Nurses' Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis

Knowledge and Attitude of Nurses in Wuxi, China Towards Alzheimer's Disease: A Cross-Sectional Study

AIM

This study investigated knowledge and attitude towards Alzheimer's disease among nurses in China.

DESIGN

A cross-sectional design.

METHODS

A total of 186 nurses were recruited in Wuxi, China from January to March 2024. The Alzheimer's Disease Knowledge Scale and Dementia Attitudes Scale were used to evaluate nurses' knowledge and attitudes towards Alzheimer's disease. Descriptive statistics, univariate analysis and multivariate linear regression analysis were utilised to evaluate the levels and influencing factors of their knowledge and attitudes towards Alzheimer's disease.

RESULTS

The participants' average the Alzheimer's Disease Knowledge Scale and Dementia Attitudes Scale scores were 20.82 ± 2.31 (approximately 69.4% correctly) and 86.23 ± 14.14 (approximately 61.6%), respectively. Professional titles and whether or not they had received previous training about Alzheimer's Disease were among the factors affecting their dementia knowledge. Education background and workplace were the influencing factors of nurses' attitude towards dementia.

CONCLUSION

Nursing personnel in the Wuxi region demonstrate a limited understanding of Alzheimer's disease, coupled with positive attitudes towards its care. It is imperative to implement effective strategies to enhance in-service training for nurses regarding dementia. This initiative aims to elevate their level of knowledge, improve their attitudes towards dementia care, and ultimately enhance the quality of nursing provided to individuals with dementia.

Nurses' experiences of providing dementia care in acute hospital settings

BACKGROUND

Increasing numbers of older people admitted to acute hospitals have dementia. For nurses, providing dementia care in acute settings involves unique challenges such as ensuring staff and patient safety and managing the stress caused by insufficient resources.

AIM

To explore nurses' experiences and challenges when caring for patients with dementia in an acute general hospital setting.

METHOD

This study used a qualitative approach and semi-structured interviews to explore participants' experiences of caring for patients with dementia. All permanent nurses working in three acute medical wards in one NHS trust ( n =120) received an email inviting them to take part. Eight nurses volunteered to be interviewed.

FINDINGS

Three main themes were extrapolated from the thematic analysis of interview data: attributes of dementia care; planning care effectively; and staff education and training needs. Participants emphasised the importance of person-centred care and the challenges involved in providing such care due to staff shortages, which could result in frustration, exhaustion and stress for both staff and patients.

CONCLUSION

Nurses in acute care settings need additional education and training to improve their knowledge and skills in relation to dementia care. The involvement of families is important for the optimal care of patients with dementia on acute hospital wards.

Nurses' Perspectives and Experiences of Using a Bed-Exit Information System in an Acute Hospital Setting: Mixed Methods Study

BACKGROUND

Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals.

OBJECTIVE

To develop a better understanding of nurses' perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting.

METHODS

BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist.

RESULTS

A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system.

CONCLUSIONS

While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses' workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses.

TRIAL REGISTRATION

German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720.

Psychological Empowerment as a Mediator of Effort-Reward Imbalance Effects on Burnout, Anxiety and Depression Among Nursing Home Professionals: A Cross-Sectional Study

AIMS

Few studies have explored empowerment as a predictor of mental health outcomes in geriatric healthcare professionals. This research addresses this gap by using the 'effort-reward imbalance' theory of work-related stress to develop a comprehensive model, examining the role of psychological empowerment in the psychological outcomes of nursing home professionals.

DESIGN

This cross-sectional exploratory study used structural equation modelling (SEM) to test a model on the mediating role of psychological empowerment in the relationship between effort-reward ratio and burnout, anxiety and depression.

METHODS

From 2021 to 2023, we used convenience sampling to enrol 280 physicians, nurses and other healthcare workers from 13 nursing homes in France. Self-administered measurements included Psychological Empowerments Scale, Effort-Reward Imbalance Questionnaire, Maslach burnout inventory-Human Services Survey and Hospital Anxiety and Depression Scale. Of the 280 healthcare professionals included, 245 had complete data.

RESULTS

Findings confirmed direct predictive paths from the effort-reward ratio to burnout, anxiety and depression. The negative direct path between effort-reward ratio and psychological empowerment was significant, as was burnout and depression prediction by psychological empowerment. Anxiety was not explained by psychological empowerment. Mediation effects were confirmed. Model fit indices indicated a good fit, supporting the role of psychological empowerment in reducing the negative impact of effort-reward imbalance on psychological outcomes, except for anxiety.

CONCLUSION

Psychological empowerment appears to be a promising way to enhance and protect psychological work-related health of nursing home healthcare professionals.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Understanding the impact of psychological empowerment on healthcare is a first step towards implementing interventions for healthcare professionals to enhance the quality of care and work conditions.

