Dementia Care Knowledge Research Articles

Dementia Training for Nurses in Acute Care Settings: Impacts and Barriers.

The provision of consistent, high-quality dementia care training for healthcare professionals in acute care hospital settings has been largely overlooked until recent years. This study was designed to investigate the effect of current healthcare professional dementia care training courses on related knowledge, attitudes, and self-efficacy in hospital nurses and to understand their training-related experiences, willingness, and perceived barriers. Using a cross-sectional design, 201 nurses were recruited from a teaching medical center in Taiwan. A questionnaire was developed by the researchers to evaluate knowledge, attitudes, and self-efficacy related to caring for people with dementia and to elucidate participant experiences and preferences regarding dementia care training courses. Five academic and clinical dementia care experts held three content validity evaluation rounds for the developed questionnaire. Inferential statistics were used to compare the knowledge, attitudes, and self-efficacy related to caring for people with dementia between participants who had and had not attended a dementia care training course. Nearly all (96.5%) of the participants had prior experience caring for people with dementia, but only 25.9% and 7.0% respectively reported haven taken basic and advanced healthcare professional dementia care training courses. Those who had taken either the basic or advanced course earned higher mean knowledge scores than those who had taken neither (p = .009 and p = .027, respectively). Time constraints and scheduling conflicts were identified as the major barriers to attending dementia care training (n = 164, 81.6%). The participants who had attended either the basic or advanced healthcare professional dementia care training course were found to have better dementia care knowledge than those who had not. Stakeholders should work to further reduce the barriers faced by nurses to attending essential dementia care training.

Comparison of Team-Based and Problem-Based Approaches to Dementia Care in Nursing Homes and Their Effects on Resident Outcomes During the COVID-19 Pandemic: A Mixed-Methods Study

ObjectivesCompare the effectiveness of 2 nonpharmacologic approaches to dementia care in nursing homes on 12- and 18-month resident outcomes, which was after the emergence of COVID-19. Design and InterventionA cluster randomized pragmatic trial, which included an embedded convergent mixed-methods design. Nursing homes were randomized to a team-based (TB) or problem-based (PB) intervention arm. Setting and ParticipantsResidents (n = 2658 at baseline) and staff (n = 327) from 52 nursing homes in the United States. MethodsThe exploratory quantitative analysis used a difference-in-differences model to compare the change in TB arm resident outcomes between baseline, 12 months, and 18 months relative to the PB arm using the Minimum Data Set 3.0. Outcomes included antipsychotic medication use, behavioral symptoms, wandering, and rejection of care. Staff interview data were analyzed in a 3-phase team-based rapid qualitative analysis approach, after which data were integrated. ResultsRejection of care decreased by 5.9 percentage points in the TB arm relative to the PB arm at 12 months (95% CI –11.7 to −0.2). Emergent results indicated that COVID-19 visitation restrictions prevented PB staff from working with families to manage rejection of care as was done before the pandemic, whereas TB staff described using collaboration strategies not hindered by the pandemic. There was no statistically significant difference between arms in antipsychotic medication use, behavioral symptoms, and wandering at either follow-up period. When integrated, qualitative data provided contradictory information on antipsychotic medication use and confirmatory information on behavioral symptoms and wandering. Conclusions and ImplicationsThe exploratory nature and mixed results of the quantitative data analysis limited the ability to determine a clear benefit of one approach over the other. Findings suggest that dementia care delivery faced complex challenges during COVID-19 and required engagement from a broad range of nursing home staff underscoring the importance of equipping all staff with foundational dementia care knowledge.

