Table 2 Continuing education interventions, pedagogical methods, assessments, and their outcomes
Theme | Content of intervention | Pedagogical methods | Assessments | Outcomes and effectiveness in lens of nurses, older people and next of kin | Source |
|---|---|---|---|---|---|
Medication | -” Awareness-campaign” to the nurses, next of kin and residents - Educational courses given by experts (sleeping problems, old age depression, behavioral problems) - Professional support | - Flyers, posters, and articles in nursing home’s own newspaper - 3 X 2 h - For 10 months two part-time project staff-members offered person-centred professional support to the nurses | Drug use was recorded at baseline, after 10 months and after 22 months in intervention home and only medication data from control nursing home. | P: Quality improvement initiative led to a significant decrease in the use of psychotropic drugs in the intervention group, even after 1-year follow-up. Education only had a limited effect, but education and professional support together had clearer effects in long-term. OP = + | Azermai et al. [36], 2017 |
- Orientation for managers, staff teams, WHELD champions and residents - WHELD champions (two/each care home) training - on-site consultation | - 2 days orientation - WHELD champions trained 4 months (1 day per month) - On-site consultation 8 h/month/care home | The quality of life of older people, reduced agitation, general neuropsychiatric symptoms, antipsychotic use, global deterioration, mood, unmet needs, mortality, quality of interactions, pain and cost were assessed at baseline and at 9 months after the intervention. | P: WHELD interventions improved the quality of life of older people S: WHELD reduced agitation, and general neuropsychiatric symptoms, and increased the number of positive interactions between nurses and residents. There were also cost advantages. N = + / OP = + | Ballard et al. [38], 2018 | |
- Training and supporting by specialists such as a psychologist, occupational therapist or nurse including about the philosophy of person-centered care, positive care planning, awareness of environmental design issues, behavioral models, developing individual interventions, active listening, communication skills, reminiscence techniques and involvement of family careers. - Supervision for the staff members, including systematic consultation, home issues, didactic training, skills modelling | - 10 months training and supporting - Weekly supervision of groups and individual staff members | Daily dose of drugs, agitation, disruptive behaviour, and quality of life were assessed at baseline and after 12 months. | P: The proportion of residents using neuroleptic drugs in research centers was significantly lower than in the control homes. S: There was no effective difference between intervention and control groups in behavioral symptoms, but behavioral symptoms did not increase when less drugs were used. OP = + | Fossey et al. [62], 2006 | |
- Training and supporting by specialists such as a psychologist, occupational therapist or nurse including about the philosophy of person-centered care, positive care planning, awareness of environmental design issues, behavioral models, developing individual interventions, active listening, communication skills, reminiscence techniques and involvement of family careers. - Supervision for the staff members, including systematic consultation, home issues, didactic training, skills modelling | - Information about the study 60 min. - 2-day workshop - Supporting by experts during the intervention | Antipsychotic drug use, prescriptions of antipsychotics and safety parameters as falls were assessed at baseline and after 3, 6, 9, and 12 months. Quality of life and agitation were assessed at baseline and after 12 months. | P: The intervention did not reduce the use of antipsychotics in nursing homes in Germany, although a reduction was seen in the control group. S: There were not statistically significant differences between the study groups in Quality of Life, agitation, falls, physical restrains or prescriptions of antipsychotics. N = 0 | Richter et al. [68], 2019 | |
- Education about sleeping problems, depression in old age, challenging behaviour. Content of was focused on evidence-based practice, reductions in psychotropic drug use and non-pharmacological alternatives. | - Transition to person-centred care by awareness campaign - Online and printed material - Educational sessions (dose?), recorded and available later online - Assessment of psychotropic drug use (GP/ residents/ nurses /relatives) | Psychotropic drugs use was assessed at baseline and after 12 months. | P: The intervention resulted in a significant decrease in psychotropic drug use among nursing home residents after 12 months. The combination of education, professional support, and the transition towards patient-centred care proved successful in discontinuation of high in-house psychotropic drug like hypnosedative and antidepressant use, except antipsychotics. OP = + | Wauters et al. [73], 2019 | |
