Training interventions to improve general hospital care for older people with cognitive impairment: systematic review

Assessing delirium knowledge among health care professionals: findings from a scoping review

BACKGROUND

Delirium is highly prevalent among older adults in various healthcare settings. Healthcare professionals' knowledge is crucial for preventing, recognizing, and managing delirium and delirium-related adverse outcomes. Despite its importance, little is known about how delirium knowledge is assessed.

OBJECTIVES

To map instruments and items used to assess delirium knowledge among healthcare professionals.

DESIGN

A scoping review based on the methodological framework of Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005).

MATERIALS AND METHODS

A systematic literature search was performed in Medline, Embase, CINAHL, Scopus, and PsycINFO to include studies that assessed delirium knowledge among healthcare professionals.

RESULTS

After removing duplicates, 760 studies were assessed for eligibility and 98 studies were included. Delirium knowledge was mainly assessed among nurses (57/98, 58.8%) and physicians (12/98, 12.4%) with a focus on critical care (32/98, 33.0%) over long-term care settings (4/98, 4.1%). Most studies used self-developed instruments (50/93, 53%), followed by original or modified versions of the Delirium Knowledge Questionnaire (14/93, 15%). Among the 32 identified instruments, limited evidence of validity and reliability was reported for six (18.8%). Analysis at the item level (n = 392 items) revealed five domains: (a) definition, signs and symptoms (81 items); (b) risk factors, incidence, and prevention (139 items); (c) detection and tools (89 items); (d) management and therapy (64 items); and (e) outcomes, prognosis and consequences (19 items).

CONCLUSIONS

Delirium poses a significant burden on patients and on the healthcare system. This scoping review provides a comprehensive overview on how healthcare professionals' delirium knowledge has been assessed. Further research in this field is needed to provide stronger evidence of instruments' validity and reliability and to explore delirium knowledge among healthcare professionals in long-term care settings.

Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes: A cross-sectional study from China

Objective

The institutionalization of care for patients with dementia is becoming a trend. Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice. Therefore, this study aimed to examine the relationship between basic attributes, caring ability, and caregiver burden in employed caregivers practicing in nursing homes.

Methods

This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Demographic characteristics of participants, characteristics of the older patients with dementia, caring characteristics, training in dementia care, and caring abilities were collected for analysis of influencing factors. A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.

Results

The ZBI score of employed caregivers in nursing homes was 40.42 ± 10.18, representing a moderate caregiver burden. Factors such as age (U = 27.82, P < 0.001), residence (U = 7.89, P < 0.001), educational level (H = 55.81, P < 0.001), self-care of older patients with dementia (H = 85.21, P < 0.001), daily care hours (H = 73.25, P < 0.001), number of older people with dementia cared for (H = 14.56, P = 0.012) and training in dementia care (U = -9.43, P < 0.001) were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden (r = -0.22, P < 0.01). Furthermore, after controlling for demographic characteristics, the characteristics of older people with dementia, caring characteristics, training in dementia care, and caring ability explained 8.5%, 5.8%, and 4.8% of the caregiver burden, respectively.

Conclusion

The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors. We recommend tailored interventions, such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

International Standards for Dementia Workforce Education and Training: A Scoping Review

BACKGROUND AND OBJECTIVES

The increasing number of people with dementia requires transparency and quality dementia education, training, and care. This scoping review aimed to determine the key elements of national or state-wide standards on dementia education and training that could underpin the development of international standards for dementia workforce training and education.

RESEARCH DESIGN AND METHODS

The English-language peer-reviewed and gray literature were searched (2010-20). Key search domains were training, workforce, standards/frameworks, and dementia.

RESULTS

Thirteen standards were identified from the United Kingdom (n = 5), the United States (n = 4), Australia (n = 3), and Ireland (n = 1). Most standards focused on training health care professionals with some including people in customer-centric settings, people living with dementia, and informal carers or the general community. Seventeen training topics were identified in 10 or more of the 13 standards. Cultural safety, rural issues, health care professional self-care, digital literacy, and health promotion topics were less commonly reported. The barriers to standards implementation were lack of organizational support, lack of access to relevant training, low staff literacy, lack of funding, high staff turnover, ineffective past program cycles, and inconsistent service delivery. Enablers included a strong implementation plan, funding, strength of partnerships, and building on previous work.