Improving the quality of communicating with dementia patients: A virtual reality‐based simulated communication approach

AbstractDementia patients may have language barriers and decreased comprehension ability. Their family caregivers can feel frustrated when communicating with them. Poor communication hinders family caregivers from obtaining accurate health information about patients, and may also increase their emotional burden, affecting patient care quality. The present study developed a virtual reality‐based simulated communication training (VRSCT) system and applied it to a training course for family caregivers of dementia patients. It allowed family caregivers to simulate real‐world situations in a VR environment, experience the daily communication barriers and stress with dementia patients, and apply their acquired knowledge and skills to solve related problems. This study used a randomised control experimental design with mixed analysis methods. A total of 63 family caregivers were recruited and randomly divided into the experimental group (N = 32) learning with the VRSCT system to interact with virtual dementia patients and practice communication skills, and the control group (N = 31) using the traditional role‐playing method for practice. Quantitative data were analysed to determine participants' knowledge of dementia care, attitudes, communication confidence and skills. In addition, the qualitative method was used to analyse the participants' discussion records. The results showed that by using the VRSCT approach, participants significantly improved their knowledge of dementia care, attitudes, communication confidence and communication skills compared to the control group. In addition, participants reported that through the real‐time feedback of the VRSCT system, they could recognise their previous incorrect communication approach. As a result, they adjusted their communication strategies and increased their self‐confidence. Practitioner notesWhat is already known about this topic Situational simulation helps learners improve their communication skills in a safe environment. Virtual reality (VR) creates a realistic, highly interactive learning environment, allowing users to be deeply immersed in the learning experience. What this paper adds This study proposed a VR‐based simulated communication training (VRSCT) approach; moreover, seven dementia cases of different degrees of severity were designed in the VR system to enable family members to experience possible challenges of taking care of dementia patients they might encounter in their daily lives. Each case in the VRSCT system has its unique symptoms and communication barriers. The learner in the story plays a caregiver, experiencing and solving the problems and challenges posed by the system. The experimental results show that the proposed method improves learners' knowledge, attitudes, communication confidence, and communication skills related to dementia care. Implications for practice and/or policy Utilising VR training can amplify awareness and secure enhanced social support for dementia‐related challenges. Using VRSCT, as governments and institutions recognise the effectiveness of VR training, they will provide more resources and promote its widespread application.

A spark of change: developing an innovative gerontological nursing intervention mapping initiative for training and education (IGNITE)

BackgroundWith an aging global population and advancements in medical technology, there is an urgent need for innovative gerontological nursing education programs. This study aimed to develop and evaluate the Innovative Gerontological Nursing Intervention Mapping Initiative for Training and Education (IGNITE) program. This program is a digital platform-based postgraduate nursing curriculum that employs the Intervention Mapping Approach (IMA) and Transformative Learning Theory to address the evolving needs of gerontological nursing.MethodsThe IGNITE program’s development process encompassed a comprehensive approach, including needs assessment, mapping of course objectives, integration of theory-based methods and strategies, course design, implementation, and rigorous evaluation. The pilot evaluation study involved pre- and post-tests focused on ageism, attitudes towards elder care, knowledge about older adults, transformative behavior change, and program satisfaction. The findings revealed significant improvements across all these dimensions, affirming the effectiveness of the program.ResultsThe program leveraged experiential learning, critical reflection, and rational discourse to facilitate transformative educational experiences. Notably, pre- and post-test comparisons showed marked improvements in attitudes towards older adult care and dementia care knowledge. Participants expressed high satisfaction with the program, with significant reported changes in transformative behaviors. The study also illuminated the initial negative attitudes of clinical nurses towards older adults and underscored the importance of transformative learning experiences in fostering empathy and understanding.ConclusionsThe IGNITE program lays a foundational framework for developing educational materials that promote transformative learning and self-reflection among healthcare professionals. This approach can lead to innovative nursing practices and personal growth. The application of the IMA and Transformative Learning Theory in gerontological nursing education shows significant promise. Future research should focus on exploring the long-term impacts of such programs and their applicability in diverse healthcare settings.

Health and social care needs of people living with dementia: a qualitative study of dementia support in the Victorian region of Gippsland, Australia.

