[A Multicenter randomized comparative study of dementia nursing practice skills development programs for nurses in acute care hospitals: A Comparison of person-centered care and dementia-type-specific programs].

PURPOSE: The present multicenter randomized controlled trial explored the effectiveness of a person-centered care program (intervention group) and a dementia-type-specific program (control group) for nurses in acute-care hospitals. METHODS: Seven hospitals in Prefecture A were randomly allocated to two groups (an intervention group and a control group), and a study of these groups was conducted from July 2021 to January 2022. RESULTS: A total of 158 participants were included in the study: 58 in the control group and 100 in the intervention group. In a comparison of assessment values immediately after the course, three months later, and six months later for both the intervention and control groups, "expertise in dementia nursing," "medical expertise in dementia, " and "confidence in nursing older people with dementia" were all significantly higher than before the course. Significant improvements in the intervention group's "knowledge of dementia" and "sense of dignity" on the ethical sensitivity scale were found immediately after the course compared to baseline, three months later, and six months later and were also significantly greater than the control group in terms of the amount of change. In the control group's "unique care tailored to cognitive function and the person," there were significant improvements in the ratings immediately after the course and three and six months after the course compared to baseline, with significantly greater amounts of change than in the intervention group. CONCLUSION: The person-centered care program for nurses led to improvements in the knowledge about dementia and awareness of the dignity of ethical sensitivity. In addition, the type of dementia program had a significant influence on medical knowledge and unique care tailored to the cognitive function and the individual patient. Further outcome evaluations of physical restraint rates as a quality of care in nursing practice are needed.

Development of a Daily Living Self-Efficacy Scale for Older Adults in Japan.

OBJECTIVES: Older adults tend to experience decreased enjoyment and fulfillment in life, social interactions, and independent living, with aging. These situations often result in lower levels of daily living self-efficacy in activities, which is one of the factors resulting in a decline in the quality of life (QOL) among older individuals. For this reason, interventions that help maintain daily living self-efficacy among older adults may also help maintain a good QOL. The objective of this study was to develop a daily living self-efficacy scale for the elderly that can be used to evaluate the effects of interventions aimed at enhancing self-efficacy. METHODS: An expert meeting involving specialists in dementia treatment and care was held, to prepare a draft for a daily living self-efficacy scale. In the meeting, previous studies on self-efficacy among older adults, which were collected in advance, were reviewed, and the experiences of the specialists were discussed. Based on the reviews and discussions, a draft of a daily living self-efficacy scale comprising 35 items was prepared. This study on daily living self-efficacy was conducted from January 2021 to October 2021. The internal consistency and concept validity of the scale were evaluated based on the assessment data. RESULTS: The mean age ± standard deviation of the 109 participants was 84.2 ± 7.3 years. The following five factors were extracted based on factor analysis: Factor 1, "Having peace of mind"; Factor 2, "Maintaining healthy routines and social roles"; Factor 3, "Taking personal care of oneself"; Factor 4, "Rising to the challenge"; and Factor 5, "Valuing enjoyment and relationships with others". The Cronbach's alpha coefficient exceeded 0.7, thereby suggesting sufficiently high internal consistency. Covariance structure analysis confirmed sufficiently high concept validity. CONCLUSIONS: The scale developed in this study was confirmed to be sufficiently reliable and valid, and when used during dementia treatment and care to assess the levels of daily living self-efficacy among older adults, it is expected to contribute to the improvement of QOL among older adults.

Effects of Bowel Training and Defecation Posture on Chronic Constipation in Older Adults With Dementia: A Randomized Controlled Trial.

