caring for people with dementia. When a person with dementia is admitted for hospital care, hospital wards are obliged to not only address the cause for admission but also provide dementia-specific care during the hospital stay. Research has shown that the delivery of person-centred care to people with dementia is often inadequate or absent in the hospital setting. Moreover, whilst registered nurses often wish to improve the in-hospital care of patients with dementia, there is evidence of experienced barriers. This study aimed to describe registered nurses’ experiences of facilitators for the delivery of person-centred care to inpatients with dementia. By way of systematic searches in the databases PubMed, CINAHL and PsycINFO, qualitative studies (n = 19) reporting registered nurses experience of caring for inpatients with dementia were identified. Relevant content was analysed using a method of thematic synthesis. Three main categories and nine subcategories were presented, internal facilitators (experience and knowledge; values and beliefs; professional identity; empathy), external facilitators (physical environment; organisational culture and structure) and facilitating actions (forming a holistic picture; establishing trust; adjusting routines and interventions). While facilitators did exist in the hospital setting, the findings indicate that care received by inpatients with dementia is dependent on individual registered nurses knowledge, personal aptitude and ability to compensate for structural flaws. In order to minimise arbitrary outcomes of care for patients with dementia, consistent organisational support in the form of educational interventions and allocation of resources is crucial.
Collapse
Affiliation(s)
| | | | - Connie Lethin
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
15
|
Kales HC, Gitlin LN, Lyketsos CG. When Less is More, but Still Not Enough: Why Focusing on Limiting Antipsychotics in People With Dementia Is the Wrong Policy Imperative. J Am Med Dir Assoc 2019; 20:1074-1079. [PMID: 31399358 DOI: 10.1016/j.jamda.2019.05.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 01/09/2023]
Abstract
Antipsychotic reductions have been the primary focus of efforts to improve dementia care in nursing homes by the Centers for Medicare & Medicaid Services National Partnership. Although significant antipsychotic reductions have been achieved, this policy focus is myopic in 2 ways; there is no evidence for any increases in use of nonpharmacologic interventions, and there are indications for compensatory increases in the use of other (unmeasured) sedating psychotropics. This increased use of other sedating psychotropics is more concerning than the antipsychotics that they replaced, as there is even less support of efficacy for behavioral and psychological symptoms of dementia (BPSD) and ample proof of harms, including mortality. The current paradigm of "assessment" and "treatment" for BPSD is largely cursory and reflexive, with little effort put forth to understand possible underlying causes. This contrasts with the methodical, evidence-based way the field handles other symptoms considered "medical" (eg, shortness of breath). To move beyond this nonmedical approach to BPSD, we suggest a conceptual model that includes putative causal contributors. Although at their core BPSD are caused by brain circuitry disruptions, such disruptions are theorized to increase the person with dementia's vulnerability to 3 categories of triggers: those related to the (1) patient (eg, pain, hunger, and infection), (2) caregivers (eg, competing priorities, unrealistic expectations, and negative communications), and (3) environment (eg, overstimulation and limited light exposure). Assessing modifiable triggers is inherently person-centered as it enables clinicians to select specific nonpharmacologic strategies to mitigate identified triggers. Assessing triggers and selecting strategies, however, is time-intensive and reflects a paradigm shift necessitating a reorganization of dementia care including compensation for time spent elucidating and addressing modifiable triggers, vs unintendedly incentivizing the use of potentially harmful psychotropics. This paradigm shift should also include the measurement and restriction of any sedating medications for BPSD, particularly without assessment of underlying causes.
Collapse
Affiliation(s)
- Helen C Kales
- Program for Positive Aging, Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA; Department of Psychiatry, University of Michigan, Ann Arbor, MI.
