How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Phase 1: Exploring Theoretical Evidence
2.1.1. Data Collection
2.1.2. Data Analysis
2.2. Phase 2: Identifying Practical Needs
2.2.1. Participants
2.2.2. Data Collection
2.2.3. Data Analysis
2.2.4. Trustworthiness
2.3. Phase 3: Validating Essential Components
2.3.1. Participants
2.3.2. Data Collection
2.3.3. Data Analysis
2.4. Ethical Considerations
3. Results
3.1. Phase 1: Topic Modeling of the Existing Literature
3.2. Phase 2: In-Depth Interviews with Experts
- Assessing residents and their backgrounds holistically
- Monitoring pharmacological interventions
- Discerning unique individual patterns
- Having a consistent and empathetic attitude
- Adjusting care to individual conditions
- Sharing views with other staff
- Deciding on priorities based on collaborative discussions
- Preventing residents from potential harm caused by BPSD
- Considering the safety of all LTCF members
3.3. Phase 3: Delphi Survey of Nursing Staff Members
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | In-Depth Interview | Delphi Survey |
---|---|---|
(N = 5) | (N = 14) | |
Age (M ± SD), years | 57.4 ± 8.29 | 54.5 ± 8.10 |
Gender (%) | ||
Male | 1 (20) | 0 (0) |
Female | 4 (80) | 14 (100) |
Profession (%) | ||
Professor | 1 (20) | 0 (0) |
Director of the long-term care facility | 3 (60) | 2 (14.3) |
Nurse | 1 (20) | 7 (50) |
Care worker | 0 (0) | 5 (35.7) |
Education level (%) | ||
Graduate school | 4 (80) | 4 (28.6) |
University | 1 (20) | 6 (42.8) |
High school | 0 (0) | 4 (28.6) |
Working experience (M ± SD), years | 26.32 ± 9.72 | 18.02 ± 11.68 |
Category | Sub-Category | Relevant Quotations from the Interviews |
---|---|---|
I. Using knowledge for assessment and monitoring the status of residents | 1. Assessing residents and their backgrounds holistically | It is important to get information from their families to understand the residents. Based on that, we can figure out the underlying causes of BPSD. It needs efforts to draw out useful information from communication with them. (Expert 2) |
2. Monitoring pharmacological interventions | The most important thing when using medications is to check the safety of the residents rather than the symptoms themselves. Although medications are important in managing BPSD, side effects should be carefully considered. It is very important to balance the benefits and side effects of drugs. (Expert 1) I use medications as long as I see residents’ pupils stay clear. If their eyes are blurred as if they were drunk, it means the medication is not appropriate and some action is needed. Non-pharmacological interventions are used if the symptoms do not harm other residents. (Expert 3) | |
II. Individualizing approaches on how to understand residents and address BPSD | 1. Discerning unique individual patterns | Residents with BPSD do not express their needs in an ordinary way. In that case, we need to read their minds to understand their needs by a combination of data such as their personal characteristics and preferences. (Expert 3) Even if they have exactly the same symptoms, each resident has different life experiences. The only way to find the underlying causes of BPSD, nurses need to investigate residents’ life experiences, habits, and values. (Expert 4) |
2. Having a consistent and empathetic attitude | The respectful attitude of the nursing staff also affects other staff’s care. It is professional care to maintain a consistent attitude of respect and interest toward residents. (Expert 4) Even if they have dementia, they know who truly cares sincerely for them. They give more trust to those sincere nurses and follow their instructions better. (Expert 5) | |
3. Adjusting care to individual conditions | Nursing staff should consider the condition of the symptoms, and not always provide the same care. On days when residents are having a hard time or bad condition, we need the flexibility to make it an alternate approach even if providing the same program. (Expert 5) | |
III. Building relationships for shared decision making | 1. Sharing views with other staff | Nursing staff should check the resident’s diet, sleeping, body movements, and everything in detail by asking other staff and sharing information, and taking a holistic approach to the resident. (Expert 3) It is important to listen to other staff’s opinions. It is good to use tea-time to talk about residents’ daily conditions and any information about BPSD. (Expert 4) |
2. Deciding on priorities based on collaborative discussions | I think the most important point is finding the symptoms that many practitioners feel are problematic in common. Those various perspectives of interdisciplinary staff give nursing staff a comprehensive insight into the utmost important care residents need to alleviate BPSD. (Expert 2) | |
