Tensions and ambiguities: A qualitative study of final year adult field nursing students' experiences of caring for people affected by advanced dementia in Wales, UK

The approaches and motivations to learning of student nurses: a phenomenological study

This research study was undertaken to elicit a group of final-year student nurses' perceptions of their motivations and approaches to learning, and the implications of their views. It is important to explore this subject because students' motivations and approaches to learning can potentially impact patient care. This study was part of a larger research project. The sample consisted of 18 final-year student nurses at a large UK university. Students completed semi-structured interviews that used a qualitative constructivist approach to explore their educational experience. Students described what motivated them to learn, and how they approached their learning because of their understanding of which subjects they believed were and were not important. Students felt that clinical skills were the most important subjects, and topics such as health promotion, law and ethics, were less important and therefore they approached these subjects in a superficial way, learning just enough to pass their course. Clinical skills were perceived as more useful because they would be used directly in clinical practice. The findings of this study are significant to inform nurse educators as they plan curricula and provide an insight into what may potentially adversely affect patient care when students become registered nurses.

A phenomenological insight into what final year undergraduate student nurses perceive is the role of the Registered Nurse and who they learn this from

BACKGROUND

This paper considers the perceptions of 18 final year student nurses around their perception of the role of the nurse.

METHODS

A qualitative phenomenological research study was undertaken, with final year student nurses as the data source, undertaking semi-structured interviews from a United Kingdom Higher Education Institution. Data analysis was undertaken by using interpretative phenomenological analysis.

RESULTS

Findings indicate that student nurses had little insight as to the role of the nurse when commencing the programme. Being on the programme has led them to understand there are many aspects of a nurse's role including, surprisingly for them, much responsibility. It was also found that a lot of the learning that takes place comes from working with healthcare assistants, and due to this, the student nurses perceive that the role of the modern nurse is task orientated and there is little holistic care.

CONCLUSIONS

The future practice of this group of registrants may be affected depending on how they move forward with their role, alongside the holistic role of the nurse being detracted from. While phenomenology does not account for generalisations but does seek to illuminate this phenomenon; however if this view were to be shared globally, then the caring aspect of nursing may well be in danger of being lost. If this assumption of the role of the nurse is shared globally, then there are inevitably implications for the nursing profession, and more importantly patient care may be affected.

Development and Validation of Dementia Care Content in Nursing Curricula Instrument-Revised

Background: Understanding the extent to which dementia care content is integrated into curricula is vital to prepare the nursing workforce to provide quality dementia care. Purpose: To revise and examine the content validity of the Dementia Care Content in Nursing Curricula Instrument (DCCNCI), an instrument for assessing dementia care content in prelicensure nursing curricula. Method: We generated additional items and refined the original DCCNCI. Ten recruited expert reviewers rated each item for relevancy and assessed their clarity, meaningfulness, and completeness. Results: 39 of 47 items on the DCCNCI-Revised indicated significant content validity (cut-off value: 0.62, as calculated by applying Lawshe's formula for calculating content validity ratio). Conclusion: The DCCNCI-Revised demonstrated acceptable content validity for assessing dementia care content and its integration into prelicensure nursing curricula.

Innovation in dementia education within undergraduate healthcare programmes: A scoping review

OBJECTIVES

The increase in the number of people living with dementia has resulted in a greater need for healthcare professionals from all disciplines to meet the needs of those living with the condition. This means a workforce which is competent in delivering dementia care which is person-centred, regardless clinical specialism. The aim of scoping review is to provide an overview of the novel education models being used to ensure the future healthcare workforce are able to meet this aspiration.

DATA SOURCES

Online databases PubMed, Web of Science, CINAHL, Medline, PsychInfo, ERIC were used.

REVIEW METHODS

Search terms 'Healthcare Student(s)', 'Dementia or Alzheimer's Education' were used. Inclusion criteria included papers published in English between 2009 and September 2019, with data pertaining to the assessment of dementia knowledge and attitudes among healthcare students. Abstracts were reviewed and identified for inclusion for full-text review. Included studies were assessed using the MMAT (Mixed Methods Appraisal Tool).

RESULTS

27 studies were included within the review. These were groups into five educational categories; long term experiential (n=5), activity-centered programmes with people with dementia (n=11), interprofessional education (IPE) (n=5), immersive conference style programmes (n=3) and dementia simulation (n=3). Long term experiential and activity centered programmes gave students the greatest increase in perceived confidence, and improvement in dementia attitudes. Programmes were most effective when directly involving people living with dementia.

CONCLUSION

The majority of the education programmes showed a potential benefit in improving either knowledge, confidence, attitude, or all three among healthcare students. This highlights the benefit that novel experiential programmes may have in aiding a culture of positive attitudes among future healthcare professionals who will be treating people with dementia. This review also demonstrates the positive benefit that directly involving people living with dementia within education can have on both student learners.

Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

Background

Being in hospital can be particularly confusing and challenging not only for people living with dementia, but also for their carers and the staff who care for them. Improving the experience of care for people living with dementia in hospital has been recognised as a priority.