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD
| |
Collapse
|
16
|
Evripidou M, Merkouris A, Charalambous A, Papastavrou E. Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol. BMJ Open 2019; 9:e030459. [PMID: 31326938 PMCID: PMC6661557 DOI: 10.1136/bmjopen-2019-030459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/16/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is an evidence showing that when nurses have to allocate their time because of a lack of resources, older patients and especially those with dementia have a secondary care priority. The purpose of this study is to advance the level of knowledge, promote positive attitudes of nurses and reduce care deficits towards people with dementia through the implementation of a training programme. The programme will be enriched by an observational study of the care of patients with dementia to identify areas of missed care. METHOD AND ANALYSIS This study will follow a mixed methodology consisting of three stages: (1) evaluation of the level of nurses' knowledge and attitudes towards dementia care through the use of structured questionnaires, (2) observational study to evaluate nursing care in hospital settings, in order to detect any missed care and (3) quasi-experimental study, with a before-and-after design, through the implementation of the training programme in order to increase nurses' knowledge, improve attitudes and consequently to promote care for patients with dementia. The data will be analysed with descriptive and inferential statistics with the use of the SPSS V.24.0 and with content analysis as regard to the observational data. ETHICS AND DISSEMINATION The protocol was approved by the National Bioethics committee and other local committees (ΕΕΒΚ: 2018.01.02). The participants will give their informed consent and the anonymity and confidentiality. Also, the protection of data will be respected. The results of the study will be disseminated in peer-reviewed international journals and conferences. If the intervention is successful, the training package will be given to the continuous education unit of the National Professional Association in order to be used on a regular basis.
Collapse
Affiliation(s)
- Melina Evripidou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
- Nursing, Turun Yliopisto, Turku, Finland
| | - Evridiki Papastavrou
- Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| |
Collapse
|
17
|
Gitlin LN. Whose Responsibility Is It? Balancing Individual, Family, and Societal Needs for Supporting Seriously Ill Older Adults. J Am Geriatr Soc 2019; 67:S457-S460. [PMID: 31074862 DOI: 10.1111/jgs.15819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/23/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
18
|
Yous ML, Ploeg J, Kaasalainen S, Martin LS. Nurses' Experiences in Caring for Older Adults With Responsive Behaviors of Dementia in Acute Care. SAGE Open Nurs 2019; 5:2377960819834127. [PMID: 33415227 PMCID: PMC7774429 DOI: 10.1177/2377960819834127] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/09/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Approximately 56,000 individuals with dementia were
admitted to Canadian hospitals in 2016, and 75% of them experience responsive
behaviors. Responsive behaviors are words or actions used to express one's needs
(e.g., wandering, yelling, hitting, and restlessness). Health-care professionals
perceive these behaviors to be a challenging aspect in providing care for
persons with dementia. Aims: This study explores the perceptions of nurses about (a) caring
for older adults with dementia experiencing responsive behaviors in acute
medical settings and (b) recommendations to improve dementia care. Methods: Thorne's interpretive description approach was used.
In-person, semistructured interviews were conducted with 10 nurses and 5 allied
health professionals from acute medical settings in an urban hospital in
Ontario. Interviews were conducted with allied health professionals to
understand their perspectives regarding care delivery for persons with
responsive behaviors of dementia. Data were analyzed using Braun and Clarke's
experiential thematic analysis. Findings: Themes related to caring for individuals with responsive
behaviors included (a) delivering care is a complex experience, (b) using
pharmacological strategies and low investment nonpharmacological strategies to
support older adults with responsive behaviors, (c) acute medical settings
conflicted with principles of dementia care due to a focus on acute care
priorities and limited time, and (d) strong interprofessional collaboration and
good continuity of care were facilitators for care. Conclusions: Findings provide guidance for improved support for
nurses who provide care for individuals experiencing responsive behaviors in
acute medical settings such as increasing staffing and providing educational
reinforcements (e.g., annual review of dementia care education and
in-services).
Collapse
Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | | | - Lori Schindel Martin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| |
Collapse
|
19
|
Evripidou M, Charalambous A, Middleton N, Papastavrou E. Nurses' knowledge and attitudes about dementia care: Systematic literature review. Perspect Psychiatr Care 2019; 55:48-60. [PMID: 29766513 DOI: 10.1111/ppc.12291] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To explore nurse's knowledge and attitudes toward the care of people with dementia. DESIGN AND METHODS A systematic review informed by the PRISMA-P (preferred reporting items for systematic reviews and meta-analyses protocols) guidelines in four databases (CINAHL, PsyINFO, Pubmed, Cohrane, EMBASE) using keywords "attitudes," "behaviors," "dementia," "knowledge," and "nurses." Predetermined inclusion criteria were selected. The review was conducted between January 1 and December 30, 2017. FINDINGS Sixteen quantitative studies, one qualitative, and two mixed methods studies were included. Nurses lack knowledge, communication skills, management strategies, and confidence in the provision of dementia care. Interventional studies suggested that knowledge and attitudes improved after training programs were implemented. PRACTICE IMPLICATION This review contributes to care advancement and practice development through the reinforcement of organizational support and educational opportunities for nurses.
