Staff Training Intervention Research Articles

The development of an intradisciplinary staff training intervention on the optimal management of behavioural and psychological symptoms of dementia: A qualitative study

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder (NCD), including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff trainings on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for trainings based on high-quality research to strengthen existing evidence, ensure feasibility and reproducibility. Methods: This qualitative study, part of a larger research project, occurred in 2022 on a long-term care (LTC) center unit and an alternate level of care (ALT) hospital unit located in the Province of Quebec, Canada. This study aimed to: 1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, 2) identify the training content and modalities to prioritize according to experts, 3) develop an intradisciplinary training on BPSD management, and 4) pretest the preliminarily version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants’ consent, transcribed verbatim, and thematically content analyzed using an established method. Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALT unit). The main staff training need identified on each site was the management of resident’s aggressive behaviours. Staff verbalized a preference for a virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers and experts’ input, five interactive online staff training capsules lasting from 20-25 minutes each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites. Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in investigation will be to evaluate the feasibility and acceptability of the training.

Improving Children’s Services Engagement of Fathers in Child Protection: Logic Model for an Organisational Development and Staff Training Intervention

There is a long-standing and ongoing problem of practice with at-risk families in child welfare work focusing primarily on mothers and failing to properly engage fathers. The article describes a child welfare innovation from the UK designed to tackle this issue—the ISAFE (Improving Safeguarding through Audited Father-Engagement) intervention, developed by The Fatherhood Institute and The Children’s Social Care Research and Development Centre (CASCADE) at Cardiff University and based on two previous separate interventions which had positive initial evaluations. ISAFE combines in-service social work practitioner training with other elements of organisational development to improve the engagement of fathers. Activities targeting organisational culture are case file audits, identification and training of team champions, and a webinar for service leaders. The practitioner training involves both awareness raising about the importance of engaging men and skills development via an introduction to motivational interviewing. ISAFE’s theory of change is summarised in the form of a logic model. Limitations of the intervention and its evaluation are discussed.

A blocking and distance management staff training intervention for torso- and head-directed aggression.

Although decades of behavior-analytic studies have focused on decreasing the aggressive behavior of clients, relatively little research has been conducted on preventing injuries for the staff members who implement treatment plans. In this study, three direct-care staff members working with clients presenting with aggressive behavior were taught targeted blocking and distance management techniques designed to keep the clients safe while preventing injuries to the participants. Findings indicated that all staff members acquired the target skills in simulations, after which the skills for two participants generalized to the natural work environment.

Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention

Objective A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. Design and setting Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. Intervention Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. Patients Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. Main outcome measures Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on −0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. Results In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%–61% (control 50%–52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%–40% (control 36%–36%), p = .043, and digit preference decreased, 39%−27% (control 41%−35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 − 1.64 (control 1.62 − 1.62), non-significant, but drug choice changed in line with recommendations. Conclusion Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.

An ethnography of mealtime care for people living with dementia in care homes.

Many people living with dementia have difficulties at mealtimes, which can result in serious complications for physical and mental health, leading to hospital admissions and even death. However, current training in mealtime care for staff working with this population has been found to be poorly reported, with variable effectiveness. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to explore current practice in mealtime care for this population, identify good practice, and understand the factors influencing mealtime care. Approximately 28h of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care staff and residents living with dementia. Twenty-five semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. A constant comparative approach was taken, to probe emergent findings and explore topics in greater depth. Key thematic categories were identified, including: tensions in mealtime care; the symbolic nature of mealtime care; navigating tensions via a person-centred approach; contextual constraints on mealtime care; and teamwork in mealtime care. The findings indicated that a person-centred approach helps carers to find the right balance between apparently competing priorities, and teamwork is instrumental in overcoming contextual constraints. This evidence has contributed to development of a training intervention for care home staff. Future research should investigate the feasibility of mealtime care training in care homes.

Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation

ObjectivesWe explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes. MethodWe undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation. ResultsTwo pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members. ConclusionFunding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers’ long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer’s and other dementias plan.

