Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial

Reimagining neuroscientific and andragogical principles for dementia care education

This article aims to explore the integration of Louis Cozolino's (2013) andragogical strategies with the tenets of person-centered dementia care practices to enhance dementia care education. The article examines the multiple dimensions of learning in adulthood, highlighting the role of neural plasticity and lifelong brain adaptation in shaping learning and experiential strategies. This in-depth evaluation underscores the significance of tailoring andragogical approaches to the needs of adult learners, who, in this context, are care providers for persons with dementia. This is done through proper understanding of the neurobiological realities and the unique learning needs of adults. Such tailored approaches can be aligned with the brain's adaptive nature by recognizing the intricate interplay of cognitive, emotional, and social dimensions. Highlighting the need for including lessons on the person-centered approach in dementia care education, the paper argues that adult learners - who are essentially part of the dementia care workforce - first need to learn, appreciate, and embrace the approach before applying it in their caregiving practices. This article presents an overarching argument that integration of Cozolino's principles of adult learning with tenets of person-centered dementia care could provide a robust framework for dementia care education.

A multi-stakeholder collaboration model of dementia-friendly communities: Experiences from Nanjing, China

The care for people with dementia (PwD) in low- and middle-income countries (LMICs) is dominated by home care and supplemented sporadically by public care provided using public resources. In the context of community resources cannot meet the demand for high-quality services for PwD, dementia-friendly communities (DFCs) provide ideas for alleviating this situation by integrating resources from multiple stakeholders. However, there is still a considerable gap between the capacity of services and the demand of PwD. Based on the experience of elderly services and DFCs construction in Nanjing, China, this study developed a stakeholder collaboration model and clarified the collaborative relationship among stakeholders such as the government, communities, and medical institutions in meeting the needs of PwD. This work summarizes the partnerships and specific actions of stakeholders and highlights the importance of facilitating resource integration to provide comprehensive services.

Epidemiology of Dementia in China in 2010-2020: A Systematic Review and Meta-Analysis

BACKGROUND

Dementia has become one of the leading causes of death across the world.

AIMS

The aim of this study was to investigate the incidence, prevalence, and mortality of dementia in China between 2010 and 2020, and to investigate any geographical, age, and sex differences in the prevalence and incidence of dementia.

METHODS

Five databases were searched. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the included studies. A random-effects meta-analysis was performed to estimate the pooled prevalence of dementia. Subgroup analysis was based on the type of dementia. The incidence and mortality of dementia were synthesized qualitatively.

RESULTS

A total of 19 studies were included. The meta-analysis showed that the prevalence of dementia was 6% (95%CI 5%, 8%), the prevalence of Alzheimer's disease (AD) was 5% (95%CI 4%, 6%), and the prevalence of vascular dementia (VaD) was 1% (95%CI 0%, 2%). The subgroup analysis showed that the prevalence rates of dementia in rural (6%, 95%CI 4%, 8%) and urban areas were similar (6%, 95%CI 4%, 8%). Deaths due to dementia increased over time.

CONCLUSION

The prevalence, incidence, and mortality of dementia increased with age and over time. Applying consistent criteria to the diagnosis of cognitive impairment and dementia is necessary to help with disease monitoring. Promoting dementia knowledge and awareness at the community level is necessary.

The Dementia Knowledge Assessment Scale, the Knowledge in Dementia Scale, and the Dementia Knowledge Assessment Tool 2: Which Is the Best Tool to Measure Dementia Knowledge in Greece?

Background

Measuring dementia knowledge can be a valuable tool for assessing the effectiveness of dementia awareness activities, identifying the potential benefits of dementia training programs, and breaking down common myths and stereotypes about dementia.

Objective

To compare the psychometric properties of three widely used dementia knowledge tools, the Dementia Knowledge Assessment Tool 2 (DKAT2-G), the Dementia Knowledge Assessment Scale (DKAS-G), and the Knowledge in Dementia Scale (KIDE-G) in the Greek adult population.

Methods

A convenience sample of 252 participants from the general population completed the survey online. Statistical analyses included Cronbach's internal reliability, retest reliability, factor analysis, concurrent and construct validity, and floor and ceiling effects.

Results

The DKAS-G had the most appropriate reliability levels (Cronbach's alpha  =  0.845; retest reliability  =  0.921), whereas the DKAT2-G had satisfactory indexes (Cronbach's α= 0.760; retest reliability  =  0.630). The KIDE-G showed unsatisfactory reliability (Cronbach's α= 0.419; retest reliability  =  0.619). Construct validity was confirmed for all questionnaires, showing that all of them detected participants with pre-existing knowledge of dementia. Confirmatory factor analysis revealed a four-factor model for the DKAS-G and proposed the removal of 5 items. Floor and ceiling effects were found for the DKAT2-G and the KIDE-G, mainly among those who had previously participated in dementia training.

Conclusions

The DKAS-G was found to have the highest levels of reliability and validity. The results prove that the DKAS-G meets the requirements for measuring dementia knowledge and evaluating dementia training programs in health professionals, caregivers, and the general population.

Psychometric evaluation of the Indonesian version of the Person-centered Care Assessment Tool

BACKGROUND

The number of Indonesian care staff working in hospitals and long-term care facilities caring for persons with dementia in Japan is increasing; however, there is no instrument available in the Indonesian language to assess their dementia care practice.

OBJECTIVES

This study aimed to translate the Person-centered Care Assessment Tool (P-CAT) and evaluate its psychometric properties in a sample of Indonesian care staff working in dementia care and long-term care facilities in Japan.

METHODS

This is a descriptive, methodological, and cross-sectional study. The P-CAT was translated into the Indonesian language. The draft was administered to Indonesian care staff (n = 218) working at long-term care facilities in Japan. Data were analysed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), known-group validity, internal consistency, and test-retest reliability.

RESULTS

EFA showed three-factor and CFA of the three-factor indicated that the model had an acceptable fit (chi-squared statistics/degree of freedom = 1.78, comparative fit index = 0.94, root mean square error of approximation = 0.06) with a slightly different structure compared to the original P-CAT. Regarding known-group validity, the P-CAT total score was significantly higher for those who had training in dementia, who knew about person-centred care, and who showed satisfaction in the job. Internal consistency (Cronbach's α) of the total scale was 0.68 which is considered acceptable, and the test-retest reliability intraclass correlation coefficient was 0.61 which is considered moderate.

CONCLUSION

The Indonesian P-CAT indicated sound validity and reliability to measure person-centred care among Indonesian care staff working in dementia care and long-term care facilities in Japan.

IMPLICATION FOR PRACTICE

The development of Indonesian P-CAT allows the evaluation of dementia care, promotes and further improves person-centred care for persons with dementia provided by Indonesian care staff working in long-term care facilities in Japan.

The Effectiveness of a Community Nurse-Led Support Program for Dementia Caregivers in Chinese Communities: The Chongqing Ageing and Dementia Study

Background

As the primary caregivers for people with dementia in China, family caregivers face a significant care burden that can negatively impact their mental and physical health. It is vital to investigate ways to support these caregivers.

