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Yous ML, Hunter PV, Coker E, Fisher KA, Nicula M, Kazmie N, Bello-Haas VD, Hadjistavropoulos T, McAiney C, Thompson G, Kaasalainen S. Experiences of Families, Staff, Volunteers, and Administrators With Namaste Care for Persons With Advanced Dementia in Canadian Long-Term Care Homes. J Am Med Dir Assoc 2024; 25:830-836. [PMID: 37709261 DOI: 10.1016/j.jamda.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To explore the experiences of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC). DESIGN A qualitative descriptive design was used. Staff Carers (eg, personal support worker, nurse, or activity aide) delivered Namaste Care with the support of volunteers in a small group. Activities provided during the Namaste Care sessions to enhance quality of life included massages, aromatherapy, music, and snacks/beverages. SETTING AND PARTICIPANTS Family carers of residents with advanced dementia, LTC staff, administrators, and volunteers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included. METHODS Experiences and acceptability of Namaste Care was assessed through semistructured interviews ranging from 30 to 60 minutes following the 6-month study duration period with family carers, LTC staff, administrators, and volunteers. Thematic analysis was used for interview transcripts. RESULTS A total of 16 family carers and 21 LTC staff, administrators, and volunteers participated in the study. Namaste Care was found to be acceptable and successful in enhancing the quality of life of residents due to collaborative efforts of all group of participants. Families, volunteers, and staff noted positive responses in residents, such as smiling and laughing. The program environment supported the development of relationships within the LTC community, which included families, residents, staff, and volunteers. CONCLUSIONS AND IMPLICATIONS Namaste Care was perceived by the LTC community as an acceptable intervention for persons with advanced dementia. It was perceived as offering multiple benefits for residents with advanced dementia such as improved communication and mood.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada.
| | - Paulette V Hunter
- Department of Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Li DHY, Yous ML, Hunter PV, Coker E, Just D, Bello-Haas VD, McAiney C, Wickson-Griffiths A, Kaasalainen S. Supporting the "hallway residents": a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care. BMC Geriatr 2023; 23:661. [PMID: 37845662 PMCID: PMC10580502 DOI: 10.1186/s12877-023-04360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Long-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society's most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia. METHODS Using a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data. RESULTS LTC staff (n = 46) emphasized the program's ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers. CONCLUSIONS LTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.
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Affiliation(s)
- Donny H Y Li
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Marie-Lee Yous
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paulette V Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Peter's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Danielle Just
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | | | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Yous ML, Hunter PV, Coker E, Fisher KA, Nicula M, Kazmie N, Bello-Haas VD, Hadjistavropoulos T, McAiney C, Thompson G, Kaasalainen S. Feasibility and Effects of Namaste Care for Persons with Advanced Dementia in Canadian Long-Term Care Homes. J Am Med Dir Assoc 2023; 24:1433-1438.e5. [PMID: 37301225 DOI: 10.1016/j.jamda.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effects of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC) and their family carers. DESIGN A pre-posttest study design. Staff carers delivered Namaste Care for residents with the support of volunteers in a small group setting. Activities provided included aromatherapy, music, and snacks/beverages. SETTING AND PARTICIPANTS Residents with advanced dementia and family carers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included. METHODS Feasibility was evaluated using a research activity log. Outcome data for residents (ie, quality of life, neuropsychiatric symptoms, pain) and family carers (ie, role stress, quality of family visits) were collected at baseline and 3 and 6 months of the intervention. Descriptive analyses and generalized estimating equations were used for quantitative data. RESULTS A total of 53 residents with advanced dementia and 42 family carers participated in the study. Mixed findings were found for feasibility as not all intervention targets were met. There was a significant improvement in resident neuropsychiatric symptoms at the 3-month time point only (95% CI -9.39, -0.39; P = .033) and family carer role stress at both time points (3-month 95% CI -37.40, -1.80; P = .031; 6-month 95% CI -48.90, -2.09; P = .033). CONCLUSIONS AND IMPLICATIONS Namaste Care is an intervention with preliminary evidence of impact. Feasibility findings revealed that not all targets were met as the intended number of sessions were not delivered. Future research should explore how many sessions per week are required to lead to an impact. It is important to assess outcomes for both residents and family carers, and to consider enhancing family engagement in delivering the intervention. Given the promise of this intervention, a large-scale randomized controlled trial with a longer follow-up should be conducted to further evaluate its outcomes.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Paulette V Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Esther Coker
