Exploring nurses' difficulties and strategies when caring for patients with dementia in a neurological ward.

Nurses in neurological wards face numerous challenges when caring for patients with dementia, particularly those who also present other acute illnesses. However, studies focusing on this area are limited. This study aimed to explore the difficulties and strategies in caring for patients with dementia among nurses working in a neurological ward. A qualitative descriptive design was adopted. Twelve nurses from a neurology ward participated in individual semi-structured interviews. The data collected through these interviews were subjected to qualitative content analysis. Two main themes emerged from the analysis: (i) various shortcomings and concerns, which include subthemes: insufficient support, worry about patient safety, inadequate care ability of the caregiver, and insufficient self-competence, and (ii) unique clinical strategies, which include subthemes: cooperate with the caregiver, improve self-competence in dementia care, and employ meticulous resorts. The findings highlighted the nurses' dedication to minimizing patient risks and utilizing available resources as well as stakeholders to provide optimal care. To enhance patient care quality, it is essential to support nurses by addressing care-related barriers, offering continuous education, and establishing care pathways.

Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic.

BACKGROUND: Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management. AIMS: This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic. METHODS: A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings. RESULTS: Among demographic characteristics, sex (ß = -0.11; p = 0.016) and living arrangement (ß = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all ß > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks. CONCLUSIONS: Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work. IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT: Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Development and psychometric properties of a friendly dietary function assessment scale for home-dwelling people with dementia.

BACKGROUND: Mealtime difficulties related to cognitive functioning negatively impact a patient's life during the various stages of dementia, and they typically cause a burden and stress on family caregivers. Most people with dementia live at home alone or are cared for by informal caregivers, typically their spouses or other family members. However, no suitable screening tools for home-dwelling patients with dementia have been developed, nor have measurements focused on executive and self-eating functions. This study aimed to develop and evaluate the psychometric properties of the Dietary Function Assessment Scale (DFAS) for community-dwelling persons with dementia. METHODS: A mixed-method design was used to develop the instrument. Methods included a comprehensive literature review to identify the item pool and an expert panel to assess the initial item pool. We performed convenience sampling of 190 home-dwelling people with dementia for psychometrical evaluation. The psychometric properties tests included item and factor analyses, criterion-related validity testing, internal consistency reliability testing, and defining the optimal cut-off values. The study was conducted from 2018 to 2019. RESULTS: Items were generated based on an extensive literature review and pre-existing scales related to mealtime and executive functions in persons with dementia. The S-CVI/Ave of the DFAS was 0.89. A Principal Component factor analysis demonstrated seven items, with a two-factor structure accounting for 56.94% of the total variance. The two extracted factors were Self-eating ability and Dietary executive function. The confirmatory factor analysis indicated a good model fit. The criterion-related validity was adequate (r = -0.528, p < 0.01). The reliability of Cronbach's alpha internal consistency was 0.74, and McDonald's Omega coefficient was 0.80; the optimal cut-off value of 13 points with an AUC of 0.74 was established to determine poor dietary functioning in persons with dementia. CONCLUSION: The DFAS was simple, user-friendly, and a valid and reliable instrument to assess dietary functioning in community-dwelling persons with dementia. This short scale can be helpful for caretakers, who can use it to identify the dietary needs of home-dwelling persons with dementia and improve their care and eating experience.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

DESIGN: This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES: The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS: More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS: Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE: Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Development of an educational protocol for ergonomic risk assessment of working postures to enhance the competence of occupational health nurses.

AIM: To develop a protocol and provide a valid, evidence-based procedure for identifying the ergonomic risk of working postures by occupational health nurses. BACKGROUND: Although ergonomic risk assessment tools have been used for the early detection of risky working postures, their operational procedures and validations do not target the competence of occupational nursing personnel. DESIGN: This study developed and validated an educational protocol, comprised of 13 procedures in five stages. First, the number of work tasks in the workplace is determined. Second, the working postures are confirmed. Third, the raters are trained to use the assessment tools. Fourth, high-risk postures are identified and categorized. Fifth, the inter-rater reliability of the tool is reported. The content of the protocol is validated by experts, with a validity value of 0.87. DATA SOURCES: The protocol was created through review of literature published from 1991 to 2021, protocol development (between 2018 to 2020) and expert validation (2020). CONCLUSION: The protocol can be applied to educate occupational health nurses and increase their competence in detecting workers' ergonomic risks. It can be used as a reference in occupational health nursing education to evaluate work tasks and detect risky postures.

