scholarly journals Involving the Person with Dementia in Crisis Planning: Focus Groups with Crisis Intervention Teams

2020 ◽  
Vol 17 (15) ◽  
pp. 5412
Author(s):  
Alessandro Bosco ◽  
Justine Schneider ◽  
Claudio Di Lorito ◽  
Emma Broome ◽  
Donna Maria Coleston-Shields ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Therapeutic Relationship ◽  
Care Pathway ◽  
Care Staff ◽  
Framework Analysis ◽  
Term Care ◽  
Staff Members ◽  
Active Involvement ◽  
Person With Dementia

Dementia leads to progressive critical situations that can escalate to a crisis episode if not adequately managed. A crisis may also resolve spontaneously, or not resolve after receiving professional support. Because of the intensity of the crisis, the extent to which the person engages in decision making for their own care is often decreased. In UK mental health services, ‘crisis teams’ work to avert the breakdown of support arrangements and to avoid admissions to hospital or long-term care where possible. This study aimed to explore the views of crisis teams about promoting the involvement of the person with dementia in decision-making at all points in the care pathway, here defined as co-production. The staff of crisis teams from three NHS Trusts in the UK were interviewed through focus groups. Data were analysed using framework analysis. Three focus groups were run with 22 staff members. Data clustered around strategies used to promote the active involvement of the person with dementia, and the challenges experienced when delivering the care. Staff members reported that achieving a therapeutic relationship was fundamental to successful co-production. Miscommunication and/or lack of proper contact between the team and the individuals and carers receiving support adversely affected the quality of care. Making service users aware of the support provided by crisis teams before they need this may help promote a positive therapeutic relationship and effective care management.

Communication Disordered: Program Implementation in Long-Term Care

2016 ◽  
Vol 1 (15) ◽  
pp. 64-67
Author(s):  
George Barnes ◽  
Joseph Salemi
Keyword(s):  
Program Implementation ◽  
Long Term Care ◽  
Family Satisfaction ◽  
Regulatory Compliance ◽  
Care Staff ◽  
Term Care ◽  
Staff Members ◽  
Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

scholarly journals ENHANCING PERSON-CENTERED DEMENTIA CARE BY NURSING HOME STAFF USING MICROLEARNING: LITTLE MESSAGE WITH A BIG IMPACT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S3-S3
Author(s):  
Jenny Inker ◽  
Christine J Jensen ◽  
Sonya Barsness
Keyword(s):  
Job Satisfaction ◽  
Nursing Home ◽  
Focus Groups ◽  
Long Term Care ◽  
Dementia Care ◽  
Care Staff ◽  
Training Curriculum ◽  
Term Care ◽  
Online Platform

Abstract Effective training is critical to providing quality care in long-term care environments, where many residents have dementia. Training has been linked to positive resident care outcomes and improved job satisfaction of staff. The aim of this study was to develop, pilot, and evaluate a Microlearning training curriculum, using short (5-10 minute) “bursts” of training available through an online platform on demand (i.e. 24/7). The expected outcomes were to improve staff knowledge, attitudes, and skills regarding person-centered dementia care and to increase job satisfaction. Researchers translated the Centers for Medicare and Medicaid Hand-in-Hand training curriculum into 52 weekly Microlearning lessons delivered via an online platform (accessible by computer, IPad or smart phone) followed by a short quiz. Using pre- and post-tests, nine focus groups, and fourteen telephone interviews, the researchers engaged with a convenience sample of staff (N = 244) working at all levels from direct care to leadership in nine nursing homes in Virginia. Pre- and post-tests comprised items from the Dementia Attitudes Scale and the Nursing Home Nurse Aide Job Satisfaction Scale. Results from a between subjects t-test demonstrated significant improvements in attitudes to people with dementia. Focus groups and interviews revealed high satisfaction with the training with a significant majority agreeing it was a helpful way to learn and that they were able to apply what they had learned to caring for residents. This pilot demonstrates a promising new practice for training long-term care staff. Further research using a control group receiving usual training is indicated.

