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Aim: This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers. Methods: This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included. Results: Twenty‐one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers). Conclusions: This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia. Summary statement: What is already known about this topic? In Europe, the population is ageing, and the number of People with Dementia (PwD) who require long‐term care and family support is increasing.A diagnosis of dementia is a 'family affair', as dementia is associated with physical, emotional and social costs for both PwD and their family caregivers, with impacts on family dynamics and functioning, even more so, when the PwD are older. What this paper adds? This scoping review provides insight into the types of healthcare interventions targeting older PwD and family caregivers in Europe.It reveals that most studies (n = 19; 90%) consider the family of PwD as the 'context of care' and not as a recipient of care. As a result, the focus of interventions is on the well‐being and health of the PwD first and the family second, being seen as a resource for the care of the PwD. Implications of the study The family plays a central role in long‐term care of older PwD.A holistic approach to dementia care is needed that focuses on the health of family caregivers of PwD, in addition to the health of PwD. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. What the paper adds to existing knowledge?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non‐pharmacological care interventions that address environmental and situational variables that reflect military action. What are the implications for practice?: Specialized education and training is needed to improve the identification of PTSD when existent with other co‐occurring neurocognitive conditions such as delirium, dementia and depression. Introduction: Co‐occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia‐related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question: The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co‐occurrence of PTSD symptoms in Veterans with dementia. Methods: Eight semi‐structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results: Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust‐based and validation‐oriented strategies resulting in more effective care management. Discussion: Improvement in the identification of co‐occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice: Recognizing the complex needs of older Veterans with co‐occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement: This paper provides mental health nurses with new understanding of co‐occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities.Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying.A mixed‐methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. What the paper adds to existing knowledge: Through the Quality of dying in Long‐Term Care Scale (QoD‐LTC), nurses described symptom management, quality of care, and end‐of‐life appearance as adequate and end‐of‐life communication as lacking.Generally speaking, the scores on the scale were consistent with the data from semi‐structured interviews conducted with nurses.In the semi‐structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person‐centred care frameworks. What are the implications for practice?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision‐making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. Introduction: The complex nature of end‐of‐life assessment of individuals diagnosed with dementia would benefit from a mixed‐methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question: To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long‐Term Care settings (QoD‐LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method: Mixed‐methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD‐LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi‐structured scale‐based interviews were conducted. Results: Symptom management, quality of care, and end‐of‐life appearance were found to be adequate, while end‐of‐life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD‐LTC. Discussion: Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice: The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coronavirus disease 2019 (COVID‐19) is a new infectious disease that has spread across the world and infected a large number of people many of whom have died.People with moderate to severe dementia are at very high risk of becoming infected as the disease mainly impacts on older people with other health problems and once infected the person with dementia is more likely to become seriously ill than other people.To prevent infection, people are required to wear masks and isolate from contact with others. It is believed that these measures can reduce the quality of life and general well‐being of people with moderate to severe dementia in hospital or social care. This belief has not yet been demonstrated by research. What does this paper add to the existing knowledge?: We show that people with moderate to severe dementia receiving care on mental health hospital wards and subject to strict infection prevention measures can still achieve high levels of well‐being.We show that mental health nurses alter the focus of their care to deliberately overcome the challenges and particularly the restrictions on visiting by families. What are the implications for practice?: We believe that the changes in practice we observed can occur in other healthcare and social care settings and that whilst restrictions remain in place care staff can protect and possibly enhance well‐being for people with moderate to severe dementia. Introduction: The effect of coronavirus (COVID‐19) on people living with dementia is potentially severe in its clinical impacts. More widely, for this vulnerable group, the social restrictions to limit the spread of infection may be emotionally and psychologically damaging. Aim: To explore the impact of restrictions on well‐being for people with moderate to severe dementia in acute mental health hospital care. Method: "Dementia Care Mapping" was the observational tool used to determine well‐ or ill‐being. Observations were undertaken in two mental health hospital wards during a time of restrictions and the use of personal protective equipment. Results: We report levels of well‐being that are higher than might be expected alongside a change in the focus of psychological care delivered through mental health nursing interventions aimed at enhancing well‐being. Discussion—We postulate that mental health nurses faced with an unprecedented challenge respond by changing practice to mitigate for infection prevention measures and to compensate for family absence. Implications for practice: We suggest that the desirable enhancing actions by nursing staff which raise well‐being in these hospital settings are readily transferable to other settings that are aiming to maintain well‐being but also practising under COVID‐19 restrictions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To review the literature on family caregivers' experiences of providing care for a family member from an ethnic minority group living with dementia within the European context. Background: Due to labour migration during the late 1960s and early 1970s, many European countries are now encountering an increasing number of older people from diverse ethnic minority groups who have been diagnosed with dementia. Although family care is predominantly used as a care pathway among families with immigrant backgrounds, little is known about family caregivers' experiences of providing care for a family member with dementia. Design: A systematic review of qualitative literature. Methods: Eight databases (CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS, Social Care Online, SocIndex and Epistemonikos) were searched for original, peer‐reviewed papers, published in English between 2010 and 2021. The literature review was conducted and reported in accordance with PRISMA 2020 checklist for reporting systematic reviews. Results: After identifying, screening and assessing articles for eligibility, 14 articles were critically appraised using the standardised assessment tool Mixed methods Appraisal Tool (MMAT, version 2018) and included in the review. The data synthesis process identified four themes across the qualitative studies: controversies and challenges; a lack of health literacy; barriers to seeking support from the healthcare or social services; and models of care. Conclusions: Most of the family caregivers highlighted the value of being able to care for a family member living with dementia. However, the findings also reveal that they experience controversies and challenges due to their lack of dementia health literacy and perceived barriers to seeking healthcare support. Relevance to clinical practice: The findings from the current review can inform healthcare and social services in relation to implementing models of care that facilitate and complement family caregivers' role in caring for family members living with dementia from minority ethnic groups. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact of cultural beliefs of dementia as witchcraft in sub‐Saharan Africa. Background: The population of sub‐Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. Method: A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. Results: The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health‐seeking behaviours of and for people with dementia. Conclusion: There remains a need for dementia awareness and education across sub‐Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best‐placed healthcare professionals to support these initiatives and the development and implementation of low‐resource nonpharmacological interventions to support people with dementia and their families living in the community. Relevance to clinical practice: Nurses working in sub‐Saharan Africa and those caring for patients from sub‐Saharan Africa can only provide person‐centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Although the seminal work of McCormack et al. (International Practice Development Journal, 2015, 5, 1) and Nolan, Davies, Brown, Keady, and Nolan () provides useful conceptual frameworks in person‐centred care, research is needed to understand how theoretical concepts can be applied into practice to support dementia care. Also, evidence is needed to demonstrate the impacts of implementing person‐centred care and staff experiences. What does this paper add to existing knowledge?: This paper adds to the emerging work that is providing a greater understanding of how team education in practice can make a difference in building capacity to improve dementia care.We offer timely evidence and useful insights into how an education programme, Gentle Persuasive Approaches (GPA), was implemented ("what worked" and "how") in a large Canadian hospital to improve knowledge and skills among staff in dementia care.The GPA education helped hospital staff enact person‐centred care by cultivating shared values and a learning environment to change attitudes, practices and conditions for continuous practice development. What are the implications for practice?: Mental health nurses in advance practice are well positioned to lead dementia education and advocate for person‐centred care in hospitals.Hospital leaders are responsible for providing resources to cultivate a supportive environment for continuous learning to ensure the workforce gains the capacity to meet the changing demands and needs of the ageing population. System support is essential for creating conditions to enable person‐centred care. Introduction: Hospital staff lacks knowledge and skills in dementia care. There is a need to understand how person‐centred care theory can be operationalized in staff's practices to improve dementia care. Aims: To describe the staff's experiences of learning and applying the Gentle Persuasive Approaches (GPA) to enact person‐centred care in a hospital. Methods: Mixed methods, including posteducation survey and focus groups, were used. Thematic analysis was conducted to identify themes that describe participants' experiences. Results: Three hundred and ten staff and leaders in a hospital participated in the GPA education and completed a posteducation survey (n = 297). After 1 year, two follow‐up focus groups were conducted with interdisciplinary staff (n = 24) across medicine and mental health programmes. Our analysis identified three themes to enable person‐centred care: (a) changing attitudes, (b) changing practices and (c) changing conditions. Discussion: This study contributes to the literature by providing evidence of how an education programme was implemented in a large Canadian hospital to build capacity for dementia care. Joint education for interprofessional staff offers value in enabling person‐centred care. Implication: Mental health nurses are in position to lead dementia education and advocate for person‐centred care in hospitals. Staff need structural support to engage in team learning for practice improvement. [ABSTRACT FROM AUTHOR]