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn A Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Quiroz-Saavedra R, Alfaro J, Rodríguez-Rivas ME. Perceptions of professionals about factors affecting the implementation of early childhood support systems: A case study evaluation from an ecological perspective. EVALUATION AND PROGRAM PLANNING 2023; 97:102210. [PMID: 36571969 DOI: 10.1016/j.evalprogplan.2022.102210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
This evaluation research looked at factors affecting collaboration across the various levels of implementation of early childhood support systems. An ecological conceptual framework was used to examine barriers and facilitators to implementing social and health care services from the perspective of the professionals involved at the national, state, and local level of government. A single case study following a qualitative research strategy was conducted with a total of 29 professionals from social development and health ministries, one municipality and a family health center responsible for implementing the Chile Grows with You system. The results show that at the national level, the main factors include socio-political aspects, funding, and the empathy that professional employees hold for peers who are at lower rungs in the hierarchy. At the state level workplace conditions play a key role. For the local level those factors include information system management and the political support of the local government. The discussion section emphasizes the relevance of considering the interdependence of such factors that influence implementation outcomes and the need to move away from a single program evaluation to a multilevel implementation analysis of public policy.
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Affiliation(s)
- Rodrigo Quiroz-Saavedra
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile.
| | - Jaime Alfaro
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Matías E Rodríguez-Rivas
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
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Yous ML, Ploeg J, Kaasalainen S, McAiney C, Fisher K. Feasibility, acceptability, and preliminary effectiveness of the adapted Namaste Care program delivered by caregivers of community-dwelling older persons with moderate to advanced dementia: a mixed methods feasibility study. BMC Geriatr 2022; 22:797. [PMID: 36229789 PMCID: PMC9559259 DOI: 10.1186/s12877-022-03483-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Caregivers have considerable responsibilities in supporting persons in advanced stages of dementia, however they receive little education. Namaste Care is a multisensory program originally designed to be delivered by healthcare providers in long-term care homes for persons with advanced dementia. The program has not yet been adapted and evaluated for use by caregivers of persons with moderate to advanced dementia living at home. The purpose of this feasibility study is to determine the feasibility, acceptability and preliminary effectiveness of the adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia. METHODS This feasibility study, with a one-group before-after design and interviews, was part of a larger study using a multiphase mixed methods design. A total of 12 caregivers delivered the program over three months. Caregivers completed questionnaires on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Caregivers participated in interviews at the 3-month follow-up to explore acceptability and perceived benefit. Descriptive statistics and paired t-tests were used to analyze quantitative data. A secondary analysis used multiple imputation to explore the impact of missing data. Experiential thematic analysis was used in analyzing qualitative data. RESULTS The adapted Namaste Care program was judged to be feasible, given that all caregivers used it at least twice a week over the 3-month period. The retention rate of caregivers was 83% (10 of 12). Caregivers perceived that the program was practical, enhanced the wellbeing of persons with dementia, and brought them closer in their relationships with persons with dementia. There were no statistically significant changes for quality of life, perceptions of caregiving, self-efficacy, or burden outcomes. Multiple imputation results revealed promising findings for an improvement in caregiver wellbeing related to quality of life. CONCLUSIONS The adapted Namaste Care program for use by caregivers of community-dwelling older persons with moderate to advanced dementia was feasible and acceptable. The program has the potential to enhance the quality of life and other outcomes of caregivers, however there is a need to conduct a larger trial that is adequately powered to detect these effects.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- School of Public Health Sciences, Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, ON L8S 4K1 Canada
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Amrollah Majdabadi Kohne Z, Nikpeyma N, Bayat F, Salsali M, Hunter PV, Kaasalainen S, Khavasi M, Keyvanloo Shahrestanaki S, Rezaei M. The effects of a Namaste care program on quality of life: A pilot study in Iranian women with late-stage Alzheimer's disease. Geriatr Nurs 2020; 42:78-82. [PMID: 33302002 DOI: 10.1016/j.gerinurse.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023]
Abstract
The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings.
