Dementia Care In Hospitals Research Articles

A mixed-methods evaluation of a dementia education program for hospital staff and volunteers in Melbourne, Australia

ABSTRACT People with dementia have a high likelihood of being hospitalized at some point during the disease process. Recent research has found that more can be done to improve dementia care in hospitals. One of the strategies suggested to help achieve this objective is to provide dementia education programs to hospital staff. Such programs have the potential to improve the knowledge, attitudes, and skills of staff in caring for people with dementia to optimize their in-hospital experiences and clinical outcomes. This paper reports a mixed-methods evaluation of a dementia education program delivered to staff at a hospital in Melbourne, Australia. The quantitative evaluation found significant improvements in participant’s knowledge of dementia but did not show significant improvements in “social comfort,” a measure of how comfortable respondents are around people with dementia. Qualitative interview data supported the quantitative finding regarding improvements in knowledge about dementia and demonstrated participants were largely satisfied with the content of the education program. However, qualitative data also indicated a problem with engagement with some non-clinical staff. There is a need to improve the quality of care for patients with dementia in hospitals, and this study shows that a dementia education program can be effective in improving staff knowledge about people with dementia.

Documented nursing practices of pain assessment and management when communicating about pain in dementia care.

AimTo evaluate nurses' documented practice when communicating about pain for people with dementia in hospital.DesignRetrospective medical record review.MethodMedical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self‐report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay.ResultsOne‐hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty‐six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety‐three percent of nurses used a self‐reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management.ConclusionPain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non‐association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care.ImpactPain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required.

Dementia care in acute hospitals-A qualitative study on nurse managers' perceived challenges and solutions.

The aim of this study was to explore the perceived challenges of nurse managers when caring for patients with dementia in acute hospitals and identify possible solutions to address these challenges. Although dementia care in acute hospitals is suboptimal, few solutions have been identified. Multi-level factors need to be considered to promote changes in practice. Two focus groups were held with sixteen nurse managers responsible for eleven acute medical wards in Malta. Deductive qualitative analysis using an adapted version of McKinsey 7-S model was used as an a priori framework to categorize the perceived challenges and solutions. The nursing managers identified a number of organizational challenges that have a direct impact on the quality of care of patients with dementia. They also suggested a number of solutions such as realigning the hospital strategy, improving training and care coordination, redesigning the ward environment and changing leadership styles. This study highlight the complexity of improving dementia care in hospitals and continues to show that a system-wide approach is needed. Understanding the challenges and identifying possible solutions can help hospital staff provide better person-centred dementia care.

Interprofessional Work Model for Dementia Care in Hospitals for Community-Based Care

In this manuscript the authors have studied interprofessional work model for dementia care in hospitals for community-based care. As present situations and problems of dementia patients in hospitals for community-based care, 8 core categories (19 categories) were extracted and as actual situations of interprofessional work for dementia care, 8 core categories (13 categories) were obtained. The authors examined a function of interprofessional work model and practice contents using these categories. The results revealed that better interprofessional work can be expected by six specialists of nurses rehabilitation specialists, MSW, pharmacists, dietitians and care workers developing dementia care based on “Family handling function” “ADL maintenance and improved function” “Staff member education and empowerment function”.

Creating a toolkit with stakeholders for leveraging tablet computers to support person-centred dementia care in hospitals.

IntroductionPeople with dementia may refuse care because they feel overwhelmed by an unfamiliar environment. Everyday technology such as tablets have the potential to support person-centred dementia care in hospitals.AimsWe aimed to identify barriers and enabling factors in order to develop a toolkit to support the use of tablets in engaging individual and group activities, especially to play family videos, for hospitalized older people with dementia.MethodsA participatory action research approach was employed. We facilitated staff focus groups and conducted interviews with stakeholders. A toolkit was developed based on participants’ perspectives on how to support successful adoption.ResultsOur analysis identified two enabling factors: users’ engagement in developing a toolkit for support and adapting implementation to meet local needs. Barriers included staff and family inexperience, mechanical instability of hardware, issues around privacy and data access, technology use and personalization of messages. The toolkit includes short videos, a brochure for family caregivers, and a pocket card for staff.Discussion and implications: Staff, family and patients start with varying levels of experience with the use of tablets, making education and support vitally important to implementation. Health organizations should involve staff, patients, and families to find practical solutions.