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Over the past two decades the advocates of person-centred approaches to dementia care have consistently argued that some of the negative impacts of dementia can be ameliorated in supportive social environments and they have given lie to the common but unfounded, nihilistic belief that meaningful engagement with people with dementia is impossible. This discussion paper contributes to this welcome trend by exploring how carers can use empathic curiosity to establish the common ground that is necessary to sustain meaningful engagement with people who have mild to moderate dementia. The first section of the paper gives a brief theoretical introduction to the concept of empathic curiosity, which is informed by perceptual control theory and applied linguistics. Three case examples taken from the literature on dementia care are then used to illustrate what empathic curiosity may look like in practice and to explore the potential impact that adopting an empathic and curious approach may have. [ABSTRACT FROM AUTHOR]

Accessible summary The move towards new ways of working in Mental Health services has challenged multidisciplinary teams to consider how new roles and responsibilities can be supported., Staff development is central to this but there are concerns about education and training opportunities within the dementia workforce., This papers asks nurses working in dementia care to assess their own level of knowledge and competence and to identify areas of unmet educational needs., The results suggest that not all nurses are developed to such a point that new ways of working can be effectively introduced., Abstract It is expedient to consider new ways in which dementia care services may be configured to meet increasing demographic, societal and regulatory demands. Greater equity in the distribution of clinical responsibility across multidisciplinary teams has been suggested as one method that may offer a range of benefits to both the service user and the service itself. However, within the dementia workforce there are concerns about inconsistency and variability in both knowledge of dementia and competency in meeting the needs of those affected. Taking this into account it was felt important to explore perceived knowledge and competency of specialist dementia care nurses who would not only be expected to possess higher levels of knowledge and skill but are positioned as the obvious clinical group to engage with new ways of working. Consequently, this paper offers the results and subsequent discussion of a survey of senior nurses working in dementia care across the UK. [ABSTRACT FROM AUTHOR]

Aim. To present evidence-based factors for the recruitment and retention of licensed nurses caring for older people and persons with dementia. Background. The international nurse shortage crisis is intensified in the aged and dementia care sector. Strategies to address this crisis rely on qualitative, quasi-experimental, anecdotal and unsubstantiated literature. Design. Systematic literature review. Method. Search terms ‘nurse’‘nurses’‘nursing’‘clinical supervision’‘staff’‘staffing’‘staff mix’‘staff levels’‘recruitment’‘retention’‘aged care’‘gerontology’‘gerontological’‘dementia care’‘residential’‘nursing home,’ were used in all possible combinations and applied in a wide range of relevant academic databases, with secondary hand searches of selected bibliographies. Results. Two hundred and twenty-six papers were retrieved and scanned, with 105 chosen for closer examination that were relevant to recruitment and retention strategies for dementia and aged care nursing. Twenty-five of the papers chosen for review were rated at level 2++ to 3, according to the guidelines of the National Institute for Health and Clinical Excellence (The NICE Guidelines Manual, National Institute for Health and Clinical Excellence, London). The 25 critically reviewed papers are organised as promising strategies for (1) nurse recruitment and (2) nurse retention. Conclusions. The intrinsic rewards of the caring role attract nurses to dementia and aged care. Essential strategies linking recruitment with retention are: careful selection of student nurse clinical placements and their ongoing supervision and education, training for skills, leadership and teamwork for new and existing nurses, increased staffing levels, pay parity across different health settings and family friendly policies. Relevance to clinical practice. A family-friendly, learning environment that values and nurtures its nursing staff, in the same way as nurses are expected to value and care for their patients and residents, is critical in ensuring their retention in dementia and aged care. [ABSTRACT FROM AUTHOR]