INTRODUCTION: Chronic constipation (CC), which can cause behavioral and psychiatric symptoms of dementia and related caregiver distress, is common in older adults admitted to care facilities with dementia. This study aimed to examine the effect of defecation care on CC and related problems. METHODS: This study compared bowel training and defecation posture intervention (intervention group) with general care (control group) as the treatment of CC among older adults with dementia in 6 long-term care facilities. The primary outcomes were the number of spontaneous bowel movements (SBMs) and complete SBMs. The secondary outcomes were Patient Assessment of Constipation Quality of Life Questionnaire, Constipation Scoring System, constipation symptoms, and Neuropsychiatric Inventory Nursing Home Version scores. The differences were analyzed using 2-way ANOVA with repeated measures. RESULTS: The data of 30 patients (14 in the intervention group, 16 in the control group) were analyzed. Weekly mean complete SBMs increased from 0.53 times at baseline to 1.58 times at 8 weeks in the intervention group compared with a change from 0.56 to 0.43 times in the control group (interaction P < 0.001). The Patient Assessment of Constipation Quality of Life Questionnaire, Constipation Scoring System, behavioral and psychiatric symptoms of dementia, and caregiver distress scores showed significant improvement after 8 weeks of defecation care intervention. DISCUSSION: Defecation care, including bowel training and appropriate defecation posture, is effective for CC among older adults with dementia, improving patient mental health and reducing burden on caregivers.

[Subjective effectiveness and safety of twiddle muff for staff to reduce the wearing of mittens].

PURPOSE: This study investigated the subjective effects and safety of using a twiddle muff to reduce the wearing of mittens by care staff for older patients with dementia. METHODS: A survey was conducted among hospital staff using muffs since January 2022. In addition to the use of questionnaires, the staff were interviewed via the Zoom platform. RESULTS: A total of 18 participants were surveyed, including 15 nurses (83.3%) and 3 physical and occupational therapists (16.8%). Based on the responses to the questionnaire, all participants indicated that the muffs were effective in "removing or reducing physical restraints," and 11 participants (61.1%) pointed out that the muffs were effective in "alleviating behavioral and psychological symptoms" of dementia. The effects of the twiddle muff, as perceived by the staff, were as follows: 1) provides relief from physical and mental tension by reducing mitten restraints and inducing relaxation by pleasant sensory stimulation; 2) improves understanding and allows gentle communication with older patients with dementia; 3) promotes assistance and rehabilitation, enabling transfers and moving operations by reducing the act of clutching bed fences and lines; and 4) is useful as a rehabilitation method for preventing disuse syndrome. CONCLUSION: According to the staff surveyed, the use of the twiddle muff not only eased the distress of older patients with dementia but also helped the respondents understand dementia and promoted communication among themselves. However, it is necessary to objectively demonstrate the effectiveness of a twiddle muff in the future.

Care Staff's Daily Living Decision-Making Support Scale for Older Adults with Dementia in Japan: Development of Validity and Reliability.

This study aimed to develop and validate a scale to assess the daily-living decision-making support of care staff for older adults with dementia (OwDs) in Japan. A questionnaire survey was conducted among 138 care staff at two geriatric healthcare facilities from February to March 2021. The Daily Living Decision-Making Support Scale for Older Adults with Dementia (DL-DM) was developed using item analysis, factor analysis, and covariance structure analysis. The factor analysis yielded 12 items and three factors: (1) support for the formation and expression of intentions in daily life based on the life background and values of OwDs; (2) attitudes and devising ways to communicate regarding the formation and expression of intentions in OwDs daily lives; and (3) devising ways to support OwDs in realizing their intentions in daily life. The internal consistency reliability analysis yielded a Cronbach's α of 0.87 for the total scale. The DL-DM correlated with the concurrent validity measures as expected. The DL-DM demonstrated validity and reliability as a potential scale to assess support for OwDs in daily life decision-making. The results also suggest an association between the DL-DM and person-centered care for OwDs.

[Effectiveness of programs developed for nurses to improve dementia nursing intervention ability in an acute care setting].

