Involving people with dementia and their carers in dementia education for undergraduate healthcare professionals: a qualitative study of motivation to participate and experience

The associations of e-health perception and dementia knowledge with dementia public stigma in nursing students: A cross-sectional study

BACKGROUND

Preparing nursing students for dementia care, a prevalent cause of mortality, disability, and dependency among older people, is essential. Positive perceptions of e-health are believed to be associated with better knowledge, attitude, and skills among nurses across various care contexts. However, the relationship between e-health perception and nursing students' dementia knowledge and stigma remains underexplored.

AIM

To investigate the relationship between e-health perceptions, dementia knowledge, and dementia stigma among nursing students.

SETTINGS AND PARTICIPANTS

A total of 513 nursing students from a college in Hong Kong participated in an online survey.

METHODS

A cross-sectional design.

RESULTS

Students had an average age of 20.6 years, with the majority being females (69.8 %) and lacking experience in providing direct care for people with dementia (69.9 %). Most participants were in their first academic years (95.5 %) and had no family members with dementia (92.4 %). Students showed inadequate dementia knowledge (scoring indicator was 64.4 %) and a moderate stigma score (58.9 ± 9.0). Bivariate regression analysis indicated that e-health perception is significantly related to dementia knowledge but not to dementia stigma. Multiple regression analysis showed that being male (β = 0.520, p = 0.01) and having family members with dementia (β = 0.77, p = 0.03) were positively associated with dementia knowledge. Additionally, greater dementia knowledge (β = -0.53, p < 0.005) and senior-year bachelor programme entry were negatively associated with dementia stigma.

CONCLUSION

The curricula of pre-registration nursing education should be enhanced to improve dementia knowledge and reduce stigma. The lack of a significant correlation between e-health perception, experience in caring for individuals with dementia, and dementia knowledge and stigma underscores the need to improve the quality of dementia education by leveraging e-health opportunities and clinical practicum.

Exploring community stakeholder perspectives of partnership development in community-engaged undergraduate Global Health Education in the UK: a qualitative study

OBJECTIVES

Traditionally, patients have had passive roles in medical education; however, there have been increasing efforts to partner with communities to create authentic representation of laypeople in medical education. Communities' perspectives of these initiatives have rarely been reported in the literature. This study explores the perspectives of members of community-based organisations (CBOs) who were partnered with a community engagement programme for intercalating medical students at Imperial College London.

DESIGN

A qualitative study using semistructured interviews was conducted, employing reflexive thematic analysis.

SETTING

London, UK.

PARTICIPANTS

A total of five participants (one member from five CBOs who agreed to participate) were interviewed for this study. The selection criterion was direct involvement in the community engagement programme.

RESULTS

Three key themes were identified aligning with the core principles of co-production: building partnership, reciprocity in partnership and maintenance of relationship. Partnership development was influenced by the CBOs' perception of students which caused power differentials in the development of learning plans. Reciprocity refers to a multidirectional benefit pathway resulting from the community involvement programme, which had short-term and anticipated long-term effects. Relationships built were maintained via a service evaluation report, and participants discussed how attitudes of academic institutions towards collaboration influence communities' ability to participate in medical education.

CONCLUSIONS

The perspectives of CBOs reported in this study demonstrate that factors important to partnership development in community-engaged medical education are consistent with the key principles of co-production. Supported by literature, the findings emphasise that community involvement can be linked to social accountability and sustainable health practice. Provided that the possible risks/challenges are appropriately identified and mitigated to facilitate co-productive partnerships between stakeholders, the involvement of CBOs in medical education has the potential to provide benefits for communities, students and educational institutions.