Aim: To explore home‐dwelling people with dementia and family members' perceptions of the feasibility and acceptability of an intervention using dementia‐related literature excerpts to facilitate conversations on ethical issues related to living with dementia. Background: Ethical issues in dementia care emerge throughout the illness. In the early stages, they may involve decisions about disclosing the illness to the family, shifting roles and responsibilities, and considerations of transitioning to a nursing home. Addressing ethical issues and providing adequate support to home‐dwelling people with dementia and their families are often lacking. Design: An exploratory‐descriptive qualitative study. Methods: We conducted eight interviews with 14 home‐dwelling persons with dementia and their family caregivers. Six were dyadic interviews, and two were individual interviews with family caregivers. We analysed the interview data using template analysis. We adhered to the COREQ checklist in reporting this study. Results: Using excerpts from dementia‐related literature was a feasible and acceptable way of initiating discussions on ethical issues among home‐dwelling persons with dementia and family caregivers. However, engaging the families of newly diagnosed individuals was challenging due to emotional distress. The intervention provided peer support, including identifying with others and sharing experiences. Moreover, participating couples found intimacy and relational attunement through shared reflections. Conclusion: Based on the findings, it appears that the participants in this study felt that using excerpts from dementia‐related literature to deliberate on ethical issues was feasible and acceptable. Deliberating on ethical issues with peers and family caregivers offers valuable social support and opportunities for strengthening relationships. Implications for patient care: This study makes an important contribution by providing valuable insights into how ethical issues related to living with dementia can be addressed using related literature and suggests how the intervention can be integrated into existing care initiatives for home‐dwelling people with dementia and their families. Reporting method: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. Patient or public contribution: A healthcare professional working as a so‐called dementia coordinator (a title used in the Danish context) was involved in the conduct of this study by being responsible for the recruitment of home‐dwelling people with dementia and their family members. Moreover, she had joint responsibility for facilitating the intervention along with the first author. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings., Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings., Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care., What this paper adds to existing knowledge? Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care., Mental health staff face difficulties using electronic records alongside other systems of information sharing., Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care., What are the implications for practice? Frontline staff should be involved in designing new information systems including care plans., Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia., Practice-based mentors could be deployed to strengthen good practice in effective information sharing., Abstract Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service ( NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. [ABSTRACT FROM AUTHOR]

Accessible summary Digital stories provide a creative way for people to tell their stories using an amalgamation of voice, image and music, and can be used to engage nurses with others' experiences in the classroom setting., Seven people with early-stage dementia and one carer participated in making their own stories during a digital storytelling workshop., These participants experienced particular and varied challenges relating to telling a story and engaging with the technical process of digital storytelling. They were supported in overcoming these challenges through person-centred relationships with facilitators, allowing them to negotiate the help required., During the workshop a number of positive changes were observed in the participants: increased confidence, improved speech, a sense of purpose and increased connection., Abstract Care and compassion are key features of the NHS Constitution. Recent reports have identified a lack of compassion in the care and treatment of older people. Nurses draw on aesthetic knowledge, developed through engagement with the experience of others, when providing compassionate care. Patient Voices reflective digital stories are used in healthcare education to facilitate student engagement with the patient experience. Digital stories were made with seven people with early-stage dementia as part of a learning package for student nurses. In this paper the authors reflect on their experience and observations from facilitating the 4-day digital story-making workshop. Social theories of dementia provide a theoretical framework for understanding these reflections. Despite considerable challenges in developing a story, and anxiety about using the technology, reading and speaking, all participants engaged in creating their own digital stories. Positive changes in the participants' interactions were observed. These improvements appeared to be the product of the person-centred facilitation and the creative process which supported self-expression and a sense of identity. Nurses working in this way could facilitate ability of the person with dementia to participate in their care, and improve their sense of well-being by supporting self-expression. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence‐base to support nursing practice when caring for people with dementia in an orthopaedic setting. Background: People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. Design: Integrative literature review. Methods: An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person‐Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. Results: The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. Conclusions: Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. Relevance to Clinical Practice: This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the clinical reasoning process of experienced registered nurses during care planning and documentation of nursing in the electronic health records of residents in long‐term dementia care. Background: Clinical reasoning is an essential element in nursing practice. Registered nurses' clinical reasoning process during the documentation of nursing care in electronic health records has received little attention in nursing literature. Further research is needed to understand registered nurses' clinical reasoning, especially for care planning and documentation of dementia care due to its complexity and a large amount of information collected. Design: A qualitative explorative design was used with a concurrent think‐aloud technique. Methods: The transcribed verbalisations were analysed using protocol analysis with referring phrase, assertional and script analyses. Data were collected over ten months in 2019–2020 from 12 registered nurses in three nursing homes offering special dementia care. The COREQ checklist for qualitative studies was used. Results: The nurses primarily focused on assessments and interventions during documentation. Most registered nurses used their experience and heuristics when reasoning about the residents' current health and well‐being. They also used logical thinking or followed local practice rules when reasoning about planned or implemented interventions. Conclusion: The registered nurses moved back and forth among all the elements in the nursing process. They used a variety of clinical reasoning attributes during care planning and nursing documentation. The most used clinical reasoning attributes were information processing, cognition and inference. The most focused information was planned and implemented interventions. Relevance to clinical practice: Knowledge of the clinical reasoning process of registered nurses during care planning and documentation should be used in developing electronic health record systems that support the workflow of registered nurses and enhance their ability to disseminate relevant information. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate how digital life stories can be used to support person‐centred care focusing on benefits and challenges experienced by the staff and the management team in a nursing home context. Background: Life story work can be used to support person‐centred care and help people with dementia maintain their identity. The use of digital life stories provides opportunities to easily share the content between staff and relatives and combine different types of multimedia, for example pictures, videos, text and sound. Design: Six healthcare professionals and two members of the management team at a nursing home were recruited. Participant observations with informal interviews of the formal health career were conducted in two day shifts and two night shifts. Field notes were taken during the observations. Also, individual semi‐structured interviews were held with four of the recruited participants. This article adheres to the Standards for Reporting Qualitative Research (SRQR). Results: Themes revealed were (1) person‐centred care and life story work as interrelated approaches; (2) Pros and cons related to the My Life Story app; and how (3) Time and information and communication technology (ICT) can restrict life story work. Conclusion: Digital life stories can be used to support a person‐centred care approach. However, a number of challenges exist related to digital life story work. When using digital life stories, it is important to ensure the staff time and competences needed to work with, for example an app and that visible support and encouragement are provided by the management team. Relevance to clinical practice: Challenges are revealed when life story work is embedded in the culture and everyday work of a nursing home. It is of great importance to clinical practice to be aware of and address these challenges in order to succeed with digital life story work. [ABSTRACT FROM AUTHOR]

