Knowing versus doing: education and training needs of staff in a chronic care hospital unit for individuals with dementia.

Hospital clinical staff routinely confront challenging behaviors in patients with dementia with limited training in prevention and management. The authors of the current article conducted a survey of staff on a chronic care hospital unit concerning knowledge about dementia, perceived educational needs, and the care environment. The overall mean score for a 27-item knowledge scale was 24.08 (SD = 2.61), reflecting high level of disease knowledge. However, staff indicated a need for more information and skills, specifically for managing behaviors nonpharmacologically (92.3%), enhancing patient safety (89.7%), coping with care challenges (84.2%), and involving patients in activities (81.6%). Although most staff (i.e., nurses [80%] and therapists [86.4%]) believed their care contributed a great deal to patient well-being, approximately 75% reported frustration and being overwhelmed by dementia care. Most reported being hit, bitten, or physically hurt by patients (66.7%), as well as disrespected by families (53.8%). Findings suggest that staff have foundational knowledge but lack the "how-to" or hands-on skills necessary to implement nonpharmacological behavioral management approaches and communicate with families.

Feasibility of the Tailored Activity Program for Hospitalized (TAP-H) Patients With Behavioral Symptoms.

PURPOSE OF THE STUDY: To evaluate feasibility of implementing the Tailored Activity Program for Hospitals (TAP-H) to improve engagement in patients with dementia admitted for behavioral disturbances. DESIGN AND METHODS: TAP-H involves up to 11 in-hospital sessions to develop activities tailored to patient interests and capabilities and train staff/families in their use. Interventionists (occupational therapists) recorded session lengths, patient engagement (N = 20), and staff (N = 4) readiness to use activities. Family interviews (N = 20) identified patient behaviors at admission and satisfaction with TAP-H 1 month postdischarge. A time series design with multiple behavioral observations (63 videotaped sessions) compared affective, verbal, and nonverbal behavioral responses in a standardized activity (baseline) to treatment sessions. RESULTS: Average number of treatment sessions per patient was 8.00 (SD = 2.71, range 3-13). Average time spent per session was 38.18min (SD = 10.01, range 19.09-57.50). Interventionists observed high patient engagement across treatment sessions. Observational data revealed increases in pleasure and positive gestures and decreases in anxiety/anger, negative verbalizations, and negative nonverbal behaviors from baseline to intervention sessions. Staff improved in readiness and families expressed high program satisfaction with 59.4% of activities used at home. IMPLICATIONS: TAP-H represents a unique collaborative care model that integrates facility-based staff in the behavioral treatment of patients with dementia and results in improved affect and reduced negative behaviors. TAP-H can be incorporated into routine hospital care and payment mechanisms. Future efforts should evaluate its effectiveness in reducing inappropriate pharmacologic use and strategies to enhance continued activity use by staff during hospitalization and families following discharge.