The benefits of and barriers to using a social robot PARO in care settings: a scoping review

BackgroundGiven the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.MethodsScientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.ResultsA total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.ConclusionsMost interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits.

Using non-participant observation to uncover mechanisms: Insights from a realist evaluation

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.

Volunteers motivations and involvement in dementia care in hospitals, aged care and resident homes: An integrative review

ObjectiveTo review the current literature related to the role of volunteers in dementia care in hospitals, aged care and resident homes. DesignIntegrative review method was used to identify and analyse current literature. MethodData extracted included; author, methodology, sample, aims, data collection and analysis, findings, limitations, and comments. The Mixed Methods Appraisal Tool (MMAT) version 2011, was used to appraise the quality of the final articles. Data SourcesDatabases searched included CINAHL, Medline, ProQuest Central and PubMed. Keywords and MeSH terms: dementia, cognitive impairment, Alzheimer's disease, volunteers, volunteering, voluntary workers, hospital, acute care, aged care, residents. Results14 articles reviewed, and three major themes revealed: volunteer motivation, volunteer involvement, and understanding roles. Recommendations to assist with future volunteer programs in dementia care are presented. ConclusionVolunteer programs are beneficial to patients, family, volunteers, health care, and staff. Research of volunteers’ needs, motivations and role required, aiming to improve support and training.

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications.

BackgroundHospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.MethodTo investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data.ResultsFor adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).DiscussionHospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.ConclusionsComplications and dementia were found to cost more than other kinds of inpatient complexity.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

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. 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. 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. 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.

Dementia awareness training alone 'not enough to improve care'.

Training in dementia awareness alone will not improve dementia care in hospitals or outcomes for patients, and team members with specific expertise should work closely with hospital staff to develop skills, according to a study.

Excellent Dementia Care in Hospitals: A Guide to Supporting People with Dementia and their Carers James Jo Cotton Beth Knight Jules et al Excellent Dementia Care in Hospitals: A Guide to Supporting People with Dementia and their Carers 192pp £16.99 Jessica Kingsley 9781785921087 1785921088 [Formula: see text

Specialist nurse Jo James and colleagues in the dementia team at Imperial College Healthcare NHS Trust share their expertise and profound understanding of the needs of people with dementia in hospital in this useful guide for nurses and healthcare assistants.

Using appreciative inquiry to implement person-centred dementia care in hospital wards.

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an appreciative inquiry approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using appreciative inquiry approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in appreciative inquiry workshops, during which they are listened to and appreciated for what they can contribute.

Dementia care in hospitals: interprofessional education.

Janet Scammell, Associate Professor at Bournemouth University, discusses the recent Alzheimer's Society report and its implication for nurses and patient care

Introduction to the transforming dementia care in hospitals series.

A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN's development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward.

Transforming dementia care in an NHS trust.

Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

Dementia care in hospitals still poor

Second national audit finds lack of awareness training for nurses and healthcare assistants

Reliability and validity of the Algase Wandering Scale - version 2 for Japanese people with dementia

In Japan, where older people already make up more than 23% of the population and the proportion is still growing, the burden on those caring for people with dementia is an increasing problem. This burden is magnified by wandering behavior, a peripheral symptom. Thus, there is a need for an objective measure of wandering behavior to determine what constitutes effective care. In this study, we translated the Algase Wandering Scale – Version 2 into Japanese, and examined its reliability and validity. Ambulatory residents with dementia were selected from two nursing homes and two wards specializing in dementia care in hospitals in Japan. Nurses and care workers taking care of these residents answered questionnaires regarding the residents. From the results, the Algase Wandering Scale – Version 2, Japanese version, was examined for inter-rater reliability, stability, internal consistency, and concurrent validity. The results of the analysis in the present study demonstrated that the Algase Wandering Scale – Version 2, Japanese version, has reliability and validity, and that it can measure the presence or absence of wandering and its severity. Surveys of residents with various wandering patterns in many facilities and verification of construct validity are warranted in the future.

Improving dementia care in hospitals

AbstractIn their article on managing challenging behaviour in older people with dementia (page 20), Dr Krishnamoorthy and Dr Anderson highlight the importance of a person‐centred approach to dementia care. However, several recent reports indicate that elderly patients may not always receive the care they deserve in UK hospitals. Copyright © 2011 Wiley Interface Ltd

What role should websites play in dementia care in hospitals?

What role should websites play in dementia care in hospitals?