Interaction and caring culture | - Education to enhance nurses knowledge and skills concerning person-centered dementia care in eight themes: person-centered care and dementia, the emotional impact of caregiving, communication in dementia, conflict management, challenging behaviours, teamwork, the environment and dementia, motor simulation, problem solving, relaxation and multisensory stimulation. - Individual assisted sessions for nurses by experts - Supportive to improve nurses ability to cope with job-related stress and burnout | - Eight weekly session, 90 min per time - Three days after session, individual sessions with nurses | Direct care workers person-centredness video-recorded and then coded by global behavioral scale were assessed at baseline and after 8 weeks in the end of the intervention. | OC: Person-centered care-based continuing education intervention can be effective during the morning care to residents with dementia. It may increase nurses person-centeredness. Stress support for the test group was not effective. N = + | Barbosa et al. [42], 2017 |
- Education to enhance nurses knowledge and skills concerning person-centered dementia care in eight themes: Person-centered care and dementia, the emotional impact of caregiving, communication in dementia, conflict management, challenging behaviours, teamwork, the environment and dementia, motor simulation, problem solving, relaxation and multisensory stimulation - Individual assisted sessions for nurses by experts - Support to improve nurses’ ability to cope with job-related stress and burnout. | - Eight weekly session, 90 min per time - Three days after session, individual sessions with nurses | Direct care workers communicative behaviours with people with dementia were video-recorded and assessed at baseline and 2 weeks after eight-week intervention. | OC: Experimental group had a broader impact with the frequency of all behaviour categories than the control group. Experimental group had more verbal and non-verbal communication than the control group. N = + | Barbosa et al. [44], 2016a | |
- Education to enhance nurses knowledge and skills concerning person-centered dementia care in eight themes: Person-centered care and dementia, the emotional impact of caregiving, communication in dementia, conflict management, challenging behaviours, teamwork, the environment and dementia, motor simulation, problem solving, relaxation and multisensory stimulation - Individual assisted sessions for nurses by experts - Supportive to improve nurses’ ability to cope with job-related stress and burnout | - Eight weekly session of 90 min - Three days after session, individual sessions with nurses | Direct care workers’ stress, burnout, job satisfaction, and person-centered communicative behavior with people with dementia were assessed baseline, after eight-week intervention and after 6 months follow-up. | OC: Person-centered care-based continuing education is effective for reducing nurses’ burnout and improving communicative behaviors, up to 6 months after the intervention. Thus, the impact on stress levels sees to deteriorate after 6 months. Continuing education intervention did not influence the job satisfaction. N = + | Barbosa et al. [46], 2016b | |
- Functioning of long-term memory in people with dementia, reminiscing and one-to-one contact - Theatrical communication; importance of the” saying goodbye” ritual and relation with the life history of residents - Repeating the information from the first three monthly sessions and discussing the experiences of caregivers and the reactions of residents when applying VCM - Connection is made with the” authentic self” of the caregivers and exercise in how to start up a communication according VCM and related to the life history of residents as described in their care plan. | - Three monthly training sessions of 3 h - Three on-the-job coaching training sessions (1 h per session) before training sessions. - Two 3 h follow-up training sessions | Attitude of professional caregivers and self-rated ability to work with a care plan were assessed by measurements at baseline and at the end of the one-year intervention. The communicative behaviour of caregivers and residents’ behaviour were observed at baseline and at the end of the intervention. | OC: Significant improvements in caregivers’ communicative behavior and some aspects of residents’ behavior and quality of life were found on the experimental wards with a high implementation score. No significant differences were found between the groups in caregivers’ attitudes, residents’ care plans, or mood. N = + / 0 OP = + / 0 | Boersma et al. [48], 2019 | |
- Education including lectures on person-centered care, communication and relationships. | - 4 X 1 h sessions - Demonstration videos, homeworks, discussion, using an interaction worksheet. | Nursing assistants’ awareness of Person-centered care and interactions with residents and nursing assistants were assessed at baseline, 6 weeks after intervention and 7 weeks after that. | OC: Theory-driven person-centered training intervention for nurses could be developed and implemented in Nursing Homes. Residents reported a closeness of relationship with the CNA. Both CNAs and residents reported increased satisfaction in their relationship after the training period. N = + OP = + | Coleman & Medvene [57], 2013 | |