Motivations of family advisors in engaging in research to improve a palliative approach to care for persons living with dementia: an interpretive descriptive study

BACKGROUND

A Strategic Guiding Council (SGC) was created within a Family Carer Decisions Support study, to engage family carers of persons with advanced dementia as advisors to inform the design and implementation of the study. The SGC consists of an international group of family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, and the Czech Republic. There are limited studies that have explored the integration of Patient and Public Involvement (PPI) in dementia research, end-of-life care and long-term care. Therefore, this study explores PPI engagement in health research with family carers to understand further their interest in being involved in the SCG within the FCDS intervention which is focused on supporting caregivers to make decisions about end-of-life care for residents with advanced dementia.

METHODS

This study utilized an interpretive descriptive design and explored the motivations of ten family advisors from Canada, the Republic of Ireland, the United Kingdom, and the Netherlands in being part of the SGC. Semi-structured interviews were conducted by phone or videoconferencing and were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Three themes generated from the findings of the study were (1) engaging in reciprocal learning; (2) using lived experience to support other family carers; and (3) creating a collective momentum for advocacy and change.

CONCLUSIONS

Family carers motivations to being part of the SCG was driven by their intent to help carers navigate the health system and to create a psychosocial support system for other carers experiencing end-of-life with their loved ones. Being part of the SCG provided a benefit to family carers which provided a venue for them to contribute meaningful information from their experience, learn from other health professionals, research and other advisors and an avenue for advocacy work to improve access to end-of-life care supports through education. To our knowledge, this is the first study that explores the motivations of an international group of family advisors' engagement in health research to promote integration of a palliative approach to dementia care in long-term care homes. This study further contributes to the literature from an international perspective the importance of PPI in research. Further research is warranted that explores PPI in research to improve access to end-of-life supports.

Dementia Education for Workforce Excellence: Evaluation of a Novel Bichronous Approach

Dementia education and training for workforce development is becoming increasingly important in bridging knowledge gaps among health and social care practitioners in the UK and internationally. Dementia Education for Workforce Excellence (DEWE) was developed during the COVID-19 pandemic, blending both synchronous and asynchronous instruction and delivered across three different contexts: care homes, home care, and nurse education within the UK and India. This study aimed to evaluate DEWE using mixed methods with online survey data analyzed descriptively and interview data analyzed thematically. Integration of survey and interview data aimed toward a comprehensive evaluation of this novel approach for dementia workforce development. Thirty-four social care practitioners and nurse educators completed the online survey demonstrating high-level learner satisfaction, learning gains, behavioral change, and motivation to share new knowledge. Four key themes developed from the analysis of interviews (n = 9) around participants' pursuit of new knowledge; delivery modes in DEWE; learning gains and impact of DEWE; and adaptations for future program implementation. Findings suggest DEWE is an innovative resource that promotes person- and relationship-centered dementia care across all stages of one's dementia journey. Cultural adaptations are recommended for international delivery to ensure contextual alignment and maximum impact.

Lost in translation: how can education about dementia be effectively integrated into medical school contexts? A realist synthesis

OBJECTIVES

The prevalence of dementia in both community and hospital settings requires a clinical workforce that is skilled in diagnosis and management of the condition to competently care for patients. Though evidence of successful educational interventions about dementia exists, effective translation into medical school curricula is the exception rather than the norm.

DESIGN

We adopted a realist synthesis approach following Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines to answer the following questions: (1) what are the barriers to integrating effective interventions about dementia into medical school curricula and (2) where they are successfully delivered, what are the contextual factors that allow for this enactment?

DATA SOURCES

We searched PubMed, Embase, CINAHL and PsycINFO using the MesH terms Schools, Medical; Students, Medical; Education, Medical AND Neurocognitive disorders or the closest possible set of terms within each database.

ELIGIBILITY CRITERIA

Undergraduate or graduate entry medical school programme, teaching and learning focussing on dementia, evaluating student outcomes (satisfaction, knowledge, skills, attitudes or behaviours), interventions described clearly enough to classify teaching method, any research design (quantitative and qualitative), English language.

DATA EXTRACTION AND SYNTHESIS

We used a shared spreadsheet to enter key information about eligible studies and the reasons for excluding studies that did not fit eligibility criteria. We extracted descriptive data about the nature of educational interventions and narrative information as to barriers and facilitators to implementing those interventions.