IV. Securing a safe environment for residents and staff in LTCFs | 1. Preventing residents from potential harm caused by BPSD | Nursing staff should not miss the possibility of physical harm in managing symptoms. It is important to check carefully if residents have lunch enough or if they bumped into anything. So much detailed management is needed, such as giving finger food to prevent nutritional deficiencies due to BPSD. (Expert 2) |
2. Considering the safety of all LTCF members | Always be aware that BPSD can affect the safety of the entire LTCF members as well as the residents with BPSD. It is also up to the nursing staff to maintain a safe LTCF community where there is no harm to other residents, and our staff can provide care safely. (Expert 1) If symptoms do not harm the resident oneself or others, it is enough to express their symptoms freely as long as they are physically safe. They can be left alone without being taken any special care. (Expert 4) |
Category | Sub-Category | 1st Round | 2nd Round | 3rd Round | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Validity | Importance | Validity | Importance | Validity | Importance | ||||||||||||||
M ± SD | % | CVR | M ± SD | % | CVR | M ± SD | % | CVR | M ± SD | % | CVR | M ± SD | % | CVR | M ± SD | % | CVR | ||
I. Using knowledge for assessment and monitoring the status of residents | 1. Assessing residents and their backgrounds holistically | 4.42 ± 0.93 | 85.71 | 0.714 | 4.78 ± 0.57 | 92.85 | 0.857 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.92 ± 0.46 | 100 | 1 | 4.71 ± 0.75 | 92.85 | 0.857 | 4.92 ± 0.26 | 100 | 1 |
2. Monitoring pharmacological interventions | 4.35 ± 0.84 | 78.57 † | 0.571 | 4.71 ± 0.61 | 92.85 | 0.857 | 4.42 ± 0.64 | 85.71 | 0.714 | 4.78 ± 0.42 | 100 | 1 | 4.78 ± 0.63 | 92.85 | 0.857 | 4.78 ± 0.26 | 100 | 1 | |
3. Keeping an up-to-date knowledge of BPSD care ‡ | - | - | - | - | - | - | 4.28 ± 0.82 | 78.57 † | 0.571 | 4.42 ± 0.75 | 85.71 | 0.714 | 4.50 ± 0.75 | 85.71 | 0.714 | 4.57 ± 0.63 | 92.85 | 0.857 | |
II. Individualizing approaches on how to understand residents and address BPSD | 1. Discerning unique individual patterns | 4.35 ± 0.84 | 78.57 † | 0.571 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.64 ± 0.49 | 100 | 1 | 4.85 ± 0.75 | 100 | 1 | 4.85 ± 0.53 | 100 | 1 |
2. Having a consistent and empathetic attitude | 4.57 ± 0.64 | 92.85 | 0.857 | 4.57 ± 0.64 | 92.85 | 0.857 | 4.57 ± 0.64 | 92.85 | 0.857 | 4.50 ± 0.65 | 92.85 | 0.857 | 4.85 ± 0.53 | 100 | 1 | 4.78 ± 0.26 | 100 | 1 | |
3. Adjusting care to individual conditions | 4.35 ± 0.84 | 78.57 † | 0.571 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.64 ± 0.63 | 92.S85 | 0.857 | 4.78 ± 0.42 | 100 | 1 | 4.78 ± 0.53 | 100 | 1 | 4.92 ± 0.57 | 100 | 1 | |
III. Building relationships for shared decision-making | 1. Sharing views with other staff | 4.71 ± 0.61 | 92.85 | 0.857 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.85 ± 0.53 | 92.85 | 0.857 | 4.78 ± 0.57 | 92.85 | 0.857 | 4.92 ± 0.74 | 100 | 1 | 4.85 ± 0.46 | 92.85 | 0.857 |
2. Deciding on priorities based on collaborative discussions | 4.64 ± 0.63 | 92.85 | 0.857 | 4.85 ± 0.53 | 92.85 | 0.857 | 4.74 ± 0.61 | 92.85 | 0.857 | 4.85 ± 0.36 | 100 | 1 | 4.78 ± 0.89 | 92.85 | 0.857 | 4.92 ± 0.51 | 100 | 1 | |
IV. Securing a safe environment for residents and staff in LTCFs | 1. Preventing residents from potential harm caused by BPSD | 4.57 ± 0.75 | 85.71 | 0.714 | 4.78 ± 0.57 | 92.85 | 0.857 | 4.78 ± 0.57 | 92.85 | 0.857 | 4.85 ± 0.53 | 92.85 | 0.857 | 4.85 ± 0.64 | 92.85 | 0.857 | 4.85 ± 0.63 | 92.85 | 0.857 |
2. Considering the safety of all LTCF members | 4.14 ± 0.94 | 78.57 † | 0.571 | 4.42 ± 0.75 | 85.71 | 0.714 | 4.50 ± 0.75 | 85.71 | 0.714 | 4.78 ± 0.42 | 100 | 1 | 4.64 ± 0.63 | 92.85 | 0.857 | 4.92 ± 0.63 | 100 | 1 |
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Kim, D.; Choi, Y.-R.; Lee, Y.-N.; Park, W.-H.; Chang, S.-O. How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia? Int. J. Environ. Res. Public Health 2022, 19, 10493. https://doi.org/10.3390/ijerph191710493
Kim D, Choi Y-R, Lee Y-N, Park W-H, Chang S-O. How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia? International Journal of Environmental Research and Public Health. 2022; 19(17):10493. https://doi.org/10.3390/ijerph191710493
Chicago/Turabian StyleKim, Dayeong, Young-Rim Choi, Ye-Na Lee, Won-Hee Park, and Sung-Ok Chang. 2022. "How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?" International Journal of Environmental Research and Public Health 19, no. 17: 10493. https://doi.org/10.3390/ijerph191710493