Content of intervention | Pedagogical methods | Assessments | Results and effectiveness in lens of nurses, older people and next of kin | Source | |
- Education by mentor homes | - Workbook - DVDs | Nursing homes perceive their adoption of person-centered care practices were assessed at baseline and after one-year education. | OC: Pre-adopters had lower scores 1 year after the education. This may be influenced the conceptualizing of person-centered care during the education. Better understanding of the concept of person-centered care can improve the rate of adoption. Education and training are important when changing the caring culture. The nurses role in the perception of person-centered care practices is important. N = 0 | Cornelison et al. [61], 2019 | |
- Therapeutic touch - Music therapy - Individualized meaningful activity | - 2 h training session | Non-pharmacological intervention based on the resident’s underlying needs was assessed at baseline and 3 days after the last session in 2 months intervention time. | OC: The frequency of aggression, loss of decorum, depression and the severity of aggression decreased for all three interventions. Person-centred team-based approach is effective to reduce agitated or aggressive behaviour amongst nursing home residents. OP = + | Gillis et al. [63] 2019 | |
- Individual communication plans - Dementia care workshop - Support system, for nurses | - 4-h workshop - Support by experts | Residents mood and daily functioning were assessed at baseline and 10 weeks after the care providers were instructed in using the communication plans. Care providers’ attitudes, satisfaction, and burden were assessed at baseline and 10 weeks following the workshop. | OC: Individually tailored resident interventions may improve the quality of life of residents with dementia. Also positive effects on care providers’ mood and burden were measured. N = + OP = + | McGilton et al. [67], 2017 | |
- Information about the project and the engagement of doctors, nurses, managers and the older people’s next of kin to the project - Education about the dementia care and Montessori activity training - Support system - Environment changes | - Four days education - One day / month consultation on nursing home - Support by phone and email | ABLE model was assessed at baseline and 12–14 months after the intervention. | OC: Significant behavior changes were evident among residents. Staff reported increased knowledge about meeting the needs of people with dementia and organizational culture change experiences. Next of kin were satisfied for the changes. N = + NK = + OP = + | Roberts et al. [69], 2015 | |
- Nurses and residents’ dyads were video recorded before and after the intervention - The first session introduced effective and ineffective communication; video vignettes were used - The second session focused on elderspeak and its identification and negative effects, video recordings used to provide examples. - The third session taught positive communication strategies, participants critiqued videos and corrected transcripts eliminating elderspeak | - 3 X 1 h group session - Videos | Changing Talk communication intervention was assessed by collected video recordings at baseline, immediately after the 3 weeks intervention and at three-month follow-up. | OC: Post-intervention improvements in communication occurred for each measure; however, the changes were statistically significant only for behavioral and psycholinguistic measures. Methods and results for each communication measure were compared. N = + OP = + | Williams et al. [74], 2018 | |
- Knowledge and skill concerning of person-centered care. - Information on dementia, verbal and non-verbal communication strategies, multisensory stimulation types. | - 8 weekly group sessions (90 min/session) by experts - Group discussions, simulations, homework exercises, role-playings and brainstorming | Multisensory and motor stimulation intervention effects were assessed at baseline and after the eight-weeks intervention through video-recordings. | P: Intervention seems to increase the frequency of engagement in the morning tasks. S: Residents’ frequency of closing their eyes decreased. They were less sad, smiled more and engaged in verbal communication more after the intervention increased. OP = + | Sposito et al. [72], 2017 | |
