Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial

Aasmul, Irene; Husebø, Bettina S.; Flo, Elisabeth

doi:10.1016/j.jpainsymman.2016.07.004

Cited by 20 publications

(11 citation statements)

References 41 publications

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“…We found a decrease in nursing staff distress in the intervention as compared to the control group. This is in line with previous studies, which have demonstrated a link between staff distress and staff competence in the NH setting (Aasmul et al, 2016). Increased knowledge may also empower staff members to cope with difficult symptoms (Hsu et al, 2007; Whitaker et al, 2014).…”

Section: Discussionsupporting

confidence: 93%

Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

et al. 2018

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Introduction: The majority of nursing home (NH) patients suffer from complex diseases, including dementia. This makes advance care planning (ACP) particularly important.Objectives: The aim was to investigate the effect of an ACP intervention on communication among NH staff, patient, and family. We further investigated whether the intervention affected nursing staff distress.Methods: The ACP intervention was a part of the 4-month cluster randomized controlled COSMOS trial with a 9-month follow-up. Norwegian NH units (n = 72), with 765 patients were invited, and eligible units were cluster randomized to usual care or the intervention group. The ACP intervention consisted of an education program targeting all NH staff (nurses and physicians) and managers. Implementation was supported by a train-the-trainer approach, with regular phone calls from the researchers. The effect of the intervention was assessed by a data collection form and questionnaires. Nursing staff distress was assessed by the Neuropsychiatric Inventory -Nursing Home version.Results: Five hundred and forty five patients from 67 NH units were included and randomized to the intervention (N = 297; 36 units) and control group (N = 248; 31 units). Organized meetings between the family, patient, and nurses were conducted more frequently in the intervention compared to the control group at month 4 (OR = 3.9, 95% CI = 1.6 to 9.4, p = 0.002). Monthly contact between family and nurses was also more frequent in the intervention group (OR = 6.5, 95% CI = 1.6 to 3.5, p = 0.010). Nurses and families were more satisfied with their communication in the intervention compared to the control group. Staff distress was reduced in the intervention group at month 4 (B = -1.8, 95% CI = -3.1 to -0.4, p = 0.012). The intervention effect at month 4 did not persist during follow-up at month 9.Conclusion: Compared to control, the ACP intervention improved the communication, and family and staff satisfaction as well as reduced staff distress. However, during the follow-up period these positive effects were not persistent. Indicating the necessity for ongoing staff support regarding ACP.Trial Registration: www.ClinicalTrials.gov (NCT02238652).

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Section: Discussionsupporting

confidence: 93%

Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

et al. 2018

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“…Though it may be assumed that care home staff would be less affected than relatives who would be caring for someone at home, they often discussed how it made their job more stressful. Sleep disturbances in care home residents have been associated with staff distress in a number of quantitative studies (Aasmul et al, 2016;Song and Oh, 2015;Zwijsen et al, 2014) and may cause particular distress for staff caring for residents with early onset (Van Duinen-Van Den Ijssel et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study

Webster¹,

Powell²,

Costafreda

et al. 2020

Int. Psychogeriatr.

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Objectives: Nearly 40% of care home residents who are living with dementia also have symptoms of disturbed sleep. However, the impact of these disturbances is relatively unknown and is needed to indicate whether interventions are warranted; therefore, we aimed to investigate the impact. Design: One-to-one semi-structured interviews. Settings: Four UK care homes. Participants: We interviewed 18 nurses and care assistants about residents with sleep disturbances. Measurements: We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio recorded and transcribed and then analyzed thematically by two researchers independently. Results: Staff described that sleep disturbances in most, but not all, residents impacted negatively on the resident, other residents, staff, and relatives. Residents became more irritable or agitated if they had slept badly. They slept in the daytime after a bad night, which then increased their chances of being awake the following night. For some, being sleepy in the day led to falls, missing medication, drinks, and meals. Staff perceived hypnotics as having low efficacy, but increasing the risk of falls and drowsiness. Other residents were disturbed by noise, and staff described stress when several residents had sleep disturbance. Some of the strategies reported by staff to deal with sleep disturbances such as feeding or providing caffeinated tea at night might be counterproductive. Conclusions: Sleep disturbances in care home residents living with dementia negatively affect their physical and psychological well-being. These disturbances also disturb other residents and increase stress in staff.

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“…The patients in our study had a low MMSE score, which complicates the implementation of ACP due to patients’ inability to communicate sufficiently and provide consent. At the same time, this is the reality in the today’s NH population, where most are multimorbid and have dementia, resulting in a high need for education in delivering ACP to people with reduced capacity [ 8 , 22 , 44 , 48 , 50 , 51 ]. Importantly, the COSMOS education programme met this need, which subsequently influenced the feasibility, fidelity, and sustainability of the implementation [ 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation

2018

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BackgroundAdvance Care Planning (ACP) is the repeated communication and decision-making process between the patient, family, and healthcare professionals. This study describes an ACP intervention in nursing homes and evaluates the outcomes of the implementation process.MethodsThe ACP intervention was part of a 4-month complex, cluster randomized controlled trial (COSMOS). 37 Norwegian nursing homes with 72 units (1 cluster = 1 unit) and 765 patients were invited to participate and eligible units were randomised to the intervention group or control. Nursing home staff in the intervention group was offered a standardized education programme to learn early and repeated communication with patients and families and to implement ACP in their units. We used a train-the-trainer approach to educate staff in the units, supported by regular telephone calls and a midway seminar after two months. Individual patient logs consisting of different communication deliverables were used to evaluate the implementation process. Supported by Qualitative Content Analyses, we identified facilitators and barriers of the ACP implementation based on feedback during midway seminars and individual patient logs.ResultsThe ACP intervention was conducted in 36 NH units (n = 297); 105 healthcare providers participated at the education seminar prior to the study, and 3–4 employees from each unit participated in the midway seminar. NH staff reported the educational material relevant for the implementation strategy. The patient logs showed that ACP was successfully implemented in 62% (n = 183) of the patients using our predefined implementation criteria. The staff emphasized the clear communication of the relevance of ACP addressed to leaders and staff as important facilitators, along with the clearly defined routines, roles and responsibilities. Identified barriers included lack of competence, perceived lack of time, and conflicting culture and staff opinions.ConclusionMonthly communication with the family was the most frequently conducted communication, and the predefined criteria of successfully implemented ACP were largely achieved. Nursing home routines and engagement of leaders and staff were crucial facilitators, whereas lack of time and competence reduced the implementation success.Trial registrationThe COSMOS-trial was registered in the ClinicalTrials.gov (NCT02238652) July 7th, 2014Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0713-7) contains supplementary material, which is available to authorized users.

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Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial

Cited by 20 publications

References 41 publications

Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study

Description of an advance care planning intervention in nursing homes: outcomes of the process evaluation

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