RESULTS

Our initial literature search identified 16 relevant papers for review. Systematic extraction of data informed the development of an initial programme theory (IPT) structured around four contextual barriers: 'culture', 'concern for patient welfare', 'student attitudes' and 'logistics' with associated facilitatory mechanisms embed medical education about dementia.

CONCLUSIONS

We outline the process of generating our IPT, including overlap with Cultural Historical Activity Theory. We outline our intention to refine our programme theory through ongoing review of the evidence base and collaboration with stakeholders, with the aim of finalising a model for successful integration of dementia education.

Understanding the experiences of people with dementia and their family carers participating in healthcare student dementia education: A mixed-methods evaluation from the time for dementia programme

BACKGROUND

There is increasing awareness of the potential for positive impacts on student learning from involving people with dementia and family carers within undergraduate teaching. However, research on the experience of people with dementia and their family carers is sparse. This study aimed to evaluate the satisfaction and views of families (people with dementia and their family carers) who volunteered in Time for Dementia (TFD); an educational programme where undergraduate healthcare students visit families at home over a 2-year period.

METHODS

Families taking part in TFD completed a satisfaction survey after taking part in the programme (n = 803). Frequencies of satisfaction survey items were summarised and multiple linear regression models for factors associated with total satisfaction scores were produced. Open text responses were analysed using thematic framework analysis as to the most favourable aspects of the programme and areas requiring improvement.

RESULTS

Overall satisfaction was high for taking part in TFD, with a perception of contribution, and being of value. There was strong evidence that families enjoyed the experience and would recommend participation to others. Higher numbers of student visits were significantly associated with greater satisfaction. Families identified aspects of the programme that benefited them, with social interaction rating highly. Improvements suggested by the families included increased visit structure and organisational improvements.

CONCLUSIONS

This study has sought to evaluate at scale the satisfaction of families taking part in a dementia education programme. It is positive that families report high satisfaction in the programme and identify perceived value for themselves as well as students, suggesting reciprocal benefits. This study contributes to the broader understanding of what Experts by Experience value when taking part in educational interventions.

Understanding the experience of time for dementia education programme on undergraduate radiography students

INTRODUCTION

Dementia is a global health priority, which requires the healthcare workforce to have the necessary attitudes and skills to deliver person-centred care to people with dementia. Radiographers have frequent contact with people with dementia, and undergraduate training is potentially an optimal time to deliver dementia education. Time for Dementia is an education programme in which undergraduate healthcare students visit a person with dementia and their carer over a two-year period to gain an in-depth understanding of the condition. The aim of this study was to understand undergraduate radiography students' experiences of undertaking the Time for Dementia (TFD) programme.

METHODS

Two focus groups were undertaken with 14 radiography students who were half-way through the TFD programme. Data was analysed using thematic analysis.

RESULTS

Three key themes were constructed from the analysis: A Holistic Learning Experience, Transferring Learning into Practice and Preparedness & Expectations. Participants discussed the value from learning directly from people with dementia and their carers, reporting an increase in their awareness and understanding of dementia as well as the impact of caring for somebody with the condition. Participants were able to identify learning to take into practice such as person-centred care, compassion, and patience. Challenges to learning were also identified.

CONCLUSIONS

This study suggests that a longitudinal, experiential education programme provides radiography students with the opportunity to develop a more holistic understanding of dementia and the impact it may have on the individual and their family members.

IMPLICATIONS FOR PRACTICE

Experiential dementia teaching is of value to radiography students, however preparation and learning support should fit with previous personal and teaching experience.

