What works in delivering dementia education or training to hospital staff? A critical synthesis of the evidence

Background: The quality of care delivered to people with dementia in hospital settings is of international concern. People with dementia occupy up to one quarter of acute hospital beds, however, staff working in hospitals report lack of knowledge and skills in caring for this group. There is limited evidence about the most effective approaches to training hospital staff on dementia. Objective: The purpose of this literature review was to examine published evidence on the most effective approaches to dementia training and education for hospital staff. Design and review methods: The review was conducted using critical synthesis and included qualitative, quantitative and mixed/multi-methods studies. Kirkpatrick’s four level model for the evaluation of training interventions was adopted to structure the review. Data sources: The following databases were searched: MEDLINE, PsycINFO, CINAHL, AMED, British Education Index, Education Abstracts, ERIC (EbscoHost), The Cochrane Library-Cochrane reviews, Economic evaluations, CENTRAL (Wiley), HMIC (Ovid), ASSIA, IBSS (Proquest), Conference Proceedings Citation Indexes (Web of Science), using a combination of keyword for the following themes: Dementia/Alzheimer’s, training/education, staff knowledge and patient outcomes. Results: A total of 20 papers were included in the review, the majority of which were low or medium quality, impacting on generalisability. The 16 different training programmes evaluated in the studies varied in terms of duration and mode of delivery, although most employed face-to-face didactic techniques. Studies predominantly reported on reactions to training and knowledge, only one study evaluated outcomes across all of the levels of the Kirkpatrick model. Key features of training that appeared to be more acceptable and effective were identified related to training content, delivery methods, practicalities, duration and support for implementation. Conclusions: The review methodology enabled inclusion of a broad range of studies and permitted common features of successful programmes to be identified. Such features may be used in the design of future dementia training programmes, to increase their potential for effectiveness. Further research on the features of effective dementia training for hospital staff is required

Monitoring and improving the quality of person-centred care in health and social settings using Dementia Care Mapping (DCM): Staff experiences of implementation barriers and supports

Dementia Care Mapping (DCM) is a person-centred care quality monitoring and improvement tool used for nearly 20 years in formal dementia care settings and there are thousands of people trained in its use internationally. However, little is known about if and how DCM is used in practice or regarding application of inter-rater reliability checks to ensure data quality. This study aimed to explore the application of DCM in practice in the UK. A mixed methods design including an on-line survey and in-depth, semi-structured interviews was employed. There were 98 survey respondents, representing 71 health and social care, University/research and training/consultancy organisations. Twenty-one people participated in the semi-structured interviews. Fifty-nine percent of survey respondents had used DCM since completing training. Those working in clinical roles and in health and social care provider organisations were least likely to have used DCM. A range of barriers and supports to use of DCM in practice after training were reported, including lack of management support and time. The majority of those who had used DCM also conducted inter-rater reliability checks at least once per year or more frequently. Of the 20% who did not the main barriers to this were absence of someone to conduct the checks with and lack of time and resources. The study has shown that it is possible to apply an evidence-based quality monitoring and improvement tool such as DCM to support implementation of person-centred care in practice, despite widespread limitations on time and resources as well as identifying a range of setting conditions that can help or hinder implementation

Looking Under the Hood of Competency-Based Education: The Relationship Between Competency-Based Education Practices and Students' Learning Skills, Behaviors, and Dispositions