A mini-flipped, game-based Mediterranean diet learning program on dietary behavior and cognitive function among community-dwelling older adults in Taiwan: A cluster-randomized controlled trial.

The Mediterranean diet has been recommended to delay cognitive decline, but adherence to the diet among older adults remain poor, and research on interventions that effectively promote the diet has been inconclusive. This study examined the effects of a mini-flipped, game-based Mediterranean diet learning program in improving dietary behavior and cognitive function in community-dwelling older adults in Taiwan. A cluster randomized controlled trial was conducted. The experimental group completed an 8-week, mini-flipped, game-based learning program. Data were collected at baseline and 8 weeks after intervention. Outcome measures included dietary behavior, global cognitive function, and subjective cognitive dysfunction. Compared with the control group, the experimental group exhibited significantly improved Mediterranean diet behavior and global cognitive function after the intervention, although there was no significant difference in subjective cognitive function. Future research should be conducted with larger populations and longer-term follow-up to evaluate the effect of this learning program.

Predictors of cancer-related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy.

BACKGROUND: Breast cancer is the most common diagnosis and the leading cause of cancer death among women worldwide and ranks first among Asian and Taiwanese women. Cancer-related fatigue (CRF) affects patients' functioning significantly. AIMS: The aim of this study was to examine changes in cancer-related fatigue (CRF) and related factors among women with breast cancer undergoing a single chemotherapy, and to identify predictors of CRF's change over the course of the chemotherapy cycle. METHODS: Four self-report questionnaires were administered to assess CRF, sleep quality, depression and anxiety, and symptom distress. Heart rate variability (HRV) was assessed to evaluate autonomic nervous system activation related to CRF. Data were collected four times: (1) before initiation of the single chemotherapy cycle (T0), (2) after completion of the single cycle (T1), (3) 1 week post-chemo (T2), and (4) 3 weeks post-chemo (T3). Repeated measurement of variance and generalized estimating equations (GEE) were conducted to estimate the trajectories and predictors. RESULTS: One-hundred women with breast cancer (mean age 50.4 ± 9.42) participated. CRF (F = 7.46), sleep quality (F = 2.74), symptom distress (F = 9.99), anxiety (F = 5.72), and depression (F = 4.14) varied significantly over the single cycle of chemotherapy (p < .001), which the trajectories showed exacerbating at T2. HRV indicated a higher variation only on the day of injection (T0, T1). Results of the GEE revealed that anxiety, depression, and symptom distress were predictors of CRF's change over the single cycle of chemotherapy. LINKING EVIDENCE TO ACTION: CRF worsens at 1 week after a chemotherapy injection among Taiwanese women with breast cancer. Based on the risk predictors in CRF that included anxiety, depression, and symptom distress, multistrategy CRF-alleviating interventions should be provided prior to chemotherapy and targeted at the most disturbed period, that is, 1 week after injection.

Cognitive function and associated factors among postmenopausal women with hypertension and natural menopause in Taiwan.

Hypertension is prevalent among postmenopausal women worldwide and is a risk factor for cognitive impairment. This study examined the cognitive differences between Taiwanese postmenopausal women with and without hypertension after natural menopause and identified factors associated with cognitive function in hypertensive postmenopausal women. A two-group comparative design study of 171 Taiwanese postmenopausal participants (mean age = 64.8±6.6) was conducted in southern Taiwan. Cognitive performance on neuropsychological tests was evaluated, and demographic, health, menopausal, and disease related variables were assessed. Compared to the non-hypertensive group, women with hypertension showed significantly worse performance and a higher percentage of impairment in global cognitive functioning and memory. Fewer years of education and longer duration of hypertension were associated with lower global cognitive function, and increased age was associated with lower scores in delayed memory. Cognitive screening as well as training on global cognitive functioning and memory are needed for postmenopausal hypertensive women. (148 words).

Effects of the biopsychosocial functional activity program on cognitive function for community older adults with mild cognitive impairment: A cluster-randomized controlled trial.

