Dementia Care Competence Research Articles

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

Dementia care competence is defined as the ability, acquired through practical experience, to deliver high-quality care services to persons with dementia (PWD). However, many studies only focus on one aspect of competence using qualitative or quantitative research design and have small sample sizes of care staff with dementia. This study aims to conduct a mixed-methods systematic review of the factors influencing the competence of dementia care staff, and explore the relationship between these factors and competence. This review was designed following the PRISMA-P 2015 statement and methodological guidance for the conduct of mixed-methods systematic reviews from the Joanna Briggs Institute (JBI). Seven English and four Chinese databases will be searched to systematically review the existing eligible studies. JBI Critical Appraisal Checklist for Qualitative Research and Analytical Cross-Sectional Studies will be used to assess the methodological quality of each study. A JBI Mixed-Methods Data Extraction Form will be applied for data extraction. The JBI convergent integrated approach will be used for data synthesis and integration. The synthesized findings will be graded according to the JBI ConQual approach as high, moderate, low, or very low. The protocol was registered with PROSPERO in October 2023 (CRD42023474093).

Exploring the associations between competence in dementia care and work attitudes among formal caregivers in nursing homes.

Based on the two-factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations. A cross-sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study. Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China. The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction. The results demonstrate that the two-factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations. Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden. No patient or public contribution.

The impact of need-based care on formal caregivers' wellbeing in nursing homes: A cluster randomized controlled trial

BackgroundNeed-based care is a structured and standardized model that supports formal caregivers in nursing homes in delivering person-centered care by responding with tailored non-pharmacological interventions on residents' unmet needs as well as having positive effects on behavioral and psychological symptoms on residents with dementia. However, limited resources as well as the shortage of caregivers in nursing homes make the implementation of need-based care challenging, especially when it comes to finding ways to spend more time with residents. The aim of this study is to evaluate the impact of the implementation of need-based care in nursing homes on formal caregivers' wellbeing. MethodsA three-arm cluster randomized controlled trial was set up in 24 Belgian nursing homes: formal caregivers in the ‘need-based care’ group (intervention; n = 195) spent time twice a week with residents who had behavioral and psychological symptoms according to the principles of need-based care while formal caregivers in the ‘time’ group (n = 257) filled in the way they spent time twice a week; a third group delivered standard care (n = 299). An implementation strategy was built upon the Implementation Quality Framework and used in the ‘need-based care group’. A total of 741 formal caregivers completed the digital questionnaire at one or more of the five time points (every nine weeks) between November 2021 and July 2022; they rated their sense of competence in dementia care, level of burnout, and, level of engagement. Moments of time were registered in a printed registration book. ResultsOnly formal caregivers from the ‘need-based care’ group experienced a higher sense of competence in dementia care at time points three (p = 0.010) and four (p = 0.001) compared with baseline with an increase of respectively 1.5 (95 % confidence interval [0.25, 2.84]) and 2.4 (95 % confidence interval [0.77, 4.04]) points. No differences in scores on burnout and engagement were found. ConclusionDespite challenging workforce circumstances in nursing homes, caregivers in the need-based care group as well as in the time group were able to spend time twice a week with residents with behavioral and psychological symptoms. No negative effects were found on formal caregivers' wellbeing after the implementation of need-based care in nursing homes. However, it requires strong leadership and the use of well-considered implementation strategies including reflective practice. Trial registryTrial registration number ISRCTN56768265 (10/08/2023).

Staff's experiences of a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme: A qualitative process evaluation.