The Nellie Mae Education Foundation (Nellie Mae), in partnership with the American Institutes for Research (AIR), has recently released a comprehensive analysis of competency-based education (CBE), an instructional approach that emphasizes what students learn and master rather than time spent in a classroom. The study, titled "Looking Under the Hood of Competency-Based Education," examines the relationship between various competency-based practices and increased student learning capacity. Additionally, the study highlights the varying degrees of CBE practices in schools that have an existing reputation for implementation."Schools across the country are increasingly seeking ways to provide a competency-based education for students, yet many educators are not sure of where to begin or how they can implement this approach to learning," said Eve Goldberg, Director of Research at the Nellie Mae Education Foundation. "The framework developed by AIR of learning skills, behaviors, and dispositions and the findings on specific practices can help educators strengthen their practices and gives them the tools to continuously improve their practice. We hope educators interested in making this shift will benefit from this analysis.""Looking Under the Hood" analyzes a variety of competency-based practices to examine how schools implement CBE and determine how it relates to students' learning capacities. Some notable findings include:Learning in contexts outside the classroom (for example, internships) positively relates to increasing students' learning capacitiesThe option for students to learn at a comfortable pace (for example, extra time to finish a topic or unit and the opportunity to retake an exam or re-do a final project) has a positive association with self-efficacy and increasing students' motivation to learnThe option for students to receive both instruction and assessment in a variety of formats, including collaborative group projects, helped students' intrinsic motivationEstablishing clear learning targets was positively related to increasing students' learning capacitiesOverall, the study finds that many students' experiences with CBE-aligned practices were positively associated with changes in learning capacities in several areas, most notably in students' intrinsic motivation for classroom work."Competency-based education varies tremendously from school to school and even across classrooms, so it can be hard to determine if it is working," said Erin Haynes, Senior Researcher at the American Institutes for Research. "This study examined specific CBE-aligned practices, giving us a more finely-honed view of how such practices are related to students' capacity to learn. We hope this research will help inform future efforts to implement competency-based methods across districts, schools and classrooms.

Impact of a person-centred dementia care training programme on hospital staff attitudes, role efficacy and perceptions of caring for people with dementia: A repeated measures study.

Background: People with dementia occupy up to one quarter of acute hospital beds. However, the quality of care delivered to this patient group is of national concern. Staff working in acute hospitals report lack of knowledge, skills and confidence in caring for people with dementia. There is limited evidence about the most effective approaches to supporting acute hospital staff to deliver more person-centred care. Objectives: This study aimed to evaluate the efficacy of a specialist training programme for acute hospital staff regarding improving attitudes, satisfaction and feelings of caring efficacy, in provision of care to people with dementia. Design: A repeated measures design, with measures completed immediately prior to commencing training (T1), after completion of Foundation level training (T2: 4-6 weeks post-baseline), and following Intermediate level training (T3: 3-4 months post-baseline). Setting: One NHS Trust in the North of England, UK. Participants: 40 acute hospital staff working in clinical roles, the majority of whom (90%) were nurses. Methods: All participants received the 3.5 day Person-centred Care Training for Acute Hospitals (PCTAH) programme, comprised of two levels, Foundation (1/2 day) and Intermediate (3 days), delivered over a 3-4 month period. Staff demographics and previous exposure to dementia training was collected via a questionnaire. Staff attitudes were measured using the Approaches to Dementia Questionnaire (ADQ), satisfaction in caring for people with dementia was captured using the Staff Experiences of Working with Demented Residents questionnaire (SEWDR) and perceived caring efficacy was measured using the Caring Efficacy Scale (CES). Results: The training programme was effective in producing a significant positive change on all three outcome measures following intermediate training compared to baseline. A significant positive effect was found on the ADS between baseline and after completion of Foundation level training, but not for either of the other measures. Conclusions: Training acute hospital staff in Intermediate level person-centred dementia care is effective in producing significant improvements in attitudes towards and satisfaction in caring for people with dementia and feelings of caring efficacy. Foundation level training is effective in changing attitudes but does not seem to be sufficient to bring about change in satisfaction or caring efficacy

Exploring the potential for secondary uses of Dementia Care Mapping (DCM) data for improving the quality of dementia care

