Staff training using STAR: a pilot study in UK care homes

2012 ◽  
Vol 24 (6) ◽  
pp. 911-920 ◽  
Author(s):  
Judith Goyder ◽  
Martin Orrell ◽  
Jennifer Wenborn ◽  
Aimee Spector
Keyword(s):  
Pilot Study ◽  
Behavioral Problems ◽  
Staff Training ◽  
Large Scale ◽  
Controlled Trial ◽  
Care Home ◽  
Care Staff ◽  
Care Homes ◽  
People With Dementia ◽  
Star Program

ABSTRACTBackground: Symptoms such as depression, anxiety, and behavioral problems are very common in people with dementia living in care homes. Staff training has been identifed as a promising psychosocial intervention. This pilot study investigated the feasibility of implementing the Staff Training in Assisted Living Residences (STAR) program in UK care homes.Methods: The eight-week STAR program was delivered in two care homes. Twenty-five care staff attended the training. Thirty-two residents, with dementia and clinically significant anxiety, depression, or behavioral problems, were included in the study. Residents and staff were assessed at baseline and eight-week follow-up.Results: Residents demonstrated significantly reduced symptoms of depression and behavioral problems following the implementation of the program, although resident-rated quality of life and anxiety symptoms did not improve significantly. Staff sense of hopefulness towards people with dementia also improved significantly and staff rated themselves as significantly more competent at forming relationships with residents.Conclusion: Delivering the STAR program to care staff can have an impact on the behavioral and psychological symptoms of dementia displayed by care home residents. The program was feasible to implement and was rated highly by care staff. A large-scale randomized controlled trial is now required to evaluate the effectiveness of this training intervention.

scholarly journals Restraints and Restrictive Interventions during Essential Personal Care in Elderly People Living with Dementia in Care Homes

2021 ◽  
pp. 26-38
Author(s):  
Matthew Crooks ◽  
Katherine Wakenshaw ◽  
Julie Young ◽  
Kayleigh Purvis ◽  
Karin Smith ◽  
...  
Keyword(s):  
Care Home ◽  
Legal Framework ◽  
Care Staff ◽  
Care Homes ◽  
Personal Care ◽  
Personal Assistance ◽  
Care Home Staff ◽  
People With Dementia ◽  
Training Materials ◽  
Materials Used

Care home staff are frequently required to provide invasive personal care for their residents, and on occasions need to use restraint and restrictive practices with people with dementia. This often occurs in situations where the residents no longer have the insight that they require help and may misperceive the personal assistance as an assault. On a practical level, a significant number of people with dementia are currently being admitted to inpatient units due to their level of resistance around essential personal care. Often these same people are settled at all other times. This paper provides practical advice on how to support residents and their caregivers, and gives clinical, legal and ethical guidance. Previous work undertaken by the present authors have shown that care staff require supervision and coaching on this topic. The paper includes training materials used by the authors.  This includes a composite, fictitious case example that illustrates approaches that are compliant with UK guidelines.  It addresses the training of staff working in care homes. As such this paper provides a review and practical example of the appropriate use of restraint for residents unable to consent to the ‘intimate’ care they are receiving. It describes a method delivered in a person-centred manner and within a legal framework.  Having read this paper, care home staff should feel more confident, competent and secure in the assistance they are providing in this contentious area.

scholarly journals MEDREV: feasibility study of a combined pharmacy–health psychology intervention to improve care for people with dementia with behaviour that challenges in care homes

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703253
Author(s):  
Ian Maidment
Keyword(s):  
Feasibility Study ◽  
Qualitative Interviews ◽  
Care Home ◽  
Training Session ◽  
Dementia Care ◽  
Training Data ◽  
Care Staff ◽  
Care Homes ◽  
Inappropriate Use ◽  
People With Dementia