To understand participants' experiences with a culturally specific DEmentia Competence Education for Nursing home Taskforce programme within the contexts which was delivered. An exploratory descriptive qualitative approach. Semi-structured individual interviews were conducted within one week with the participants upon their completion of the programme from July 2020 to January 2021. A purposive sample of participants with different demographic characteristics in five nursing homes was recruited to maximize the sample variation. Interviews were audiotaped and transcribed verbatim for qualitative content analysis. Participation was on voluntary and anonymous basis. Four major themes were identified, including perceived benefits of the programme (i.e., enhanced sensitivity to the needs of residents with dementia, increased communication with families of residents with dementia, facilitated guidance on care for residents with dementia), facilitators (i.e., comprehensive content, active learning, qualified trainer, intrinsic motivation and organizational support), barriers (i.e., busy working schedules, discrimination against care assistants' learning capability) and suggestions for improvement. The results suggested the acceptability of the programme. The participants positively appraised the programme in enhancing their dementia-care competence. The facilitators, barriers and suggestions identified provide insights on improving programme implementation. The qualitative findings from the process evaluation are pertinent to support the sustainability of dementia competence programme in nursing home setting. Future studies could address the modifiable barriers to enhance its effectiveness. This study was reported in adherence to the Consolidated criteria for reporting qualitatve studies (COREQ) checklist. Nursing-home staff was involved in intervention development and delivery. The educational programme could be integrated into the routine practice in nursing homes to improve staff's dementia-care competence. More attention should be paid on the educational needs of the taskforce when implementing the educational programme in nursing homes. Organizational support is the precondition for the educational programme and cultivates a culture for practice change.

Baseline data from the Australian PITCH study: Characteristics of home care workers providing dementia care

AbstractBackgroundPeople living with dementia increasingly prefer to live in their own home as their care needs progress. Home care workers (HCWs) are essential for supporting independent living, and need training and support on how to deliver evidence‐based and best‐practice dementia care. The home care workforce is diverse, and in Australia, the number of workers who identify as culturally and linguistically diverse (CALD) in 2020 represented 21% of the total direct‐care workforce.The Promoting Independence Through quality Care at Home (PITCH) project aims to improve outcomes for people living with dementia and their paid and family carers by co‐designing and testing an evidence‐based specialist training program for dementia care. A pragmatic stepped‐wedge cluster RCT is being conducted to evaluate the program. To date, 227 HCWs from seven home care providers across Australia have completed baseline measures.MethodHCWs completed the Strain in Dementia Care Scale (SDCS), Sense of Competence In Dementia Care – Staff (SCIDS), Dementia Attitudes Scale (DAS) and Dementia Knowledge Assessment Scale (DKAS). Associations between these measures was assessed using Pearson correlations. HCWs were grouped into CALD/non‐CALD groups based on self‐reported cultural background. ANOVAs examined group differences by CALD status.ResultFor the whole sample, SCIDS was correlated with DAS (r = 0.599, p<0.005) and DKAS (r = 0.257, p<0.005). DAS and DKAS were moderately correlated (r = 0.334, p<0.005). Nearly 30% of HCWs in our sample identified as CALD. The CALD group showed lower DAS, DKAS and SCIDS compared to the non‐CALD group (p’s<0.001). No differences were observed on SDCS (p = 0.58).ConclusionHCWs who were more knowledgeable about dementia had more positive attitudes toward dementia and a higher sense of competence in dementia care. HCWs who did not identify as CALD showed greater dementia knowledge, more positive dementia attitudes, and higher sense of competence in dementia care. Findings suggest that better dementia literacy supports more positive attitudes to dementia and sense of competence, and highlights that more targeted and specialized support may be beneficial for staff from CALD backgrounds (who comprise a high proportion of the Australian aged care workforce). Findings have implications for clinicians, researchers, policy‐makers, educators, and providers of dementia services.