Objectives

To understand the experience of care in hospital for people living with dementia, their carers and the staff who care for them and to assess what we know about improving the experience of care.

Review methods

We undertook three systematic reviews: (1) the experience of care in hospital, (2) the experience of interventions to improve care in hospital and (3) the effectiveness and cost-effectiveness of interventions to improve the experience of care. Reviews 1 and 2 sought primary qualitative studies and were analysed using meta-ethnography. Review 3 sought comparative studies and economic evaluations of interventions to improve experience of care. An interweaving approach to overarching synthesis was used to integrate the findings across the reviews.

Data sources

Sixteen electronic databases were searched. Forwards and backwards citation chasing, author contact and grey literature searches were undertaken. Screening of title and abstracts and full texts was performed by two reviewers independently. A quality appraisal of all included studies was undertaken.

Results

Sixty-three studies (reported in 82 papers) were included in review 1, 14 studies (reported in 16 papers) were included in review 2, and 25 studies (reported in 26 papers) were included in review 3. A synthesis of review 1 studies found that when staff were delivering more person-centred care, people living with dementia, carers and staff all experienced this as better care. The line of argument, which represents the conceptual findings as a whole, was that ‘a change of hospital culture is needed before person-centred care can become routine’. From reviews 2 and 3, there was some evidence of improvements in experience of care from activities, staff training, added capacity and inclusion of carers. In consultation with internal and external stakeholders, the findings from the three reviews and overarching synthesis were developed into 12 DEMENTIA CARE pointers for service change: key institutional and environmental practices and processes that could help improve experience of care for people living with dementia in hospital.

Limitations

Few of the studies explored experience from the perspectives of people living with dementia. The measurement of experience of care across the studies was not consistent. Methodological variability and the small number of intervention studies limited the ability to draw conclusions on effectiveness.

Conclusions

The evidence suggests that, to improve the experience of care in hospital for people living with dementia, a transformation of organisational and ward cultures is needed that supports person-centred care and values the status of dementia care. Changes need to cut across hierarchies and training systems to facilitate working patterns and interactions that enable both physical and emotional care of people living with dementia in hospital. Future research needs to identify how such changes can be implemented, and how they can be maintained in the long term. To do this, well-designed controlled studies with improved reporting of methods and intervention details to elevate the quality of available evidence and facilitate comparisons across different interventions are required.

Study registration

This study is registered as PROSPERO CRD42018086013.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 43. See the NIHR Journals Library website for further project information. Additional funding was provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

The experiences of hospital staff who provide care for people living with dementia: A systematic review and synthesis of qualitative studies

AIMS AND OBJECTIVES

To systematically review and synthesise qualitative data from studies exploring the experiences of hospital staff who care for people living with dementia (Plwd).

BACKGROUND

In hospital, the number of Plwd continues to rise; however, their experiences of care remain problematic. Negative experiences of care are likely to contribute to poorer mental and physical health outcomes for Plwd while in hospital and after discharge. Experiences of the hospital staff who care for Plwd can also be poor or unrewarding. It is important to understand the experiences of staff in order to improve staff well-being and ultimately the experience of care for Plwd while in hospital.

DESIGN

Systematic review and evidence synthesis of qualitative research.

DATA SOURCES

We searched 16 electronic databases in March 2018 and completed forward and backward citation chasing.

METHODS

Eligible studies explored the experiences of paid and unpaid staff providing care in hospital for Plwd. Study selection was undertaken independently by two reviewers, and quality appraisal was conducted. We prioritised included studies according to richness of text, methodological rigour and conceptual contribution. We adopted approaches of meta-ethnography to analyse study findings, creating a conceptual model to represent the line of argument.

FINDINGS

Forty-five studies reported in 58 papers met the inclusion criteria, and of these, we prioritised 19 studies reported in 24 papers. The line of argument was that Institutions can improve staff experiences of care for Plwd by fostering person-centred care (PCC). PCC aligned with staff perceptions of 'good care'; however, staff often felt prevented from providing PCC because of care cultures that prioritised tasks, routines and physical health. Staff experienced conflict over the care they wanted to give versus the care they were able to give, and this caused moral distress. When staff were able to provide PCC, this increased experiences of job satisfaction and emotional well-being.

CONCLUSIONS

Person-centred care not only has the potential to improve the experience of care for Plwd and their carers, but can also improve the experiences of hospital staff caring for Plwd. However, without institutional-level changes, hospital staff are often unable to provide PCC even when they have the experience and knowledge to do so.

IMPLICATIONS FOR PRACTICE

Institutional-level areas for change include the following: training; performance indicators and ward cultures that prioritise psychological needs alongside physical needs; adequate staffing levels; inclusive approaches to carers; physical environments that promote familiarisation, social interaction and occupation; systems of documentation about individual needs of Plwd; and cultures of sharing knowledge across hierarchies.