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Affiliation(s)
- Zahra Amrollah Majdabadi Kohne
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran; Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
| | - Nasrin Nikpeyma
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Bayat
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahvash Salsali
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammed Khavasi
- School of Nursing and Midwifery, Dezful University of Mesical Sciences, Dezful, Iran.
| | - Sahar Keyvanloo Shahrestanaki
- Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
| | - Masoud Rezaei
- Phd student, Nursing Care Research Center, Midwifery and Reproductive Health Department, School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.
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Yous ML, Ploeg J, Kaasalainen S, McAiney C. Namaste care delivered by caregivers of community-dwelling older adults with moderate to advanced dementia: A mixed methods study protocol. J Adv Nurs 2020; 77:1027-1036. [PMID: 33222232 DOI: 10.1111/jan.14623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study is to adapt and evaluate the feasibility, acceptability, and preliminary effectiveness of a multisensory, psychosocial intervention called Namaste Care delivered by family and friend caregivers of community-dwelling older adults with moderate to advanced dementia. DESIGN A multiphase mixed methods design combining quantitative and qualitative methods will be used. METHODS This study is composed of two phases. Phase 1 is guided by a qualitative description approach. Small group workshop sessions with 8-10 caregivers of community-dwelling older adults with moderate to advanced dementia will be conducted to adapt Namaste Care. In Phase 2, 10-20 caregivers will receive training and implement the adapted Namaste Care approach at home. A one group, before-after design will be used to evaluate feasibility, acceptability and preliminary effectiveness of the approach over 3 months. Feasibility will be assessed using quantitative measures and acceptability will be explored using qualitative methods. Outcomes to evaluate preliminary effectiveness include quality of life (QoL), positive perceptions of caregiving, self-efficacy, and caregiver burden. DISCUSSION There are currently few skill-building interventions that can be delivered by caregivers of people with moderate to advanced dementia at home. Caregivers should be involved in developing programs to enhance program relevance. This research will be the first to explore the feasibility of implementing the Namaste Care approach at home by caregivers. IMPACT Study results will provide important information about the feasibility and preliminary effects of an adapted form of Namaste Care. This program has the potential to improve the QoL of caregivers and may prevent hospitalization or long-term care placement of older persons with moderate to advanced dementia. The revised Namaste Care program supports building the skills of caregivers so that their needs and the needs of older persons with dementia living at home are being addressed.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | | | - Carrie McAiney
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Hunter PV, Thorpe L, Hounjet C, Hadjistavropoulos T. Using Normalization Process Theory to Evaluate the Implementation of Montessori-Based Volunteer Visits Within a Canadian Long-Term Care Home. THE GERONTOLOGIST 2020; 60:182-192. [PMID: 30219890 DOI: 10.1093/geront/gny103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Montessori-based interventions (MBIs) have potential to improve the life quality of long-term care residents with dementia. In this study, we aimed to understand the processes by which staff integrated a volunteer-led MBI into practice within a special dementia care unit, and to explore staff members ' perceptions of associated strengths and limitations. RESEARCH DESIGN AND METHODS This study relied on a qualitative descriptive design. Following a 3-month period of volunteer involvement, we conducted 21 interviews with staff members to document perceptions of the new program and subjected interview transcripts to qualitative content analysis, guided by normalization process theory. RESULTS During the implementation of the volunteer-led MBI, staff members developed a shared understanding of the intervention, a sense of commitment, practical ways to support the intervention, and opinions about the value of the residents. Overall, we found that the volunteer-led MBI was quickly and successfully integrated into practice and was perceived to support both residents and staff members in meaningful ways. Nevertheless, some limitations were also identified. DISCUSSION AND IMPLICATIONS Volunteer-delivered MBIs are a useful adjunct to practice within a special dementia care unit. This article raises attention to some strengths and limitations associated with this approach.