Objective

To assess the effectiveness of a program led by community nurses to support caregivers of individuals with dementia.

Methods

A total of 30 caregivers received nurse-led support in addition to usual care, while 28 caregivers received only usual care. The primary outcome was caregivers' sense of competency in providing dementia care, which was measured using the Short Sense of Competence Questionnaire (SSCQ). Secondary outcomes included caregivers' ability to perform daily activities, behavioral and psychological symptoms of dementia (BPSD) using a neuropsychiatric inventory questionnaire, and quality of life using the short form health survey (SF-36). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR 2300071484).

Results

Compared to the control group, the intervention group had significantly higher SSCQ scores and a lower caregiver distress index over time. Physical and mental health-related quality of life also improved significantly among caregivers in the intervention group. However, there was no significant difference between the two groups in terms of activities of daily living and BPSD.

Conclusions

The community nurse-led support program significantly improved caregivers' competency in providing dementia care and quality of life and reduced distress. These findings have important implications for dementia care policies, resources, and workforce development in China, including strengthening community dementia care services through collaboration with specialists in hospitals.

Nursing students' knowledge and attitudes about dementia: A cross-sectional study

AIM

This study aimed to determine knowledge and attitudes of nursing students about dementia and factors affecting them.

BACKGROUND

With the increased aging population in the world including Turkiye, the prevalence of dementia is on the rise. Nursing students must have knowledge of dementia to offer high-quality, evidence-based nursing care to people who have dementia. Nursing students' attitudes towards dementia directly affect the quality of the care that they give. A positive attitude contributes to provision of more empathetic and personalized care for people with dementia.

DESIGN

A cross-sectional design.

METHOD

The study was performed with 784 nursing students at six universities in Turkiye. Data were collected using a socio-demographic questionnaire, the Dementia Knowledge Assessment Scale and the Dementia Attitudes Scale. Data were analyzed using an independent samples t-test, one-way ANOVA and multiple linear regression analysis. Factors predicting knowledge and attitudes about dementia were examined using multiple linear regression analysis.

RESULTS

The mean age of the nursing students was 20.37 ± 1.85 years. Of all the nursing students, 82.9% were female, 15.1% were living with an older person, 5.5% had a family member with dementia, 9.8% had prior experience with dementia care and 19.4% received education about dementia. The students had inadequate knowledge of dementia (13.01 ± 6.66 out of 34), but a moderately positive attitude towards dementia (82.53 ± 12.44). Female gender (β = 0.087), increased year of study (β = 0.346), living in the city center (β = 0.070), having a family member with dementia (β = -0.081) and receiving education about dementia (β = 0.103) had a positive effect on the knowledge about dementia. Knowledge of dementia (β = 0.226), living in a city (β = 2.371) and prior experience in dementia care (β = 0.097) positively affected the attitudes about dementia.

CONCLUSION

Findings of the study suggest that curricula of undergraduate nursing education in Turkiyeshould be improved. Positive effects of education about dementia and clinical experience on knowledge and attitudes regarding dementia reveal a need for a change in the duration and quality of education about dementia.

Dementia care practices among community healthcare workers in Vietnam: a qualitative descriptive study

BACKGROUND

Vietnam is one of the most rapidly aging countries in the world and the likelihood that someone may have dementia rises dramatically as the population ages. Although caring for persons living with dementia is important, little is known about the circumstances under which community healthcare professionals in Vietnam provide dementia care. This study aimed to describe the practice of caring for persons with dementia among community healthcare professionals in Vietnam.

METHODS

This qualitative descriptive study was conducted with 23 community healthcare professionals recruited from 10 primary healthcare centers, representing 10 of 24 districts in Ho Chi Minh City, Vietnam. Participants were physicians (n = 11), physician's assistants (n = 8) and community nurses (n = 4). Data were collected through in-depth face-to-face semi-structured interviews. Interview data were audio recorded, transcribed verbatim, and analyzed using content analysis.

RESULTS

The mean age of the 23 participants was 44.6 ± 8.8 years; most were female (n = 16, 69.6%); and the mean time of working in the field of dementia care was 15.9 ± 8.4 years. Analysis of the interview data revealed five categories, which informed how care was provided: 1) Knowledge about dementia and its prevalence among older adults; 2) Identification of dementia in Vietnam; 3) Lack of attention to early diagnosis of dementia and difficulty in providing continuous care; 4) Dependence on family members for prompt and continuous care; and 5) challenges to providing dementia care. Despite having knowledge about dementia, some healthcare professionals incorrectly viewed dementia as an inevitable part of the ageing process. Participants reported that their limited training and practical experience in caring for persons with dementia caused a lack of confidence in dementia care.

CONCLUSIONS

The quality of care provided to persons living with dementia was negatively impacted by the limited training of healthcare personnel. The diagnosis, treatment, and provision of supportive services to persons living with dementia and their families are substantial challenges for the Vietnamese healthcare system. It is crucial to initiate and cultivate dementia care education programs aimed at expanding curricula for physicians, physicians' assistants, and nurses.

Confidence in dementia care and care approach toward dementia among the nursing staff in long-term care facilities in China: a cross-sectional survey

Background

Confidence and appropriate care approach toward dementia among nursing staff (nurses and care assistants) are crucial manifestations of competency to deal with the complexity of dementia care in long-term care facilities (LTCFs). The purpose of this study was to investigate the confidence in dementia care and care approach among nursing staff in LTCFs in mainland China.

Methods

A cross-sectional study design was utilized in LTCFs in Shandong Province, mainland China. A convenient sample included of 317 nursing staff drawn from 15 LTCFs. Survey questions included (a) demographics, (b) dementia knowledge, (c) dementia care confidence, and (d) approach to care for people with dementia. Data were analyzed with descriptive statistics. Factors associated with confidence and care approach for people with dementia were examined using Pearson's correlation and multivariate regression analyses.

Results

Dementia care confidence was generally moderate. Factors affecting confidence to care for people with dementia included educational level, months of caring dementia patients, and dementia knowledge. Most nursing staff did not use a person-centered care approach which was significantly associated with their age, dementia-learning experience, and knowledge and confidence toward caring for people with dementia.

Conclusion

A positive correlation was identified between confidence to care for people with dementia and nursing staff care approach. Clinical recommendations are provided to further develop education strategies tailored for nursing staff to meet the growing demand for dementia care services.

Group multi-component programme based on cognitive behavioural therapy and positive psychology for family caregivers of people with dementia: a randomised controlled study (3C study)

BACKGROUND

Caregivers of people with dementia frequently experience an elevated level of psychological distress and burden. This study aimed to examine the effectiveness of a group-format multi-component programme which is based on cognitive behavioural therapy and positive psychology.

METHODS

Family caregivers of dementia were allocated (1:1) to the intervention group and the wait-list control group, stratified by age (<65 years, ≥65 years) and care status (at home or in an institution). The intervention group received a six-session, 10-week, group-format programme. The primary outcome was the Hospital Anxiety Depression Scale (HADS). Secondary outcomes were the short-version of the Zarit Burden Interview (personal strain and role strain), Neuropsychiatric Inventory Questionnaire, Dementia Caregiver Positive Feeling Scale, and Self-Compassionate Reactions Inventory. The evaluations were conducted at baseline, 10 weeks (post-intervention), and 14 weeks (follow-up).