There is a lack of information about the experiences of people living with dementia and their carers, especially in rural and regional areas. Understanding these experiences helps to identify gaps and unmet needs within the health system and improve quality of care and outcomes for people living with dementia. The aim of this study was to improve our knowledge of dementia support needs. This included access to health and social care services and supports for people living with dementia and those who provide informal or formal support to someone living with dementia. Interviews were conducted with 26 participants from the Gippsland region of Victoria, Australia with knowledge of dementia care. Purposive sampling engaged people with lived experience, carers/family members and health professionals delivering dementia care and social services. Discussions centred around participants' experiences of support services, the diagnosis process and what they thought was needed to improve the services and supports offered. Thematic analysis of the data was undertaken using the framework method. The interview data indicated that the needs of many people living with dementia and their carers were not currently being met. The themes were limited access to services and supports, including primary and specialist care, often impacted by lack of knowledge of care options, difficulty navigating the system and funding models as a barrier, leading to delays in getting a diagnosis and accessing specialist services; lack of holistic care to enable people living with dementia to 'live well'; and stigma impacted by a lack of knowledge of dementia among professionals and in the community. Relationship-centred care was described as a way to improve the lives of people living with dementia. Key areas for improvement include increasing community awareness of dementia and available local services, more support to obtain an early dementia diagnosis, increased help to navigate the system, especially immediately after diagnosis, and easier access to appropriate home support services when they are needed. Other recommendations include person-centred care across settings - supported by funding models, more education and communication skills training for health professionals and care staff - and greater support for and increased recognition of carers.

Intervention to improve acute care nurses confidence and knowledge in hospital dementia care

ProblemAcute care nurses are the front line of hospital care for persons with dementia (PwD), yet many have inadequate dementia education and lack the confidence to appropriately manage PwD in the hospital setting. ImplementationTwo acute care units with high rates of PwD in a large tertiary-care hospital were provided an education intervention involving interactive case-based discussion of the challenges of inpatient dementia care. ResultsOut of 190 nurses, 171 completed a one-hour virtual educational session, 142 completed pre/post-session confidence surveys, and 123 completed pre/post-session knowledge tests. There was a statistically significant improvement in knowledge scores from 75.8% pre-session to 88.4% post-session (p < 0.001), and pre/post-session dementia care confidence increased from 3.49 to 4.44 ( + 27.22%; p < 0.001) ConclusionAn interactive virtual education intervention improves acute care nurses’ confidence and knowledge in managing PwD in the acute care setting and may improve hospital outcomes for this population.

The needs of family caregivers of persons living with dementia cared for in primary care practices.

The informal caregivers who provide unpaid support for persons living with dementia (PLWD) are often unprepared to appropriately manage symptoms and navigate health services to support themselves or the PLWD. To understand informal caregivers' perceived capabilities of handling dementia symptomology and perceived support from providers. We identified and surveyed caregivers of primary care patients in the Mass General Brigham health system. We included a self-efficacy questionnaire to assess caregivers' ability and confidence in access to dementia care, symptom management, and provider support. Respondents indicated that although their provider had knowledge of dementia and memory care, they were least likely to agree (39.2%) that their provider helped them with these challenging symptoms. Those who live with the care recipient were least likely to receive advice about common symptoms (43.6%) and to access community services (63.8%), and in general felt moderately knowledgeable about the progression of the disease (47.9%). The findings imply that caregivers are aware of disease progression, dementia symptoms, and do not feel supported by their providers in managing care or accessing support services. There is opportunity to support informal caregivers in a primary care setting by appropriately uptraining providers in dementia care.