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Affiliation(s)
| | - Lilian Thorpe
- Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Celine Hounjet
- Department of Psychology, University of British Columbia, Vancouver, Canada
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Intervention Fidelity of a Volunteer-Led Montessori-Based Intervention in a Canadian Long-Term Care Home. Can J Aging 2020; 40:293-305. [PMID: 32993823 DOI: 10.1017/s071498082000029x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Montessori-based interventions (MBIs) were developed to promote guided participation in meaningful activities by people with dementia patients. In this study, we assessed nursing home volunteers' fidelity to an MBI, relying primarily on a qualitative descriptive design. We completed a deductive content analysis of eight volunteer interviews using the Conceptual Framework for Intervention Fidelity. We also calculated average volunteer and resident scores on the Visiting Quality Questionnaire (VQQ), which assesses volunteers' and residents' perceptions of visits. We found good evidence that volunteers attended scheduled visits, made use of pre-designed activities, and attended to training recommendations. Most reported enjoying the visits (VQQ $ \overline{x} $ = 6.12, standard deviation [SD] = 0.75) and receiving a positive response from residents (VQQ $ \overline{x} $ = 5.46, SD = 0.88). Nevertheless, use of pre-designed activities and response to the MBI was lower for volunteers working with residents who had late-stage dementia. Therefore, overall, fidelity depended on the cognitive status of the resident.
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Palmer JA, Smith AM, Paasche-Orlow RS, Fitchett G. Research Literature on the Intersection of Dementia, Spirituality, and Palliative Care: A Scoping Review. J Pain Symptom Manage 2020; 60:116-134. [PMID: 31923556 DOI: 10.1016/j.jpainsymman.2019.12.369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
CONTEXT Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. OBJECTIVES We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research. METHODS The scoping review followed methods from The Joanna Briggs Institute Reviewers' Manual (2015). We developed a priori a scoping review protocol outlining the population, concept, and context for study; data sources; search strategy; inclusion/exclusion criteria; and procedure for screening, extracting, and analyzing data. RESULTS The final sample consisted of 19 studies with the following themes: characterizing spiritual needs, preferences, and resources; characterizing palliative or spiritual care; predicting provision of spiritual care; and assessing spiritual care interventions. Eighteen studies were published in the past decade, and 11 studies were based in Europe. Most studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and generalizability/transferability and used less sophisticated research designs. CONCLUSION Research across dementia, spirituality, and palliative care needs to examine settings beyond long-term care, distinct stages of dementia, and formal spiritual care interventions plus use rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.
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Affiliation(s)
- Jennifer A Palmer
- The Hinda & Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, USA.
