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Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model

Published online by Cambridge University Press:  21 December 2016

Elizabeth L. Sampson ,
Victoria Vickerstaff ,
Stephanie Lietz  and
Martin Orrell
Elizabeth L. Sampson*
Affiliation:
Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK Barnet Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK
Victoria Vickerstaff
Affiliation:
Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
Stephanie Lietz
Affiliation:
UCL Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Martin Orrell
Affiliation:
Institute of Mental Health, University of Nottingham, Nottingham, UK
*
Correspondence should be addressed to: Elizabeth L. Sampson, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Phone: 020 7679 9730; Fax: 020 7679 9426. Email: e.sampson@ucl.ac.uk.
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Abstract

Background:

There are concerns about the quality of care that people with dementia receive in the general hospital. Staff report a lack of confidence and inadequate training in dementia care.

Methods:

A train-the-trainer model was implemented across eight acute hospital trusts in London via a large academic health and science network. Impact was evaluated using mixed methods. Data were collected at (a) individual level: “Sense of Competence in Dementia Care” (SCID), (b) ward level: Person Interaction and Environment (PIE) observations, (c) organization level: use of specific tools, i.e. “This Is Me,” (d) systems level: numbers and types of staff trained per trust. Results were analyzed with descriptive statistics and paired t-test with thematic framework analysis for PIE observations.

Results:

The number of staff trained per trust ranged from 67 to 650 (total 2,020). A total of 1,688 (85%) baseline questionnaires and 456 (27%) three month follow-up questionnaires were completed. Mean SCID score was 43.2 at baseline and 50.7 at follow-up (paired t-test, p < 0.001). All sub-scales showed a small increase in competence, the largest being for “building relationships.” Organizational level data suggested increased use of carer's passport, “This Is Me” documentation, dementia information leaflets, delirium screening scales, and pathways. PIE observations demonstrated improved staff–patient interactions but little change in hospital environments.

Conclusions:

There was a significant improvement in staffs’ sense of competence in dementia care and the quality of interactions with patients. More hospitals adopted person-centered tools and pathways. Work is required to investigate if these changes improve hospital outcomes for people with dementia.

Keywords

dementiainpatienttrainingeducationliaison
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 4 , April 2017 , pp. 605 - 614
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Alzheimer's Society (2009). Counting the Cost: Caring for People with Dementia on Hospital Wards. London.Google Scholar
Bourne, J. (2007). Improving Services and Support for People with Dementia. National Audit Office. London.Google Scholar
Elvish, R. et al. (2014). ‘Getting to Know Me’: the development and evaluation of a training programme for enhancing skills in the care of people with dementia in general hospital settings. Aging & Mental Health, 18, 481–488.Google Scholar
Elvish, R. et al. (2016). ‘Getting to Know Me’: the second phase roll-out of a staff training programme for supporting people with dementia in general hospitals. Dementia (London). Epub ahead of print. DOI: 10.1177/1471301216634926 Google Scholar
Ferlie, E. B. and Shortell, S. M. (2001). Improving the quality of health care in the UK and the USA: a framework for change. Milbank Quarterly, 79, 281–315.Google Scholar
Galvin, J. E., Kuntemeier, B., Al-Hammadi, N., Germino, J., Murphy-White, M. and Mcgillick, J. (2010). “Dementia-friendly hospitals: care not crisis”: an educational program designed to improve the care of the hospitalized patient with dementia. Alzheimer Disease & Associated Disorders, 24, 372–379.CrossRefGoogle ScholarPubMed
Griffiths, A., Knight, A., Harwood, R. and Gladman, J. R. (2014). Preparation to care for confused older patients in general hospitals: a study of UK health professionals. Age Ageing, 43, 521–527.Google Scholar
Guy's and St Thomas' NHS Foundation Trust (2013). Barbara's Story. Available at: http://www.guysandstthomas.nhs.uk/education-and-training/staff-training/Barbaras-story.aspx; last accessed 12 September 2016.Google Scholar
Kitwood, T. and Bredin, K. (1992). Towards a theory of dementia care: personhood and well-being. Ageing & Society Research, 12, 269–287.Google Scholar
Knapp, M. and Privette, A. (2007). Dementia UK. Alzheimer's Society. London.Google Scholar
Lave, J. and Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation, Cambridge, Cambridge University Press.Google Scholar
Miles, M. B. and Huberman, A. M. (1994). Qualitative Data Analysis: An Expanded Sourcebook, London & Thousand Oaks, California: Sage.Google Scholar
Mukadam, N. and Sampson, E. L. (2010). A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. International Psychogeriatrics, 23, 344–355.Google Scholar
Royal College of Psychiatrists (2005). Who Cares Wins. Improving the Outcome for Older People Admitted to the General Hospital: Guidelines for the Development of Liaison Mental Health Services for older people. London.Google Scholar
Sampson, E. L., Blanchard, M. R., Jones, L., Tookman, A. and King, M. (2009). Dementia in the acute hospital: prospective cohort study of prevalence and mortality. British Journal of Psychiatry, 195, 61–66.CrossRefGoogle ScholarPubMed
Schepers, A. K., Orrell, M., Shanahan, N. and Spector, A. (2012). Sense of competence in dementia care staff (SCIDS) scale: development, reliability, and validity. International Psychogeriatrics, 24, 1153–1162.Google Scholar
Statacorp (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.Google Scholar
Surr, C. A., Smith, S. J., Crossland, J. and Robins, J. (2016). 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. Internatikonal Journal of Nursing Studing, 53, 144–151.CrossRefGoogle ScholarPubMed
Watkin, L., Blanchard, M. R., Tookman, A. and Sampson, E. L. (2012). Prospective cohort study of adverse events in older people admitted to the acute general hospital: risk factors and the impact of dementia. International Journal of Geriatric Psychiatry, 27, 76–82.CrossRefGoogle Scholar
Young, J., Hood, C., Woolley, R. J., Gandesha, A. and Souza, R. (2011). Report of the National Audit of Dementia Care in General Hospitals. Health Quality Improvement Partnership. London.Google Scholar
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