The reuse of existing datasets to identify mechanisms for improving healthcare quality has been widely encouraged. There has been limited application within dementia care. Dementia Care Mapping is an observational tool in widespread use, predominantly to assess and improve quality of care in single organisations. Dementia Care Mapping data have the potential to be used for secondary purposes to improve quality of care. However, its suitability for such use requires careful evaluation. This study conducted in-depth interviews with 29 Dementia Care Mapping users to identify issues, concerns and challenges regarding the secondary use of Dementia Care Mapping data. Data were analysed using modified Grounded Theory. Major themes identified included the need to collect complimentary contextual data in addition to Dementia Care Mapping data, to reassure users regarding ethical issues associated with storage and reuse of care related data and the need to assess and specify data quality for any data that might be available for secondary analysis

Dementia care mapping in long-term care settings: a systematic review of the evidence

YesThis systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings. The review was limited to studies that used Dementia Care Mapping as an intervention and included outcomes involving either care workers and/or people living with dementia. Searches were conducted in PubMed, Web of Knowledge, CINAHL, PsychINFO, EBSCO and Scopus and manually from identified articles reference lists. Studies published up to January 2017 were included. Initial screening of identified papers was based on abstracts read by one author; full-text papers were further evaluated by a second author. The quality of the identified papers was assessed independently by two authors using the Cochrane Risk of Bias Tool. A narrative synthesis of quantitative findings was conducted. We identified 6 papers fulfilling predefined criteria. Studies consist of recent, large scale, good quality trials that had some positive impacts upon care workers’ stress and burnout and benefit people with dementia in terms of agitated behaviours, neuropsychiatric symptoms, falls and quality of life. Available research provides preliminary evidence that Dementia Care Mapping may benefit care workers and people living with dementia in care settings. Future research should build on the successful studies to date and use other outcomes to better understand the benefits of this intervention

A biopsychosocial interpretation of the Neuropsychiatric Inventory – Nursing Home assessment: reconceptualising psychiatric symptom attributions

Background: The Neuropsychiatric Inventory is predicated on the assumption that psychiatric symptoms are manifestations of disease. Biopsychosocial theories suggest behavioural changes viewed as psychiatric may also arise as a result of external behavioural triggers. Knowing the causes of psychiatric is important since the treatment and management of psychiatric symptoms relies on this understanding. Aims: This study sought to understand the causes of psychiatric symptoms recorded in care home settings by investigating qualitatively described symptoms in NPI-NH interviews. Method: The current study examined the NPI-NH interviews of 725 participants across 50 care homes. The qualitatively described symptoms from each of the 12 subscales of the NPI were extracted: 347 interviews included at least one qualitatively described symptom (n=651 descriptions). A biopsychosocial algorithm developed following a process of independent researcher coding (n=3) was applied to the symptom descriptions. This determined whether the description had predominantly psychiatric features, or features that were cognitive or attributable to other causes (i.e. issues with Orientation & Memory, Expressions of Need, Poor Care and Communication or Understandable Reactions) Results: Our findings suggest that the majority (over 80%) of descriptions described symptoms with features that could be attributable to cognitive changes and external triggers (e.g. poor care and communication). Conclusions: The finding suggest that in its current form the NPI-NH may over attribute the incidence of psychiatric symptoms in care homes by overlooking triggers for behavioural changes. Measures of psychiatric symptoms should determine the causes of behavioural changes in order to guide treatments more effectively

El Comité de los Veinte: Su origen, su evolución y sus procedimientos

El autor describe el establecimiento y desarrollo del Comité de la Junta de Gobernadores que se creó en 1972 para preparar los proyectos de reforma del sistema monetario internacional.En su reunión anual de 1972, la Junta de Gobernadores del Fondo instituyó un comité para ayudar a resolver las cuestiones de la reforma monetaria internacional. Se denominó oficialmente en el "Comité ad hoc de la Junta de Gobernadores para la Reforma del Sistema Monetario Internacional y Cuestiones Afines", pero en el uso corriente el nombre se abrevia a "Comité de los Veinte", título que alude al número de los comitentes que eligen a los miembros del Comité