Feasibility analysis of the design of a psychosocial intervention in dementia: Sensitivity analysis

AbstractBackgroundA multicomponent staff training intervention was conducted to improve residential dementia care. The purpose of this work is to present the simulation of the effectiveness of the intervention design over time.MethodPilot study with mixed methods, two‐arm randomized controlled clinical outcomes in 7 care homes in Mexico City. Staff outcome measures were: Maslach Burnout Inventory (MBI); Approaches to Dementia Questionnaire (ADQ); Sense of Competence in Dementia Care Staff (SCIDS). Residents' outcome measures were: Quality of Life‐Alzheimer’s Disease scale (QoL‐AD) and Neuropsychiatric Inventory‐Nursing Home Version (NPI‐NH). Using the functions of the R package powerlmm, we performed computer simulations based on linear changes over a period of up to 24 weeks. The measurements were divided into three time points corresponding to the schedule of our study (baseline, post‐intervention and follow‐up). In the different trials, we specified different numbers of subjects and group sizes, including those in the present study, always considering an unbalanced cluster design. We also considered the dropout rate of participants, which in this study was almost 30% and focused on the post‐intervention period, with no additional dropouts at follow‐up. We conducted simulations to determine the performance of our longitudinal study design with fewer or no unanticipated dropouts.Result55 residents and 126 staff participants were recruited in seven care homes. We found that the highest power was achieved for MBI: Personal fulfillment and SCIDS: Sustaining personhood, which were the only variables with a significant effect for the Time × Treatment interaction in the model inference. Focusing on the first of these variables and assuming the specific values for each input parameter, we see that our study design with 7 care homes was potentially capable of detecting a significant effect size of the growth effects of the intervention. Thus, the estimated sample size for a power of 80% would be nearly 85 participants, which corresponds to the complete data (i.e., no dropouts), and about 138 participants for a power of 90%.ConclusionA higher level design that includes more care homes would be sufficient to achieve effective estimates above the 80% threshold while maintaining the lowest number of participants.

Combined Training Intervention Targeting Medical and Nursing Staff Reduces Ciprofloxacin Use and Events of Urinary Tract Infection.

Inappropriate diagnosis of urinary tract infections (UTI) contributes to antimicrobial overuse. A combined training intervention for medical and nursing staff mainly addressing the analytic process reduced UTI events (9.20 vs. 7.36 per 1000 PD, −20.0%, p = 0.003) and the utilization rate of ciprofloxacin (11.6 vs. 3.5, −69.6 p = 0.001) in a Bavarian University Hospital. Combined training intervention—as part of an antibiotic stewardship program—can be effective in avoiding unnecessary urinalysis and reducing antibiotic consumption.

Multicomponent Staff Training Intervention to Improve Residential Dementia Care (PROCUIDA-Demencia): A Mixed-Methods 2-Arm Cluster Randomized Controlled Pilot and Clinical Outcomes Study.

To evaluate the feasibility outcomes of implementing a multicomponent staff training intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce antipsychotic prescription in Mexican care homes and study its effect on staff's care experience and residents' quality of life. A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training program with baseline, 12weeks, and 24weeks of the PROCUIDA-Demencia intervention vs treatment as usual (TAU). Eight care homes in Mexico City were selected, from which 55 residents and 126 staff were recruited. In situ staff training consisting of evidence-based manualized psychosocial interventions of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance therapy, and antipsychotic prescription review. Fidelity to protocol was supervised once a week. Cluster-level feasibility measures included views of staff, residents, and relatives on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff. Residents' outcome measures included Quality of Life-Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance scale. Feasibility was elicited through a focus group, and hierarchical linear mixed effects models were used to assess the adjusted effects of the respective measures. Observed medical practice showed the prescription of at least 1 antipsychotic in 41% of participants in the intervention group. Overall, 39% of residents reported discontinuation, and 15% reduction of antipsychotics, following the 12-week medical review in parallel with psychosocial interventions. Clinical outcomes contributed positively to the reduction in baseline staff burden according to the MBI after the intervention [mean difference-8.9, 95% confidence interval (CI)-17.7,-0.1, P= .049] and to the reduction in severity and frequency of behavior as per NPI-NH in residents (mean difference-9.4, 95% CI -17.5,-1.3, P= .025). PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff training to implement psychosocial interventions prior to prescribing antipsychotic medication.

Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial

BackgroundPeople with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.ObjectiveThe primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.DesignCluster randomised controlled trial of nursing homes with process evaluation conducted alongside.Subjects & settingOne thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.MethodsRandomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.ResultsAt 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.ConclusionThis study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257. Registered 14 December 2018.

Measuring the impact of a training intervention for early childhood centre staff on child development outcomes: Findings from a cluster randomized control field trial in rural Malawi.