This article presents results from interviews with twelve persons with mild dementia about how life had changed since they received their diagnosis, exploring their experiences of dementia and how they manage life by using different strategies and techniques. Knowledge about how people with mild dementia experience life is important to explore through their unique perspective, providing clinical practice with knowledge to improve dementia care. Twelve participants were recruited at a Danish school service for people with mild dementia where they receive cognitive stimulation. Semi‐structured interviews were conducted, video recorded, transcribed and analysed by using Max Van Manen's five lifeworld existentials: spatiality, corporeality, temporality, relationality and materiality. SRQR checklist was used. Five themes were identified, illustrating the dilemmas and challenges the participants experience, as all existentials are compromised in some way: living a social and active life regardless of difficulties; trying to look at the bright side of life with dementia; it takes time to adapt but at the same time, time is being lost; it is possible to learn, but it is challenging; to try to remember but keep forgetting. The article concludes that all existentials are negatively influenced by dementia, setting the lifeworld of the participants under pressure. However, they still try to live their lives regardless of the difficulties. The study shows it is possible for people with mild dementia to describe their lived experience of dementia and what strategies and techniques they use to manage life. The experienced dilemmas and challenges in the lifeworld of people with mild dementia are of great relevance to be aware of and address in clinical practice. To support people with dementia to identify relevant strategies and techniques, as expressed in the study, that can support them managing life with dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain insight into the request, use and associated factors of involuntary treatment in people with dementia (PwD) receiving professional home care in the Netherlands and Belgium. Background: Most of the PwD remain living at home as long as possible. Due to complex care needs, this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. Design: Secondary data analyses of two cross‐sectional surveys. Methods: Dementia case managers and district nurses filled in a questionnaire for each PwD in their caseload. This study included data of 627 PwD receiving professional home care in the Netherlands and 217 in Belgium. The same methodology (questionnaire and variables) was used in both samples. Descriptive statistics and multi‐level logistic regression analyses were used to analyse the data. The study adhered to the STROBE checklist. Results: More than half of the PwD (50.7%) living at home received involuntary treatment (Belgium 68.2% and the Netherlands 44.7%). Nonconsensual care (82.7%) was the most common, followed by psychotropic medication (40.7%) and physical restraints (18.5%). Involuntary treatment use was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. Involuntary treatment was most often requested by family caregivers. Conclusions: Involuntary treatment is often used in PwD, which is in line with previous findings indicating dementia as a risk factor for involuntary treatment use. More research is needed to gain insight into variations in prevalence across other countries, which factors influence these differences and what countries can learn from each other regarding prevention of involuntary treatment. Relevance to clinical practice: To provide person‐centred care, it is important to study ways to prevent involuntary treatment in PwD and to stimulate dialogue between professional and family caregivers for alternative interventions. [ABSTRACT FROM AUTHOR]

Aim: To describe a study protocol for a survey study in German nursing homes that (1) plans to enhance a typology of care units (2) and investigates the association between different care unit types and the provision of dementia-specific interventions based on a stratified randomized sample. Background: Many nursing homes in Germany provide Dementia Special Care Units. Existing definitions often do no justice to the complexity of their context. In this study, we define context as structural and organizational variables. It is necessary to define an empirical based set of indicators to characterize care units with respect to dementia care. Design: Observational survey study with a cross-sectional design. Methods: We will use a stratified random nationwide sample of 160 German nursing homes. Stratification variables are federal state and the existence of a Dementia Special Care Unit. The sampling frame from which the participating nursing homes are selected is a list with the total population of German nursing homes (n = 11.658). Data will be gathered on the level of the nursing homes and one of their care units via computer-assisted telephone interviews with a standardized questionnaire. The distribution of the assessed variables (contextual characteristics) will be described in absolute and relative frequencies for the whole sample in the first step in order to describe dementia-specific care structures. In the second step, factor analysis of mixed data (FAMD) with hierarchical clustering (HC) will be applied to analyze relationships between variables. The study was ethically approved in October 2018. Discussion: The typology can be used in future studies to define the context of care units in nursing homes. This may improve the interpretation of findings from future studies that investigated interventions in nursing homes. Impact: The typology will visualize and describe the complexity of contextual characteristics of several care units. [ABSTRACT FROM AUTHOR]