Translation and psychometric testing of the sense of competence in Dementia Care Staff Scale in Chinese amongst dementia care staff in nursing homes of China

BackgroundAlthough China has the largest population of persons with dementia, there is no validated tool available to accurately assess formal caregivers’ competence in dementia care in long-term care settings. Appropriately assessing nursing staff’s level of competence in dementia care is the first step to develop precision training interventions to improve the quality of dementia care. The Sense of Competence in Dementia Care Staff scale (SCIDS) is a user-friendly tool with satisfactory reliability and validity. We adapted SCIDS into a Chinese version (SCIDS-C) and validated its uses in China’s socio-cultural context to assess nursing staff’s capability and competence in dementia care at nursing homes.AimsWe aimed to adapt and psychometrically test the tool among frontline nursing staff in long-term care settings in China.MethodsThe research employed a correlational design with repeated measures. In translation section, we adapted and tailored the original scale in the cultural and social context in China’s nursing homes. The scale’s adaptation consists of translating adaptation and semantic equivalence. In psychometric testing phase, we tested the validity and reliability of the scale with 174 nursing staff conveniently from six nursing homes. Construct validity was tested using exploratory factor analysis (EFA), including principal component analysis and maximum variance rotation method. Reliability was tested using Cronbach’s alpha value and intraclass correlation coefficient (ICC).ResultsThe SCIDS-C has 17 items, which belong to the two sub-scales, the Relationship-Centered Care(RCC) and Professional Care(PC). The Cronbach’s alpha value was 0.88, showing a good internal consistency. The full scale’s value of ICC was 0.94 which indicated good reliability. Exploratory factor analysis(EFA) extracted 2 common factors in each sub-scale, cumulative variance contribution rate was 56.71% and 53.92%, respectively. The named four factors are the same as the Sense of Competence in Dementia Care Staff (SCIDS) scale in English, including Building Relationships, Sustaining Personhood, Professionalism and Care Challenges.ConclusionThe SCIDS-C has shown good reliability and validity. It can be used as an appropriate tool to evaluate the competence of nursing care staff to provide dementia care for residents in nursing homes.

Feasibility of a Culturally Specific DEmentia Competence Education for Nursing Home Taskforce (DECENT) Programme: A Mixed-Method Approach

Although educational resources have been developed to build staff's dementia care competence in Western culture, their applicability and cultural relevance to the Chinese population are questionable. To address this gap, the DEmentia Competence Education for Nursing home Taskforce (DECENT) programme was developed and tailored to Chinese staff. This study aimed to evaluate the feasibility and preliminary effects of the DECENT programme. A one-group pretest-posttest study, embedded with a qualitative component, was conducted among 12 healthcare professionals. The DECENT programme comprised eight topics covering essential competencies in dementia care. It was delivered face-to-face by a qualified educator once per week for 60-90 min over 8 weeks. Outcomes were measured at baseline and immediately post-intervention. A satisfaction survey and individual interviews were conducted post-intervention to understand participants' perceptions and experience with the intervention. Nine participants finished the post-intervention assessment. Except for staff's attitudes towards people with dementia, quantitative findings generally demonstrated positive changes following the intervention. Three categories were identified from the qualitative data: well-developed programme, perceived benefits, and barriers. The findings showed that the DECENT programme is feasible and is perceived by nursing home staff as relevant and useful to daily practice. A larger-scale study is needed to evaluate its effectiveness.

Evaluation of a multicomponent restraint reduction intervention in care homes

ProblemPhysical restraints have been widely applied as a means to prevent accidents among care home residents with cognitive impairment. BackgroundEvidence has shown the risks and harms of physical restraints to the physical and psychosocial health of care home residents. Research on reducing restraint use has been sporadic with inconclusive results. QuestionCan a multicomponent program reduce inappropriate use of physical restraints in care home settings? MethodsA pretest–post-test study was conducted in two care homes in Hong Kong. The multicomponent program comprised staff education, case conferences, and consultation. Data were triangulated using self-administered questionnaires, observations of restraint use practice, and documentary reviews. The following study outcomes were evaluated at baseline and 12-month follow-up: care home staff's use of restraints, knowledge of physical restraints, and perceived competence in dementia care. FindingsRestraint use was reduced by 30.9% in 12 months (p < .001), but no significant difference in the mean scores of knowledge of physical restraints and perceived competence in dementia care was noted among care home staff between baseline and the 12-month follow-up (p = .387 and p = .287, respectively). DiscussionThe findings suggest that our multicomponent program, underpinned by organisational support, was instrumental in reducing the use of physical restraints in care home settings, but its effects on care home staff and residents remain unclear. ConclusionThis study suggests the feasibility and preliminary effects of using a multicomponent program to reduce restraint use in care homes. A more robust study design is needed to evaluate the sustained effects of our multicomponent program and also its effects on the outcomes of care home staff and residents.