RESULTS

The analyses were performed with 64 registered participants. In the whole sample, no significant effect was observed on HADS. There was medium effect on role strain (P = 0.04, partial η²  = 0.08). Positive feelings of caregiving increased after the intervention but were not maintained at follow-up. In the subgroup analysis of caregivers under 65 years of age, a statistically significant effect was observed for personal strain (P = 0.03, partial η² = 0.16). An interaction effect was also found for the total score of positive feelings of caregiving (P < 0.05, partial η² = 0.02) and the meaning of caregiving (P = 0.02, partial η² = 0.10).

CONCLUSIONS

This programme did not show significant improvement in depression and anxiety of caregivers of dementia; however, it reduced the burden of their role conflict (role strain) and yielded favourable short-term effects on the positive feelings and the meaning of caregiving among the participants. Also, the programme effectively reduced the personal strain of caregivers under 65 years.

A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia

BACKGROUND

An increase in dementia prevalence has been accompanied by increasing interest in new rehabilitation methods, such as serious games. Serious games hold the potential to postpone functional and cognitive declines in people with dementia by increasing their independence and engagement; however, the efficacy of serious games remains underexplored. This review was conducted to quantify the effects of serious games in people with dementia, including several newly published trials, with the hopes of contributing to evidence-based practice by offering support for clinical decision-making.

METHODS

Only randomized controlled trials (RCTs) assessing the impacts of game-based intervention programs compared with conventional therapy on cognitive function, instrumental and non-instrumental activities of daily living, or depression among people with dementia were included in this review. Meta-analyses were performed to determine the pooled standardized mean difference (SMD) of each outcome using a random-effects model.

RESULTS

The final search identified 12 studies that met our criteria. Overall, serious games were found to improve cognitive function (pooled SMD: 0.34; 95% CI: 0.07-0.61) and alleviated depression (pooled SMD: -0.131; 95% CI: -1.85 to -0.77) in people with dementia.

CONCLUSIONS

Serious games improve cognitive function and reduce depression in people with dementia. Future studies in this field should aim to evaluate and determine the long-term effect of these games.

Reducing dementia-related stigma and discrimination among community health workers in Brazil: protocol for a randomised controlled feasibility trial

INTRODUCTION

Stigma and discrimination among healthcare workers can hinder diagnosis and the provision of appropriate care in dementia. This study is aimed at developing, delivering and evaluating the feasibility of a group antistigma intervention to improve knowledge, attitudes and behaviours in relation to people living with dementia among community health workers (CHWs).

METHODS AND ANALYSIS

This will be a randomised controlled feasibility trial conducted with 150 CHWs from 14 primary care units (PCUs) in São Paulo, Brazil. PCUs will be randomly allocated (1:1) in two parallel groups-experimental group or control group. Participants from PCUs allocated to the experimental group will receive a 3-day group intervention involving audio-visual and printed materials as well as elements of social contact. The control group will keep their usual routine. Knowledge, attitude and intended behaviour stigma-based outcomes will be assessed at baseline and at follow-up (30 days after intervention) to both groups, with additional questions on feasibility for the experimental group at follow-up. Around 10-15 participants will take part in follow-up semistructured interviews to further explore feasibility. Quantitative analyses will follow an 'intention to treat' approach. Qualitative data will be analysed using content analysis.

ETHICS AND DISSEMINATION

This study was approved by the National Commission for Ethics in Research in Brazil (n. 5.510.113). Every participant will sign a consent form. Results will be disseminated through academic journals and events related to dementia. The intervention materials will be made available online.

The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis

The present review aims to examine whether multi-component interventions for informal caregivers of people with dementia are effective on positive and negative aspects of caregiver well-being. Eleven databases were searched from inception to 8 March 2021. Only randomized controlled trials reporting the effectiveness of multi-component intervention on positive and negative aspects of caregiver well-being were eligible. Endnote X7 (Thomson ResearchSoft, Stanford, CA, USA) was used for study selection and version 5.1.0 of Cochrane Collaboration’s tool (Cochrane, London, UK) was applied for quality assessment. Review Manager (Revman) Version 5.3 (Cochrane, London, UK) was used for the meta-analysis, and if statistical synthesis was inappropriate, only narrative analysis was performed. A total of 31 RCTs with 3939 participants were included. Meta-analyses showed small to moderate effects on subjective well-being, depression, and burden of caregivers, and a moderate to high effect on caregiver anxiety. Due to insufficient data and vast heterogeneity, meta-analysis was not performed for other outcomes, such as resilience, competence, and empathy. This review suggests that individualized multi-component interventions for caregivers may be one of the ways to promote their well-being. Further research is needed to explore the impact of rigorously designed and personalized multi-component interventions on informal caregivers, especially on more positive indicators, as well as its long-term effects and sustainability.

Correctional nurse education and training to care for and support prisoners with dementia: a systematic review of text and opinion

OBJECTIVE

The objective of this review was to synthesize the best available evidence on the training required for correctional nurses to care for and support prisoners with dementia.

INTRODUCTION

Nurses caring for people in aged care facilities receive training related to aging and dementia; however, this has not carried across to training for the increasing aging population within correctional settings. Most research related to dementia care is focused on the aged and acute care sectors, and there is an absence of research in the correctional setting. Therefore, this systematic review was based on expert opinion and synthesizes information related to correctional nurse training for the support and care of prisoners with dementia.

INCLUSION CRITERIA

Articles focusing on correctional nurses, regardless of gender, who were responsible for the health care of adult prisoners were considered for this review. The primary phenomenon of interest was the training needs and requirements for correctional nurses to support prisoners with dementia. The secondary phenomenon of interest was how the delivery of the training could be facilitated. The context of this review was the adult correctional setting. The sources of information considered for this review included text and narratives describing expert opinion, expert opinion-based guidelines, expert consensus, published discussion papers, unpublished dissertations, reports accessed from professional organization websites, and government policy documents.

METHODS

A three-step search strategy was employed to look for both published and unpublished articles as recommended by JBI. The search was conducted for English-only articles, and from database inception to November 2020. All included articles were assessed by two independent reviewers for methodological quality. The data were extracted and pooled. Categories were developed and assigned based on similarity of meaning, and a set of synthesized conclusions was developed after subjecting the categories to meta-synthesis.

RESULTS

Sixteen papers met the inclusion criteria and underwent critical appraisal and data extraction. Five synthesized findings were generated from 103 findings, which were aggregated into 15 categories. As expected, the rating was very low due to the nature of the included papers (ie, non-research), and the mix of unequivocal, credible, and unsupported findings.

CONCLUSIONS

The review highlighted gaps in correctional nurse training related to caring for prisoners with dementia. Training for correctional nurses should incorporate information on general aging, alterations in aging, and dementia screening and management. Other findings included the need for policy and procedures related to training nurses to become dementia experts, and the development of partnerships with experts in the community to adapt training to the correctional setting.