Blogging with dementia: Writing about lived experience of dementia in the public domain

Public narratives around dementia have historically been negative, and have not been shaped by people with dementia themselves, but stories of living with dementia are becoming more common in the public domain. This qualitative study explored the motivations and experiences of bloggers by conducting interviews with six bloggers with dementia in the UK. Thematic analysis suggested that the asynchronous nature of blogging offered a valuable, personalised space for people with dementia to tell their own stories in their own way. Blogging as a format posed some practical challenges, but bloggers developed strategies to overcome these. Motivations for blogging were on three levels: the personal (as a journal, and as a 'room of one's own'); community (as solidarity for other people with dementia, and as comfort for families and friends) and society (as an educational and campaigning tool). Whilst the study is small, and there are many voices of people with dementia missing from the blogging community, this research demonstrates the potential for blogging by people with dementia to change public narratives and perceptions of dementia.

Covid-19 and the quality of life of people with dementia and their carers-The TFD-C19 study

Introduction

COVID-19 has placed unprecedented pressure on dementia health and social care systems worldwide. This has resulted in reduced services and support for people with dementia and their family carers. There are gaps in the evidence on the impact of the pandemic on Quality of Life (QoL). We carried out a study on the impact of the pandemic on the QoL of a group of people with dementia and their family carers who were part of a larger existing cohort study.

Methods

We quantitatively measured QoL, on two occasions during the two national lockdowns in 2020 and compared these data with those obtained when they entered the study (before the pandemic). Measures used included: DEMQOL-Proxy, Clinical Dementia Rating Scale and C-DEMQOL. To understand how QoL changed over time, a repeated measures ANOVA was run for each dependent variable with the following variables entered as co-variates: duration in study, baseline dementia severity, gender of the family carer, gender of the person with dementia, family carer relationship, dementia type, living status, age of the person with dementia, and age of the family carer.

Results

248 participants took part in the study. QoL scores did not significantly decline between either time period for the person with dementia or their family carer. There was variation in subgroups; with co-resident status, carer relationship, gender of the person with dementia, age of the person with dementia, and baseline cognitive status influencing QoL outcomes in family carers.

Discussion

It is striking that people with dementia and their carers did not report a decline in QoL during the pandemic or in the months following restrictions suggesting the possibility of resilience. Variation in subgroups suggests that specific groups of family carers were more vulnerable to lower QoL; indicating the need for more tailored, nuanced support during this period.

Clinical Observation on the Effect of Systematic Nursing Intervention on Cognitive Function, Life Activity Ability, and Quality of Life of Senile Dementia Patients

OBJECTIVE

To explore the influence of systematic nursing intervention on the life ability and quality of senile dementia patients.

METHODS

Total of 82 senile dementia patients who were admitted to our hospital from January 2018 to January 2020 were divided into two groups according to the random number table, and the nursing intervention was analyzed. 41 patients in the control group were given routine nursing care, and 41 patients in the observation group were given systematic nursing intervention. Patients were assessed cognitively using the Montreal Cognitive Assessment Scale (MoCA). The Barthel index and SF-36 were used to evaluate the patients' daily activity function and quality of life. A Symptom Checklist-90-Revised (SCL-90-R) was used to assess mental distress. The Social-Adaptive Function Rating Scale (SAFE) and Social Skills Inventory (SSC) were used to evaluate the patients' social interaction ability before and after nursing intervention. Nursing satisfaction was distributed to patients in the form of a self-prepared nursing satisfaction questionnaire for scoring.

RESULTS

After the nursing intervention, the MoCA scores of patients in the two groups were higher than those before the nursing intervention, and the scores in the observation group were higher than those in the control group (P < 0.05). After the nursing intervention, the Barthel index scores of patients in the two groups were higher than those before the nursing intervention, and the scores in the observation group were higher than those in the control group (P < 0.05). After the nursing intervention, the SF-36 scores of patients in the two groups were higher than those before the nursing intervention, and the scores in the observation group were higher than those in the control group (P < 0.05). After nursing intervention, the SCL-90-R scores of patients in the two groups were lower than those before nursing intervention, and the scores in the observation group were lower than those in the control group (P < 0.05). After the nursing intervention, the SAFE scores of patients in the two groups were lower than those before the nursing intervention, and the safe scores of the observation group were lower than those of the control group (P < 0.05). After the nursing intervention, the SSC scores of patients in the two groups were lower than those before the nursing intervention, and the scores in the observation group were lower than those in the control group (P < 0.05). After nursing intervention, the total satisfaction degree of the control group (80.49%) was lower than that of the observation group (97.56%) (P < 0.05).