Collapse
Affiliation(s)
- Melina Evripidou
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Andreas Charalambous
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Evridiki Papastavrou
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| |
Collapse
|
20
|
Isobe A, Izumi M, Akifusa S. Attitudes towards people with dementia: a cross-sectional study comparing dental hygiene students with registered dental hygienists. Gerodontology 2018; 36:45-54. [PMID: 30307049 DOI: 10.1111/ger.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In order to adequately care for patients with dementia, it is necessary for dental hygienists to develop unprejudiced attitudes towards and obtain sufficient knowledge of dementia. The aim of this study was to assess attitudes towards and knowledge of dementia among Japanese dental hygiene students and identify related factors to the attitude and the knowledge. We compared the attitude and the knowledge between dental hygiene students and practising dental hygienists. BACKGROUND Dental hygienists are required to care for patients with dementia by developing appropriate attitudes towards dementia and gaining knowledge of dementia. MATERIAL AND METHODS Between May 2016 and July 2016, 191 third-grade dental hygiene students and 64 registered dental hygienists were surveyed. We modified questionnaires to assess attitudes towards and knowledge of dementia. Ageism was assessed using the Fraboni Ageism scale. To determine potential dementia awareness factors, information regarding participants' experiences with dementia was collected. RESULTS Factor analysis revealed four factors in the attitude scale (Cronbach's α, 0.652-0.820). All item-total correlation coefficients for the knowledge scale were above 0.3, and Cronbach's α was 0.827. All awareness factors for dementia were significantly different between students and registered dental hygienists. Total scores of attitude and knowledge were higher among registered dental hygienists, indicating better attitude and knowledge, but total scores of ageism were lower among registered dental hygienists, indicating worse ageism. Multiple regression analysis revealed that the attitudes towards dementia correlated with years of experience, ageism, interest in dementia and desire to work with patients with dementia. CONCLUSION Registered dental hygienists had more positive and more knowledge compared to dental hygiene students. Attitudes towards dementia, but not knowledge of dementia, were significantly positively correlated with ageism.
Collapse
Affiliation(s)
- Ayaka Isobe
- School of Oral Health Sciences, Kyusyu Dental University, Fukuoka, Japan
| | - Maya Izumi
- School of Oral Health Sciences, Kyusyu Dental University, Fukuoka, Japan
| | - Sumio Akifusa
- School of Oral Health Sciences, Kyusyu Dental University, Fukuoka, Japan
| |
Collapse
|
21
|
Gu D, Yang X, Li X, Jain HK, Liang C. Understanding the Role of Mobile Internet-Based Health Services on Patient Satisfaction and Word-of-Mouth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091972. [PMID: 30201921 PMCID: PMC6164192 DOI: 10.3390/ijerph15091972] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022]
Abstract
With the rapid advancement of Web 2.0 technologies, Internet medicine, and mobile healthcare, the influence of the use of patient-oriented Mobile Internet-based Health Services (MIHS) on patient satisfaction and the electronic word-of-mouth (WOM) of health service agencies is becoming the focus of the academic research community. Many large hospitals, including some Internet hospitals, have provided various online healthcare service platforms that enable patients to expediently consult with physicians and obtain healthcare services in an online to offline format. The purpose of this study is to analyze the main mechanisms of how the features and users' experiences of MIHS influenced patient satisfaction and continuous use behaviors of the system to generate additional WOM dissemination behaviors. Based on post-adoption behavior and Expectation Confirmation Model of Information Technology Continuance (ECM-IT), this study conducted an empirical study through data collection from users (patients) from a large hospital providing online healthcare services. A total of 494 pieces of data were collected and analyzed using SmartPLS2.0(SmartPLS GmbH, Hamburg, Gernmany). The results show that: (1) patient satisfaction with MIHS and their intentions to continue use of MIHS have significantly positive influences on WOM; (2) patient satisfaction with MIHS is positively influenced by perceived usefulness and confirmation of MIHS performance expectations; (3) and patient intentions to continue use of MIHS are also affected by some technology factors, such as facilitating conditions and perceived risk, as well as some subjective feelings, such as perceived usefulness and perceived interactivity. The results of this study provide important implications for both research and practice of public health.