Background‘Behaviour that Challenges’ is common in older people with dementia in care homes and treated with antipsychotics. Policy is focused on reducing the use of antipsychotics in people with dementia and therefore reducing harm. This submission reports results on a NIHR-funded feasibility study MEDREV.AimTo assess the feasibility of medication review by a specialist dementia care pharmacist combined with staff training with the objective of limiting the inappropriate use of psychotropics.MethodCare homes were recruited. People meeting the inclusion (dementia; medication for behaviour that challenges), or their personal consultee, were approached. A specialist dementia care pharmacist reviewed medication and made recommendations. Care staff received a 3-hour training session promoting person-centred care and GPs’ brief training. Data were collected on recruitment and retention, and implementation of recommendations. Other outcomes included the Neuropsychiatric Inventory-Nursing Home version, quality of life (EQ-5D/DEMQoL), cognition (sMMSE), and health economic (CSRI). Qualitative interviews explored expectations and experiences.ResultsMedication reviews were conducted in 29 of 34 residents recruited and the pharmacist recommended reviewing medication in 21 of these. Fifteen (71.4%) of these were antidepressants: 57.1% (12 of 21) of recommendations were implemented and implementation took a mean of 98.4 days. Non-implementation themes for will be presented. One hundred and sixty-four care staff received training (care homes = 142; primary care = 22). Twenty-one participants (care home managers = 5; GPs = 3; nurses = 2; care staff = 11) were interviewed.ConclusionThe study was feasible, although the approach would need modification to improve the uptake of reviews and reduce the delay in implementation. Most of the recommendations related to antidepressants.

scholarly journals Exploring the role of external experts in supporting staff to implement psychosocial interventions in care home settings: results from the process evaluation of a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Claire A. Surr ◽  
Emily Shoesmith ◽  
Alys W. Griffiths ◽  
Rachael Kelley ◽  
Joanne McDermid ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Care Home ◽  
Psychosocial Interventions ◽  
Care Homes ◽  
Successful Implementation ◽  
Care Home Staff ◽  
People With Dementia ◽  
External Expert ◽  
Expert Support

Abstract Background Psychosocial interventions offer opportunities to improve care for people with dementia in care homes. However, implementation is often led by staff who are not well prepared for the role. Some interventions use external experts to support staff. However little is known about external expert, care home staff and manager perceptions of such support. This paper addresses this gap. Methods Multi-methods study within a process evaluation of a cluster randomised controlled trial of Dementia Care Mapping™ (DCM). Interviews were conducted with six external experts who also completed questionnaires, 17 care home managers and 25 care home staff responsible for DCM implementation. Data were analysed using descriptive statistics and template analysis. Results Three themes were identified: the need for expert support, practicalities of support and broader impacts of providing support. Expert support was vital for successful DCM implementation, although the five-days provided was felt to be insufficient. Some homes felt the support was inflexible and did not consider their individual needs. Practical challenges of experts being located at a geographical distance from the care homes, limited when and how support was available. Experts gained knowledge they were able to then apply in delivering DCM training. Experts were not able to accurately predict which homes would be able to implement DCM independently in future cycles. Conclusions An external expert may form a key component of successful implementation of psychosocial interventions in care home settings. Future research should explore optimal use of the expert role.

The experiences of Indian migrant care home staff working with people with dementia: a pilot study exploring cultural perspectives

2016 ◽  
Vol 20 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Brandon Ow Yong ◽  
Jill Manthorpe
Keyword(s):  
Pilot Study ◽  
Social Care ◽  
Care Home ◽  
Care Homes ◽  
Term Care ◽  
Content Type ◽  
People With Dementia ◽  
Care Workers ◽  
The Social ◽  
The Uk

Purpose – Little is known about migrant Indian care workers working in long-term care facilities for people with dementia in England and the purpose of this paper is to remedy this lack of information in the light of political interest in immigration to the UK and continued staff shortages in parts of the social care sector. Design/methodology/approach – This pilot study investigated the experiences of workplace acculturation among 12 migrant Indian care workers who were employed in English care homes. Qualitative face-to-face interviews were conducted in 2013. Analysis of the interviews was conducted using principles of interpretative phenomenological analysis. Findings – Following analysis five themes emerged along an acculturation timeline. First, during the first six months of their employment, the migrant care workers recalled feeling vulnerable, seemingly marked by a sense of insecurity and an overwhelming state of cognitive burden within an unfamiliar cultural context. Second, simultaneously, the migrants felt perturbed about their new role as direct care workers. Third, few had been able to draw on their networks of friends and relatives to build up knowledge of their new work environments before starting care home employment. Fourth, two years into the work, although they reported feeling better adapted, psychological and socio-cultural adjustments were still thought to be needed. Fifth, most participants retained their ambition to be recognised as a qualified nurse in the UK and to pursue a nursing career outside the social care sector. Research limitations/implications – This is a pilot study in which 12 migrant Indian care home workers were interviewed. Further interviews might provide a greater range of views and experiences. The care homes that participated in this research were in the London region where staff shortages are common in dementia services such as care homes. Practical implications – The findings suggest a need for employers and human resource managers to respond to the specific needs of Indian and other migrants working with older people who are resident in care homes. Such responses should reflect the timeline of their acculturation and employers need also to acknowledge and address aspirations to move on to NHS work. Originality/value – This study is unique to the best of the authors’ knowledge in addressing Indian care workers specifically as a substantial part of the migrant care workforce in the UK. It offers information about their perceptions and suggests practical human response and managerial initiatives.