Methods of Capturing Process Outcomes in Quality Improvement Trials: A Systematic Review

ABSTRACT

Healthcare quality can be measured by studying structure, processes, and outcomes. This study examines how trialists capture process outcomes in implementation trials to provide guidance for researchers and health professionals. Electronic databases were searched, and two researchers performed the title, abstract, and full-text selection. Only implementation studies involving nonpharmacological approaches were included. Data were extracted by one reviewer and checked for accuracy and completeness by a second reviewer. Study quality was independently assessed by two reviewers. Of the 3,186 articles screened, 24 studies matched our inclusion criteria. Most studies were cluster randomized control trials, followed by interrupted time series studies and stepped wedge studies. The population in the studies was diverse and settings included hospitals, community centers, residential aged care facilities, and primary care. The reporting of process measures across the included studies varied, and there was limited information about the mechanisms of data collection procedures. Nineteen studies extracted information about processes from electronic medical records, patient records, or chart reviews. The remaining five studies used staff surveys. Challenges remain in the practical aspect of data collection for measuring process outcomes, particularly outside of hospital settings or where processes are hard to capture in patient records.

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review

Background

Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers).

Methods

We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework.

Results

We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia.

Conclusion

Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07875-w.

Acceptability and Preliminary Effectiveness of a Remote Dementia Educational Training Among Primary Care Providers and Health Navigators

BACKGROUND

Optimal care can improve lives of families with dementia but remains under-implemented. Most healthcare professional training is in person, time-intensive, and does not focus on key aspects such as early detection, and cultural competency.

OBJECTIVE

We explored the acceptability and preliminary effectiveness of a training, The Dementia Update Course, which addressed these issues. We hypothesized that the training would lead to increased levels of perceived dementia care competency among key healthcare workers, namely primary care providers (PCPs) and health navigators (HNs).

METHODS

We conducted pre-post training assessments among 22 PCPs and 32 HNs. The 6.5-h training was remote, and included didactic lectures, case discussion techniques, and materials on dementia detection and care. Outcomes included two 5-point Likert scales on acceptability, eleven on perceived dementia care competency, and the three subscales of the General Practitioners Confidence and Attitude Scale for Dementia. We used paired samples t-tests to assess the mean differences in all preliminary effectiveness outcomes.

RESULTS

The training included 28.6% of PCPs and 15.6% of HNs that self-identified as non-White or Latino and 45.5% of PCPs and 21.9% of HNs who served in rural areas. PCPs (84.2%) and HNs (91.7%) reported a high likelihood to recommend the training and high satisfaction. Most preliminary effectiveness outcomes analyzed among PCPs (11/14) and all among HNs (8/8) experienced an improvement from pre- to post-training (p < 0.05).

CONCLUSION

A relatively brief, remote, and inclusive dementia training was associated with high levels of acceptability and improvements in perceived dementia care competency among PCPs and HNs.

Impact of settings and culture on nurses' knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review

BACKGROUND

Well-trained nurses are required to support dementia patients; however, the quality of the provided dementia nursing care can be impacted by nurses' knowledge, attitudes and perceptions towards people with dementia.

AIM

To obtain an overview of the current nursing practice towards people with dementia around the world.

DESIGN

An integrated literature review was conducted based on Whittemore and Knafl's method.

RESULTS

A total of 72 articles met the inclusion criteria. Three main themes were identified: (1) nurses' knowledge, attitudes and perceptions towards dementia; (2) nursing experience of caring for people with dementia in acute and community care settings; and (3) dementia nursing care across health regions.

CONCLUSION

Nurses play the role of facilitators in the efficient delivery of quality care for dementia patients. A variety of attitudes and perceptions towards people with dementia were found to be triggered by the severity of dementia, religion, ethnicity and gender.

IMPLICATIONS FOR PRACTICE

Healthcare organisations and educational settings need to coordinate and function together to improve nurses' knowledge and encourage positive attitudes towards people with dementia.

Barriers and enablers to implementing 'DEALTS2' simulation-based train-the-trainer dementia training programme in hospital settings across England: a qualitative study

Background

Despite approaches to provide effective dementia training in acute care settings, little is known about the barriers and enablers to implement and embed learning into practice. We were commissioned by Health Education England to develop and evaluate a new dementia training intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), an innovative simulation toolkit to support delivery of dementia training in acute care across England. This study aimed to explore barriers and enablers experienced by trainers implementing DEALTS2 and extent to which it impacted on delivery of training and staff clinical practice.

Methods

We conducted twelve one-day DEALTS2 train-the-trainer (TTT) workshops across England in 2017 for National Health Service Trust staff employed in dementia training roles (n = 199 trainers); each receiving a simulation toolkit. Qualitative data were collected through telephone interviews 6–8 months after TTT workshops with 17 of the trainers. Open ended questions informed by the Kirkpatrick model enabled exploration of implementation barriers, enablers, and impact on practice.

Results

Thematic analysis revealed six themes: four identified interrelated factors that influenced implementation of DEALTS2; and two outlined trainers perceived impact on training delivery and staff clinical practice, respectively: (i) flexible simulation and implementation approach (ii) management support and adequate resources (iii) time to deliver training effectively (iv) trainer personal confidence and motivation (v) trainers enriched dementia teaching practice (vi) staff perceived to have enhanced approach to dementia care. Trainers valued the DEALTS2 TTT workshops and adaptability of the simulation toolkit. Those supported by management with adequate resources and time to deliver effective dementia training, were likely to implement DEALTS2. Trainers described positive impacts on their teaching practice; and perceived staff had enhanced their approach to caring for people with dementia.

Conclusions

Trainers explained individual and organisational barriers and enablers during implementation of DEALTS2. The flexible simulation and implementation approach were key to supporting adherence of DEALTS2. To ensure wider implementation of DEALTS2 nationally, Trusts need to allocate appropriate time to deliver effective dementia training. Future research should measure staff behaviour change, patient perspectives of the intervention, and whether and how DEALTS2 has improved health and care outcomes.

Effect of Dementia Training on Knowledge and Attitude Among Long-Term Care Staff in Yogyakarta, Indonesia

BACKGROUND: The number of patients with dementia has increased globally. Caring for these patients is very challenging and demanding. There are many patients with dementia in long-term care facilities in Yogyakarta, Indonesia. However, most staff members do not have proper training regarding how to care for patients with dementia. AIM: This research aimed to investigate the effect of dementia care skills training on knowledge and attitudes about dementia among long-term care staff in Yogyakarta, Indonesia. METHODS: A pre-experimental study was conducted using a one-group pre-test and post-test method. There were 30 staff members in a long-term care facility in Yogyakarta, Indonesia, who participated in this study in July 2019. Training given was the Dementia Care Skills 18 h version for care workers provided by Alzheimer’s Indonesia by two certified trainers. Outcomes measured were knowledge and attitudes of the participants, which were measured using the Dementia Knowledge Assessment Scale and Dementia Attitude Scale. Data were analyzed using paired and independent t-tests as well as Pearson correlation tests. RESULTS: The results showed that staff knowledge of dementia (t = 4.78, p = 0.000) and attitudes toward persons with dementia (t = 3.27, p = 0.003) were improved significantly after the dementia training provided by the Alzheimer’s Indonesia trainers. CONCLUSIONS: Training in dementia care can improve knowledge and attitude of long-term care staff. This study recommends that dementia care skills training be provided for staff and nurses in long-term care to improve their knowledge and attitudes regarding patients with dementia and their care.