Effect of a culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in China: A quasi-experimental study

BackgroundExisting educational programmes for building capacity in dementia care are developed in the Western culture; their applicability and cultural relevancy to other cultures is questionable. There is a dearth of culturally specific dementia-care educational programme for Chinese communities. ObjectivesTo evaluate a culturally specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China. DesignA multi-site quasi-experimental study. MethodsNursing homes were pair-matched and allocated into intervention (n = 5) and control group (n = 5). The DECENT programme was delivered face-to-face using multiple pedagogies for 60–90 min per session by a trained educator once per week over 8 weeks. The primary outcome was the sense of competence in dementia care. The secondary outcomes were dementia knowledge, attitudes towards people with dementia, person-centred care in nursing homes and the severity of behavioral and psychological symptoms of dementia of residents with dementia and staff-perceived disturbance. They were measured at baseline (T0), immediately post-intervention (T1) and 3 months after the intervention (T2). ResultsThe intervention group has significantly greater improvement than control group in sense of competence both at T1 (B = 5.24, p < .001) and T2 (B = 4.43, p = .013). Regarding dementia knowledge and person-centred care, intervention group only showed greater improvement than control group at T1 (B = 3.18, p = .001; B = 5.75, p = .018, respectively), but not at T2 (p = .089 and .104, respectively). Group differences in attitudes and severity of behavioral and psychological symptoms of dementia and staff-perceived disturbance were not significant at both time points. ConclusionsThe DECENT programme is applicable and beneficial in improving staff's sense of competence in dementia care in Chinese communities, but reinforcement strategies are needed to sustain the effect for maintaining the learnt knowledge and changed person-centred care practice.

Implementing Gentle Persuasive Approaches dementia education for staff on in-patient medicine units: A program evaluation.

Older adults with dementia, when hospitalised, frequently experience responsive behaviours. Staff struggle to manage responsive behaviours without specific education. We aimed to enhance staff knowledge and confidence with care for older adults with dementia and responsive behaviours on medicine units at a Canadian hospital. An online dementia education program was disseminated to staff as part of a broader quality improvement project. Gentle Persuasive Approaches (GPA) encourages staff to reframe responsive behaviours as self-protective expressions of unmet needs and learn to assess their meaning. Participants completed online quantitative and qualitative measures of self-efficacy, competence and knowledge in dementia care at three times: immediate pre-, immediate post- and six to eight weeks post-GPA eLearning. Immediately post-GPA, participants showed significant increases relative to baseline in dementia care self-efficacy, competence and knowledge. Self-efficacy scores increased further eight weeks post-GPA. Before GPA, few participants described dementia-specific strategies for de-escalating a patient’s agitation. Eight weeks post-GPA, participants described application of tailored, person-centred, non-pharmacological interventions and successful application of GPA strategies. GPA eLearning strengthened staff preparedness to interact with older adults experiencing responsive behaviours, thus enhancing their care.