scholarly journals 409 - Trends in Involvement, Perceived Role, Role Overload and Self-efficacy of Family Carers of People with Dementia in Care Homes

2020 ◽  
Vol 32 (S1) ◽  
pp. 125-125
Author(s):  
Marleen Prins ◽  
Bernadette Willemse ◽  
Marlous Tuithof ◽  
Henriëtte van der Roest ◽  
Anne Margriet Pot
Keyword(s):  
Self Efficacy ◽  
Care Home ◽  
Care Homes ◽  
Role Overload ◽  
Family Carers ◽  
Change Over Time ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care ◽  
Over Time

IntroductionThe quality of long-term care provided to people with dementia (PwD) in care homes can be improved by implementing person-centered care. Family carers of PwD living in care homes are an important part of person-centered care. However, they often experience high levels of burden, even when a family member with dementia lives in a care home. This study examines trends in the involvement of family carers and their perceived role, role overload and self-efficacy.MethodsData from the Living Arrangements for People with Dementia study, a cross-sectional monitoring study that evaluates developments in care for PwD in care homes in the Netherlands, with four measurement cycles between 2008-2017 was used. Data from the three most current measurement cycles were used, with respectively 144, 47 and 49 participating care homes and 888, 392 and 401 participating family carers. Family involvement was measured by the number of hours per week that family carers visited the PwD and the type of activities they undertook. Perceived caregiving role was measured with the Family Perceptions of Caregiving Role instrument. We used the Self-Perceived Pressure by Informal Care to measure role overload and a 37-item questionnaire was used to measure self-efficacy. We investigated the changes over time (e.g., measurement cycles) of these measures.ResultsThe number of hours that family carers visited the PwD did not change over time. However, there was a trend towards an increase in the variety of activities they undertook. Their perceived caregiving role did not change over time. Self-efficacy of family carers increased over time and they reported more feelings of role overload.ConclusionsDuring the past decade, there has been an increasing trend towards family carers doing more diverse activities with PwD in carer homes. Family carers did feel more competent in their caring role, although their feelings of role overload also increased. Continuing attention is therefore needed for the psychological well-being of family carers after a person with dementia moves to a care home.

Older people dying with dementia: a nationwide study

2012 ◽  
Vol 24 (10) ◽  
pp. 1581-1591 ◽  
Author(s):  
Koen Meeussen ◽  
Lieve Van den Block ◽  
Michael Echteld ◽  
Nicole Boffin ◽  
Johan Bilsen ◽  
...  
Keyword(s):  
Older People ◽  
End Of Life ◽  
Elderly People ◽  
Cognitive Abilities ◽  
End Of Life Care ◽  
Large Scale ◽  
Care Home ◽  
Life Care ◽  
Early Palliative Care ◽  
People With Dementia

ABSTRACTBackground: Large-scale nationwide data describing the end-of-life characteristics of older people with dementia are lacking. This paper describes the dying process and end-of-life care provided to elderly people with mild or severe dementia in Belgium. It compares with elderly people dying without dementia.Methods: A nationwide retrospective mortality study was conducted, via representative network of general practitioners (GPs) in 2008 in Belgium, with weekly registration of all deaths (aged ≥ 65) using a standardized form. GPs reported on diagnosis and severity of dementia, aspects of end-of-life care and communication, and on the last week of life in terms of symptoms that caused distress as judged by the GP, and the patients’ physical and cognitive abilities.Results: Thirty-one percent of our sample (1,108 deaths) had dementia (43% mildly, 57% severely). Of those, 26% died suddenly, 59% in care home, and 74% received palliative treatment, versus 37%, 19%, and 55% in people without dementia. GP–patient conversations were less frequent among those with (45%) than those without (73%) dementia, and 11% of both groups had a proxy decision-maker. During the last week of life, physical and psychological distress was common in both groups. Of older people with dementia, 83% were incapable of decision-making and 83% were bedridden; both significantly higher percentages than found in the group without dementia (24% and 52%).Conclusions: Several areas of end-of-life care provision could be improved. Early communication and exploration of wishes and appointment of proxy decision-makers are important components of an early palliative care approach which appears to be initiated too infrequently.