Effects of an Enhanced Training on Primary Care Providers Knowledge, Attitudes, Service and Skills of Dementia Detection: A Cluster Randomized Trial

Background: Effective training programs for primary care providers (PCPs) to support dementia detection are needed, especially in developing countries. This study aimed to investigate the effect of an enhanced training on the competency and service of PCPs for dementia detection.

Methods: We conducted a cluster randomized trial in Beijing, China. Community healthcare centers (CHCs) located in Fengtai or Fangshan District were eligible. The enrolled CHCs in each district were randomly assigned to the standard or the enhanced training group at a 1:1 ratio. PCPs serving older adults in enrolled CHCs were eligible to participate. The standard training group received three-hour didactic lectures, three monthly supervisions, 3 months of online support and dementia screening packages. The enhanced training group additionally received three monthly face-to-face supervisions and 3 months of online support. The participants became aware of their group membership at the end of the standard training. The knowledge, attitudes, service, and skills regarding dementia detection were assessed using questionnaires and submitted dementia detection records, respectively.

Results: A total of 23 and 21 CHCs were randomly assigned to the standard and the enhanced training group, respectively, and 58 participants from 20 CHCs assigned to the standard training group and 48 from 16 CHCs assigned to the enhanced training group were included in the final analysis (mean age 37.5 years, and 67.0% women). A significant increase in the knowledge score was found in both groups, but the increase was similar in the two groups (P = 0.262). The attitude score remained stable in both groups, and no between-group difference was found. Compared with the baseline, both groups reported an increase in dementia detection service, especially the enhanced training group (24.1% to 31.0% in the standard training group and 14.6% to 45.8% in the enhanced training group). The completion rate and accuracy of submitted dementia detection records in the enhanced training group were both significantly higher than those in the standard training group (both P < 0.001).

Conclusion: The enhanced training had similar effect on the knowledge of PCPs comparing with the standard training, but was better on continuous service and skills of PCPs related to dementia detection.

Trial registration:www.ClinicalTrials.gov, identifier: NCT02782000. Registration date: May 2016. The trial was completed in July 2017.

Comparison of Quality Changes in Eurasian Perch (Perca fluviatilis L.) Fillets Originated from Two Different Rearing Systems during Frozen and Refrigerated Storage

The current knowledge on how different Eurasian perch rearing systems impact the final fillet quality is scant. Therefore, two domestic storage conditions were investigated-10 months frozen (-20 °C) and 12 days refrigerated (+4 °C) storage conditions-in order to determine (i) how the choice of rearing system affects fillets quality during different processing conditions and (ii) if oxidative changes and other quality parameters were interactive. For the proposed idea, proteome analysis, oxidative changes, and some quality parameters were considered in this study. Sodium dodecyl-sulfate polyacrylamide gel electrophoresis (SDS-PAGE) indicated a higher loss of protein in the frozen fillets from ponds (PF) than the fillets from recirculating aquaculture systems (RAS) (RF). Western blot showed a higher protein carbonyls level in RF compared to PF, which was confirmed by the total protein carbonyls during frozen storage. PF indicated less liquid loss, hardness, and oxidation progress than RF in both storage conditions. The biogenic amines index (BAI) in the fillets from either origin showed acceptable levels during storage at +4 °C. Furthermore, the n-3/n-6 ratio was similar for both fillets. The deterioration of fillets during frozen storage was mainly caused by formation of ice crystals followed by protein oxidation, while protein oxidation was the main concern during refrigerated storage confirmed by principal component analysis (PCA) analysis.

The Effect of Training on Dementia Care among Nurses: A Systematic Review

Background: Dementia has become a global concern in ageing societies nowadays. Nurses have major roles in caring for dementia patients in various settings. There have been many trainings on dementia conducted for nurses and other health staff. However, reviews of the effect of the trainings on nurses are still scarce. This paper aims to review the impact of training on dementia care among nurses in differents settings. Method: systematic search from Medline, Pubmed and Scopus was conducted until February 2019. Additional references were collected using Google Scholar. The inclusion criteria were: primary papers, written in English, involving nurses, and related to dementia. Results: There were 20 papers included in this review. In terms of methodology, most of the articles employ quantitative method (90%). Only one article uses qualitative method (5%) and another one employs mixed methods design (5%). Pretest and posttest design is the mostly used design and four articles use Randomized Control Trial (RCT). The settings of the papers were nursing home or long-term care facilities (45%), hospitals (35%) and other settings (20%).  The lenght of the training was varied from 2 hours to 18 hours within a maximum period of eight months. The various outcome measures are categorised into four domains: cognitive, physical, psychological and working performance. The results of the review indicate that training and education for nurses can improve their knowledge, attitude, confidence and self efficacy towards better dementia care. However, the results regarding staff burnout, stress and physical health complaint are still unclear. Conclusion: raining and education in dementia care were varied and generally improve nurses’ capacities mainly in cognitive domain. However, the effect for the psychological and their working performance were still doubted Keywords: dementia, training, education, nurses

Impact of 'DEALTS2' education intervention on trainer dementia knowledge and confidence to utilise innovative training approaches: A national pre-test - post-test survey

BACKGROUND

Gaps in acute care staff knowledge, skills, and attitudes towards dementia exist. Innovative training approaches that improve the delivery of care for people with dementia are needed. We were commissioned by Health Education England to develop and evaluate a new dementia education intervention 'Dementia Education And Learning Through Simulation 2' (DEALTS2), a simulation toolkit to enhance delivery of dementia training nationally across England.

OBJECTIVES

Evaluate differences in trainer dementia knowledge scores pre and post training, satisfaction with DEALTS2 Train-The-Trainer (TTT) workshops and simulation toolkit, confidence to use training approaches, and spread of implementation.

DESIGN

A questionnaire survey using a pre-test - post-test design with measures completed: before (pre-test); after (T1); and 12 months post training (T2).

SETTING

Twelve one-day DEALTS2 TTT workshops delivered across England in 2017.

PARTICIPANTS

National Health Service Trust staff employed in dementia training roles (n = 199 trainers).

METHODS

Trainers attended DEALTS2 TTT workshops and received the simulation toolkit. Data were collected between 2017 and 2018 using a questionnaire capturing differences in dementia knowledge scores, Likert scales and closed-ended questions measured satisfaction, confidence and implementation. Data were analysed using quantitative methods.

RESULTS

Response rate was 92% (n = 183) at pre-test/T1 and 26% (n = 51) at T2. Trainer dementia knowledge scores increased from pre-test to T1 (p < 0.001) and were retained after 12 months in 5 of the 6 areas measured (pre-test to T2, p < 0.002); largest gains in 'humanised approaches to dementia care'. 96% (n = 176/183) were satisfied with DEALTS2 TTT workshops and simulation toolkit; 66.7% (n = 34/51) felt confident to deliver dementia training informed by DEALTS2. Adherence rates were good with 45% (n = 23/51) using the innovative training approaches within twelve months.