Effects of the culturally sensitive DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China: A quasi‐experimental study

AbstractBackgroundA number of dementia care educational programmes are developed to build nursing‐home staff’s care competence in the Western culture. However, their applicability and cultural relevancy to Chinese population are questionable. This study aimed to develop and evaluate a Culturally Specific DEmentia Competence Education for Nursing home Taskforce (DECENT) programme in mainland China.MethodA multi‐centre two‐arm repeated‐measures quasi‐experimental study was conducted with 217 care staff from 10 nursing homes. Nursing homes were pair‐matched and allocated into intervention (n = 5) and control group (n = 5). Participants were allocated into intervention group (n=101) who received the DECENT programme or control group (n = 116) who received the printed educational materials according to the settings they worked. The DECENT programme comprised eight topics and was delivered through multiple pedagogical strategies by a qualified educator once per week for 60‐90 minutes over eight weeks. The study outcomes were the sense of competence in dementia care, dementia knowledge, attitudes towards people with dementia, person‐centred care in nursing homes and the severity of behavioural and psychological symptoms of dementia (BPSD) of residents with dementia and staff‐perceived disturbance. They were measured at baseline (T0), immediately post‐intervention (T1) and 3‐month after intervention (T2). Generalised estimating equation models were performed to analyse the effect.ResultThe intervention group improved more significantly than the control group in sense of competence in dementia care both at T1 (B = 5.24, p &lt; .001) and T2 (B = 4.43, p = .013). In terms of dementia knowledge and person‐centred care in nursing homes, the intervention group only showed significant improvement at T1 (B = 3.18, p = .001; B = 5.75, p = .018, respectively), but not at T2 (p = .089 and .104, respectively), when compared to control group. Attitudes towards people with dementia and severity of BPSD and staff‐perceived disturbance were not significant both at T1 and T2 relative to control group.ConclusionThe DECENT programme is effective in improving nursing‐home staff’s perceived dementia‐care competence. Nevertheless, continual learning and support at organisational level is needed for cultivating changes in practice and residents’ outcomes.

Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial

BackgroundHome care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home.MethodsThis study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision.DiscussionUpskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs.Trial registrationanzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.

Meaning in Life for Patients With Severe Dementia: A Qualitative Study of Healthcare Professionals' Interpretations.

The need for meaning in life is a key aspect of being human, and a central issue in the psychology of religion. Understanding experience of meaning for persons with severe dementia is challenging due to the impairments associated with the illness. Despite these challenges, this article argues that meaning in life is as important for a person with severe dementia as it is for everyone else. This study was conducted in a Norwegian hospital and nursing home context and was part of a research project on meaning in life for persons with severe dementia. The study builds on two other studies which focused on how meaning-making and experience of meaningfulness appeared in patients with severe dementia. By presenting the findings from these two studies for a group of healthcare professionals and introducing them to research on meaning in life, the aim of this study was to explore how healthcare professionals interpret the patients' experience of meaning in life in practise for patients with severe dementia in a hospital and nursing home context, and to highlight its clinical implications. The study was conducted using a qualitative method with exploratory design. The data were collected at a round table conference, a method inspired by a mode of action research called “co-operative inquiry.” Altogether 27 professional healthcarers, from a variety of professions, with high competence in dementia care participated together with six researchers authoring this article. This study revealed that healthcare professionals were constantly dealing with different forms of meaning in their everyday care for people with dementia. The findings also showed clear connexions between understanding of meaning and fundamental aspects of good dementia care. Meaning corresponded well with the principles of person-centred care, and this compatibility allowed the healthcare professionals to associate meaning in life as a perspective into their work without having much prior knowledge or being familiar with the use of this perspective. The study points out that awareness of meaning in life as an integrated perspective in clinical practise will contribute to a broader and enhanced repertoire, and hence to improved dementia care. Facilitating experience of meaning calls for increased resources in personnel and competence in future dementia care.

Dementia care education interventions on healthcare providers' outcomes in the nursing home setting: A systematic review.