Collapse
Affiliation(s)
- Dongxiao Gu
- The School of Management, Hefei University of Technology, Hefei 230009, China.
- The School of Informatics, Computing and Engineering, Bloomington, IN 47405-3907, USA.
| | - Xuejie Yang
- The School of Management, Hefei University of Technology, Hefei 230009, China.
| | - Xingguo Li
- The School of Management, Hefei University of Technology, Hefei 230009, China.
| | - Hemant K Jain
- College of Business, The University of Tennessee at Chattanooga, 615 McCallie Ave, Chattanooga, TN 37403, USA.
| | - Changyong Liang
- The School of Management, Hefei University of Technology, Hefei 230009, China.
| |
Collapse
|
22
|
Chenoweth L, Jessop T, Harrison F, Cations M, Cook J, Brodaty H. Critical Contextual Elements in Facilitating and Achieving Success with a Person-Centred Care Intervention to Support Antipsychotic Deprescribing for Older People in Long-Term Care. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7148515. [PMID: 30069476 PMCID: PMC6057399 DOI: 10.1155/2018/7148515] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/19/2018] [Accepted: 05/13/2018] [Indexed: 01/16/2023]
Abstract
Antipsychotic and other tranquilising medicines are prescribed to help care staff manages behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study was undertaken to address this issue with 139 people 60 years and over with behaviours of concern for staff living in 24 care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, dementia management education for visiting general practitioners (GP) and pharmacists, use of an individualised deprescribing protocol for residents, and awareness-raising for the resident's family. The HALT champions completed open-ended questionnaires and semistructured interviews to identify the contextual elements they considered most critical to facilitating, educating care staff, and achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in the absence of antipsychotic medicines; the champions considered that this required strong managerial support, champion empowerment to lead change, reeducation of care staff, and the cooperation of families and GPs.
Collapse
Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, NSW 2052, Australia
| | - Tiffany Jessop
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, NSW 2052, Australia
| | - Fleur Harrison
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, NSW 2052, Australia
| | - Monica Cations
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, NSW 2052, Australia
| | - Janet Cook
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, NSW 2052, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, NSW 2052, Australia
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, NSW 2052, Australia
| |
Collapse
|
23
|
Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Flanagan NM, Eshraghi KJ, Zhu S. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial. Res Nurs Health 2018; 41:228-242. [PMID: 29485197 DOI: 10.1002/nur.21866] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities.
Collapse
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, University Park, Pennsylvania
| | - Nina M Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | | | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
| |
Collapse
|
24
|
Adewuyi M, Kimble LP, Dormire SL, Sudia T. Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study. J Nurs Educ 2018; 57:88-95. [PMID: 29384569 DOI: 10.3928/01484834-20180123-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula. METHOD Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews. RESULTS Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results. CONCLUSION Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].
Collapse
|
25
|
Lin PC, Hsieh MH, Chen MC, Yang YM, Lin LC. Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study. Geriatr Gerontol Int 2017; 18:276-285. [PMID: 29094496 DOI: 10.1111/ggi.13178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/05/2017] [Accepted: 08/27/2017] [Indexed: 11/28/2022]
Abstract
AIM The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. METHODS This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. RESULTS The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. CONCLUSIONS Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285.
Collapse
Affiliation(s)
- Pei-Chao Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hui Hsieh
- Department of Nursing, Landseed Hospital, Taoyuan, Kaohsiung, Taiwan
| | - Meng-Chin Chen
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan
| | - Yung-Mei Yang
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
26
|
Gitlin LN, Kales HC, Marx K, Stanislawski B, Lyketsos C. A randomized trial of a web-based platform to help families manage dementia-related behavioral symptoms: The WeCareAdvisor™. Contemp Clin Trials 2017; 62:27-36. [PMID: 28800895 PMCID: PMC6428066 DOI: 10.1016/j.cct.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022]
Abstract
Dementia-related behavioral symptoms are challenging clinical features occurring across etiologies and disease progression. They are associated with increased healthcare utilization, nursing home placement, family upset and burden. Families typically manage behavioral symptoms without requisite knowledge, skills and guidance. We designed WeCareAdvisor™ as an easy-to-use, evidence-informed web-based platform. It provides families knowledge about dementia, daily tips, and a systematic approach to describe behaviors, investigate modifiable contributors, create treatment plans (WeCareAdvisor™ Prescription) consisting of management tips tailored to symptom presentation, and evaluate effectiveness. WeCareAdvisor™ is being tested in a randomized trial to assess acceptability, usability and immediate impact on caregiver confidence managing and upset with behavioral symptoms, and secondarily, frequency of behavioral occurrences. Fifty-seven caregivers will be enrolled from communities and medical clinics at two sites (University of Michigan; Johns Hopkins University). Families reporting behavioral symptoms in a telephone screen are consented and interviewed at home. Following the interview, an envelope is opened by interviewers to reveal group assignment (immediate vs one-month delayed treatment group). Those receiving WeCareAdvisor™ immediately are provided an iPad and instruction in its use; those in the delayed treatment group are informed of next study steps. All caregivers are reassessed at home one month from baseline. The delayed treatment group then receives iPad instructions and are re-interviewed one month thereafter. During treatment phase, participants receive 3 weekly check-in calls to encourage tool use and troubleshoot. Key outcomes include number of times using WeCareAdvisor™ and for which behaviors, self-efficacy and upset managing behavioral symptoms, and frequency of behavioral occurrences. Clinical trial registration #: NCT02420535.