Nurses’ job satisfaction | - Education to enhance nurses knowledge and skills concerning person-centered dementia care in eight themes: Person-centered care and dementia, emotional impact of caregiving, communication in dementia, conflict management, challenging behaviours, teamwork, environment and dementia, motor simulation, problem solving, relaxation and multisensory stimulation. - Individual assisted sessions for nurses by experts - Supportive to improve nurses’ ability to cope with job-related stress and burnout | - Eight weekly session, 90 min per time - Three days after session, individual sessions with nurses | Direct care workers stress, burnout and job satisfaction were assessed at 2 weeks before and 2 weeks after the intervention. | OC: Continuing education intervention has a significant positive effect on nurses’ emotional exhaustion. According to the qualitative data, the experimental group perceived enhanced cohesion, emotional management, and self-care awareness. This can reduce nurses’ burnout. N = + | Barbosa et al. [47], 2015 |
- Knowledge transfer and skills training in focus on meetings - on-the-job coaching included behavioral observation and direct feedback | - 5 X 3-h team meetings - 3 × 3-h on-the-job coaching sessions | Veder Contact Methods effects to the caregivers’ job satisfaction was assessed at baseline and after the 9 months intervention. | OC: The intervention had no significant effect for job satisfaction using the quantitative data findings. The qualitative data findings indicate that intervention has positive influence on the daily work performances of nursing home caregivers. N = 0 / + | Boersma et al. [49], 2017 | |
- Person centered care group: two selected nurses per site engaged in off-site person-centered care education and after that person-centered care expert visited two full days on-site to assist these nurses to develop individual residents care plans and to implement person-centered care - Dementia Care Mapping group: two selected nurses per site engaged in off-site dementia care mapping and person-centered care education and after that experts worked alongside them to conduct dementia care mapping for all participating residents. | - Person-centered care: 2-day education off-site and 2-day on-site guide to implement person-centered care. Support by phone for 4 months. - Dementia care mapping: 3-day education off-site and alongside worked with selected nurses after the education. Support by phone for 4 months. | Staff burnout, general well-being, attitudes, and reactions towards residents behavioural disturbances, perceived managerial support and quality of care interactions were assessed at baseline, immediately after intervention and at 4 months’ follow-up. | P: Dementia care mapping was more effective than person-centered care to reduce the staff members’ job-related burnout and emotional exhaustion. The support of managers is important. Without the managers support the influence of intervention is weaker and lasts less time. S: There were no significant differences in terms of staff attitudes and reactions towards behavioral disturbances and care quality. N = + | Jeon et al. [65], 2012 | |
Nursing activities | - Knowledge-based seminar material based on two Swedish national documants about the key principles of palliative care. - The Eductional booklet used as study material with nurses had five themes: palliative care and dignified care, next of kin, existence and dying, symptom relief, collaborative care. | - 5 X 2 h education seminars | Person-centeredness education intervention effectiveness on the staff’s perception of providing person-centred palliative care for older people in nursing homes was assessed at baseline and 3 months after the 6 months intervention. | OC: The intervention was not effective, because results showed no improvement in any outcomes. The only perceived improvement area in person-centered care was the managers’ and organization’s support of the staff’s everyday work to maintain person-centered care. N = 0 | Bökberg et al. [50], 2019 |
- Education about the person-centered approach to showering and and towel baths focusing on residents’ needs, the accommodation of residents’ preferences, attending to the relationship and interaction with residents, using effective communication and interpersonal skills, adapting the physical environment and bathing procedures to decrease distress and discomfort. | - 2 × 6 weeks training periods including didactic sessions, reviewed videotaped material, coaching in bathing situations by clinical nurse specialist | Effects of two bathing interventions on caregiving were assessed at baseline, end of the first 6 weeks intervention, and end of the next 6 weeks intervention also. | OC: Bathing interventions improved gentleness, verbal support, confidence, and ease, but not reduce the hassles. N = + OP = + | Hoeffer et al. [64], 2006 | |
- Developed from Kitwood’s model of Dementia and framework for person-centered care: understanding dementia (the person and disease), being with the person who has dementia, making a difference in the life of the cognitively impaired. | - One 2 h and two 3-h lectures with learning exercises and role playing. - On-site training twice per week × 4 weeks (total 16 h) - 4-h dementia care mapping session - On-the-job practicing - Consultation | Sleeping of assisted living residents with dementia was assessed 3 days at baseline and 3 days after the intervention. | P: Staff education intervention may have effective for improving the sleep of residents with dementia. In the intervention group residents had significantly more night-time sleep and less daytime sleep than in control group. OP = + | Li et al. [66], 2017 | |