Using Academic Detailing to enhance the knowledge, skills and attitudes of clinicians caring for patients with behavioral and psychological symptoms of dementia: 18‐month follow‐up

AbstractBackgroundApproximately 90% of persons with dementia experience behavioral and psychological symptoms of dementia (BPSD) over the course of their illness. Primary care clinicians often provide care because specialty geriatric psychiatry consultation may be difficult to obtain. Academic detailing (AD) is an evidence‐based approach for engaging and persuading healthcare professionals to make changes in their practice. We sought to enhance the knowledge, skills and attitudes of primary care providers’ care of patients with BPSD using the AD model.MethodsWe implemented AD in an urban clinic serving a largely Black community and a rural clinic serving a largely White community. Each AD visit included didactic content, case discussion, and consultation regarding patients. Eleven visits over 18 months were planned for each site. Outcome measures included a 10‐item multiple‐choice knowledge assessment and an adaptation of the General Practitioners Attitude and Confidence Scale for Dementia at baseline, 6 and 18 months, and Likert‐scale measurement of acceptability at 6 and 18 months, all self‐report. Differences in knowledge and attitude scores were determined for those providing complete responses at baseline and follow‐up. Thematic analysis of qualitative feedback collected 18 months will be completed.ResultsFive urban and 14 rural providers completed baseline assessments. Providers were mostly White (95%) and Non‐Hispanic (100%); 47% were female (Table 1). Seventeen (89%) participated in one or more AD visits and 13 (68%) participated in the 6‐month survey. Knowledge, attitudes and confidence regarding BPSD and dementia care increased (Table 2). Assessments at 18‐months and qualitative analysis of case discussions are forthcoming and will be presented.ConclusionsAcademic detailing (AD) is a feasible way of increasing self‐reported knowledge and skills and improving self‐reported attitudes of primary care providers responsible for the care of patients with BPSD. Knowledge and confidence in BPSD and dementia care increased after 6 months’ participation in AD. During the pandemic we successfully adapted the AD model to a virtual platform, which has implications for portability of this model to other settings. The pilot data collected in this study will inform the design of a larger study to measure the impact of AD on patient outcomes.

Relationship Between Dementia Knowledge and Occupational Strain Among Staff of Residential Facilities for Older Adults: A Cross-sectional Survey

Working with people living with dementia in residential facilities for older adults can be challenging, and this is exacerbated when staff have a limited understanding of dementia. However, the relationship between knowledge of dementia and strain in caring for people with dementia among residential facility staff is unclear. This cross-sectional study investigated the relationship between dementia knowledge and strain in caring for people with dementia. A questionnaire containing the Dementia Knowledge Assessment and Strain in Dementia Care Scales was administered in 2017 and 2019 to 141 staff in three southern Australian residential facilities for older adults. Bivariate and hierarchical regression analysis examined inter-scale relationships and the power of dementia strain to explain knowledge variance. It was found that staff had substantial gaps in dementia knowledge (mean score 32/50) and low strain in dementia care (mean score 4/16). A positive relationship was found between higher dementia knowledge and greater strain in dementia care (rs = 0.319, p < .001), particularly with feeling that residents are not receiving appropriate care from colleagues (Factor 1 Frustrated Empathy; rs = 0.392, p < .001). Frustrated Empathy explained a significant amount of variance in dementia knowledge beyond demographic variables. The findings suggest that more comprehensive dementia knowledge is associated with higher strain in care of people with dementia, particularly in the context of perceived lapses in the quality of care provided by colleagues. Arguably, organisational-wide dementia education to address identified gaps should be supported by facilitating staff enaction of their knowledge to improve care.

Knowledge of dementia and dementia care in a cross-sectional sample of individuals living in rural and urban areas in KwaZulu-Natal, South Africa

Knowledge of dementia is considered one of the facilitators of dementia risk reduction because it has been linked to early detection, diagnosis, and help-seeking in people with dementia. This study explored knowledge of dementia symptoms, causes, and care in a community sample of individuals living in rural and urban areas in KwaZulu-Natal, South Africa. A cross-sectional household study of 300 participants, ⩾ 18 years old, using semi-structured individual interviews was conducted. Of the 300 participants, 94% recognised the presence of the cognitive decline symptoms, and 12.4% identified the symptoms as dementia. Participants emphasised biological and medical risk factors over socio-cultural factors. Although the participants primarily adopted a biomedical understanding of dementia, with a small number acknowledging a traditional understanding, they preferred a multi-disciplinary approach to care. Participants advocated for a multidisciplinary care approach that included medical, family, social work, mental health services, and spiritual and traditional care for people with dementia and their families. Therefore, policy and care services for African people with dementia and their families need to holistically integrate multiple care approaches. This will maximise the benefit of public health interventions while also building capacity in our understaffed and burdened healthcare systems.