Early preventive interventions may delay the onset of dementia for people with mild cognitive impairment. This study was designed to examine the effects of the biopsychosocial functional activity program on the cognitive function of community middle to older adults with mild cognitive impairment. A cluster-randomized controlled trial was conducted. The experimental group received a 12-month biopsychosocial functional activity program intervention that contained two phases. The first phase was a 6-week teaching program followed by a second-phase home follow-up phase. The measurement was carried out at baseline, 6 months and 12 months after the biopsychosocial functional activity program. The measurement tool was the Chinese version of the Saint Louis University Mental Status Examination. The Generalized Estimating Equations statistical approach was used to analyze the data. The experimental group showed significant short-term and continuous improvement in overall cognitive function in the immediate- and short-term memory domain while the domain of attention and executive function showed improvement on the 12-month measurement compared to the control group. Yet, there was no significant improvement overall and in the three domains of cognitive function for the control group. The findings may become references for advancing the dementia prevention program for communities as well as the national policies for dementia prevention programs.

Effects of Group Reminiscence Therapy on Agitated Behavior and Quality of Life in Taiwanese Older Adults With Dementia.

The purpose of the current study was to evaluate short- and long-term effects of group reminiscence on agitated symptoms and quality of life (QOL) for individuals with dementia. A quasi-experimental study using a repeated-measures design was conducted in 43 residents with dementia. Participants received a 50-minute group reminiscence therapy session once per week for 10 weeks. Outcomes were measured 1 week before, 1 week after, and at 3 months postintervention. Results showed no significant difference on the overall agitated behavior of participants. However, verbally aggressive behavior decreased significantly (p = 0.025), whereas intentional falling (p = 0.025), hoarding (p = 0.021), and akathisia (p = 0.027) significantly decreased in the short term. Participation in group reminiscence therapy significantly improved QOL (p < 0.001) across time periods for individuals with dementia. The findings provide information for professional and nonprofessional caregivers of individuals with specific agitated behaviors to improve their QOL. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 30-36.].

Effect of Aromatherapy Massage on Agitation and Depressive Mood in Individuals With Dementia.

The current study examined the effects of aromatherapy massage on alleviating agitation and depressive mood in individuals with dementia. A randomized controlled trial and repeated measures design was conducted. A total of 59 participants were randomly assigned to intervention or control groups. The intervention group received aromatherapy massage once per week for 8 weeks. Results indicated no significant changes over time in overall agitation for either group, but agitation decreased from Week 1 to Week 5 for the intervention group. In addition, the overall depressive symptoms decreased significantly over time for the intervention group compared to the control group (p < 0.001). However, changes in agitation within 24 hours following aromatherapy massage showed some significant changes in Weeks 5 and 9. Aromatherapy massage can be an effective and safe intervention to alleviate specific agitated behaviors and depressive mood in individuals with dementia. [Journal of Gerontological Nursing, 42(9), 38-46.].

The investigation and comparison of the underlying needs of common disruptive behaviours in patients with Alzheimer's disease.

BACKGROUND: Management of the disruptive behaviours is one of the most challenging aspects of caring for patients with Alzheimer's dementia (PwAD). The underlying needs of disruptive behaviours in PwAD had rarely been studied, especially the comparison of the underlying needs of disruptive behaviours in PwAD have never been mentioned. AIMS AND OBJECTIVES: The purpose of this study was to investigate and compare the underlying needs of five common disruptive behaviours including hoarding, aggressive behaviour, repetitive behaviour, altered eating behaviour and delusion in PwAD, as perceived by family caregivers, and to relate these needs from the perspective of Maslow's hierarchy. METHODS: An exploratory research design with qualitative data collection techniques was employed. Informed consent was obtained from each participant prior to the data collection. A total of 65 pairs of caregiver-patient with Alzheimer's disease participated in the study. A semi-structured interview guide was used during the interview, and the directed content analysis method was conducted to analyse data. RESULTS: Four themes related to the underlying needs of the five selected disruptive behaviours emerged from the data, and these included a desire for comfort (physical and psychological), a desire for security (psychological and economic), a need for a sense of belonging (including a need to connect with the outside world and a need for attention) and a need for self-control. These behaviour features were found closely related to Maslow's hierarchy model of human needs. CONCLUSION: Although the data were gathered from the caregivers, and the views of the patients were thus not included in the analysis, the findings provide information for health providers that can enable them to better understand the underlying needs of common disruptive behaviours in patients with Alzheimer's disease and thus help develop better patient-centred care plans.

Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan.

Patients with dementia, especially those with advanced dementia, may not be able to express their bowel movement and urination needs using lucid language, and instead do so through behaviors. The aim of the current study was to understand and compare the behavioral characteristics of bowel movement and urination needs in patients with dementia. Observations were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed by the research team for bowel movement and urination. Sixteen behavioral characteristics were identified for both bowel movement and urination; among these, anxiety, taking off/putting on clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated behavior, and making strange sounds were commonly reported. Facial expressions of sorrow, restlessness, and anxiety were the three most common behaviors related to bowel movement needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were the most common behaviors for urination needs. The findings suggest that the common behavioral characteristics could be seen as indicators of excretion need and the others can be used to distinguish between the need for bowel movement and urination.

Effects of an ice roller on chronic kidney disease-associated pruritus in patients receiving haemodialysis.

BACKGROUND: Chronic kidney disease-associated pruritus is a distressing symptom and has a far-reaching impact on patients' sleep and quality of life for most patients receiving haemodialysis. Traditional therapies have limited effectiveness. OBJECTIVES: This study aimed to invent a self-operated ice roller and evaluate its efficacy in relieving pruritus, sleep quality, and quality of life. DESIGN: This study was experimental with a two-arm parallel group design. PARTICIPANTS: A convenient sampling method was used to recruit 60 patients receiving haemodialysis who reported pruritus (5D-Itch Scale score >5) lasting over 4 weeks in Taiwan. The participants were randomly assigned to one of two groups: the intervention group used an ice roller for 7 days, while the control group received no anti-pruritus treatment. MEASUREMENTS: This study was experimental with a two-arm parallel group design. The measurement instruments included the 5D-Itch Scale, Pittsburgh Sleep Quality Index and WHOQOL-BREF-Taiwan Version. The analysis of covariance, chi-square, Independent t tests, and partial Eta2 (η2 p) were used to analyse the data. RESULTS: The participants' mean age was 62.77 years. Application of the ice roller significantly decreased overall pruritus (p < .05; η2 p = .09) and distribution of pruritus-associated bodily parts (p = .03; η2 p = .08). There were no statistically significant differences in sleep quality and related indicators between the experimental and control groups at the study endpoint. Regarding quality of life, only the social relationship domain significantly differed between the two groups (p = .02; η2 p = .08). CONCLUSIONS: The ice roller can decrease pruritus and its distribution in patients receiving haemodialysis, serving as an adjunct therapy alongside conventional anti-pruritus treatments.

Effectiveness of exercise programs to reduce low back pain among nurses and nursing assistants: A systematic review and meta-analysis.

INTRODUCTION: Nurses have a high prevalence of low back pain due to ergonomic hazards in healthcare workplaces. While exercise programs have been suggested as an intervention strategy, the effectiveness of low back pain programs has been inconsistent in the research literature. The purpose of study is to determine the effect of exercise programs to reduce low back pain among nursing staff. METHODS: A systematic review and meta-analysis was conducted with five databases and systematically searched. Following the PRISMA guidelines, included studies evaluated low back pain relief among nurses or nursing assistants and described the exercise program. Two reviewers independently appraised, extracted, and synthesized all available studies. The study protocol was registered in PROSPERO (CRD42022359511). RESULTS: A total of 296 articles with 1,355 nursing staff from nine countries were obtained. Nine randomized controlled trials with a moderate to low risk of bias quality were included. Exercise programs had a small but significant effect on low back pain of nursing staff (SMD = -0.48; 95% CI = -0.76 to -0.19; p = 0.03, I2 = 62%, p = 0.001). A subgroup analysis of nurses and nursing assistants showed moderate and small effects, respectively (I2 = 0% p < 0.0001, SMD -0.73 CI 95% [-0.97 to -0.48], p = 0.76, and I2 = 0% p = 0.002, SMD -0.23 CI 95% [-0.38 to -0.08], p < 0.88). Exercise for back and trunk exhibited a moderate effect on low back pain (SMD -0.56 CI 95% [-0.86 to -0.25], p = 0.01, I2 = 66%, p < 0.0004). A subgroup analysis comparing age, under 40 years old revealed a moderate effect size (SMD = -0.59; 95% CI = -0.83to -0.35; p = 0.06; I2 = 64%, p < 0.0001). CONCLUSIONS: Exercise programs are an effective treatment to reduce low back pain in nurses and nursing assistants, especially among younger staff. PRACTICAL APPLICATION: Back and trunk exercise programs should be recommended for nursing staff with low back pain.

The impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses.

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders.

The effect of sugammadex versus neostigmine on postoperative nausea and vomiting: a meta-analysis of randomized controlled trials with trial sequential analysis.

INTRODUCTION: Association between sugammadex and risk of postoperative nausea and vomiting remains unclear. EVIDENCE ACQUISITION: We performed meta-analysis of randomized controlled trials with trial sequential analysis to compare sugammadex with neostigmine in adults receiving elective surgery under general anesthesia with postoperative extubation. Databases of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2022. Primary outcome was risk of postoperative nausea and vomiting after patients received sugammadex or neostigmine. Secondary outcomes were incidences of sugammadex-related complications. EVIDENCE SYNTHESIS: Meta-analysis of 40 trials with 5455 patients showed an overall lower risk of postoperative nausea and vomiting in the sugammadex group than in the neostigmine group (risk ratio: 0.85, 95% CI [0.76-0.94], heterogeneity I2=4%, P=0.002). Subgroup analyses demonstrated a lower risk of postoperative nausea and vomiting associated with sugammadex than with neostigmine: 1) in the postanesthesia care unit (risk ratio: 0.77, 95% CI [0.66-0.90], I2=8%, P=0.001) but not in wards; 2) under volatile anesthetics but not total intravenous anesthesia; 3) regardless of the administration of prophylactic antiemetics; and 4) when sugammadex was administered at 2 mg/kg but not 4 mg/kg. No major complications such as cardiac arrest or refractory bradycardia were noted and every patient achieved adequate neuromuscular recovery before extubation in all of the included trials. The overall quality of evidence was moderate. CONCLUSIONS: Sugammadex was associated with a lower risk of postoperative nausea and vomiting compared with neostigmine immediately after surgery, especially for patients receiving volatile anesthetics regardless of the use of prophylactic antiemetics.

Machine learning approach to determine the decision rules in ergonomic assessment of working posture in sewing machine operators.

INTRODUCTION: There are some inherent problems with the use of observation methods in the ergonomic assessment of working posture, namely the stability and precision of the measurements. This study aims to use a machine learning (ML) approach to avoid the subjectivity bias of observational methods in ergonomic assessments and further identify risk patterns for work-related musculoskeletal disorders (WMSDs) among sewing machine operators. METHODS: We proposed a decision tree analysis scheme for ergonomic assessment in working postures (DTAS-EAWP). First, DTAS-EAWP used computer vision-based technology to detect the body movement angles from the on-site working videos to generate a dataset of risk scores through the criteria of Rapid Entire Body Assessment (REBA) for sewing machine operators. Second, data mining techniques (WEKA) using the C4.5 algorithm were used to construct a representative decision tree (RDT) with paths of various risk levels, and attribute importance analysis was performed to determine the critical body segments for WMSDs. RESULTS: DTAS-EAWP was able to recognize 11,211 samples of continuous working postures in sewing machine operation and calculate the corresponding final REBA scores. A total of 13 decision rules were constructed in the RDT, with over 95% prediction accuracy and 83% path coverage, to depict the possible risk tendency in the working postures. Through RDT and attribute importance analysis, it was identified that the lower arm and the upper arms exhibited as critical segments that significantly increased the risk levels for WMSDs. CONCLUSIONS: This study demonstrates that ML approach with computer vision-based estimation and DT analysis are feasible for comprehensively exploring the decision rules in ergonomic assessment of working postures for risk prediction of WMSDs in sewing machine operators. PRACTICAL APPLICATIONS: This DTAS-EAWP can be applied in manufacturing industries to automatically analyze working postures and identify risk patterns of WMSDs, leading to the development of effectively preventive interventions.

A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia.

BACKGROUND: Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE: This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS: A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS: Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.