DISCUSSION AND IMPLICATIONS

The U.K. Dementia Skills and Core Training Standard, the Irish Department of Health Dementia Together, and the National Health Services Scotland Standard are the recommended strongest standards for underpinning the development of international standards. It is essential that training standards are tailored to the needs of the consumer, worker, and regions.

Recognition of cognitive dysfunction in hospitalised older patients: a flash mob study

BACKGROUND

It is important that healthcare professionals recognise cognitive dysfunction in hospitalised older patients in order to address associated care needs, such as enhanced involvement of relatives and extra cognitive and functional support. However, studies analysing medical records suggest that healthcare professionals have low awareness of cognitive dysfunction in hospitalised older patients. In this study, we investigated the prevalence of cognitive dysfunction in hospitalised older patients, the percentage of patients in which cognitive dysfunction was recognised by healthcare professionals, and which variables were associated with recognition.

METHODS

A multicentre, nationwide, cross-sectional observational study was conducted on a single day using a flash mob study design in thirteen university and general hospitals in the Netherlands. Cognitive function was assessed in hospitalised patients aged ≥ 65 years old, who were admitted to medical and surgical wards. A Mini-Cog score of < 3 out of 5 indicated cognitive dysfunction. The attending nurses and physicians were asked whether they suspected cognitive dysfunction in their patient. Variables associated with recognition of cognitive dysfunction were assessed using multilevel and multivariable logistic regression analyses.

RESULTS

347 of 757 enrolled patients (46%) showed cognitive dysfunction. Cognitive dysfunction was recognised by attending nurses in 137 of 323 patients (42%) and by physicians in 156 patients (48%). In 135 patients (42%), cognitive dysfunction was not recognised by either the attending nurse or physician. Recognition of cognitive dysfunction was better at a lower Mini-Cog score, with the best recognition in patients with the lowest scores. Patients with a Mini-Cog score < 3 were best recognised in the geriatric department (69% by nurses and 72% by physicians).

CONCLUSION

Cognitive dysfunction is common in hospitalised older patients and is poorly recognised by healthcare professionals. This study highlights the need to improve recognition of cognitive dysfunction in hospitalised older patients, particularly in individuals with less apparent cognitive dysfunction. The high proportion of older patients with cognitive dysfunction suggests that it may be beneficial to provide care tailored to cognitive dysfunction for all hospitalised older patients.

Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation

BACKGROUND

Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital.

METHODS

We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz's content-structuring analysis scheme.

RESULTS

We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups' motivation and competence of managing change facilitated the implementation.

CONCLUSIONS

The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.

Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The pandemic of coronavirus disease 2019 challenged educators to move staff education online and explore innovative ways to motivate learning to support dementia care for patients in geriatric settings. This article presents how the Consolidated Framework for Implementation Research (CFIR) was used to support the adoption of an online dementia education game in Canadian hospitals and long-term care homes (LTC). The dementia education was codeveloped with local staff and patient partners to teach practical person-centered care communication techniques.

RESEARCH DESIGN AND METHODS

CFIR guided our strategy development for overcoming barriers to implementation. Research meetings were conducted with practice leaders, frontline health care workers, and a patient partner. Our analysis examined 4 interactive domains: intervention, inner context, outer settings, and individuals involved and implementation process.

RESULTS

Our analysis identified 5 effective strategies: Easy access, Give extrinsic and intrinsic rewards, Apply implementation science theory, Multiple tools, and Engagement of champion. The CFIR provided a systematic process, a comprehensive understanding of barriers, and possible enabling strategies to implement gamified dementia education. Interdisciplinary staff (n = 3,025) in 10 hospitals and 10 LTC played online games. The evaluation showed positive outcomes in knowledge improvement in person-centered dementia care.

DISCUSSION AND IMPLICATIONS

Gamified education in dementia care offers a social experience and a component of fun to promote adoption. In addition, CFIR is useful for engaging stakeholders to conduct project planning and team reflection for implementation. The real-time discussion and adjustment helped overcome challenges and timely meet the needs of multiple organizations.

Dementia care in acute hospitals: A framework for practice development and theory-based evaluation

AIM

The aim was to generate a framework for dementia care in acute hospitals.

DESIGN

Framework development with logic modelling.

METHODS

In phase one, we identified relevant elements of the framework by analysing several sources and by critically discussing them within the research team. We created the framework with logic modelling. In phase two, we adapted the framework in expert workshops and by reanalysing the included sources. We used the first stage of CReDECI 2 checklist for reporting.