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.

Undergraduate Nursing Students’ Willingness of Providing Care for Older Adults With Dementia as Their Future Work

This study examines how undergraduate nursing students’ knowledge of dementia care are associated with their willingness of providing care for older adults with dementia across care settings as nurses in urban China, controlling for factors such as their socio-demographic characteristics, willingness of being a nurse, and years of studying nursing. We surveyed 320 undergraduate students from Shanghai, China and found that students with a better knowledge of dementia care, a longer year of nursing study, have no experience of being cared for by grandparents during childhood, and being the only child at home tended to be less willing to provide care for older adults with dementia in their future work. In order to prepare high-quality future dementia care workforce, nursing educators not only need to disseminate knowledge of dementia care, they should also tailor teaching to students’ characteristics and motivate students to take the leadership in dementia care across settings.

LEVEL OF KNOWLEDGE AND ATTITUDE ON DEMENTIA CARE AMONG NURSES

Background: It is a concern in meeting patients’ needs with a high prevalence of dementia across the world. However, dementia care has always been neglected. Nurses are expected to be capable of being able to care for people with dementia. Purpose: This study aims to determine the level of knowledge and attitude on dementia care and their association among nurses at a private hospital. Methods: This is a quantitative cross-sectional study. A self-administered questionnaire using Dementia Knowledge Assessment Scale (DKAS) and Dementia Attitude Scale (DAS) were adopted in the study. In this study, a simple random sampling method was used to recruit 102 nurses. Results: Findings show that nurses have poor knowledge (M=23.59, SD=6.79) but with a positive attitude (M=98.99, SD=12.08) on dementia care. There is no association between level of knowledge and attitude in dementia care (p&gt; .05) among nurses. Conclusions: The educators, policy makers and administrators in healthcare settings are recommended to provide a support system and training strategy for nurses to improve their knowledge in caring for patients with dementia. Future study may be considered to examine the influencing factors and barriers related to dementia care.

Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer

Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.

Nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting.

An ageing population with a range of co-morbidities means the number of hospital admissions of older people with dementia is increasing. People with dementia can find acute hospital settings unsettling and they need to be cared for by a workforce skilled and knowledgeable in dementia care. To explore nursing students' experiences of, and socialisation in, dementia care in the acute hospital setting in England through a secondary qualitative analysis of data from a phenomenological study of nursing students' cultural beliefs around, and understanding of, dementia. Data from ten focus groups with 81 undergraduate nursing students at two universities in the south of England were subjected to content analysis. This was a secondary qualitative analysis of data retrieved from an earlier study. Two categories emerged: 'exposure to dementia care' and 'socialisation in dementia care'. Participants often felt unprepared to care for patients with dementia and their experiences were negatively affected by staff's views of patients with dementia, who were often considered challenging to manage. Participants also encountered specialist dementia nurses who enabled them to learn more about person-centred dementia care. Optimal dementia care knowledge and skills can contribute to enhanced patient outcomes and positive attitudes towards older people's care. To reduce deficits in dementia care education, nurses need regular continuing professional development in dementia care, higher education institutions need to commit to developing dementia care in their curricula, and students need to be socialised in dementia care earlier during undergraduate nurse education.

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.