scholarly journals A qualitative study exploring therapists’ experiences of implementing a complex intervention promoting meaningful activity for residents in care homes

2018 ◽  
Vol 33 (3) ◽  
pp. 575-583 ◽  
Author(s):  
Raymond Smith ◽  
Julia Wood ◽  
Fiona Jones ◽  
Sue Turner ◽  
Michael Hurley
Keyword(s):  
Care Home ◽  
Complex Interventions ◽  
Occupational Therapists ◽  
Care Staff ◽  
Care Homes ◽  
Complex Care ◽  
Meaningful Activity ◽  
Qualitative Interview Study ◽  
Home Intervention ◽  
Trusting Relationships

Objectives: To explore the experiences of occupational therapists and physiotherapists and to reveal any factors that can facilitate delivering a complex care home intervention promoting meaningful activity. Design: Qualitative interview study using data from three focus groups conducted longitudinally post intervention implementation. Data were analysed thematically. Setting: Three residential care homes in South London, UK. Subjects: All therapists involved in the implementation of the intervention: three occupational therapists and three physiotherapists. Results: Three interconnected themes emerged from the analysis: (1) developing trusting relationships, (2) empowering staff and (3) remaining flexible. Therapists described how successfully implementing a complex care home intervention was dependant on developing trusting relationships with care staff. This enabled the therapists to empower care staff to take ownership of the intervention and help embed it in care home culture, facilitating long-term change. The therapists described how remaining flexible in their approach helped keep care staff engaged for the duration of implementation. Conclusion: This study has revealed several important factors that can help facilitate therapists delivering complex interventions in care homes.

The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

2021 ◽  
Vol 27 (8) ◽  
pp. 1-8
Author(s):  
Chris Harvey ◽  
Simon Froggatt ◽  
Bryan Lightowler ◽  
Andrew Hodge
Keyword(s):  
Qualitative Study ◽  
Care Home ◽  
Community Services ◽  
Ambulance Service ◽  
Care Staff ◽  
Care Homes ◽  
Service Demand ◽  
Staff Members ◽  
Care Home Staff ◽  
Advanced Practitioner

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

scholarly journals A systematic review and meta-analysis of the prevalence and associations of stress and burnout among staff in long-term care facilities for people with dementia

2018 ◽  
Vol 31 (08) ◽  
pp. 1203-1216 ◽  
Author(s):  
Harry Costello ◽  
Sebastian Walsh ◽  
Claudia Cooper ◽  
Gill Livingston
Keyword(s):  
Long Term Care ◽  
Meta Analysis ◽  
Care Home ◽  
Maslach Burnout Inventory ◽  
Personal Accomplishment ◽  
Care Staff ◽  
High Turnover ◽  
Term Care ◽  
People With Dementia

ABSTRACTBackground:Care home staff stress and burnout may be related to high turnover and associated with poorer quality care. We systematically reviewed and meta-analyzed studies reporting stress and burnout and associated factors in staff for people living with dementia in long-term care.Methods:We searched MEDLINE, PsycINFO, Web of Science databases, and CINAHL database from January 2009 to August 2017. Two raters independently rated study validity using standardized criteria. We meta-analyzed burnout scores across comparable studies using a random effects model.Results:17/2854 identified studies met inclusion criteria. Eight of the nine studies reporting mean Maslach Burnout Inventory (MBI) scores found low or moderate burnout levels. Meta-analysis of four studies using the 22-item MBI (n = 598) found moderate emotional exhaustion levels (mean 18.34, 95% Confidence Intervals 14.59–22.10), low depersonalization (6.29, 2.39–10.19), and moderate personal accomplishment (33.29, 20.13–46.46). All three studies examining mental health-related quality of life reported lower levels in carer age and sex matched populations. Staff factors associated with higher burnout and stress included: lower job satisfaction, lower perceived adequacy of staffing levels, poor care home environment, feeling unsupported, rating home leadership as poor and caring for residents exhibiting agitated behavior. There was preliminary evidence that speaking English as a first language and working shifts were associated with lower burnout levels.Conclusions:Most care staff for long-term care residents with dementia experience low or moderate burnout levels. Prospective studies of care staff burnout and stress are required to clarify its relationship to staff turnover and potentially modifiable risk factors.

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