Elder abuse in Flanders, Belgium: perspectives from home care nurses

The present study focuses on elder abuse in the home care setting. The aim of this study was to explore home care nurses' definition, general perspectives and experiences of elder abuse, and the barriers they experience to avoid elder abuse. Individual qualitative interviews were held with Flemish home care nurses (N = 17), employed by a Dutch home nursing organization. Data analysis was performed using reflexive thematic analysis. Results showed that (1) participants' understanding of elder abuse was based on intuition and daily practice. (2) Participants highlighted several institutional barriers to avoid elder abuse. (3) The participating home care organizations did not have a standard protocol to report or handle elder abuse. Institutional structures, procedures and decisions should be critically reviewed as to how they lead to staff abusing older adults.

Workload-Related Issues among Nurses Caring for Patients with Behavioral and Psychological Symptoms of Dementia: A Scoping Review

BACKGROUND/OBJECTIVES

As the elderly population grows, the prevalence of dementia is rising, with 70-95% of patients in hospital settings exhibiting problematic behaviors such as aggression. These behaviors significantly contribute to increased nursing workloads, affecting nurses' well-being and patient care quality. This study aims to review workload-related issues among nurses caring for dementia patients, highlighting the need for targeted interventions to mitigate stress and improve care quality.

METHODS

A scoping review was conducted using the five-stage framework of Arksey and O'Malley. The literature search covered studies published between 2013 and 2023, focusing on quantitative research about nurses' workload-related stress when managing patients with dementia and problematic behaviors. Databases such as PubMed and PsycINFO were searched, and 13 studies were selected based on predefined inclusion and exclusion criteria.

RESULTS

The review revealed that problematic behaviors, particularly aggression, significantly increase nurses' stress and workload. This stress has negative consequences on nurses' physical and mental health, often leading to burnout, decreased job satisfaction, and a decline in care quality. Inadequate staffing and support systems exacerbate these issues.

CONCLUSIONS

Targeted education, sufficient staffing, and support are essential to reduce the workload and stress experienced by nurses caring for dementia patients. Implementing these strategies can enhance the quality of care provided and improve the well-being of healthcare professionals.

Nursing strategies for enhancing calm in older Arabs with dementia: integrating Snoezelen methods, aromatherapy, and personal items to reduce agitation

BACKGROUND

Agitation significantly impacts Arab elders with dementia. Multisensory stimulation, such as Snoezelen, shows promise but lacks exploration in Arab contexts.

OBJECTIVE

Evaluate a culturally adapted multisensory intervention-combining Snoezelen, aromatherapy, and personal items-on agitation in Arab elders with dementia.

METHODS

A quasi-experimental design assessed 31 patients receiving the intervention against 31 controls. Agitation, quality of life, and neuropsychiatric symptoms were measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI).

RESULTS

The intervention group exhibited notable reductions in CMAI scores for aggression and agitation behaviors (p < 0.001) and improvements in quality of life and NPI scores for agitation/aggression and depression/dysphoria (p < 0.001).

CONCLUSION

This culturally tailored multisensory approach effectively reduced agitation and improved well-being in Arab dementia patients. The findings advocate for further research and suggest such interventions can be beneficial in culturally diverse dementia care settings.

TRIAL REGISTRATION

ClinicalTrials.gov, ID NCT06216275.

Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed-methods systematic review

AIM

To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia.

BACKGROUND

People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive.

METHODS

A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach.

RESULTS

Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care.

CONCLUSION

Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers.

RELEVANCE TO CLINICAL PRACTICE

Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed.

REPORTING METHOD

The review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No.

Transforming the discharge conversation through support and structure: A scoping review

Background

System level demands and interpersonal barriers can disrupt nurse delivery of high-quality information at discharge, which can contribute to a lack of caregiver preparedness to manage care of the patient and ultimately affect patient health.

Objective

To synthesize evidence on effective nurse communication with informal caregivers during hospital discharge of adult patients with cognitive decline or Alzheimer's disease and related dementia.

Design

A scoping review of inpatient nurse communication with informal caregivers.

Methods

Collected research (published between 2011 and 2023) from three databases (MEDLINE, PsycINFO, and CINAHL), along with a separate search for gray literature (N = 18), to extract and synthesize recommended communication practices evidenced to improve the nurse care experience and support caregiver activation and preparedness.

Results

Extraction synthesis of strategies resulted in two themes with corresponding sub-themes: Support (Information exchange, Space and time to determine preparedness, and Positive reinforcement of caregiver efforts) and Structure (Setting shared expectations, Informational resources, and Standardization).