CONCLUSION

The implementation of systematic nursing intervention is conducive to improve the cognitive function, activity of life, and quality of life of senile dementia patients who have a positive effect, and nursing satisfaction is higher.

Health promotion initiative: A dementia-friendly local community in Sweden

Dementia is a great public health concern worldwide. Despite this, little is known from a health-promoting perspective about dementia in general as a public health issue, in dialog with people living with dementia, applicable at individual, group, and societal levels with regard to policies and practice. This study therefore aims to explore the experiences related to living with dementia in the local community by advancing a health-promoting perspective. Semi-structured individual and group interviews were conducted with participants (n = 22) with lived, professional, and personal experiences of dementia living in a medium-sized municipality in Sweden. Transcripts were analyzed by thematic analysis. Four themes emerged: health promotion through knowledge and public awareness, health promotion through opportunities to be active, health promotion through meaningful meeting places, and health promotion through improvements in the welfare system. We found that more knowledge and public awareness about dementia are needed to advance a health-promoting perspective and increase the prominence of dementia as a public health issue. Further research and policy need to focus more on how professionals in dementia care practice could be involved in promoting health and well-being for people with dementia.

Needs, issues, and expectations on dementia care at home across Europe to inform policy development: Findings from a transnational research study

This qualitative descriptive study explored needs, issues, and expectations on dementia care at home as expressed by relatives of people living with dementia (PwD), health and social care professionals (HSCPs), and members of civil society organisations (CSOs) from four European countries. A focus group methodology integrated with individual semi-structured interviews was adopted to collect data by employing a purposeful sampling method. A total of 13 focus groups and 12 individual interviews were conducted in 2019, involving 65 relatives of PwD, 32 HSCPs, and 23 members of CSOs. Deductive content analysis and findings triangulation were performed to analyse data, and a subgroup of participants confirmed the findings. Relatives need to be (a) informed and trained to cope with changes in PwD, (b) recognised for their caregiving role, and (c) assisted by specialised HSCPs. Professionals who work in partnership with PwD and their relatives call for a reorganisation of available services. CSOs compensate for the lack of proper support, promoting networks, and cooperation with local communities. Several commonalities emerged across countries, highlighting the chance to inform and develop common policies to improve the quality of life of PwD and their relatives across Europe. Policies improving person- and family-centred care and spreading dementia-friendly community concepts and practices are suggested. Strong collaborations between formal and informal services and communities are also needed as well as information on educational strategies to improve the use of resources, promote PwD care, and support PwD relatives' needs.

What factors affect paramedics' involvement of people with dementia in decisions about their care? A qualitative study

BACKGROUND

Paramedics are frequently called to people with dementia, but decision making can be challenging due to lack of information or difficulties in assessment. Best-practice dementia care should be holistic and involve people with dementia in decisions as far as possible.

AIMS

To explore how paramedics make decisions when attending people with dementia, with a particular focus on factors that impact on how, and to what degree, paramedics involve people with dementia in these decisions.

METHODS

A generic qualitative research approach was used. Data were collected through semi-structured individual interviews with seven paramedics. The interviews were recorded and transcribed verbatim and subsequently analysed using thematic analysis.

RESULTS

Four themes were identified that all touched on challenges to delivering person-centred care. Themes identified were: 1) paramedics' differing approaches to assessing capacity and making best interest decisions; 2) communication and developing a rapport; 3) interconnections with others important to the person with dementia; and 4) the impact of paramedics' values and attitudes.

CONCLUSION

The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics with the skills and ethical frameworks needed to deliver high quality dementia care.