Obtaining information from family caregivers to inform hospital care for people with dementia: A pilot study

Abstract

Aim We aimed to implement a systematic nurse–caregiver conversation, examining fidelity, dose and reach of implementation; how implementation strategies worked; and feasibility and mechanisms of the practice change. Background Appropriate hospital care for people living with dementia may draw upon: information from the patient and family caregiver about the patient's perspective, preferences and usual support needs; nursing expertise; and opportunities the nurse has to share information with the care team. Within this context, planned nurse–caregiver communication merits further investigation. Methods In Phase I, we established the ward staff's knowledge of dementia and Alzheimer's disease, prepared seven nurse change leaders, finalised the planned practice change and developed implementation plans. In Phase II, we prepared the ward staff during education sessions and leaders supported implementation. In Phase III, evaluations were informed by interviews with change leaders, follow‐up measures of staff knowledge and a nurse focus group. Qualitative data were thematically analysed. Statistical analyses compared nurses' knowledge over time. Results Planned practice change included nurses providing information packs to caregivers, then engaging in, and documenting, a systematic conversation. From 32 caregivers, 15 received information packs, five conversations were initiated, and one was completed. Knowledge of dementia and Alzheimer's disease improved significantly in change leaders (n = 7) and other nurses (n = 17). Three change leaders were interviewed, and six other nurses contributed focus group data. These leaders reported feeling motivated and suitably prepared. Both nurses and leaders recognised potential benefits from the planned conversation but viewed it as too time‐consuming to be feasible. Conclusions The communication initiative and implementation strategies require further tailoring to the clinical setting. A caregiver communication tool may be a helpful adjunct to the conversation. Implementation may be enhanced by more robust stakeholder engagement, change leader inclusion in the reference group and an overarching supportive framework within which change leaders can operate more effectively. Implications for Practice Nurse‐caregiver communication in this context requires inititatives tailored to the clinical setting with input from all stakeholders.

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

“…Furthermore, patient outcomes were only reported in one study, while outcomes for the relatives were not reported in any of the studies. Thus, [21] showed an improved sense of competence of healthcare staff three months after education, and another study included in our review showed an increase in the knowledge of the healthcare staff after six months [28].…”

“…In total, 19 articles met the inclusion criteria (see the flow chart in Figure 1). Most of the interventional studies had a before-after design [20][21][22][23][24][25][26][27][28] (n = 9). One was a cluster-randomised controlled trial [29], one used a repeated measures design [30] and three were controlled clinical trials [31][32][33].…”

“…Of the interventional studies, five studies were conducted in Australia [22,23,28,32,33], four in the United States [20,24,29,30], two in the United Kingdom [21,26] and one each in Canada [31], Germany [27] and Switzerland [25]. All five systematic reviews were carried out in the UK [14,15,[34][35][36].…”

“…One focused on person-centred care, communication, self-protection and team/patient/family debriefing [31]. One was targeted to prepare nurses and change leader nurses for the implementation of a systematic nurse-caregiver conversation [28]. One educational intervention was an online training programme for nursing assistants and allied healthcare workers and contained information on dementia-friendly principles, communication and wandering and falls [24].…”

“…Four interventional studies identified a significant effect regarding knowledge of healthcare staff [24,26,28] or volunteers [27]. There was a significant increase in knowledge after the end of a two-day communication training course for nurses, doctors and allied health professionals [26] and after an online training tool for nursing assistants and allied health workers [24].…”