BackgroundEvidence from low‐income settings around early education interventions that can improve young children's development is sparse, particularly with regard to the most marginalized children. This study used a two‐arm parallel cluster randomized control design to evaluate the impact of an adapted staff training programme on the developmental outcomes of children attending community‐based early learning centres in Thyolo district, rural Malawi.MethodsAt baseline we randomly selected 48 centres, from each of which 20 children were randomly selected, although data from one centre was incomplete resulting in 932 children from 47 centres. Centres were randomly allocated to either the intervention or control arm. Twelve months later, follow‐up data were collected from 44 centres. At baseline and endline, community‐based childcare centre (CBCC) managers provided information about the centre, and parents/guardians provided information on the children, including the primary outcomes of age‐standardized development scores in the language and social domains, measured using the Malawi Developmental Assessment Tool. Children in the bottom 2.5 percentile of either domain were considered to have a delay; a third outcome variable, Any Delay, was developed to indicate children with a delay in either or both domains. Centre‐level mean scores were calculated, and linear regression models were constructed to assess differences between baseline and endline and between allocation groups.ResultsAnalysis of the difference between baseline and endline measures in the allocation groups shows a non‐significant reduction in delay associated with the study intervention across all domains. Adjustment for baseline characteristics within the CBCCs showed little impact on the magnitude of the observed effect, and the difference remained non‐significant.ConclusionsDespite no observed differences between allocation groups, the data did indicate a positive change in the intervention groups in both domains, particularly language. Community‐based early learning in Malawi holds tremendous potential for promoting inclusive development and learning.

Challenges in Implementing Evidence-Based Dementia Care Programs in Community-Based Settings: ADS Plus

The Adult Day Service Plus Program (ADS Plus) augments the usual care provided by ADS programs by integrating education, referrals, and problem-solving strategies for family caregivers of persons with dementia. Utilizing a mixed-methods, hybrid effectiveness design, we were in the process of conducting a national evaluation of ADS Plus across xx geographically and culturally diverse programs across the U.S. when the COVID-19 pandemic resulted in the shutdown of almost all of the programs participating in ADS Plus. Qualitative and quantitative data collected during the evaluation suggested that a more robust incorporation of implementation domains and measures (e.g., organizational readiness to change) may have helped avoid some of the challenges related to staff training, fidelity, and other critical intervention delivery aspects. Incorporating implementation science frameworks and measures as early as possible in intervention design may have helped to overcome some of the challenges experienced in ADS Plus.

Improving mealtime care for people with dementia: A training intervention for care home staff

AbstractBackgroundMore and more people with dementia are living in care homes. Often they depend on care home staff for help with eating and drinking. It is essential that care home staff are able to provide good care at mealtimes. The aim of this intervention development study was to produce a staff training intervention to improve mealtimes for people with dementia.MethodThere were three phases to the study. The first phase was an evidence synthesis of relevant peer‐reviewed and grey literature, using robust systematic review methods. Data were interrogated to identify thematic categories of carer‐resident interaction in mealtime care. The second phase was an ethnography conducted in UK care homes, to explore current practice in mealtime care, and identify good practice. This included over twenty‐five hours of mealtime observations, and twenty‐two semi‐structured interviews with care home staff, family carers, and visiting health and social care professionals. The third phase was a series of co‐development workshops, in which key stakeholders worked together to create a prototype training intervention, informed by evidence from phases one and two.ResultThe training intervention content was selected to promote key components of mealtime care, including empowerment, independence, and social interaction. The delivery methods were designed to employ collaborative learning techniques and interactive activities. Issues of implementation, evaluation and context were considered. This will inform the design of a feasibility study, which will aim to ensure that the intervention is scalable, transferable and sustainable.ConclusionTraining interventions which are developed using relevant evidence and in collaboration with key stakeholders are more likely to be successful. This intervention development study seeks to demonstrate the value of such an approach. The feasibility study will test the intervention’s acceptability to recipients, and potential to impact practice.

Structural Justice Ethics in Health Care

Structural Justice Ethics in Health Care

A brief staff training to increase children’s physical activity during an after-school program: Preliminary effectiveness and potential for dissemination

This two-part study aimed to first evaluate the preliminary effectiveness of a brief staff training intervention to promote physical activity among children attending an after-school program, and then to determine the feasibility of delivering the training to a larger number of sites. Two Boys and Girls Club after-school sites (intervention, control) participated in study 1. Accelerometer-measured physical activity of children and directly observed staff behaviors were assessed at each site in February and May 2019. Following baseline data collection, staff at the intervention site attended a brief physical activity promotion training, which emphasized expanding the quantity and enhancing the quality of physical activity opportunities. For study 2, the training was delivered to all staff, and they completed pre- and post-training measures of self-efficacy and intention to implement strategies to promote physical activity. In study 1, children at the intervention site decreased sedentary time by 14.8 min/day, and increased light and moderate-to-vigorous physical activity by 7.8 and 7.0 min/day, respectively, relative to the control site. Instances of staff encouragement significantly increased at the intervention site. In study 2, staff reported significant improvements in self-efficacy and intention immediately following the training. These studies provide preliminary evidence that a brief staff training intervention may increase physical activity among children attending an after-school program, and that the intervention can be integrated into existing training requirements. Future research is needed to replicate these findings across a wider range of after-school programs, and to explore systematic approaches to offering sustainable physical activity training regularly at scale.