RESULTS

The framework describes necessary activities within four main bundles of measures: "developing structures and processes," "developing competences and attitudes," "building relationships" and "ensuring a social environment and adequate stimulation." The overarching outcome is a person-centred hospital culture, manifesting itself on different levels. The framework illustrates the necessity of an organization-wide person-centred culture for achieving positive outcomes for people with dementia, their relatives and health professionals.

Effectiveness of dementia education for professional care staff and factors influencing staff-related outcomes: An overview of systematic reviews

BACKGROUND

Care staff often lack knowledge, confidence, skills, and competency to provide optimal care for people with dementia. Dementia education can increase staff competency and wellbeing along with the actual care of people with dementia. Several factors can affect the effectiveness of dementia education; however, it is not yet established which factors are most important.

OBJECTIVE

The aim of the overview of systematic reviews is to investigate the effectiveness of dementia education for care staff on staff-related outcomes and influencing factors, identify needs for future research, and provide practical recommendations for effective dementia education.

METHODS

Systematic searches were conducted in PubMed, Cinahl, and PsycInfo accompanied by manual citation and reference searches. For inclusion, reviews must report on either effectiveness of one staff-related outcome or on factors influencing the effectiveness of dementia education for care staff. Quality assessments were conducted using AMSTAR2. After data extraction, results on effectiveness were structured according to satisfaction, learning, behavior, and results. Results on contributing factors to effectiveness were categorized into program, personal and organizational factors. All results were qualitatively summarized and reported according to the PRISMA statement.

RESULTS

Seventeen systematic reviews of low to medium quality were included. Dementia education positively affects knowledge, self-efficacy, and attitudes towards dementia and people with dementia. Care staff experienced improvements in communication and behavior management and reduction in behavioral symptoms of dementia of people with dementia was seen as well. Most reviews found no changes within restraints, medication, staff well-being and job satisfaction. Factors contributing to effectiveness are relevant and directly applicable content, active learning methods, classroom teaching combined with practical experience, theory-driven approaches and feedback sessions. Finally, the instructor needs to be experienced within dementia and sensitive to the needs of participants.

CONCLUSION

There is no one-size-fits-all in dementia education: however, perceived relevance and applicability are key elements for effective dementia education. Due to low quality of primary studies, further research of high methodological quality is needed on effectiveness of dementia education on staff behavior, wellbeing, and job satisfaction as well as on influencing factors and their impact on mechanisms of change.

Teaching delirium to undergraduate medical students: Exploring the effects of a cross‐professional group objective structured clinical examination compared to standard education

OBJECTIVES

To compare a cross-professional facilitated delirium group objective structured clinical examination (GOSCE) educational intervention with standard delirium education for medical students during clinical placement, and explore the differences in the examiner's written feedback between the two groups.

METHODS

A non-randomised clustered controlled designed study at a single metropolitan university across several campuses in Sydney, Australia. A convenience sample of third-year medical students was recruited. Students' knowledge, communication, and clinical reasoning skills were assessed using a delirium case mock OSCE at the end of the academic year. The OSCE marks and the examiner's feedback for the intervention and control group were compared.

RESULTS

The intervention group (n = 41) had a higher total mean OSCE mark compared to the control group (n = 29) (36.5, SD 2.9 vs. 33.7, SD 2.9, p < 0.001). Content analysis of the examiner's feedback showed the intervention group had a greater understanding of the need for forward planning and future cognitive assessments, and the roles of the interdisciplinary team in delirium care.

CONCLUSIONS

The innovative cross-professional facilitated delirium GOSCE education was effective in increasing delirium knowledge, communication, and clinical reasoning skills compared to conventional education for medical students during clinical placement. Further studies are needed to investigate how this is translated into practice.