Given the increasing prevalence of people with dementia in long-term care, various educational interventions have been developed to enhance the dementia care competence of healthcare providers. The study aim was to appraise the evidence of the effects of dementia care educational programs on improving the preparedness of nursing home staff. Articles on dementia care education interventions for nursing home staff were searched from eight databases. The primary outcomes were staff knowledge, attitude, competence, and sense of competence or self-efficacy related to dementia. The secondary outcomes were psychological outcomes, including burnout, caregiving stress, well-being, and job satisfaction. The quality of evidence was appraised using the Joanna Briggs Institute Critical Appraisal tool. Out of the 3269 articles identified, 19 randomized controlled trials comprising 3947 participants from eight countries were included. The methodological quality of included studies was fair. A significant improvement in staff knowledge regarding dementia was reported. The intervention effects on attitudes and competence were insignificant, and the effects on the sense of competence or self-efficacy related to dementia care were inconsistent. The effects on psychological outcomes seem limited because few significant changes were found. Multiple teaching methods, peer support, qualified trainers, and post-training support were effective components in designing the educational interventions. However, given the variations in content and dose and the methodological limitations of the included studies, the effects of educational programs were inconclusive. The findings highlight the necessity of high-quality studies on dementia-care educational interventions, especially in other cultures than Western countries, such as in Asia.

A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study

BackgroundCaring of older adults with dementia at home can be challenging for home care workers. There is a need to develop suitable training for home care workers to improve the quality of dementia care. We evaluated a 12-week dementia care training including mobile e-learning, social networking, and mentoring support group meetings on the dementia care knowledge, attitude, and competence of home care workers.MethodsThis controlled study involved 140 home care workers from two home care agencies, which were selected from 12 home care agencies in eastern Taiwan. The two home care agencies were randomly allocated either the intervention group or the control group. The intervention group received mobile e-learning, mentor-led online social support networking, and monthly face-to-face mentoring support group meetings. Participants in the control group received 8-h conventional lectures. The primary outcomes were knowledge, attitude, and competence in dementia care. Questionnaires consisting of the Dementia Knowledge Assessment Scale, Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff scale were administered to the participants at three time points (baseline, end of the 12-week intervention, and 12 weeks after the end of the intervention).ResultsGeneralized estimating equation analyses showed that the intervention significantly improved the knowledge, attitude, and competence of home care workers on dementia care. The effects remained significant even 12 weeks after the end of the intervention.ConclusionsA 12-week dementia care training program consisting of mobile e-learning, social networking, and face-to-face mentoring support group meetings were found to a feasible approach in improving the knowledge, attitude, and competence of home care workers. Mobile e-learning and online environment provides a platform that is self-directed, flexible, accessible, and cost-effective for training home care workers. The findings provide a call to action for nurse educators and policy makers to re-design existing dementia care training for home care workers to meet the critical home care needs of a growing dementia population.Trial registrationClinicalTrials.gov. NCT03822286. Registration date: 27/01/2019. Posted date: 31/01/2019.

Development and psychometric testing of a dementia care competence scale for nurses working in acute care setting.

Nurses often have difficulty to deal with dementia-related problematic behaviours, resulting in the prolonged hospitalisation of patients, which further waste medical resources and affect care quality, patient safety and nurses' job satisfaction. It is imperative to improve the dementia care competence of nurses working in acute care. Prior to educational interventions to promote dementia care, using an instrument to evaluate dementia care competence of nurses is needed. The purpose of this study was to develop and test the psychometric properties of a scale suitable for the investigation of dementia care competence of nurses working in acute care setting. The instrumental development design adapted Iceberg Theory as the theoretical foundation was used to develop a scale through three stages: Item development, Content validity and Psychometric testing of the scale. Stratified random sampling was used to enrol subjects from two medical centres in southern Taiwan. The Content Validity Index (CVI), categorical principal components analysis (CATPCA), Cronbach's α coefficient test and the intra-class correlation coefficient test were used to analyse the data. This study enrolled a total of 308 subjects. The CVI of the entire scale reached .97. Through the CATPCA, resulting 33 items in total with the Knowledge subscale consists of 13 items (range = 0-13), the Attitude subscale consists of 11 items (range = 11-55) and the Skills subscale consists of 9 items (range = 0-9). The final Cronbach's alpha coefficient for the Knowledge subscale was .88; for the Attitude subscale was .94; and for the Skills subscale was .85. The test-retest reliability after 2 weeks reached .818. This scale has good reliability, validity and theoretical support. It can be used to understand the current status and predicaments of dementia care faced by healthcare personnel working in acute care setting, as well as the educational training intervention required to be implemented. Hopefully, nurses' ability to deal with problematic behaviours of dementia can be improved.