- Oral pathology, dementia care, individualized care planning and skills training | - Seminars - On-site training daily for 2 weeks by dental hygienist and geriatric psychologist - Consultation. | Residents’ oral hygiene were assessed at baseline via videotaped performing mouth care by CNAs and during the 6 weeks intervention by measurements and video recording by CNAs. | P: The intervention had a significant effect on the residents’ oral hygiene outcomes as Plaque Index and Gingival Index. S: after the intervention mouth care was more thorough, took more time and consistency of care appeared to be more important for natural teeth than dentures. OP = + | Sloane et al. [70], 2013 | |
- Person-centered bathing focused on resident comfort and preferences, viewed behavioral symptoms as expressions of unmet needs, employed communication techniques appropriate for the resident’s disease severity, applied problem-solving approaches to identify causes and potential solutions and regulated the physical environment to maximize resident comfort. | - 2 × 6 weeks training periods including didactic sessions, reviewed videotaped material, coaching in bathing situations by clinical nurse specialist | Nonpharmacological techniques in reducing agitation, aggression and discomfort in nursing home residents with dementia in bathing situations and skin condition were assessed at baseline and end of both intervention periods. | P: Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of people with dementia. S: Average bath duration increased significantly in showering. Neither intervention resulted in fewer body parts being bathed, both improved skin condition. N = + OP = + | Sloane et al. [71], 2004 | |
Older peoples’ quality of life | - Person-centered care: residents’ feelings when agitated, interacting with residents in a person-centered way and using Person-centered care planning to meet the residents’ psychosocial needs. - Person-centered education: improvements to the safety accessibility and utility of outdoor spaces, provision of a greater variety of social spaces and using colour and objects for wayfinding and to improve feelings of familiarity. | - Person-centered care: 32 h off-site education for” Key” nurses and on-site supervision (range 2–16 h) and support by phone. | Difference effects of PCC and PCE interventions were assessed at baseline, after 4 months intervention and at 8 months follow-up. | P: Person-centered care and person-centered education interventions together did not seem to improve the quality of life or reduce agitation but improved emotional responses to care. Depression scores did not change in any of the groups. S: Education interventions together seems to improve in care interaction quality. OP = 0 | Chenoweth et al. [53], 2014 |
- An understanding that behaviour is a form of communication. Nurses need to recognize that feelings persist despite cognitive impairment and acknowledge feelings during social interactions. Nurses should focus on the unique way that residents express feelings and needs to change usual care. | - Person-centered care: 2-day training sessions for two nurses per site - Two visits per site - Dementia care mapping: 2 X 6 h training for two nurses per site - Both: on-site assisting to implement dementia care mapping/person-centered care for residents and support by phone | Comparison of person-centred care, dementia care mapping and usual care effects to agitation and psychiatric symptoms were assessed at baseline, after 4 months intervention and at 4 months of follow-up. | P: Both person-centered care and dementia care mapping seems to reduce agitation. S: Person-centered care was less safe than dementia care mapping, because falls happened more in person-centered care groups. Person-centered care had more positive social and care interactions than other groups. Interventions did not have any influence on the level of medication use. Person-centered care intervention costs were lower than dementia care mapping. OP = + | Chenoweth et al. [56], 2009 | |
- The concept of dementia; how to respond to dementia; the concept of person-centered care; and specific methods of interacting with residents with dementia. - Discussions, based on the dementia care mapping results, focused on the following: consideration of the behaviors of residents with dementia; respecting residents during interactions; and improving future care processes. | - 3 X 60–90 min training sessions | Effects of staff training on person-centred care and dementia care mapping on quality of life of residents with dementia were assessed at 1 month before baseline, at baseline and last after the intervention. | OC: Person-centered care-based staff training, and dementia care mapping could effectively improve the quality of life of residents with dementia. OP = + | Yasuda & Sakakibara [75], 2017 |