'There's something they can do': Educating aged care staff about the trajectory of dementia, palliative care and the Namaste Care™ program: A mixed methods study.

OBJECTIVE: To evaluate outcomes of education about the dementia illness trajectory and Namaste Care™ program on aged care staff's knowledge, attitudes, self-perceived skills and competence. METHODS: A convergent mixed methods research design was adopted to compare the results of quantitative and qualitative data following an education intervention. Nurses and aged care staff (n = 35) undertook 2 × 2 h training sessions over 3 days. Data were collected pre- and post-intervention using three validated surveys. Qualitative data were collected through interviews and a focus group. Thematic analysis was used to generate themes. Quantitative and qualitative data were integrated and compared during interpretation and discussion of the findings. RESULTS: Significant improvements in knowledge, attitudes and skills survey scores from already published data were confirmed by the qualitative findings in this study. Three key themes were derived from the data, comprising dementia-related education and knowledge changes, recognising the benefits of the Namaste Care™ program, and the importance of changing practice. CONCLUSIONS: Dementia education using the Namaste Care™ program enabled staff to identify gaps in knowledge and skills within their own practice. Staff perceived that the Namaste Care™ program can be a driver for practice change including palliative care to improve quality of life for people living in the advanced stages of dementia.

Voice of persons with a life-limiting illness in conversation with healthcare professionals: systematic review and meta-synthesis.

BACKGROUND: Healthcare organisations are transforming the way care is delivered to people with a life-limiting illness with an increased focus on recognising the voice of the persons experiencing the illness and putting them in the centre of decision-making. However, the clinical practice remains largely based on the views of healthcare professionals and families or carers of the person with the illness. OBJECTIVES: To synthesise the best available evidence on the experience of persons living with a life-limiting illness about expressing their voice during communication with healthcare professionals. DESIGN: Systematic review and meta-synthesis. DATA SOURCES: CINAHL, Embase, Medline, PsycINFO, ProQuest Dissertations and Theses. REVIEW METHODS: A structured search was conducted to identify qualitative studies that reported on the experience of persons living with a life-limiting illness. The methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. The review was undertaken using the JBI and PRISMA guidelines. RESULTS: The expression of the voice of persons living with a life-limiting illness is influenced by: (1) the uncertain future surrounding illness trajectory and prognosis; (2) what is known from experience, media, family and friends; (3) emotional and psychological factors and (4) control and personal autonomy. CONCLUSIONS: In the early stages of a life-limiting illness, the voice of those experiencing the disease is not always audible. Instead, this voice is potentially present but silent and carried and promoted within healthcare professionals' values of accountability, professionalism, respect, altruism, equality, integrity and morality.

What are the Clinical and Social Outcomes of Integrated Care for Older People? A Qualitative Systematic Review.

Introduction: Older people with multiple chronic conditions have most to gain from successful integrated care models but there is a need to understand current evidence of outcomes for older people. Methods: A qualitative meta-aggregation method was used for the review. Systematic searching of CINAHL, PubMed (Medline), Web of Science, PsycINFO, Scopus and Cochrane identified an initial 93 papers, of which 27 were reviewed. Studies were selected according to the pre-defined protocol and quality assessed using The Joanna Briggs Institute Critical Appraisal Tools (JBIQARI). Eleven, peer-reviewed, English-language papers published between 2000 to 2020 were included. Results: Thirty-three findings were extracted and aggregated into six categories. Three synthesised statements were identified denoting outcomes of integrated care for older people. These indicate social participation and connectedness for older people and their families; the older person feeling motivated to engage in health goals when their preferences were taken into consideration; and older people experiencing support and wellbeing when a therapeutic relationship with a key worker is established. Discussion and conclusion: There was scant evidence of the older person's voice within included studies and a limited focus on outcomes. Stronger evidence is needed to provide meaningful and robust evaluation of outcomes within integrated care models for the older person.

Stimulating sense memories for people living with dementia using the Namaste Care programme: What works, how and why?

