A Person-Centered Care Intervention for Geriatric Certified Nursing Assistants

Coleman, Carissa; Medvene, Louis J.

doi:10.1093/geront/gns135

Cited by 43 publications

(44 citation statements)

References 18 publications

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“…Cognitive proximity was evident in intervention specifics or content, and judged by the extent to which the applicability of the intervention to the support worker's own work practice could be observed. Resonance with the work of the support worker was noted in reports of interventions which focused on individual older people within workers' services through, for example, the creation of biographies: 22 Creating brief videotaped biographies of residents is an innovative way of making personal information about residents available to CNAs [Certified Nursing Assistant]. Creating videotapes of CNA/ resident caregiving interactions and using them, in conjunction with behavioral observation instruments, is an innovative way to promote CNAs' self-awareness of the person centeredness of their caregiving behaviors.…”

Section: Resultsmentioning

confidence: 99%

“…This included the development of leadership roles for senior support workers, 24 mentorship for new staff 24 and coaching roles, which together seek to ensure that support workers can benefit from coaching, supervision, appraisal systems and mentoring. 31 32 53 In a report that described the development and pilot testing of a 6-week intervention for certified nursing assistants, 22 the intervention was set in the context of organisational efforts to improve the quality of long-term care more broadly. This involved focusing on relationships and promoting culture change within the healthcare settings, and: …identifying and operationalising person-centred caregiving behaviours…( p. 688).…”

Section: Cmo 4: Joining Things Up Around Workforce Developmentmentioning

confidence: 99%

“…40 Here, support for staff to receive the intervention echoed the organisation's direction following concern from managers. Mutual reinforcement between the organisational goals and workforce development interventions had the potential for greater sustainability and longer lasting effects because of the types of impact achieved, for example, enhancing support workers commitment to their work, 22 promoting better understanding of their work, 56 60 helping to develop positive attitudes towards older people, 55 promoting more tolerance and more interest in residents' behaviours, 40 enhancing self-reflection 32 and leading to improvements in knowledge. 24 61 For different organisations, if interventions are developed in the context of an organisation's goals, including their human resource and quality improvement strategies (context), then this prompts mutual reinforcement between the aims of the intervention and the goals of the organisation (mechanism).…”

Section: Cmo 4: Joining Things Up Around Workforce Developmentmentioning

confidence: 99%

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Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

Rycroft‐Malone

Burton

Williams

et al. 2016

Health Serv Deliv Res

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Objectives: This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services.Design: Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) 'testing out' the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations.Participants: Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process.Results: Eight context-mechanism-outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about 'what works' to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations. Conclusions:It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the employing organisations within which workforce development operates. Workforce development interventions need to balance the technical, professional and emotional aspects of care.Trial registration number: CRD42013006283.

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Section: Resultsmentioning

confidence: 99%

Section: Cmo 4: Joining Things Up Around Workforce Developmentmentioning

confidence: 99%

Section: Cmo 4: Joining Things Up Around Workforce Developmentmentioning

confidence: 99%

See 1 more Smart Citation

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

Rycroft‐Malone

Burton

Williams

et al. 2016

Health Serv Deliv Res

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“…There are preliminary studies of successful interactive online programs using actors to simulate common behaviours in context followed by demonstration of how effective responses can be achieved. [70][71][72][73] There is also increasing interest in online education. [72][73][74][75] Furthermore, emerging approaches towards personalised electronic decision support systems for targeting dementia care in community settings are being developed.…”

Section: Rationale For Current Studymentioning

confidence: 99%

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

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BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.

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“…Nursing assistants' perceptions of satisfaction and closeness, and resident satisfaction also increased. 47 To determine the impact of a HCA education programme on the quality of care for older people living in a residential home in New Zealand a pre-and postintervention evaluation study was undertaken. The proportion of observations of resident care conducted after the training that were considered 'appropriate and adequate' increased.…”

Section: Interventions To Improve Relational Carementioning

confidence: 99%

Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention

Arthur

Aldus

Sarre

et al. 2017

Health Serv Deliv Res

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Background:\ud

Older people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.

\ud \ud Objective(s):\ud

We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).

\ud \ud Design:\ud

(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.

\ud \ud Setting:\ud

(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.

\ud \ud Participants:\ud

(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.

\ud \ud Interventions:\ud

For the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.

\ud \ud Main outcome measures:\ud

Patient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.

\ud Results:\ud

(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences...

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A Person-Centered Care Intervention for Geriatric Certified Nursing Assistants

Abstract: The findings suggest that this type of intervention is feasible and warrants further research.

Cited by 43 publications

References 18 publications

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention

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