Children’s Participation in the Decision-Making Process During Hospitalization: an observational study

2002 ◽  
Vol 9 (6) ◽  
pp. 583-598 ◽  
Author(s):  
Ingrid Runeson ◽  
Inger Hallström ◽  
Gunnel Elander ◽  
Göran Hermerén
Keyword(s):  
Health Care ◽  
Decision Making ◽  
University Hospital ◽  
Care Staff ◽  
Health Care Staff ◽  
Staff Members ◽  
Children’S Participation ◽  
Decision Making Processes ◽  
Children's Participation ◽  
Degree Of Participation

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia

2012 ◽  
Vol 24 (5) ◽  
pp. 753-765 ◽  
Author(s):  
Linda J. Garcia ◽  
Michèle Hébert ◽  
Jean Kozak ◽  
Isabelle Sénécal ◽  
Susan E. Slaughter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Focus Groups ◽  
Long Term Care ◽  
Disruptive Behaviors ◽  
Well Being ◽  
Care Homes ◽  
Term Care ◽  
Staff Members

ABSTRACTBackground: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.Results: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.Conclusion: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

scholarly journals Development and Mixed-Methods Evaluation of a Pain Assessment Video Training Program for Long-Term Care Staff

2013 ◽  
Vol 18 (6) ◽  
pp. 307-312 ◽  
Author(s):  
Michelle M Gagnon ◽  
Thomas Hadjistavropoulos ◽  
Jaime Williams
Keyword(s):  
Focus Groups ◽  
Pain Assessment ◽  
Long Term Care ◽  
Care Staff ◽  
Term Care ◽  
Pain Education ◽  
Video Training ◽  
Training Video

INTRODUCTION: Inadequacies in pain assessment and management in long-term care have been well documented. Insufficient pain education and inaccurate beliefs about the nature of pain and aging have been identified as possible contributors. The present study addresses the need for improved, efficient and feasible continuing pain education through the use of an assessment training video.METHODS: A total of 148 long-term care staff viewed and evaluated the training video. Knowledge changes and pain beliefs were assessed postvideo and at a four-week follow-up. Beliefs about pain, as well as pain and aging, were also examined using multivariate procedures to determine whether these variables influenced participants’ evaluation of the video. Focus groups were also conducted, and transcripts were analyzed using thematic content analysis.RESULTS: Pain assessment knowledge improved postvideo and at the four-week follow-up. Participants positively evaluated the content and quality of the video. Individuals who held stronger beliefs (at baseline) about the organic nature of pain provided more positive evaluations. Barriers to implementation of practices in the video identified by the focus groups (and qualitative analysis) included time, workload and resistance to change. Facilitators to implementation included continued management support and observing the benefits to implementation.DISCUSSION: The present study provides support for the use of video training. However, based on the focus group results, top-down implementation approaches with ongoing management involvement throughout the implementation process may be needed to achieve sustained changes in pain assessment practices. A model useful for sustained implementation was proposed and discussed, and is hoped to facilitate future research.

scholarly journals Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study

2020 ◽  
Author(s):  
Helena Goodman ◽  
Cat Papastavrou Brooks ◽  
Owen Price ◽  
Elizabeth Alexandra Barley
Keyword(s):  
Focus Groups ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Framework Analysis ◽  
Building Relationships ◽  
Staff Members ◽  
Individual Interviews ◽  
Mental Health Settings ◽  
Dynamic Relationships

Abstract Background: Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours.Methods: Semi-structured individual interviews (n=12) and focus groups (n=3) were conducted with eight patients, four carers and twenty-five staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results: Four themes and 15 sub-themes (barrier and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions: This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The different factors which promote fear in each group should be addressed in de-escalation training.

scholarly journals “Just another piece of paperwork”: perceptions of clinicians on delirium screening following hip fracture repair elicited in focus groups

2018 ◽  
Vol 31 (06) ◽  
pp. 877-884
Author(s):  
Tarandeep Oberai ◽  
Maggie Killington ◽  
Kate Laver ◽  
Maria Crotty ◽  
Ruurd Jaarsma
Keyword(s):  
Hip Fracture ◽  
Focus Groups ◽  
Care Pathway ◽  
South Australia ◽  
Vital Role ◽  
Clinical Syndrome ◽  
Adverse Outcomes ◽  
Fracture Repair ◽  
Team Approach ◽  
Term Care

ABSTRACTBackground:Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians’ from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium.Methods:This was a qualitative study using in-depth focus groups discussions with clinical staff of one orthopedic unit within a level 1 trauma center, south of Adelaide, South Australia.Results:A total number of 17 individuals (14 nurses, 1 geriatric registrar, 1 nursing manager, and 1 speech therapist) participated in the focus groups. Four major themes were identified: (1) Delirium is important but can be hard to recognize and validate; (2) ambiguity on the use of delirium screening tool; (3) need of designated delirium care pathway; and (4) vital role of the family. Despite the initial lack of agreement on use of the objective tool to screen delirium, nurses did propose a number of ways that formal delirium screening could be included in routine nursing duties and existing nursing documentation.Conclusion:Although orthopedic nurses aim to provide effective care to patients experiencing delirium symptoms following hip fracture, they are doing so in the absence of structured screening, assessment, and multidisciplinary team approach. This study emphasizes the various barriers which need to be considered before attempting to change practice in this important area.