BACKGROUND: Sensory-based program for people with advanced dementia aim to address unmet needs and to improve behaviours, mood or cognition. Pleasurable, involuntary sense memories stimulated by sensory-based program are difficult to evaluate because it is not possible to ask what people with dementia remember about their past, or what sense memories are being evoked. Notwithstanding the challenges in identifying what sense memories people with dementia experience, nurses and caregivers should recognise the potential value of sense memories for pleasure and happiness and provide optimum conditions to stimulate the senses. AIMS AND OBJECTIVES: To examine the potential for involuntary sense memories to be activated by sensory stimulation, with a focus on the effects of the Namaste Care programme. DESIGN: This is a discursive paper applying a content analysis to the qualitative findings of studies reporting on the Namaste Care programme to critically evaluate the topic of involuntary sense memories for people living with advanced dementia. METHODS: A literature review and content analysis of qualitative findings on the Namaste Care programme was performed. Findings are reported in line with the COREQ checklist. RESULTS: Eleven studies met the inclusion criteria. Codes were grouped into four categories representing enhanced mood, pleasure, happiness and comfort capturing the effects of the sensory stimulation observed or perceived by nurses and family caregivers. Descriptions provide some evidence of sensory memories activated by stimulation of some senses but not all. CONCLUSION: Involuntary sense memories contribute to well-being of people living with advanced dementia. Caregivers, including nurses, need to be aware that involuntary sense memories that do not rely on cognitive processes can be triggered by sensory stimulation and have the potential to enhance mood and bestow pleasure, happiness and comfort over and above the "activity" of the sensory programme. RELEVANCE TO CLINICAL PRACTICE: By integrating the documented experiential findings and conceptual understandings of sense memory, this paper contributes to advancing the understanding of the value of involuntary sense memories for people living with dementia that nurses and caregivers need to be aware of and, in turn, provide the optimum conditions for memory of the senses to be activated. A sensory-based programme, such as Namaste Care, provides optimum conditions at low cost to activate sense memories.

An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

BACKGROUND: Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role. METHOD: The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment. RESULTS: Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items). CONCLUSIONS: This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.

Assessing nursing assistants' competency in palliative care: An evaluation tool.

Nursing assistants are the largest aged care workforce providing direct care to older people in residential aged care facilities (RACF) in Australia and internationally. A palliative approach is a large component of this direct care that necessitates nursing assistants possess requisite knowledge, skills and attitudes. While training needs have been identified to enhance their practices, preservice education is variable, educational interventions have been adhoc and professional development found to be inadequate to the demands of the workplace. In addition, evaluation of nursing assistants' knowledge, skills and attitudes has lacked an instrument specifically tailored to nursing assistants' level of education and role responsibilities when providing a palliative approach. This paper reports on Phase 3 of a research study to develop such an instrument capable of assessing nursing assistants' knowledge of, skills in, and attitudes within a palliative approach. This phase assesses the usability and performance capabilities of the new instrument on a purposive sample of nursing assistants in two RACFs using the survey method. Results showed that the instrument was able to discriminate between groups of nursing assistants based on experience in role. Usability results indicated that the instrument is user friendly and time efficient.

Measuring nursing assistants' knowledge, skills and attitudes in a palliative approach: A literature review.

BACKGROUND: Nursing assistants are the largest aged care workforce providing care to older people in residential aged care facilities. Although studies have focused on their training and development needs when providing a palliative approach, a valid and reliable instrument to evaluate their knowledge, skills and attitudes is required. AIMS: To examine what instruments have been used to evaluate nursing assistants' knowledge of, skills in and attitudes towards a palliative approach in residential aged care facilities, critically evaluate development processes, and discuss the strengths and limitations of existing instruments for this population. METHODS: CINAHL, the Cochrane Library, ERIC, MEDLINE, PubMed, Scopus and Web of Science were searched using key words. Selected articles were published in English in the period 2004-2014 and included instruments which evaluated nursing assistants and a palliative approach. RESULTS: Ten studies using seven instruments met the inclusion criteria. One of these instruments measured nursing assistants' level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce. CONCLUSION: Seven instruments have been used to evaluate nursing assistants' knowledge, skills and attitudes in a palliative approach. Instrument design and recommended psychometric processes for development limit specificity and usefulness of these instruments for nursing assistants' scope of practice. Adhering to recommended psychometric processes will increase the validity and reliability of an instrument tailored to this population and a palliative approach.