Aims: To examine prevalence, types, challenges and the impact of medical/nursing tasks (MNT) on caregivers of older adults with dementia. Background: Medical/nursing tasks have been perceived as a professional healthcare role; however, research shows that many caregivers of older adults with dementia perform those tasks in the home, such as giving injections, tube feedings or operation of medical equipment. Little is known about the caregivers' challenges in engaging in these MNT. Design: Integrative review. Methods: Ovid MEDLINE, CINAHL, PsycINFO and Web of Science databases were searched to explore MNT among caregivers of older adults with dementia who lived in a community setting. Four quantitative and nine qualitative studies published between 1980–2018 were included. Overall, process of the review was guided by PRISMA. Results: About 67% of U.S. caregivers of older adults with dementia performed MNT, including managing multiple medications, wound care and nutritional management. Care recipients' cognitive impairment complicated the provision of those tasks due to their limited cognitive functioning, behavioural changes, comorbidities and complex medication regimen. Insufficient information and training from healthcare professionals as well as caregivers' age and their own health problems made performance of those tasks even more challenging. As a result, caregivers frequently suffered from emotional distress such as worrying, anxiety and sleep disturbance. Conclusions: Medical/nursing tasks have become one of the daily tasks of caregivers of older adults with dementia within the home. However, the tasks are difficult and complicated, and inadequate support from healthcare professionals may compromise the caregivers' well‐being. Relevance to clinical practice: Healthcare professionals should provide education and should be aware of caregivers' needs related to MNT. Structured‐medical information, skill‐based instructions and hands‐on training may be beneficial to decrease the caregivers' distress from MNT. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine factors that facilitate or impede adjustment to residential aged care (RAC) from the perspectives of residents with dementia, families of residents with dementia and facility staff. Background: The transition to a RAC facility can be highly stressful for people with dementia and their families, but we lack an understanding of how people with dementia experience this transition. Knowledge on adjustment to the new environment is essential in order to develop procedures and interventions that better support residents. Design and methods: This study consisted of interviews with 12 residents with dementia who had resided at a RAC facility for six months or less; 14 family members of RAC residents with dementia; and 12 RAC facility staff members. Parallel interview schedules were constructed, with questions on the experience of relocating to RAC for a person with dementia and views on enablers and barriers to successful adjustment. Thematic analysis guided the analysis of data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines (see Supplementary File S1). Results: Adjustment to RAC appeared variable, with several residents reporting poor acceptance of their circumstances several months after the relocation. The three groups were largely congruent regarding the importance of support from families and staff, and the development of new relationships with other residents, but not all residents had succeeded in forming friendships. The provision of meaningful activities and opportunities to exert autonomy day‐to‐day were seen as critical, but staff experienced challenges in providing individualised care due to lack of dedicated time to engage with residents. Conclusion and relevance to clinical practice: There is a need for evaluated interventions to help people with dementia to successfully transition to RAC. Attention should be paid to the way in which care is coordinated within the RAC sector, to enable staff to provide individualised approaches to facilitate adjustment. [ABSTRACT FROM AUTHOR]

Aims and objectives: (a) Describe the co‐development of a point‐of‐care App to promote uptake of best practice recommendations and consolidate nurses' knowledge for managing symptoms of neurocognitive disorders. (b) Report acceptability, usability and feasibility of the App to nurses for patient care in hospital. Background: Strategies used in hospitals to reduce symptoms, risk of harm, or complications of behavioural and psychological symptoms associated with neurocognitive disorders are frequently inconsistent with best practice recommendations. Design: Three‐stage, mixed‐methods, process and outcome evaluation. Methods: The App was co‐developed with experts, nurse end‐users and a consumer. Evaluation data were collected from a convenience sample of nurses observed during delivery of 80.5 hr of care to 38 patients; the App (n = 32 patients); and individual and focus group interviews with nurses (n = 25). Reporting adhered to an adapted STROBE checklist. Results: The App included three components: cognition and risk assessment; tailored evidence‐based strategies; and monitoring and evaluation of effectiveness. Observation data captured nurses using the App with 44.7% (n = 17) of eligible inpatients. Cognitive screening was completed at least once for each patient, with 146 risk assessments recorded. Interview data indicated the App's acceptability was enhanced by familiarity and perceived benefits, but hindered by perceived increases in workload, inconsistent use, pressure to use the App and resistance to change. Feasibility and usability were enhanced by easy navigation, and clear and useful content, but hindered by unclear expectations, unfamiliarity and device‐related factors. Conclusions: The App provided an evidence‐based tool that was, overall, considered feasible and acceptable to support best practice. Findings provide guidance to enhance usability for future implementation. Relevance to clinical practice: Co‐development using best evidence and key stakeholders enabled creation of a novel, feasible and acceptable technology. Real‐time access to assessment tools and tailored knowledge supported nurses' clinical decision‐making; workload and unfamiliarity were barriers to use. [ABSTRACT FROM AUTHOR]