Final-year student nurses' experiences of caring for patients

BACKGROUND

Shortage of nurses in South African hospitals has affected the nurse-patient ratio, thus prompting nurses to be focussed on completing nursing-related duties with less or no caring for the patient. Caring involves having a therapeutic relationship with the patients, and it can be challenging and demanding for final-year student nurses who are still novices in the nursing profession.

OBJECTIVES

To explore and describe the experiences of caring for patients amongst final-year student nurses in order to develop and provide recommendations to facilitate caring.

METHOD

A qualitative, descriptive and contextual design was used. Data collection was done through eight in-depth individual interviews. Giorgi's five-step method of data analysis was used, along with an independent coder. Measures to ensure trustworthiness and ethical principles were applied throughout the research.

RESULTS

Four themes with 12 subthemes emerged from the data: therapeutic relationship with patients as an integral part of caring, teamwork - team spirit makes caring easy, continuous caring that promotes quality and safe nursing, as well as satisfaction amongst staff and patients, and various barriers that contributed to lack of caring in the unit.

CONCLUSION

The majority of student nurses had positive experiences of caring, which included therapeutic relationships between nurses and the patients, teamwork and team spirit that fostered safe and quality nursing care, rendered effortlessly. Barriers to caring were also highlighted as negative experiences.

Final year pre-registration student nurses perceptions of which taught theoretical knowledge is important for practice

This research illuminates the perceptions of eighteen final year undergraduate pre-registration student nurses, to understand what theoretical knowledge was perceived to be useful during their pre-registration nursing education, and what was not. The research adopted a qualitative phenomenological approach, and utilised a sample size of eighteen final year student nurses as the data source. The data collection method consisted of semi-structured interviews and the study took place at a Higher Education Institution within the North West of England approved to provide pre-registration nurse education. Participants provided their data during their final year of their undergraduate pre-registration nursing programme, via semi-structured, digitally recorded interviews, which were transcribed verbatim. The transcribed interviews were then analysed using Interpretive Phenomenological Analysis. The findings generated three themes, these were; important knowledge to learn for everyday practice, irrelevant for my future role, and, can we have some more? Findings demonstrate what aspects of the taught curriculum student nurses perceive to be of use to their practice, and why they perceive this to be the case. This affects how student nurses approach their learning during their nursing education. In addition it was clear what participants perceived was not useful for their practice and why this was the case. Additionally, participants offered suggestions of what they would also like adding to their curriculum, and provided insights for what they would like adding to the curriculum, which can be used for enhancing this. This is useful when developing future curricula to understand which aspects student nurses learn in a deep and superficial way. This can provide a useful insight for to ensure that patient care is not compromised.

Understanding compassion for people with dementia in medical and nursing students

BACKGROUND

Compassion is an essential component of good quality care. Compassion towards people with dementia in health systems is often suboptimal, which can have negative impacts on clinical outcomes and patient experience. Attitudes are formed early in training and the literature on healthcare student compassion towards those with dementia is limited. This study aimed to understand how undergraduate medical and nursing students understand compassion towards people with dementia and factors influencing the delivery of compassionate care.

METHODS

Nine individual in-depth interviews and two focus groups were undertaken with 23 medical and nursing students. A topic guide was developed, and transcripts were analysed using thematic analysis.

RESULTS

The analysis identified three themes which students used to define compassion: (i) connection, (ii) care, and (iii) respect. Three factors were identified as being either facilitators or barriers to delivering compassionate care to people with dementia: (i) patient factors, (ii) student factors, and (iii) connection. Patient factors related to the presence of behaviours which might be challenging to manage. Student factors included student exposure to dementia, as well as student knowledge and skills. Connection focussed on whether there was an awareness and understanding of the person behind the diagnosis.

CONCLUSION

Undergraduate healthcare students are the future workforce for patients with dementia, and understanding how compassion develops within them is important. We found medical and nursing students had a broad understanding of compassion, and identified factors influence their compassion towards people with dementia. These novel data can be used to shape healthcare education programmes aimed at improving dementia care.

Dementia Care Content in Prelicensure Nursing Curricula: A Pilot Mixed-Methods Study

BACKGROUND

Having a nursing workforce equipped to provide quality care for patients living with dementia is essential. The purpose of this study was to investigate how undergraduate nursing programs integration of dementia care content into their curricula.

METHOD

Using sequential explanatory mixed methods, a stratified sample of 137 representatives of programs in 11 states with dense elderly populations completed a quantitative survey. A subsample (n = 8) completed qualitative e-mail interviews.

RESULTS

Most respondents indicated dementia care content was integrated into their curricula (n = 103, 92.8%). Clinical partnership with dementia care centers was associated with a greater proportion of students interacting with individuals having dementia (p = .02). Curriculum overload was the most significant challenge to integrating dementia content (n = 61, 43.9%). Qualitative themes supported the quantitative results.

CONCLUSION

Future research is needed to identify best practices to ensure that nursing curricula provide essential content to meet the care needs of the growing population of individuals with dementia. [J Nurs Educ. 2018;57(2):88-95.].

Care assistant experiences of dementia care in long-term nursing and residential care environments

Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.