Conclusions

We offer practical recommendations for both interpersonal and policy level facilitation of nurse delivery of high-quality information at discharge to caregivers of patients with serious illness.

Using AI-Based Technologies to Help Nurses Detect Behavioral Disorders: Narrative Literature Review

BACKGROUND

The behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia and have multiple negative consequences. Artificial intelligence-based technologies (AITs) have the potential to help nurses in the early prodromal detection of BPSD. Despite significant recent interest in the topic and the increasing number of available appropriate devices, little information is available on using AITs to help nurses striving to detect BPSD early.

OBJECTIVE

The aim of this study is to identify the number and characteristics of existing publications on introducing AITs to support nursing interventions to detect and manage BPSD early.

METHODS

A literature review of publications in the PubMed database referring to AITs and dementia was conducted in September 2023. A detailed analysis sought to identify the characteristics of these publications. The results were reported using a narrative approach.

RESULTS

A total of 25 publications from 14 countries were identified, with most describing prospective observational studies. We identified three categories of publications on using AITs and they are (1) predicting behaviors and the stages and progression of dementia, (2) screening and assessing clinical symptoms, and (3) managing dementia and BPSD. Most of the publications referred to managing dementia and BPSD.

CONCLUSIONS

Despite growing interest, most AITs currently in use are designed to support psychosocial approaches to treating and caring for existing clinical signs of BPSD. AITs thus remain undertested and underused for the early and real-time detection of BPSD. They could, nevertheless, provide nurses with accurate, reliable systems for assessing, monitoring, planning, and supporting safe therapeutic interventions.

Analysis of dementia research trends in nursing using text mining approach

This research aimed to analyze dementia research trends in nursing using a text mining approach. In this study, text mining approach was used to analyze the studies on dementia in the field of nursing around the world. In this study, summaries of all available publications in English between the years 1990-2023 were extracted from the database and transferred to an Excel table by using the 'Nursing' AND 'Dementia' query from the Thomson Reuters-ISI Web of Science database. According to the results of this research, a total of 21 concept groups were identified, four of which were the most important. It was determined that the most frequently used word in all of the studies obtained from the database was 'cost'. In this direction, scientific research on dementia in the field of nursing can be planned by evaluating the most frequently used concepts.

A Scoping Review on Nurse's Pain Management of Older Patients with Dementia in a Hospital Environment

OBJECTIVES

Hospitalized persons living with dementia often experience unrelieved pain. Unmanaged pain during hospitalization has a significant negative effect on quality of life for persons living with dementia. Despite the central role of nurses in pain management, little is known about how nurses manage pain in this patient population in the hospital environment.

DESIGN

A scoping review explored the nurses' pain management practices when caring for persons living with dementia in a hospital setting.

DATA SOURCES AND REVIEW/ANALYSIS METHODS

After an extensive search for all available evidence on how nurses manage pain in hospitalized persons living with dementia, data were extracted on pain management methods that included assessment, intervention, effectiveness of pain management, and the barriers nurses encountered when managing pain. A descriptive content analysis was used to extract data from qualitative studies.

RESULTS

Six articles published between 2016 and 2021 met the inclusion criteria; four utilized qualitative methods, and the others used mixed-methods and quantitative study designs. A narrative description of the findings was summarized after data were categorized into pain management data elements and barriers nurses encountered when managing pain. Barriers were grouped into the subcategories of communication challenges (nurse to patient), information sharing (nurse to nurse), lack of knowledge, time constraints, and nursing stressors.

CONCLUSION

We identified six articles that met our inclusion criteria, highlighting a noticeable gap in the literature. Managing pain in this population is complex and lacks organizational support. Review findings indicate that pain management methods lack consistency and standardization, making it difficult to assess their effectiveness. Nurses also described knowledge deficits resulting in practice gaps that, when combined with barriers and challenges, result in underrecognized and undermanaged pain.

Evaluating the Impact of Virtual Reality on the Behavioral and Psychological Symptoms of Dementia and Quality of Life of Inpatients With Dementia in Acute Care: Randomized Controlled Trial (VRCT)

BACKGROUND

Virtual reality (VR) is increasingly considered a valuable therapeutic tool for people with dementia. However, rigorous studies are still needed to evaluate its impact on behavioral and psychological symptoms of dementia (BPSDs) and quality of life (QoL) across care settings.

OBJECTIVE

The primary aim of this study was to evaluate the impact of VR therapy on managing BPSDs, falls, length of stay, and QoL in inpatients with dementia admitted to an acute care hospital. The secondary aim was to evaluate the intervention's feasibility in terms of acceptability, safety, and patient experience.