Implementing Gentle Persuasive Approaches dementia education for staff on in-patient medicine units: A program evaluation

Older adults with dementia, when hospitalised, frequently experience responsive behaviours. Staff struggle to manage responsive behaviours without specific education. We aimed to enhance staff knowledge and confidence with care for older adults with dementia and responsive behaviours on medicine units at a Canadian hospital. An online dementia education program was disseminated to staff as part of a broader quality improvement project. Gentle Persuasive Approaches (GPA) encourages staff to reframe responsive behaviours as self-protective expressions of unmet needs and learn to assess their meaning. Participants completed online quantitative and qualitative measures of self-efficacy, competence and knowledge in dementia care at three times: immediate pre-, immediate post- and six to eight weeks post-GPA eLearning. Immediately post-GPA, participants showed significant increases relative to baseline in dementia care self-efficacy, competence and knowledge. Self-efficacy scores increased further eight weeks post-GPA. Before GPA, few participants described dementia-specific strategies for de-escalating a patient’s agitation. Eight weeks post-GPA, participants described application of tailored, person-centred, non-pharmacological interventions and successful application of GPA strategies. GPA eLearning strengthened staff preparedness to interact with older adults experiencing responsive behaviours, thus enhancing their care.

Developing curricular-content and systems-related impact indicators for intellectual disability awareness training for acute hospital settings: A modified International Delphi Survey

AIM

To identify, and reach consensus on, curricular-content and delivery methods, as well as ways to maximize the impact of intellectual disability awareness training programmes in acute hospital settings.

BACKGROUND

With the continuing evidence of avoidable deaths and unwarranted variations in the quality of care to people with an intellectual disability in acute hospitals, it could be purported that current training provided to hospital staff appears to be making a minimal difference in the care provided to this population.

DESIGN

A two-round modified Delphi survey was conducted between June 2020-January 2021.

METHODS

International experts from primary healthcare and hospital settings, and intellectual disability health fields participated in the survey. Initial curricular-content items were developed from the literature, and based on the combined clinical and academic experience base of the authors. Items were evaluated in terms of agreement/consensus, importance and stability of responses. There were 57 expert responses in Round 1 and 45 in Round 2.

RESULTS

The consensus was reached with regard to 55 of 65 curricular-content indicators relating to Aims, Design, Content and Delivery. Ten curricular-content indicators failed to be agreed on relating to the mode of training delivery. With regard to systems-related impact indicators, 28 out of 31 reached consensus. The expert panel identified and agreed on seven system barriers that could obstruct the successful implementation of the awareness training programmes in acute hospital settings.

CONCLUSIONS

This is the first international Delphi survey to agree on curricular-content and identify systems-related facilitators for intellectual disability awareness training. Potential system barriers have been highlighted which could be addressed by systemic improvement. Implications for developing, and robustly testing the efficacy of, intellectual disability awareness training programmes are discussed, as are the implications for other cognitively impaired populations.

IMPACT

In order to maximize the impact, investment in acute hospital staff education will need to be accompanied by wider changes to systems and structures concerning the governance of service provision for people with an intellectual disability.

Evaluation and Effectiveness of a Two-Day Dementia Training Program for Hospital Staff Working in an Emergency Department

Background:

Entering the hospital via an Emergency Department (ED) is a pivotal moment in the life of People with Dementia (PwD) and often starts an avoidable downward spiral. Therefore, it is required to further educate ED staff to raise awareness of the needs of PwD. Although there are many studies about existing dementia training programs for the hospital setting, empirical evidence for the ED setting and cross-level training evaluations are lacking.

Objective:

The study aims to evaluate a two-day dementia training course for ED staff on the outcome levels of learning, individual performance, and organizational performance. Furthermore, the study examines whether the training fulfilled participants’ expectations.

Methods:

Mixed methods were used to assess data from head nurses, nursing, and administrative staff working in EDs. We conducted semi-structured interviews three weeks before (N = 18) and eight months after (N = 9) the training. Questionnaire data were assessed before the training, three months, and six months after the training (N = 44). A qualitative content analysis was conducted to analyze qualitative data; quantitative data was described descriptively.

Results:

The intervention seems to be effective on both learning and individual performance levels. However, we did not observe any changes in the organizational performance. The training program met attendees’ expectations only partly. The working environment of EDs needs to be taken more into account.

Conclusion:

Hospital staffs’ expectations of a dementia training program depend on the work area in which they operate. Results support the implementation of intervention bundles to enable sustainable cross-level changes.

Evaluation and Effectiveness of Dementia Staff Training Programs in General Hospital Settings: A Narrative Synthesis with Holton's Three-Level Model Applied

Background:

People with Dementia (PwD) are frequently admitted to hospital settings. The lack of proper dementia knowledge, poor communication skills, negative attitudes toward dementia, and lack of confidence affects the quality of care, thus development of dementia trainings has increased. Nevertheless, literature regarding the effectiveness of training implementation is limited.