Aims and objectives: To generate insights about what matters and is valued by family members of older people with dementia in the emergency department. To explore the experiences of emergency nurses looking after older people with dementia in an episode of care. Background: In the emergency department, older people with dementia are at risk of suboptimal care. Little is known of the experiences of family members of being with an older person with dementia in the emergency department or the experiences of emergency nurses looking after older people with dementia in this environment. Design and methods: Phase 1 Data Analysis of the Discovery Phase of an Appreciative Inquiry study. Study participants were family members of older people with dementia and emergency nurses. Data collection methods included interviews with family members of older people with dementia and 30 hr of participant observation working alongside emergency nurses. This study was guided by the Standards for Reporting Qualitative Research. Results: Two themes emerged from the analysis: What matters to family members with four subthemes and challenges for family members and nurses in the emergency department with two subthemes. Conclusion: This study demonstrates that some emergency nurses are connecting with family members even in the briefest of clinical encounters. It is feasible for more emergency nurses to do the same more of the time. Relevance to clinical practice: The older person with dementia must be given a triage category of no less than 3 (to be seen by the doctor within the hour) on arrival in the department. Further education is needed to assist emergency nurses to establish rapport and incorporate family member insights as part of care planning and assessment of the needs of the older person with dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives: To review communication interventions that aim to improve regular care interactions between people with dementia and their carers in various settings; and to examine the impact of such interventions on both carer and care‐receiver outcomes. Background: Effective communication is imperative to ensure quality of care for people living with dementia. Due to neurodegenerative changes, people with dementia encounter ongoing and progressive difficulties in both understanding and expressing themselves. This in turn creates challenges for carers, which highlights the need for equipping them with necessary communication skills to respond to the specific communication needs of people with dementia. Design: Systematic review and meta‐analysis. Method: Medline, Embase, CINAHL, ProQuest and PsycINFO databases were searched for eligible interventions with any date of the publication. Hand searching was also conducted through reviewing the reference lists of relevant articles. The screening and selection of studies were based on the inclusion/exclusion criteria for eligibility and the methodological quality assessment checklist. Random‐effects meta‐analyses were conducted on comparable quantitative data. The review is reported following the PRISMA reporting guidelines. Results: Seventeen studies were included in the final review, including 12 randomised controlled trials (RCTs), three nonrandomised controlled trials (NRCTs) and two controlled before–after interventions. The intervention designs, settings and outcome measures were varied. The findings suggest that the communication training had a positive impact on both carer and care‐receiver outcomes, albeit to different degrees. The intervention effects were found to be strongest on carer communication skills and knowledge. Conclusion: There is solid evidence for the positive impact of communication training on the skills and knowledge of carers. More research is needed regarding the effects of such educational interventions on carer physio‐psychological outcomes and care‐receiver neuropsychiatric symptoms. It is important to establish best practices in training design, develop validated outcome measures and adopt consistent reporting approaches. Relevance to clinical practice: The increasing global prevalence of people with dementia manifests across clinical and community contexts. The profound impact of dementia on communication and associated care raises the imperative for enhanced health worker and carer communication skills to meet the needs of this particular client group. The findings of this review indicate that educational interventions incorporating face‐to‐face and diverse instructional delivery methods in dementia communication showed positive outcomes for communication skills in all carer groups and warrant inclusion as strategies in dementia training. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to identify and analyse factors influencing the use of drugs for dementia treatment in home care settings. Background: While the number of care‐dependent people with dementia is growing, it is not clear whether their medication follows the state of the art, especially in home care settings where over two‐thirds of them are cared for in Germany. Although dementia is not curable, it is possible to reduce cognitive, behavioural and psychological symptoms of dementia with the appropriate use of medication. However, there is a lack of information concerning the drug treatment in home care settings. Methods: The study was conducted as a multicentre cross‐sectional survey, including 923 participants from 102 home care institutions throughout Germany. Medical diagnosis, medication, consultations with a specialist within the previous 12 weeks of the initial assessment and additional general information were assessed following a standardised study protocol. Data were analysed using univariate and multivariate statistical methods. The manuscript was developed utilising the STROBE checklist for cross‐sectional studies. Results: In home care, one in seven clients (14.8%) is diagnosed with some form of dementia. 52.6% (n = 72) of them were treated with dementia medication: AchEIs 16.1% (n = 22), memantine 9.5% (n = 13), antidepressants 23.4% (n = 32), antipsychotic medication 9.5% (n = 13), tranquilisers 16.8% (n = 23) and anticonvulsant drugs 6.6% (n = 9). Drug treatment for dementia was significantly associated with the consultation of a neurologist/psychiatrist in the previous 12 weeks. Conclusions: It has been demonstrated that the use of drugs as a component of home care treatment for dementia depends on many factors and therefore varies. Relevance to clinical practice: It can be assumed that people living with dementia in home care settings are not sufficiently supplied with medication. Their medical care can be improved by establishing interdisciplinary care involving a neurologist/psychiatrist. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Background: Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. Design: A qualitative interpretative design informed this study. Methods: Seventeen semi‐structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. Results: At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night‐time frequency of these observations was determined by clinical judgement, ward‐level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under‐monitored, while patients nearing the end of life could be over‐monitored. Conclusion: In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long‐term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Relevance to clinical practice: Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under‐monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. Background Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents' free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. Design This model is embedded in an overall mixed-method education intervention design study called Modelling and evaluating evidence-based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. Method Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10-month period to examine restraint use in relation to organisational constraints. Results Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. Conclusion A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used - or not in particular situations with residents living with dementia. Relevance to clinical practice Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia. Background Nursing home residents with severe dementia often experience social withdrawal and lower quality of life, which are suggested to be enhanced by non-pharmacological interventions. Design A cluster-randomized controlled trial. Ten nursing home units were randomized to robot-assisted intervention or control group (treatment as usual). Methods Data were collected between March 2013-September 2014. 27 participants participated in group activity for 30 minutes twice a week over 12 weeks, 26 participated in the control group. Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline, after end of intervention and at 3 months follow-up. The scale and regular psychotropic medication were analysed stratified by dementia severity. Analysis using mixed model, one-way anova and linear regression were performed. Results An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group. The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia. The intervention group used significantly less psychotropic medication compared with the control group after end of intervention. Conclusion Pleasant and engaging activities facilitated by nursing staff, such as group activity with Paro, could improve quality of life in people with severe dementia. The trial is in adherence with the CONSORT statement and is registered at (study ID number: NCT02008630). [ABSTRACT FROM AUTHOR]