CONCLUSIONS

The results show DEALTS2 effectively increased trainer dementia knowledge and confidence to utilise innovative dementia training approaches. Implementation of DEALTS2 varied across organisations, therefore further research should explore factors determining successful implementation.

Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study

OBJECTIVES

The aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also aimed to identify the most effective features (content and pedagogical) of dementia education and training.

DESIGN

Cross-sectional survey study. Data collection occurred in 2017.

SETTINGS

Health and social care staff in the UK including acute care, mental health community care trusts, primary care and care homes.

PARTICIPANTS

All health and social care staff who had completed dementia education and training meeting the minimal standards as set by Health Education England, within the past 5 years were invited to participate in an online survey. A total of 668 health and social care staff provided informed consent and completed an online survey, and responses from 553 participants were included in this study. The majority of the respondents were of white British ethnicity (94.4%) and identified as women (88.4%).

OUTCOMES

Knowledge, attitude and confidence of health and social care staff.

RESULTS

Hierarchical multiple regression analysis was conducted. Staff characteristics, education and training content variables and pedagogical factors were found to account for 29% of variance in staff confidence (F=4.13, p<0.001), 22% of variance in attitude (knowledge) (F=3.80, p<001), 18% of the variance in staff knowledge (F=2.77, p<0.01) and 14% of variance in staff comfort (attitude) (F=2.11, p<0.01).

CONCLUSION

The results suggest that dementia education and training has limited impact on health and social care staff learning outcomes. While training content variables were important when attempting to improve staff knowledge, more consideration should be given to pedagogical factors when training is aiming to improve staff attitude and confidence.

Hospital healthcare professionals' knowledge of dementia and attitudes towards dementia care: A cross-sectional study

AIMS AND OBJECTIVES

To explore hospital healthcare professionals' knowledge and attitudes towards dementia care in China.

BACKGROUND

Hospital healthcare professionals deliver most diagnosis and treatment for people with dementia in China. Literature shows that healthcare professionals' knowledge and attitudes are of great importance in providing optimum dementia care. However, there is limited research of healthcare professionals' dementia knowledge and attitudes within hospital contexts in China.

DESIGN

A cross-sectional survey was conducted between April and December 2019.

METHODS

A self-report questionnaire composed of demographics and knowledge and attitude scales related to dementia was used for doctors and registered nurses working in settings where people with dementia are cared for in eleven public tertiary hospitals in Hebei Province, China. The STROBE checklist was adhered to in this study.

RESULTS

In total, 603 healthcare professionals completed the study. The majority of respondents were registered nurses (71.3%). The overall mean knowledge score was 20.7 (SD = 2.9) out of a maximum possible score of 30. The overall mean score for attitudes was 91.3 (SD = 15.9) out of a maximum possible score of 140. Standard multiple linear regression analysis revealed that the highest level of education, the experience of searching for dementia-related information and willingness to receive dementia training or education were significant predictors of knowledge scores. The department, the experience of working with people with dementia, length of dementia care, interest in dementia care and training type were significant predictors of attitude scores.

CONCLUSIONS

Deficits in the knowledge of dementia and a low level of positive attitude were identified among the healthcare professionals who work in hospital settings where people with dementia are cared for in China.

RELEVANCE TO CLINICAL PRACTICE

Education and training in dementia care should be integrated into undergraduate nursing and medical programmes and provided for healthcare professionals after commencing employment.

Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review

BACKGROUND

Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs.

METHODS

We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded cross-sectional studies, reviews, and book chapters that only assessed the effect of interventions. Data identifying the learning modality, and evaluation method, level, time interval, and approach were extracted from articles as primary outcomes.

RESULTS

Of 8324 identified studies, 63 articles were eligible for analysis. Most studies stemmed from Africa and Asia (69.8%), were delivered and evaluated face-to-face (74.6% and 76.2%), mainly to professionals (57.1%) and community workers (20.6%). Although the use of online and blended modalities showed an increase over the past 4 years, only face-to-face initiatives were evaluated long-term beyond individual-level. GHCB evaluations in general lacked standardization especially regarding the tools.

CONCLUSION

This is an important resource for evaluating GHCB initiatives in LMICs. It synthesizes evaluation approaches, offers recommendations for improvement, and calls for the standardization of evaluations, especially for long-term and wider impact assessment of online and blended modalities.

Design and evaluation protocol for 'DEALTS 2': a simulation-based dementia education intervention for acute care settings

BACKGROUND

There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate 'DEALTS 2', a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England.

METHODS

Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process.

EVALUATION DESIGN

Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train.

CONCLUSIONS

Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.

A comparative study of dementia knowledge, attitudes and care approach among Chinese nursing and medical students

BACKGROUND

Dementia care requires inter-disciplinary collaboration starting from formal health professional education. Yet, little is known about how undergraduate medical and nursing students perceive dementia care in China. The aim of this study was to investigate undergraduate medical and nursing students' dementia knowledge, attitudes and care approach in China.

METHODS

A cross-sectional survey was conducted. Students enrolled in a 5-year Bachelor of Medicine Program and a 4-year Bachelor of Nursing Program from four universities with campuses across Eastern, Western, Southern and Northern China were recruited into the study. Three validated instruments, Alzheimer's Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS) and Approach to Advanced Dementia Care Questionnaire (ADCQ), were used to examine students' dementia knowledge, attitudes and perceived care approach. Data were collected using a self-administered survey.

RESULTS

The number of medical and nursing students completing the survey was 526 and 467 respectively. Students' overall knowledge about dementia was poor, but attitudes were generally positive. The overall mean score of students' dementia knowledge examined by the ADKS was 19.49 (SD = 2.82) out of 30, students' attitudes to dementia was 29.92(SD = 3.35) out of 40, and students' person-centred care approach of dementia was 5.42 (SD = 2.20) out of 13. Medical students demonstrated higher dementia knowledge scores and showed less positive attitude scores than nursing students (p < 0.05). Students would not apply a person-centred care approach. There were no statistically significant differences in the mean scores of ADCQ between nursing students and medical students.

CONCLUSIONS

Study results highlight the urgent need to implement an inter-disciplinary approach to increasing dementia education among Chinese medical and nursing students, and ensuring that students have adequate knowledge, attitudes and experience in the care of people with dementia.

Healthcare professionals' dementia knowledge and attitudes towards dementia care and family carers' perceptions of dementia care in China: An integrative review

AIMS AND OBJECTIVES

To establish an understanding of healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' perceptions of dementia care in China.

BACKGROUND

Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' dementia care perceptions has been conducted in China.

METHODS

An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists.

RESULTS

Thirty-eight primary research papers were included in the review. Three themes were identified from the synthesis: (a) knowledge and competency; (b) attitudes towards dementia care; and (c) carers' burden and unmet needs. Healthcare professionals' dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses.

CONCLUSIONS

There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers.

RELEVANCE TO CLINICAL PRACTICE

Nurses, and particularly community nurses, are well-positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programmes and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed.

Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial

Background

Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation.

Methods

The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis.

Results

Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers.

Conclusion

The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial.

Trial registration

German clinical trials register, DRKS00010037. Registered 12 February 2016.

Knowledge evaluation instruments for dementia caregiver education programs: A scoping review

With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non-RCTs = 6, one-group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi-country (n = 1). Only two studies focused on minority populations. While author-developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397-413.

Development of Professional Care Program for Nurses in Dementia Wards and Its Educational Effects

PURPOSE

To develop an education program for nurses specializing in dementia care, and to investigate its effects.

METHODS

An intervention study of nurses was conducted using a quasi-experiment with 3 randomly assigned groups. Participants were 51 nurses from a psychiatric hospital dementia ward, divided into an intervention program group (17 nurses), a knowledge-acquisition-only group (16 nurses), and a usual-care group (18 nurses) as controls. The program group intervention comprised 3 frameworks: motivation for achieving the task, acquisition of professional knowledge required for dementia care, and sharing of successful experiences based on professional knowledge. The knowledge-acquisition-only group received only the acquisition of professional knowledge framework, and the usual-care group received only the usual-care framework. The intervention period was 3 months.

RESULTS

Post-intervention, the program group had a significantly greater sense of self-efficacy associated with professional knowledge and significantly greater self-efficacy associated with practice compared with the knowledge-acquisition-only and the usual-care groups. Professional knowledge was acquired by 80% of the program group, compared with 70% of the knowledge-acquisition-only group. A co-occurrence network diagram of the multivariate analysis results produced by text mining of the descriptive data indicated that nurses provided care for symptoms specific to different diseases based on their pathological mechanisms.

CONCLUSION

Program implementation led to the acquisition of deeper knowledge and greater self-efficacy by sharing expertise-based practices and successful experiences, compared with desk-based learning in a single workshop lecture, suggesting the program's usefulness in clinical practice.

Knowledge, attitudes, and qualification needs of primary health care professionals in the care of dementia

ABSTRACT Objective: To identify the knowledge and attitudes of doctors and nurses in tracking, diagnosing, treating, and monitoring dementias and their educational needs in this area. Method: Cross-sectional study, carried out among 195 doctors and 274 nurses working in teams of the Family Health Strategy (FHS) in the city of São Paulo. The instrument used was Health Care for Dementia: the Primary Care perspective. The data were submitted for descriptive statistics. Results: Among physicians, 64.1% reported routinely diagnosing dementia, but only 23.1% in the mild phase; 89.2% mentioned difficulties in identifying cases of the disease; 94.9%, difficulties in the treatment and monitoring of patients, including the needs to support the caregiver (28.2%); 84.6% of doctors and 79.2% of nurses reported difficulties in monitoring severe cases of the disease. Conclusion: Gaps in knowledge were identified regarding the tracking and diagnosis of dementia, patient monitoring, diagnostic information, and support for the caregiver.

Interventions for Attitudes and Empathy Toward People With Dementia and Positive Aspects of Caregiving: A Systematic Review and Meta-Analysis

OBJECTIVE

This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the effect of interventions on three outcomes among caregivers of people with dementia and health professionals, including positive aspects of caregiving, attitudes toward people with dementia, and empathy.

METHODS

Three electronic databases were searched to find RCTs published in peer-reviewed journals until January 7, 2019. A total of 13 studies met the eligibility criteria and were included in meta-analysis.

RESULTS

The included studies compared psychoeducational interventions, a combination of education, skill-building, and coping strategies, to control group. Meta-analyses of the included studies found that the overall effects of psychoeducational interventions on three outcomes were not statistically significant compared to control groups.

CONCLUSIONS

The findings indicate that there is no evidence for the positive effect of psychoeducational interventions on these outcomes, warranting further RCT studies designed to target on these outcomes.

Factors associated with successful dementia education for practitioners in primary care: an in-depth case study

BACKGROUND

With increasing numbers of people in the UK living with dementia, the provision of good quality person-centred care that meets the often complex needs of this population is required. Given the majority of people with dementia live in the community, significant care and support will be provided by primary care services. This means the primary care workforce needs appropriate education to ensure they have the right knowledge, skills and attitudes to meet these care needs. However, little is understood about the most successful approaches to dementia education in this setting.

METHODS

An in-depth case study was undertaken in a single primary care organisation with the aim of exploring the impact of a person-centred dementia educational programme, and identify barriers and facilitators to implementation. Data was gathered from a wide range of sources and analysed using Kirkpatrick's evaluative framework.

RESULTS

Initially, staff learners struggled to incorporate the 'whole-person' approach to dementia care, but gained knowledge and confidence through self-directed learning. They reacted positively to the training and appreciated opportunities to learn from peers in other services. They identified improvements in communication and prescribing practices, despite difficulties implementing changes during busy periods. Resultant impact for service users included more timely routine appointments, and positive satisfaction ratings from patients and families.

CONCLUSIONS

The findings indicate the perceived value of person-centred dementia education for primary care. Further recommendations for provision in this service setting include tailored programmes designed collaboratively with clinical service providers, and bringing together an interdisciplinary mix of learners to enhance knowledge exchange.

Professional education on dementias in Primary Health Care: an integrative review

OBJECTIVE

To investigate the most commonly used educational approaches in dementia training for primary health care professionals.

METHOD

Integrative literature review, conducted between April and June of 2018, in PubMed, LILACS and IBECS databases. The descriptors used were: Training, Health Personnel, Dementia, Primary Health Care for PubMed; and the MeSH terms, Training Programs, Health Personnel, Dementia, and Primary Health Care for LILACS and IBECS.

RESULTS

The sample consisted of 13 articles; eight were published in the last five years (62%); seven articles with a quantitative approach (54%); seven articles produced on the European continent (54%), followed by five published on the North American continent (38%). All journals were from the health area (100%).

CONCLUSION

Educational strategies were combined and used for education. Significant improvements in knowledge, skills, and attitudes of the teams with regard to professional management of dementias were evidenced.

Person-Centered Dementia Care in China: A Bilingual Literature Review

We conducted a bilingual literature review of the existing studies focusing on person-centered dementia care in China. We synthesized key findings from included articles according to three overarching themes: Chinese cultural relevance of person-centered care (PCC), perceived needs for PCC for older adults in China, implementation and measurement of PCC in China, and person-centered dementia care model. We also drew on frameworks, theories, and other contents from the examined articles to develop a person-centered dementia care model with specific relevance to China. The model is a good starting point to help us operationalize globally relevant core principles of PCC in the specific sociocultural context of China. The framework will be informed by more empirical studies and evolve with the ongoing operationalization of PCC. Although PCC is a new concept and has not been vigorously or systematically studied in China, it is attracting increasing attention from Chinese researchers. More empirical studies are needed to link PCC to measurable outcomes, enrich the framework for applying PCC, and construct assessment and evaluation systems to facilitate the provision of PCC across countries and cultures. Global consortia and collaborations with multidisciplinary expertise to develop a PCC common data infrastructure that is internationally relevant for data sharing and comparison are needed.