Objective:

The aim of this narrative synthesis is to 1) identify the characteristics of training programs and 2) explore the effectiveness of these training programs in everyday clinical practice.

Methods:

A systematic search in PubMed, PsycINFO, CINAHL, and Cochrane was conducted, including qualitative and quantitative peer-reviewed studies. Holton’s evaluation model with its three outcome levels (learning, individual performance, and organizational results) was adopted. 14 studies were included.

Results:

The synthesis of the results was divided into two parts: 1) to describe the characteristics and content of trainings 2) to evaluate the effectiveness of training programs according to the three outcome levels of Holton’s model, taking into consideration its construct domains: ability, motivation, and environment. Learning outcomes were assessed in all selected studies: 13 studies observed changes in individual performance, four studies reported changes within the organizational level, and only five showed sustainable changes over time.

Conclusion:

Person-centered care (PCC) approaches, interactive and varied teaching methods, supporting conditions like champions, action plans, and setting care policies, are all characteristics of effective trainings. Successful programs should be sustainable over time, demonstrating positive outcomes across the organization. Based on current findings, there is a lack of adequate evaluation with regard to training programs on the organizational level.

A systematic review of interventions to improve acute hospital care for people with dementia

The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes. The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.

Developing a dementia care leaders' toolkit for older patients with cognitive impairment

A recent review of the progress that has been made in meeting the government's Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The review also identified the need for improvements in assessing the individual needs of people with dementia while in hospital, including their emotional and social needs. This article focuses on the development and implementation of an evidence-based toolkit to improve the hospital care of older patients with cognitive impairment, including dementia and/or delirium. The toolkit's focus is on optimising the patient experience of people with cognitive impairment who have been admitted to hospital. The toolkit also promotes the importance of person-centred care and communication skills.

Effects of a Person Centered Dementia Training Program in Greek Hospital Staff-Implementation and Evaluation

People with Dementia (PwD) are frequently admitted in general hospitals. However, health care professionals have lack of dementia knowledge, negative attitudes toward dementia, and lack of confidence in caring those patients. The aim of this study is to develop, implement and evaluate a dementia staff training program in Greek general hospitals. It was a repeated-measures research design. Fourteen (14) two-day workshops were conducted, consisting of six targeted and interactive modules. Staff members (N = 242) attended the program and were assessed according to (1) individual performance: questionnaires about attitudes towards dementia, confidence in care, knowledge about dementia and anxiety before, immediately after the training and three months later, (2) an overall training evaluation immediately after the training and (3) an evaluation of training implementation three months later. Positive attitudes towards dementia, improvement of confidence in care and decrease of feeling of anxiety as a trait, were sustained over time. Knowledge about dementia also increased after the training and sustained, with, however, a slight decrease over time. A well applied training program seems to provide the basis of a better care in PwD during hospitalization. However, changes in the organizational level and a transformation of care culture are necessary for training sustainability over time.

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

Background

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

Objectives

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

Review methods

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

Data sources

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

Results

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

Limitations

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

Conclusions

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

Study registration

This study is registered as PROSPERO CRD42018086013.

Funding

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

Analysis on nursing competence and training needs of dementia caregivers in long-term care institutions

Objective

It is aimed to investigate the nursing competence and corresponding influence factors of dementia caregivers in long-term care institutions of Tianjin and identify the training needs of caregivers.

Methods

In the cross-section survey of this study, 246 dementia caregivers were selected from 6 long-term care institutions in Tianjin as objects of study through convenient sampling.

Results

The scores for nursing competence of dementia caregivers were 140.28 ± 7.73, at a moderate level. Study findings that nursing competence of dementia caregivers were positively associated with the work experience (β = 0.115,P = 0.005), educational level (β = 0.333,P < 0.01), pervdceived health status (β = 0.108,P = 0.003) and training times within 1 year (β = 0.371,P < 0.01). Through the analysis, it is found that the training needs of dementia caregivers are inconsistent with the current situation in terms of content, methods and teachers. There are some problems in the training, such as unreasonable time, single mode and not deepening the understanding of the elderly with dementia.

Conclusion

Long term care institutions shall arrange training no less than 12 times a year and evaluate training needs regularly to improve training effect. Providing online and offline training and adding more specialized contents like case analysis, employing experts in the field of dementia to teach courses.