METHODS

A prospective, open-label, mixed methods, randomized controlled clinical trial was conducted between April 2019 and March 2020. A total of 69 participants (aged ≥65 years with a diagnosis of dementia and who did not meet the exclusion criteria) were randomly assigned to either the control (n=35, 51%) or VR (n=34, 49%) arm. Participants in the experimental (VR) arm were visited by a researcher and watched 360° VR films on a head-mounted display for up to 20 minutes every 1 to 3 days, whereas individuals in the control arm received standard of care. Instances of daily BPSDs and falls were collected from nurses' daily notes. QoL was measured through semistructured interviews and the Quality of Life in Late-Stage Dementia scale. Structured observations and semistructured interviews were used to measure treatment feasibility. The primary outcomes were analyzed at a 95% significance level based on the intention-to-treat method.

RESULTS

VR therapy had a statistically significant effect on reducing aggressiveness (ie, physical aggression and loud vociferation; P=.01). Substantial impact of VR therapy was not found for other BPSDs (eg, apathy), falls, length of stay, or QoL as measured using the Quality of Life in Late-Stage Dementia scale. The average VR therapy session lasted 6.8 (SD 6.6; range 0-20) minutes, and the intervention was overall an acceptable and enjoyable experience for participants. No adverse events occurred as a result of VR therapy.

CONCLUSIONS

Immersive VR therapy appears to have an effect on aggressive behaviors in patients with dementia in acute care. Although the randomized controlled trial was stopped before reaching the intended sample size owing to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03941119; https://clinicaltrials.gov/study/NCT03941119.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/22406.

How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

Nurses' perceptions of using volunteer support in health care settings: A systematic scoping review

AIMS

To understand nurses' perceptions of volunteer support in health care settings.

BACKGROUND

Increasingly, volunteers provide specialised support to health care service users, requiring volunteers and nurses to work closely together. However, little is known about nurses' perceptions of volunteer support.

METHODS

A scoping review was conducted following the PRISMA-ScR checklist. A mixed-methods convergent integrative approach was taken guided by the JBI framework. Quantitative data were transformed into qualitative data for synthesis and descriptive thematic analysis. Six databases were searched (CINHAL+, EMBASE, PubMed, Scopus, PsycInfo, ProQuest Health and Medical Collection) on 24 January 2022 using terms related to nurses, perceptions, volunteers and care settings, followed by a manual search. The search was limited to English language articles published during 2000-2022. Studies were included if they reported nurses' perceptions of volunteers supporting care within any health care setting.

RESULTS

Of the 943 records identified, 12 met the inclusion criteria. All 12 were included in the review following critical appraisal. Five themes were identified: perceived benefits for patients, volunteers providing support for nursing staff, nurses' valuing volunteer support, nurses' understanding of the volunteer role and nurses' understanding of recruitment and training of volunteers.

CONCLUSION

Nurses generally viewed volunteer support positively and perceived that it benefitted patients and assisted nurses. Some nurses raised concerns about the burden of additional supervision of volunteers and lacked knowledge of the volunteer role, recruitment and training. Emerging innovative models of nurse-led volunteer support can maximise the contribution of volunteers and help overcome barriers to volunteer acceptance.

IMPLICATIONS

These findings will inform volunteer policies and provide guidance in developing volunteer support programs.

Prevention and management of behavioural and psychological symptoms in patients with dementia in acute care: a best practice implementation project

INTRODUCTION

Behavioural and psychological symptoms of dementia are very common in acute care. Agitation and aggressive behaviours are the most common symptoms and are challenging to manage. Early detection and a nonpharmacological approach are recommended.

OBJECTIVES

To implement evidence-based recommendations for the prevention and management of aggression/agitation in patients with dementia in an acute geriatric care unit.

METHODS

The project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit was conducted with seven audit criteria based on evidence summaries. It was followed by the implementation of an action plan and a follow-up audit.

RESULTS

Results showed moderate improvements in compliance with best practice recommendations. The second audit indicated an improvement up to 46% with the identification of factors/triggers that precipitate aggression/agitation and completion of a risk assessment. The highest improvement was the training of the nursing team (79%). Compliance with the involvement of patients and their families in the care planning improved slightly (14%). The lowest improvement was for the development and implementation of individualized care plans (10%).

CONCLUSION

The project implementation achieved some positive changes. A formalized process for preventing aggression/agitation is in place. The interprofessional collaboration, the support given to the nursing team and the basket of nonpharmacological interventions were strengthened. The electronic documentation and a limited collaboration of the nursing team were challenging. As further strategies were implemented, further audit would be required to assess achievement in change and/or demonstration of improved care provided for this vulnerable population.

Reframing nurses' time to enhance interpersonal interactions in dementia care

Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.