Health Behavior Associated With Influenza Vaccination Among Healthcare Workers in Long-Term-Care Facilities

2002 ◽  
Vol 23 (10) ◽  
pp. 609-614 ◽  
Author(s):  
D. G. Manuel ◽  
B. Henry ◽  
J. Hockin ◽  
M. Naus
Keyword(s):  
Health Behavior ◽  
Focus Groups ◽  
Influenza Vaccination ◽  
Healthcare Workers ◽  
Long Term Care ◽  
Cross Sectional ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Objective:To investigate the health behavior associated with influenza vaccination among healthcare workers (HCWs) in long-term–care facilities.Design:A cross-sectional, self-administered survey of HCWs, augmented with focus groups to further examine attitudes toward influenza vaccination.Setting:Two long-term–care facilities participated in the survey. The focus groups were held at one of the two facilities.Participants:All HCWs were invited to participate in the survey and all nonmanagerial staff members were invited to participate in the focus groups. The response rate for the survey was 58% (231 of 401).Results:Vaccinated HCWs had a more positive attitude toward influenza vaccination and a greater belief that the vaccine is effective. This was not accompanied by differences in vaccine knowledge or values of potential preventive outcomes. Nonvaccinated respondents were more likely to believe that other preventive measures, such as washing hands, taking vitamins and supplements, eating a nutritious diet, exercising, and taking homeopathic or naturopathic medications, were more effective than vaccination. Additional findings from the focus groups suggest that HCWs believe that the main purpose of influenza vaccination programs is to protect residents' health at the expense, potential harm, and burden of responsibility of the staff.Conclusions:This study identifies challenges to and opportunities for improving vaccination rates among HCWs. A message that emphasizes the health benefits of vaccination to staff members, such as including vaccination as part of a staff “wellness” program, may improve the credibility of influenza immunization programs and coverage rates.(Infect Control Hosp Epidemiol 2002;23:609-614).

Abnormal behavior of residents in a long-term care facility and the associated stress of care staff members

2001 ◽  
Vol 33 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Itsugi Nagatomo ◽  
Yasuaki Akasaki ◽  
Masataka Tominaga ◽  
Wataru Hashiguchi ◽  
Masahiro Uchida ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Care Staff ◽  
Abnormal Behavior ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Staff Members

scholarly journals Creative Team Building with Staff Through Mandala Making

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Sondra Goldman
Keyword(s):  
Team Building ◽  
Care Staff ◽  
Art Making ◽  
Term Care ◽  
Organizational Goals ◽  
Staff Members ◽  
History Of ◽  
Community Growth ◽  
Art Therapist

Objectives: Participants will learn how art therapists can achieve individual or group goals through the use of art materials and processes. They will also learn how organizational goals can be incorporated into relevant art making experiences. The presentation begins with a brief overview of art therapy and the history of mandala making in community building. We will then review the mandala-making staff workshops. The discussion will close with an exploration of how this process may be applied to other work environments.Methods: These workshops were originally offered to our long-term care staff on eight different occasions during, "Planetree Month" in May of 2011, a month dedicated to staff self-care. The “Planetree Month” planning committee asked the art therapist to develop a team-building exercise that would be fun, creative and completed within 45 minutes. The committee also hoped that the workshop participants, who had little or no artistic experience or skill, would make a collective art work (within the time constraints,) that would be a source of pride for the participants and be good enough to be installed on the walls of the centre as a testament to the teamwork achieved.Results: The goals of the workshop were accomplished through the careful design of this workshop. More than 200 staff members participated, embraced the process and completed eight mandalas which are now permanently displayed on the walls of Donald Berman Maimonides Geriatric Centre. Creativity can bring out the best in people, creating synergy and positive community growth.

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