Understanding dementia care in care home setting in China: An exploratory qualitative study.

Dementia education for healthcare providers has gained growing attention in China. This study aimed to explore the current dementia care practices in care home setting in China because people with dementia have increased need for residential care as the cognitive function worsens. An exploratory qualitative study was conducted among care staff and residents with dementia in four care homes in a metropolitan city in China between May and August 2019. Participant observations were conducted to understand how the care environment and activities affect residents with dementia. Care records were reviewed to explore the kind of care provided. In-depth individual interviews were conducted with a purposive sample of 15 care staff members of different ranks to clarify the care practices and understand their training needs with dementia care. Field notes of observations, nursing care records and interviews transcripts were triangulated for qualitative content analysis. The theme emerged is 'suboptimal dementia care practices'. Four categories about dementia care practices in care homes were identified: (a) care environment (hospital-like layout, inappropriate lighting, environmental noise, inappropriate use of colour and unclear signage), (b) care culture (being medical-oriented, overlooking individual uniqueness and privacy), (c) attitudes towards dementia (treating as children, being authoritative, adopting punitive approaches, trying to respect the residents and having a positive learning attitude) and (d) dementia care competence (questing for specific training and resources, questing for culturally specific practices and strengthening communication with family). Creating a dementia-friendly and enabling environment, shifting the care culture paradigm from disease-oriented to person-centred and developing culturally sensitive care practices are imperative. Dementia care education for care home staff using a systematic, comprehensive approach is fundamental to achieve these goals.

Development, feasibility, and acceptability of an intervention to improve care for agitation in people living in nursing homes with dementia nearing the end-of-life

To develop a staff training intervention for agitation in people with severe dementia, reaching end-of-life, residing in nursing homes (NHs), test feasibility, acceptability, and whether a trial is warranted. Feasibility study with pre- and post-intervention data collection, qualitative interviews, and focus groups. Three NHs in South East England with dementia units, diverse in terms of size, ownership status, and location. Residents with a dementia diagnosis or scoring ≥2 on the Noticeable Problems Checklist, rated as "severe" on Clinical Dementia Rating Scale, family carers, and staff (healthcare assistants and nurses). Manualized training, delivered by nonclinical psychology graduates focusing on agitation in severe dementia, underpinned by a palliative care framework. Main outcomes were feasibility of recruitment, data collection, follow-up, and intervention acceptability. We collected resident, family carer, and staff demographics. Staff provided data on resident's agitation, pain, quality of life, and service receipt. Staff reported their sense of competence in dementia care. Family carers reported on satisfaction with end-of-life care. In qualitative interviews, we explored staff and family carers' views on the intervention. The target three NHs participated: 28 (49%) residents, 53 (74%) staff, and 11 (85%) family carers who were eligible to participate consented. Eight-four percent of staff attended ≥3 sessions, and we achieved 93% follow-up. We were able to complete quantitative interviews. Staff and family carers reported the intervention and delivery were acceptable and helpful. The intervention was feasible and acceptable indicating a larger trial for effectiveness may be warranted.

Capacity building for dementia care in community care services: a mixed methods approach

BackgroundThe 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.MethodsThis 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.ResultsA 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.ConclusionsThis 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.

Exploring dementia care competence of nurses working in acute care settings.

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. 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. The study used a one-sample descriptive-correlation design. 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). 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. 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. 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.