Training Staff in Long-Term Care Facilities–Effects on Residents’ Symptoms, Psychological Well-Being, and Proxy Satisfaction

ContextLong-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care. ObjectivesThis study examines the effects of an end-of-life care staff training intervention on LTCF residents’ pain, symptoms, and psychological well-being and their proxies’ satisfaction with care. MethodsWe report findings from a single-blind, cluster randomized controlled trial featuring 324 residents with end-of-life care needs in 20 LTCF wards in Helsinki. The training intervention included four 4-hour educational workshops on palliative care principles (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff in small groups. Education was based on constructive learning methods and included participants’ own resident cases, role-plays, and small-group discussions. During a 12-month follow-up we assessed residents’ symptoms with the Edmonton Symptom Assessment Scale (ESAS), pain with the PAINAD instrument and psychological well-being using a PWB questionnaire. Proxies’ satisfaction with care was assessed using the SWC-EOLD. ResultsThe change in ESAS symptom scores from baseline to 6 months favored the intervention group compared with the control group. However, the finding was diluted at 12 months. PAINAD, PWB, and SWC-EOLD scores remained unaffected by the intervention. All follow-up analyses were adjusted for age, gender, do-not-resuscitate order, need for help, and clustering. ConclusionOur rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents’ symptoms and no robust effects on psychological well-being or on proxies’ satisfaction with care.

37 Factors Influencing Mealtime Care for People with Dementia Living in Care Homes: An Ethnographic Study

Abstract Introduction More and more people with dementia are living in care homes. Often they depend on care home staff for help with eating and drinking. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to identify factors influencing mealtime care for this population. Methods Over twenty-five hours of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care home staff and residents living with dementia. Twenty-two semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. The study used a constant comparison approach, so that data from early observations and interviews were explored in more depth subsequently. Results Five factors were identified which influenced mealtime care for people with dementia living in care homes. These were: environment (such as background music and building layout); kitchen and food (including connectivity between kitchen staff and others); staffing (for example: staff ratios and allocation); knowledge and support (including training, resources and supportive culture); and relationship with wider care team (such as family involvement, and the role of visiting health and social care professionals). Conclusions This study is part of a bigger project which will develop a staff training intervention to improve mealtime care for people with dementia living in care homes. The intervention will be informed by these findings, and by complementary evidence on good practice in mealtime care (from primary and secondary studies). It is anticipated that good mealtime care may improve quality of life for care home residents, and reduce hospital admissions.

A descriptive study of United States bleeding disorders camps

Abstract Background Disease-specific camps present one means of helping children overcome the challenges associated with chronic conditions and improving clinical and psychosocial outcomes. For more than 50 years, bleeding disorders camps (BDCs) in the United States (US) have been promoting independence, self-care, and leadership skills in children with bleeding disorders, all while fostering camaraderie in a secure and safe environment. However, little is known about how BDCs are organised, administered, funded, staffed, or how staff are compensated. Aim This article aims to describe the attributes of BDCs that service the US bleeding disorders community, and to compare and contrast these attributes to identify gaps in the BDC system and areas for improvement. Methods The National Hemophilia Foundation (NHF), in collaboration with several members of its Nursing Working Group and Physical Therapy Working Group, developed a survey that was distributed to BDC administrators (CAs) and health care providers (HCPs). Results A total of 101 HCPs and 20 CAs completed the survey. Findings indicated that BDCs are an informal extension of both the HTCs and NHF chapters, reaffirming that camps play a crucial role in the overall care of bleeding disorders. In general, diminishing financial resources threaten the existence of BDCs. Although there are BDC guidelines for formal staff training and specific interventions delivered to camp participants, adherence is variable. Other gaps included minimal self-infusion education follow-up with no documentation on effect or benefit of infusion education provided at camp. Conclusion Addressing the gaps identified by this survey and documenting resultant data supporting the value of BDCs will facilitate their continued sustainability in light of increasingly limited funding.

Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?

More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.

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.