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Kaasalainen S, Hunter PV, Dal Bello-Haas V, Dolovich L, Froggatt K, Hadjistavropoulos T, Markle-Reid M, Ploeg J, Simard J, Thabane L, van der Steen JT, Volicer L. Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada. Pilot Feasibility Stud 2020; 6:34. [PMID: 32161658 PMCID: PMC7053118 DOI: 10.1186/s40814-020-00575-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia. METHODS This study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family. RESULTS The feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants' pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process. CONCLUSIONS These study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3H48C, Hamilton, ON L8S 3Z1 Canada
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
| | | | | | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | | | | | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster Institute for Research on Aging/Collaborative for Health and Aging, McMaster University, 1280 Main Street West, HSc 3N25B, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, HSc 3N25C, Hamilton, ON L8S 4K1 Canada
| | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL USA
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Allison TA, Smith AK. "Now I Write Songs": Growth and Reciprocity After Long-Term Nursing Home Placement. THE GERONTOLOGIST 2020; 60:135-144. [PMID: 31112596 PMCID: PMC10686246 DOI: 10.1093/geront/gnz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home residents have a need for activities that are meaningful, yet mandated scheduled activities remain poorly characterized. In order to understand how scheduled activities provide meaning for nursing home residents, we conducted a study of daily life in a nursing home with a robust activities program. RESEARCH DESIGN AND METHODS This 2-year, longitudinal ethnographic study embedded an ethnographer into the activities department of a 430-bed, not-for-profit, faith-based nursing home. Forty-three interviews and more than 250 hr of participant-observation were conducted, with a focus on creative arts and religious activities. Thirty-two residents and 15 activities staff were followed more than 12-23 months. Data were coded concurrently, and emerging themes challenged through purposive recruitment until thematic saturation was reached. RESULTS Scheduled activities in the nursing home offered opportunities for learning and personal growth regardless of functional or cognitive disability. Three major themes emerged. Artistic development included new self-identification as a musician, painter, or sculptor through arts programming. Intellectual and spiritual growth involved the use of activities to support ongoing practice and study. Reciprocity occurred as residents used the arts to remain contributing members of their institutional society, reciprocating with the institution that housed them. DISCUSSION AND IMPLICATIONS Nursing home scheduled activities can facilitate the transformation of identity from resident or patient to the normalized social roles of artist, Torah scholar, and productive member of society.
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Affiliation(s)
- Theresa A Allison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Department of Family & Community Medicine, University of California, San Francisco
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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Walshe C, Kinley J, Patel S, Goodman C, Bunn F, Lynch J, Scott D, Lund AD, Stacpoole M, Preston N, Froggatt K. A four-stage process for intervention description and guide development of a practice-based intervention: refining the Namaste Care intervention implementation specification for people with advanced dementia prior to a feasibility cluster randomised trial. BMC Geriatr 2019; 19:275. [PMID: 31638902 PMCID: PMC6802319 DOI: 10.1186/s12877-019-1275-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/10/2019] [Indexed: 02/03/2023] Open
Abstract
Background Some interventions are developed from practice, and implemented before evidence of effect is determined, or the intervention is fully specified. An example is Namaste Care, a multi-component intervention for people with advanced dementia, delivered in care home, community, hospital and hospice settings. This paper describes the development of an intervention description, guide and training package to support implementation of Namaste Care within the context of a feasibility trial. This allows fidelity to be determined within the trial, and for intervention users to understand how similar their implementation is to that which was studied. Methods A four-stage approach: a) Collating existing intervention materials and drawing from programme theory developed from a realist review to draft an intervention description. b) Exploring readability, comprehensibility and utility with staff who had not experienced Namaste Care. c) Using modified nominal group techniques with those with Namaste Care experience to refine and prioritise the intervention implementation materials. d) Final refinement with a patient and public involvement panel. Results Eighteen nursing care home staff, one carer, one volunteer and five members of our public involvement panel were involved across the study steps. A 16-page A4 booklet was designed, with flow charts, graphics and colour coded information to ease navigation through the document. This was supplemented by infographics, and a training package. The guide describes the boundaries of the intervention and how to implement it, whilst retaining the flexible spirit of the Namaste Care intervention. Conclusions There is little attention paid to how best to specify complex interventions that have already been organically implemented in practice. This four-stage process may have utility for context specific adaptation or description of existing, but untested, interventions. A robust, agreed, intervention and implementation description should enable a high-quality future trial. If an effect is determined, flexible practice implementation should be enabled through having a clear, evidence-based guide.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Julie Kinley
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Shakil Patel
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK.,Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Jennifer Lynch
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - David Scott
- Patient Representative c/o The Alzheimer's Society, London, UK
| | | | - Min Stacpoole
- St Christopher's Hospice, 51-59 Lawrie Park Road, Sydenham, London, SE26 6DZ, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
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