Correctional nurse education and training for the care and support of prisoners with dementia: a systematic review of text and opinion protocol

The objective of this systematic review is to synthesize the best available evidence on the perceived education and training required for correctional nurses to care for and support prisoners with dementia in the Australian context. The review questions are.

Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]

BACKGROUND

Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study.

METHODS/DESIGN

This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation.

DISCUSSION

We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals.

TRIAL REGISTRATION

DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.

Health professionals' perceptions of developing dementia services in primary care settings in China: a qualitative study

OBJECTIVES

Primary care plays a crucial role in the timely diagnosis and proper management of dementia. Evidence from low and middle income countries is much needed to inform service development in primary care and to address the dementia burden in these countries. The aim of this study was to explore community health professionals' perceptions of dementia service development using China as a case.

METHOD

An interpretive study design was utilized and focus groups were used for data collection guided by a semi-structured interview guide. Each focus group lasted between 90-120 min. Thematic analysis was applied for data analysis.

RESULTS

Twenty-one community health professionals participated in this study and three major themes were identified. These themes are: incorporating dementia components in the government-subsidized primary care services; an under-prepared workforce to meet the demand for dementia care; and an enabling environment to sustain dementia care.

CONCLUSION

Government policies, regulations, standards and guidelines need to be established for dementia service development in primary care to improve the home care for people with dementia and to create a dementia-friendly society. Regular education and training activities for health professionals are a way to build dementia care service capacity in primary care.

Overview of dementia care under the three-tier long-term care system of China

OBJECTIVES

This paper provides an overview of the status of dementia care in Mainland China under the framework of the three-tier long-term care system proposed by the Chinese government, and gives the direction for service development.

METHODS

Official documents, annual reports of related associations, and studies conducted in Mainland China from 2006 to 2017, published both in English and Chinese were reviewed.

RESULTS

With the establishment of the three-tier long-term care system, the Government has invested a lot in long-term care, and improvements have been made. However, specific areas of dementia care still face challenges.

DISCUSSION

Strategies in improving the long-term care services have been achieved. These included training for informal caregivers at home settings, increased investment in community health centers, and increased institutional placements, etc. However, these are not enough to fulfill the needs of people with dementia and their caregivers.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Multiple levels of training and interaction within the framework of the three-tier long-term care system as well as more research are recommended for improving dementia care.

Nursing students' cultural competence in caring for older people in a multicultural and developing region

BACKGROUND

Health disparities exist among different cultural groups in a multicultural society. Older people from minority groups usually face greater challenges in accessing and utilizing healthcare services due to language barriers, low levels of health literacy and cognitive impairment.

OBJECTIVES

The aims of this study were to measure nursing students' cultural competence in the context of caring for older people from diverse cultural backgrounds and explore associated factors affecting their cultural competence in order to inform curriculum design in Xinjiang, China.

DESIGN

A cross-sectional study design.

SETTINGS

The study was undertaken in the School of Nursing, Xinjiang Medical University, Xinjiang Uygur Autonomous Region, China.

PARTICIPANTS

Students enrolled in a 4-year Bachelor of Nursing Program.

METHODS

Students' cultural competence was measured using a validated Chinese version of Cross-cultural Care Questionnaire. Data were collected using a self-administered survey.

RESULTS

The number of students in the survey was 677. Of those students, 59.5% of them were from an ethnic group other than Han Chinese. A higher proportion of students from ethnic groups, other than Han Chinese, were able to fluently speak a language other than Chinese and used this language in their study and daily lives. Nursing students demonstrated low scores in knowledge, skills and encounters subscales for cultural competence, but had a relatively high score in awareness across all academic years. Findings from students' responses to open-ended questions reveal the need to integrate cross-cultural care and gerontological care into the nursing curricula and support students to apply gerontological knowledge to practice in clinical placements.

CONCLUSIONS

Nursing students enrolled in a 4-year Bachelor degree program in a multicultural and less developed region demonstrated lower scores on cultural competence and recognized the need to develop crosscultural and gerontological competencies.

Development, implementation and evaluation of Australia's first national continuing medical education program for the timely diagnosis and management of dementia in general practice

BACKGROUND

Dementia is the second leading cause of death in Australia. Over half of patients with dementia are undiagnosed in primary care. This paper describes the development, implementation and initial evaluation of the first national continuing medical education program on the timely diagnosis and management of dementia in general practice in Australia.

METHODS

Continuing medical education workshops were developed and run in 16 urban and rural locations across Australia (12 were delivered as small group workshops, four as large groups), and via online modules. Two train-the-trainer workshops were held. The target audience was general practitioners, however, international medical graduates, GP registrars, other doctors, primary care nurses and other health professionals were also welcome. Self-complete questionnaires were used for the evaluation.

RESULTS

Of 1236 people (GPs, other doctors, nurses and other health professionals) who participated in the program, 609 completed the full program (small group workshops (282), large group workshops (75), online modules (252)); and 627 elected to undertake one or more individual submodules (large group workshops (444), online program (183)). Of those who completed the full program as a small group workshop, 14 undertook the additional Train-the-trainer program. 76% of participants felt that their learning needs were entirely met and 78% felt the program was entirely relevant to their practice.

CONCLUSION

Continuing medical education programs are an effective method to deliver education to GPs. A combination of face-to-face and online delivery modes increases reach to primary care providers. Train-the-trainer sessions and online continuing medical education programs promote long-term delivery sustainability. Further research is required to determine the long-term knowledge translation effects of the program.

Community health professionals' dementia knowledge, attitudes and care approach: a cross-sectional survey in Changsha, China

BACKGROUND

Community health professionals play a significant role in dementia care. However, little is known about community health professionals' capacity in dementia care, especially in low and middle-income countries. The aim of the present study was to assess community health professionals' dementia knowledge, attitudes and care approach in China, a country with the largest population of people with dementia in the world and where community based dementia care services are much needed.

METHODS

A cross-sectional survey was conducted. 450 health professionals were recruited into the study using random sampling from community health service centres in Changsha, China. Their knowledge, attitudes and care approach were assessed utilising the Chinese version of the Alzheimer's Disease Knowledge Scale, Dementia Care Attitude Scale and Approach to Advanced Dementia Care Questionnaire respectively.

RESULTS

A total of 390 participants returned the questionnaire (response rate 87%). Age, education, professional group and care experience were associated with knowledge scores, and overall dementia knowledge was poor. Attitudes were generally positive and influenced by age, professional group, gender and care experience. The experience of caring for people with dementia was positively associated with a person-centred care approach, although the participants tended not to use a person-centred care approach. A statistically significant association was found between knowledge and attitudes (r = 0.379, P < 0.001), and between attitudes and care approach (r = 0.143, P < 0.001). However, dementia knowledge has no relationship with a person-centred approach.

CONCLUSIONS

Community health professionals showed generally positive attitudes towards people with dementia. However, they demonstrated poor dementia knowledge and tended not to use a person-centred care approach. The results suggest that a multifaceted approach consisting of educational interventions for community health professionals, and policy and resource development to meet the demand for community dementia care services, is urgently needed in China.