Aims and Objectives The study aims to evaluate the effects of a communication skills training programme on community aged care staff's knowledge of communication support in dementia and on staff's care experience. Background Dementia can lead to impairments in communication. Therefore, quality community-based dementia care requires that staff be skilled communicators, equipped to facilitate interactions with people with dementia. The current investigation evaluated the effectiveness of the MESSAGE Communication Strategies in Dementia for Care Staff training programme with respect to knowledge of communication support and the staff/caregiver experience. Design A multi-centre controlled pretest/post-test design with randomised cohort allocation was used. Outcome measures were completed at baseline, immediately after training (training group only), and at three-month follow-up. Methods Thirty-eight care staff working in community aged care participated and completed all outcome measures (training = 22; control = 16).Training and control groups completed the following outcome measures: knowledge of communication support strategies, self-efficacy, preparedness to provide care, strain in nursing care and attitude to dementia care. Staff in the training group provided written feedback on the training. Results A significant improvement in knowledge scores from baseline was found for the training group both immediately after training and at three-month follow-up. There was also a significant training effect for self-efficacy and preparedness to provide care. No significant difference was found for the control group for any measure. No significant training effects were found for measures of strain or attitudes to dementia care. Feedback from staff suggests that the training was well received. Conclusions The MESSAGE training was positively received by staff and had a significant effect on care staff knowledge, and confidence to provide care for people with dementia. Relevance to clinical practice The easily accessible multimedia training programme is well received by staff and has the potential to improve quality of care. [ABSTRACT FROM AUTHOR]

Accessible summary Prevalence of dementia is expected to increase globally, and as such, so is the demand on health, social, legal and financial services., It is important to understand the experience and needs of families living with dementia in order to reduce the direct and indirect costs of dementia., Maintaining purposeful activity (work or volunteering) may help to preserve the person with dementia's dignity and sense of self and also facilitate carers and family members to continue to work and support the person with dementia., The provision of high-quality and age-specific day programmes for younger people with dementia can potentially play a significant role in providing this purposeful activity in a safe and supportive environment., Abstract As the global focus on dementia care increases due to the demand on health, social, legal and financial services, it is imperative to further understand the experience of those living with a diagnosis of dementia. There is a particular lack of research focused on younger people (under the age of 65 years) with dementia and virtually none focuses on the experience of the family unit. The literature suggests that periods of transition place significant stressors on families living with dementia. One such transition is the transition out of perceived purposeful activity, be this employment or voluntary work. This transition was explored during the course of a qualitative repeated interview study with younger people with dementia and their families. Nine families (20 participants) took part in semi-structured research interviews that were transcribed and analyzed using a Framework approach to qualitative analysis. Meaningful Activity emerged as a major theme through this analysis. Two subthemes also emerged: (1) the traumatic cessation of work; and (2) the need for purposeful activity. These themes have significant clinical implications as maintaining a purposeful role through high-quality, age-specific dementia services may decrease the direct and indirect costs of dementia to global economies. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore published literature that describes what is known about the role of informal caregivers as they manage medications for older adults and/or people living with dementia residing in the community. Background The number of informal caregivers of older adults, including people living with dementia, is growing worldwide. Good medication management by informal caregivers contributes to improved health outcomes and reduced institutionalisations for the care recipient; however, little is known about this domain of care. Design Narrative review. Methods A literature search was conducted to identify relevant research articles written in English between January 2000-April 2013, sourced from online database searches using multiple keywords, reviewing reference lists and citations of key articles and Internet searches. Articles were included if they described informal caregiver medication management for older adults and/or people living with dementia. Results Ten articles were found that described this role from the perspective of the informal caregiver. The evidence suggests that this role is complex and is often made more difficult because of increasing medication regimen complexities, aspects of the relationship between the caregiver and the care recipient, healthcare system practices and a lack of information and/or training available to the informal caregiver, especially when caring for people living with dementia. Conclusion Responsibility for managing medications for older adults and/or people living with dementia in the community often falls to informal caregivers. More information resources are required for this role, which requires specific medication management skills and knowledge and is further complicated by the cognitive decline of the care recipient. Relevance to clinical practice Informal caregivers are often expected to manage medications in a safe and effective manner for their older care recipient, who may also have cognitive impairment. Nurses, who may be in frequent contact with community-living older adults/people living with dementia, can be an important source of information, training and support for informal caregivers. [ABSTRACT FROM AUTHOR]

Aim To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities. Background Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units. Design This study had a cross-sectional design. Method Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010. Findings Person-centred care was correlated with residents' ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care. Conclusions There seems to be a relationship between person-centredness, residents' ability to perform activities of daily living, and residents' quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. To provide insight into family caregiver perspectives on social relations within the 'caregiving triangle' between family caregiver, professional caregiver and elderly resident with dementia. Results were compared between traditional versus small-scale long-term care settings in the Netherlands and Belgium. Background. Residential dementia care is shifting towards a more holistic and person-centred approach. Until now, little is known about family caregiver perspectives. Design. A quasi-experimental longitudinal design. Methods. This study was part of a larger research project focusing on the quality of life of residents with dementia in traditional and small-scale settings ( n = 179). This study focused on family caregivers related to these residents ( n = 64). They filled in a questionnaire containing 25 items (baseline and after 12 months) related to their perspectives on the interaction within the 'caregiving triangle'. Analyses were performed using mixed models and logistic regression. Results. Compared to traditional settings, family caregivers of relatives with dementia living in small-scale settings had more contact with the professional caregivers, were more satisfied with this contact and felt that staff paid more attention to their feelings as family members. They also reported that staff showed better listening skills towards the residents. Furthermore, compared to those in Belgium, family caregivers in the Netherlands perceived staff to be less hurried and more accepting of help from family and felt that staff more often takes the resident seriously. Conclusion. In the move towards more person-centred care for residents with dementia, this study finds preliminary evidence for the importance of integrating the family perspective. Relevance to clinical practice. Gaining more insight into the perspectives of family caregivers on the social relations within the 'caregiving triangle' may provide knowledge about the importance of the social system surrounding elderly residents with dementia and can provide pointers for future research. [ABSTRACT FROM AUTHOR]