Collapse
Affiliation(s)
- Laura N Gitlin
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolf Street, Baltimore, MD 21205, United States.
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI, United States; Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
| | - Katherine Marx
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolf Street, Baltimore, MD 21205, United States.
| | - Barbara Stanislawski
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI, United States; Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, United States.
| |
Collapse
|
27
|
Karlin BE, Young D, Dash K. Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:375-391. [PMID: 27454748 DOI: 10.1080/02701960.2016.1209419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nonpharmacological approaches for managing behavioral symptoms of dementia remain widely underutilized, due in part to near-universal training needs reported by dementia caregivers in recent research. This article examines the development, core components, and initial outcomes of an evidence-informed, competency-based training program in the prevention and management of behavioral symptoms of dementia among care managers and nurses within an aging services system. The Vital Outcomes Inspired by Caregiver Engagement (VOICE) Dementia Care Training Program was developed based on identification of state-of-the-art approaches to managing behaviors through expert review of the literature and structured needs assessment. Results reveal robust improvements in knowledge, attitudes, and self-efficacy among training participants, with largest effect sizes (d = 1.8) on domains of knowledge and self-efficacy to manage behaviors. Findings support the feasibility and effectiveness of training in improving the abilities and confidence of aging services providers in dementia care and, specifically, in the nonpharmacological management of dementia-related behaviors.
Collapse
Affiliation(s)
- Bradley E Karlin
- a Education Development Center, Inc ., Waltham , Massachusetts , USA
- b School of Nursing, Bouvé College of Health Sciences , Northeastern University , Boston , Massachusetts , USA
| | - David Young
- c Center for Clinical Excellence , Seniorlink, Inc ., Boston , Massachusetts , USA
| | - Kim Dash
- a Education Development Center, Inc ., Waltham , Massachusetts , USA
| |
Collapse
|
28
|
Hardie D, Smith J. Perceptions and development needs of assistant practitioners supporting individuals with dementia. ACTA ACUST UNITED AC 2017; 26:918-923. [PMID: 28880610 DOI: 10.12968/bjon.2017.26.16.918] [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: 11/11/2022]
Abstract
In the UK there are an estimated 850 000 people living with dementia. The condition costs the NHS £26 billion each year and it is estimated that this amount will treble over the next 30 years. Thus, there is a need for health and social care staff to be increasingly competent in the delivery of care to those living with dementia. The education of staff will improve knowledge and build capability to support and care for individuals with dementia. This research involved 44 assistant practitioners who shared opinions about their preparation for practice in dementia care. Focus groups and questionnaires were used to collect data that were then thematically analysed. The research also considered the assistant practitioner role in relation to workforce development. Key themes were 'training, awareness and knowledge associated with dementia care' and 'the perceptions of the assistant practitioner regarding confidence to support individuals with dementia'. There was role and responsibility protection from staff, for example, doctors and nurses were reluctant to delegate duties to the assistant practitioner. Participants' commentary indicated, however, that they were competent to support service users with dementia, although there were gaps in their experiences. The case study demonstrated the positive achievement of partnership working between a higher education institution and the workplace, which supported the assistant practitioners' learning and development.