Improving Dementia Care for Gitxsan First Nations People

&#x0D; &#x0D; &#x0D; This project originated from nursing staff’s learning need for knowledge, approach, attitude, and skills in dementia care that was identified by the Gitxsan Health Society. In collaboration with the First Nations Health Authority, the Gitxsan Health Society sought to educate nurses on how to provide culturally appropriate care to older Gitxsan persons living with dementia, and also to increase the understanding of nurses, family caregivers, and the wider community about dementia as a chronic condition. This project involved a mixed-methods approach (multiple qualitative approaches, as well as a quantitative component). The team was guided at each stage by a Cultural Advisory Council of four Elders recognized as Knowledge Holder from the community. The project involved a strong element of reciprocal co-learning and knowledge exchange. From discussions and exchange with community members, three large interlinking themes emerged to guide the researchers: (a) loss and grief; (b) relationality; and (c) access and connection. These themes gave voice to the gaps and needs in care, but also highlighted the potential areas of strength that can be built on to improve care for the older Gitxsan person living with dementia. Family and other community members identified the need for more information regarding dementia, the need to access in-community and external supports, and the need to inform nurses about what considerations are required when caring for Gitxsan people living with dementia. A better understanding of the Gitxsan ways of knowing about dementia can help nurses incorporate more culturally safe practices into the care of persons living with dementia.&#x0D; &#x0D; &#x0D;

Nurses' attitudes towards caring for people with dementia in acute hospital settings: a literature review.

People with dementia are often admitted to acute hospital settings and it is essential that nurses recognise their complex needs. However, research shows that this patient group often experiences suboptimal care in acute hospital settings as well as increased mortality rates. This article reports the findings of a literature review into the attitudes of nurses who care for patients with dementia in acute hospital settings. It sets out the findings under four themes: the unworthy patient, safety before care, breaking routines and knowledge in dementia care. These themes detail nurses' negative attitudes towards these patients, but also identify that a person-centred approach can support more positive attitudes. The review concludes that acute hospital nurses require education about caring for people with dementia to foster more positive attitudes. Also, there is a need for further research into why nurses hold various attitudes to people with dementia and the association between these attitudes and care outcomes.

Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care

ObjectivesPeople with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff–resident interactions. DesignAn exploratory, cross-sectional study. Setting and ParticipantsIn total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. MethodsStructured observations were carried out to assess the support of resident autonomy within staff–resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents’ responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. ResultsIn total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents’ needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. Conclusions and ImplicationsThe findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents’ individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.

Knowledge, attitudes and skills of dementia care in general practice: a cross-sectional study in primary health settings in Beijing, China

BackgroundGeneral practitioners (GPs) play a significant role in dementia care. However, the knowledge and attitudes of them towards dementia care are poorly characterized. The present study aimed to investigate GPs’ knowledge, attitudes and skills of dementia care in primary health settings in Beijing.MethodsA cross-sectional survey was conducted in 27 community health service centers (CHSCs) in Beijing. The GPs’ knowledge, attitudes and skills were assessed utilizing the Alzheimer’s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and self-designed questionnaire, respectively.ResultsA total of 341 participants returned the questionnaire. The overall mean score of GPs’ dementia knowledge measured by the ADKS was 21.42 (SD = 2.73) out of 30 (71.4%), GPs’ attitudes to dementia care was 36.25 (SD = 5.12) out of 50 (72.5%), and GPs’ self-confidence on dementia care skills was 53.93 (SD = 9.57) out of 75 (71.9%). GPs’ overall knowledge towards dementia care was limited and the attitudes were generally positive. They had low level recognition of their roles towards dementia care. The majority of GPs believed that dementia care was within a specialist’s domain not that of general practice.ConclusionGPs demonstrate low levels of dementia knowledge and skills, but express generally positive attitudes towards dementia in this study. It is much needed to translate detailed dementia care handbook, and adequate dementia knowledge training for GPs into practice to improve care outcomes for people with dementia in China. In addition, dementia management should be covered in the national basic package of public health services in primary care.