PURPOSE: The number of hospitalizations of older patients with dementia who require medical treatment has increased and delirium or physical restriction have become problems in the acute care setting. Dementia nursing intervention ability developing program by e-learning assumed the quality improvement of dementia medical care and the nursing of older patients with dementia based on person-centered aimed at reduction of body restriction. The purpose of this study was to validate the effectiveness of the developed e-learning programs for nurses in the acute care setting of seven to one nursing standards. METHOD: This study was conducted between April and December 2020. This study was introduced to the floor nurse of the hospital for suitable application. Interested nurses were asked to attend "Developing programs for Dementia nursing intervention ability (4 weeks)" at four different time points (1) before attendance (baseline), post-attendance (1 month later), (3) practiced 3 months post-attendance, and (4) practiced 6 months post-attendance. A questionnaire to evaluate program effectiveness asked about consciousness of the dementia nursing with four items on "Interest in nursing of people with dementia and so on (four items)".In the evaluation on the person-centered dementia care, using the Self-assessment Scale of Nursing Practice for Elderly Patients with Cognitive Impairment, the Approach to Dementia Questionnaire - Japanese Edition (19 items). In the evaluation of ethics, ethical sensitivity scale for clinical nurses (19 items), self-efficacy on reduction of the physical restriction (six items). A statistical analysis was conducted using the Bonferroni test as the multiple test method to compare baseline values with the values obtained 1, 3, and 6 months later. RESULTS: A total of 70 subjects were analyzed in this study. They belonged to different wards including the surgical and internal wards from where 60 subjects (85.7%) were recruited. The average clinical experience of the nurses was 13.5±9.5 years. The degree of self-efficacy was assessed in terms of attaching mitten type gloves as a physical restraint to avoid the pulling of tubes used for intravenous feeding, central veins, normal feeding, etc. by the patients and so on. Most patients had cognitive functional disorder, including dementia [n = 30 (42.9%)]. The self-assessed scale of nursing practice for elderly people with cognitive impairment, which aimed to promote person-centered care in an acute care hospital, revealed that the total score of each of the Approaches to Dementia Questionnaire - Japanese Edition significantly increased just after intervention (1 month) in comparison to baseline, and 3 months and 6 months after intervention. CONCLUSION: This study indicated that the program developed to improve dementia nursing intervention ability significantly increased the above-mentioned evolution and consciousness of nurses after the intervention program (1 month), followed by 3 months and 6 months later. Along with ethical sensitivity, practice aimed at person-centered care was also found to improve. It was suggested that the intervention program of this study was effective and that nurses could easily learn using their respective free time and practice.

[Effects of a fall intervention program for elderly patients with dementia based on person-centered care on care staff].

AIM: This study aimed to clarify the effects of a fall prevention intervention that focused on the characteristics of falls among elderly patients with dementia and was based on person-centered care in geriatric facilities on care staff. METHODS: This study was conducted between May 2016 and January 2017, and the subjects were classified into two groups: the intervention group, consisting of members who had participated in a three-month education training program, and the control group, consisting of members who provided the usual care. The study period was nine months divided as follows: training period (three months), fall prevention practice (three months), and follow-up period (three months). The quality of care was measured using the Nursing Quality Indicator for Preventing Falls (NQIPFD), and the assessment scale of health care professionals' recognition of the successful Interdisciplinary Team Approach in Health Care Facilities for the Elderly was also used. In total, the care staff members were evaluated four times: once to obtain baseline values before training, and again after the training period, after the fall prevention practice, and after the follow-up period. The results were analyzed using an analysis of variance (fixed factors = group and time, random factor = subjects, and covariance = years of experience working at the geriatric facility and type of job). RESULTS: There were 50 care staff subjects in the intervention group and 69 people in the control group. The results of the analysis of variance indicated that there was a significant difference in the NQIPFD between baseline 68.60 (±9.09) and follow-up 70.02 (±9.88) in the intervention group. With regard to the differences by intervention, the effect size of the dementia knowledge scale scores was 0.243 higher than the others, which was significant (p<0.01). CONCLUSIONS: The results showed that the participation of care staff in a fall intervention program to support elderly patients with dementia based on person-centered care significantly improved the NQIPFD and other measured factors. These findings suggest that the program fostered positive effects among the care staff.