Collapse
Affiliation(s)
- Debra Hardie
- Work-based Education Facilitator, University of Bolton
| | - Joanne Smith
- Associate Teaching Professor, University of Bolton
| |
Collapse
|
29
|
Gitlin LN, Marx KA, Alonzi D, Kvedar T, Moody J, Trahan M, Van Haitsma K. Feasibility of the Tailored Activity Program for Hospitalized (TAP-H) Patients With Behavioral Symptoms. THE GERONTOLOGIST 2017; 57:575-584. [PMID: 27076056 PMCID: PMC5434496 DOI: 10.1093/geront/gnw052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/31/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY To evaluate feasibility of implementing the Tailored Activity Program for Hospitals (TAP-H) to improve engagement in patients with dementia admitted for behavioral disturbances. DESIGN AND METHODS TAP-H involves up to 11 in-hospital sessions to develop activities tailored to patient interests and capabilities and train staff/families in their use. Interventionists (occupational therapists) recorded session lengths, patient engagement (N = 20), and staff (N = 4) readiness to use activities. Family interviews (N = 20) identified patient behaviors at admission and satisfaction with TAP-H 1 month postdischarge. A time series design with multiple behavioral observations (63 videotaped sessions) compared affective, verbal, and nonverbal behavioral responses in a standardized activity (baseline) to treatment sessions. RESULTS Average number of treatment sessions per patient was 8.00 (SD = 2.71, range 3-13). Average time spent per session was 38.18min (SD = 10.01, range 19.09-57.50). Interventionists observed high patient engagement across treatment sessions. Observational data revealed increases in pleasure and positive gestures and decreases in anxiety/anger, negative verbalizations, and negative nonverbal behaviors from baseline to intervention sessions. Staff improved in readiness and families expressed high program satisfaction with 59.4% of activities used at home. IMPLICATIONS TAP-H represents a unique collaborative care model that integrates facility-based staff in the behavioral treatment of patients with dementia and results in improved affect and reduced negative behaviors. TAP-H can be incorporated into routine hospital care and payment mechanisms. Future efforts should evaluate its effectiveness in reducing inappropriate pharmacologic use and strategies to enhance continued activity use by staff during hospitalization and families following discharge.
Collapse
Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland.
| | - Katherine A Marx
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland
| | - Dana Alonzi
- Johns Hopkins Bayview Hospital, Baltimore, Maryland
| | | | | | | | | |
Collapse
|
30
|
Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
Collapse
Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| |
Collapse
|
31
|
Hobday JV, Gaugler JE, Mittelman MS. Feasibility and Utility of Online Dementia Care Training for Hospital Staff: The CARES ® Dementia-Friendly Hospital ™ Program. Res Gerontol Nurs 2017; 10:58-65. [PMID: 28152156 DOI: 10.3928/19404921-20170131-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/06/2017] [Indexed: 11/20/2022]
Abstract
The current project tested the feasibility and utility of the CARES® Dementia-Friendly Hospital™ (CDFH) program, a 4-module, online training program for nursing assistants (NAs) and allied hospital workers (AHWs) who provide care to individuals with dementia. A single group pretest/posttest design was used for 25 hospital NAs/AHWs, and quantitative and qualitative data were collected to determine whether NAs'/AHWs' knowledge of hospital-based dementia care significantly increased, and if CDFH was perceived as useful and acceptable. Dementia care knowledge increased significantly (p < 0.001). Open- and closed-ended data suggested that the delivery of online training to NAs/AHWs to enhance dementia care is feasible, useful, and efficient. Ongoing gaps in care exist for individuals with dementia in hospitals, and delivering robust training for NAs/AHWs may serve as an effective modality to enhance quality of dementia care in such settings. [Res Gerontol Nurs. 2017; 10(2):58-65.].
Collapse
|
32
|
Resnick B, Kolanowski A, Van Haitsma K, Boltz M, Galik E, Bonner A, Vigne E, Holtzman L, Mulhall PM. Pilot Testing of the EIT-4-BPSD Intervention. Am J Alzheimers Dis Other Demen 2016; 31:570-579. [PMID: 27609932 PMCID: PMC10852713 DOI: 10.1177/1533317516662337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.
Collapse
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | | | | - Marie Boltz
- William F. Connell School of Nursing, Boston College, Boston, MA, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Alice Bonner
- School of Nursing, Northeastern University, Boston, MA, USA
| | - Erin Vigne
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Lauren Holtzman
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | |
Collapse
|