jonas-simpson c., mitchell g.j., carson j., whyte c., dupuis s. & gillies j. (2012) Phenomenological shifts for healthcare professionals after experiencing a research-based drama on living with dementia. Journal of Advanced Nursing 68(9), 1944-1955. Abstract Aim. The aim of this article is to report research findings describing phenomenological shifts, that is, changes in patterns of lived experience, for healthcare professionals who attended a performance of a research-based drama, called I'm Still Here. Background. The research drama, based on six studies, was created to help change the ways persons understand, think about and relate with persons living with dementia. Methods. In 2006-2007, 50 healthcare professionals from various disciplines and eight nursing students participated in this study. Participants were recruited from four Canadian cities in the province of Ontario where focus groups were held before and after engaging in a live performance of I'm Still Here. Findings. Analysis of focus group transcripts showed shifts in patterns of lived experience for the healthcare professional participants as evident in the participants' descriptions. The phenomenological shifts reflected a move from descriptions of 'diminishing humanness to discerning humanness', from 'disengaged care/mundane relating to reflexive relating in the now', and 'terrifying portrayals of loss to awakening to hopeful possibility'. The shifts described herein are supported with examples from the focus group transcripts. Conclusions. Findings reveal the power of drama as a vibrant and meaningful means of shifting understandings, images and intended actions of healthcare professions which have the potential to affect the lived experiences, relationships and quality of life of persons with dementia. [ABSTRACT FROM AUTHOR]

Accessible summary There is currently no standard provision of care for younger people with dementia and their families in the UK and there is little involvement of families in care provision and care planning., Specialist services for young-onset dementia are consistently recommended in published and grey literature but continue to be overlooked in UK healthcare policy and service development., Staff experience difficulty working with family relationships because they are complex and family members often have different views and opinions about the best approach to care., Recommendations are made for the implementation of family-centred working in dementia care to increase the effectiveness of care for families living with a diagnosis of young-onset dementia., Abstract There is no standard model of specialist care for younger people with dementia (onset before the age of 65 years) and specialist service provision varies widely throughout the UK. In order to gain a clearer picture about ways in which clinical staff work with younger people with dementia, semi-structured interviews were conducted with dementia care staff working in the north-west of England. Interviews focused on exploring daily working practices and the meaning placed on clinical decision making when involving family/carers in routine practice. Content analysis generated three core themes: (1) Maintaining Separation: how clinical staff conceptualize the meaning of 'family' in the provision of dementia care services; (2) Providing Practical Help: the focus in care provision on assisting families with aspects of daily life such as finances, education and physical care; and (3) Acknowledging the Family Context: how staff understand and interact with family members in an attempt to initiate care, utilizing biographically informed practice. By understanding how staff view their role in providing younger people with dementia with effective, high-quality dementia care, it is anticipated that a more family-centred approach can be integrated into already established patterns of working that more holistically meet the needs of this group. [ABSTRACT FROM AUTHOR]

Aim. To describe the frequency of aggressive acts experienced by frontline staff working in two models of dementia care: Residential Alzheimer's Care Centers and Secured Dementia Units and to explore the associations between aggressive acts experienced by frontline staff and factors related to the work context and care providers. Background. Aggression towards healthcare providers in residential long-term care settings is well documented. However, few studies have examined associations between aggressive behaviours towards care providers and organisational factors. Design. A cross-sectional survey. Method. The survey included demographic items and questions about aggressive acts experienced by staff and contextual factors. Analyses included: (1) descriptive statistics, (2) tests of difference (i.e. Student's t-test, Mann-Whitney U-test, chi-squared test and anova), (3) bivariate associations (i.e. Pearson and Spearman rank order correlations) and (4) multivariate linear regression. Results. Ninety-one health care aides and licensed practical nurses working in four nursing units using two models of dementia care participated (response rate 81%). The most frequently reported types of aggression were physical assault (50% of staff, n = 45) and emotional abuse (48% of staff, n = 44). Aggressive acts were significantly associated with working in Secured Dementia Units rather than Residential Alzheimer's Care Centers. Conclusions. Frontline staff working in Secured Dementia Units were exposed to higher frequencies of various types of aggressive acts mainly initiated by residents. Future research needs to explore modifiable workplace factors associated with aggressive acts in a larger sample across a variety of long-term care settings. Relevance to clinical practice. To prevent staff perceived aggressive acts, leaders and managers in dementia care need to acknowledge the complex topic of workplace aggression and encourage an open discussion among frontline staff without assigning blame. Care provider strategies for dealing with aggressive behaviour have to be implemented in policies and clinical practice. [ABSTRACT FROM AUTHOR]

Aggression is reportedly common among older people with dementia in residential care. The attitudes of staff in care homes and strategies they use are under researched. Theoretical models that may be used to both understand and respond to such behaviour exist. They are the standard and person-centred paradigms. The aim of this study was to explore the views of nursing staff about aggressive behaviour in people with dementia and strategies used in practice. A survey of the attitudes of staff in six dementia care units using the Management of Aggression in People with Dementia Attitude Questionnaire was conducted including an audit of aggressive incidents using the Staff Observation Aggression Scale -- Revised over a 3-month period. Staff expressed views reflective of a person-centred as opposed to standard paradigm. They viewed aggressive behaviour by people with dementia as deriving from the environment, situation or interactions with others. Participants strongly supported interpersonal means of responding to aggression, the moderate use of medication, and were largely opposed to physical restraint. Aggressive incidents were managed using less intrusive strategies such as distraction and de-escalation. Responses to aggressive behaviour, while pragmatic, were largely underpinned by a person-centred ethic as reflected in the attitudes expressed by staff. [ABSTRACT FROM AUTHOR]