An audit of dementia education and training in UK health and social care

Smith, S. et al. | An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards | BMC Health Services Research | volume 19, Article number 711 (2019)

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Abstract

Background

Despite people living with dementia representing a significant proportion of health and social care users, until recently in the United Kingdom (UK) there were no prescribed standards for dementia education and training. This audit sought to review the extent and nature of dementia education and training offered to health and social care staff in the UK against the standards described in the 2015 Dementia Training Standards Framework, which describes the knowledge and skills required of the UK dementia workforce.

Methods

This audit presents national data concerning the design, delivery, target audience, length, level, content, format of training, number of staff trained and frequency of delivery within existing dementia training programmes offered to health and social care staff. The Dementia Training Standards Framework was used as a reference for respondents to describe the subjects and learning outcomes associated with their training.

Results

The findings are presented from 614 respondents offering 386 training packages, which indicated variations in the extent and quality of training. Many training packages addressed the subjects of ‘person-centred care’, ‘communication’, ‘interaction and behaviour in dementia care’, and ‘dementia awareness’. Few training packages addressed subjects concerning ‘pharmacological interventions in dementia care’, ‘leadership’ and ‘end of life care’. Fewer than 40% of The Dementia Training Standards Framework learning outcomes targeted to staff with regular contact with people with dementia or in leadership roles were covered by the reported packages. However, for training targeted at increasing dementia awareness more than 70% of the learning outcomes identified in The Dementia Training Standards Framework were addressed. Many training packages are not of sufficient duration to derive impact; although the majority employed delivery methods likely to be effective.

Conclusions

The development of new and existing training and education should take account of subjects that are currently underrepresented and ensure that training reflects the Training Standard Framework and evidence regarding best practice for delivery. Lessons regarding the limitations of training in the UK serve as a useful illustration of the challenge of implementing national dementia training standards; particularly for countries who are developing or have recently implemented national dementia strategies.

Full article: An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards

Person-centered dementia care in acute hospital wards

Anthony Scerri et al. | Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes | Geriatric Nursing | available online 17 October 2019

Highlights

  • Achieving person-centered dementia care in hospitals is challenging for staff partly due to their lack of educational preparation.
  • Only 40% of participants (hospital staff) had previous training in dementia.
  • The more the staff were knowledgeable about dementia, the more critical they were about the level of person-centered care they delivered.
  • The more positive were the attitudes of the staff towards persons with dementia, the more they perceived were individualizing their care.

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Abstract

Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices.

A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards.

The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices.

The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.

Full detail at ScienceDirect

Benefits of attending a ‘Dementia First Aid’ course for family caregivers of people with early dementia

Study results suggest that the dementia first aid course is effective in changing the knowledge and attitude of dementia caregivers. It is hoped that this will also enhance their ability and skills of caring, which may in turn reduce caregivers’ sense of burden and wellbeing | British Journal of Medical Practitioners

Abstract
Objective: Pilot evaluation of the impact of a ‘Dementia First Aid’ (DFA) training course on the knowledge and attitude of family caregivers of people with early dementia.

Methods: The participants in the study were primary family caregivers of people with dementia residing in northwest Hertfordshire. The 4-hour ‘Dementia First Aid’ course was delivered by NHS professionals. The training was organised once every second month from November 2015 till March 2017. The course provided overview of dementia and its impact on the person and their families, mindfulness based stress reduction, and the dementia first aid action plan for crises. The participants were asked to complete the Alzheimer’s disease Knowledge Scale (ADKS) before and after the completion of the course & complete carer burden scale (Zarit Burden Scale). Participants were asked to complete the scales after six months.

Results: The study sample comprised 65 people who had completed the DFA course. All completed pre- and post-training measures (ADK and Zarit burden scale), and a further 34 provided follow-up data approximately 6 months later. The scores were compared using a correlated group t-test. ADK scores improved significantly immediately after attending the course. For the subgroup that completed data at 6 months, the improvement in scores was sustained.

Conclusions: This ‘Dementia First Aid’ course appears to be effective in improving family caregiver’s knowledge of dementia and this knowledge was sustained at 6 months follow up.

Full article: Rahul Tomar et al. | Benefits of attending a ‘Dementia First Aid’ course for family caregivers of people with early dementia: findings of a pilot evaluation | British Journal of Medical Practitioners | 2019;12

e-Dementia e-learning programme updated

Health Education England e-Learning for Healthcare (HEE e-LfH) has been working with the University of Bradford to review, add new content and update sessions within the e-Dementia e-learning Programme

e-learning-3734521_1920The programme about dementia care has been designed to enhance the training and education of the health and care workforce. It focuses on the essential knowledge and skills needed to support and enable people living with dementia and their family carers to live as well as possible, wherever they live.

e-Dementia will also be of interest to those responsible for training and educating the health and care workforce. It can be used in a variety of ways including as part of induction; to structure reflective practice with individual staff and teams; for self-paced learning; and to revisit as a form of refresher training.

As part of the e-Dementia update, 14 new sessions have been added and 12 sessions have been retired from the programme.

Full details at e-learning for Healthcare

More about the e-learning programme in Dementia Care, including how to access the programme here 

Memory training for adults with probable mild cognitive impairment

Graham J. McDougall, Ian M. McDonough & Michael LaRocca | Memory training for adults with probable mild cognitive impairment: a pilot study |  Aging & Mental Health | Published online: 10 Oct 2018

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Abstract
Background & Objectives:
This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI).

Research Design & Methods:
Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing.

Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates.

Results:
Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition.

Conclusions:
Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants’ declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.

Full detail at Aging & Mental Health 

Dementia Training Standards Framework

Health Education England, Skills for Health & Skills for Care, | July 2018 |Dementia Training Standards Framework

Health Education England (HEE) have released the Dementia Training Standards Framework, the resource was previously known as Dementia Core Skills Education and Training Framework, its recent update and review included a number of additions regarding food, drink and oral health.

 

The framework is  an extraordinarily useful resource which details the essential skills and knowledge necessary across the health and social care spectrum. Three tiers are described:

  • Awareness, which everyone should have;
  • Basic skills which are relevant to all staff in settings where people with dementia are likely to appear and;
  • Leadership.

This framework will help ensure quality and consistency in dementia education and training if you are an organisation or an individual working in health, social care or housing.

The framework will allow the differentiation of high quality services, ensure personalised care and support for people living with dementia, and support organisations and individuals to meet requirements of regulators  (source: HEE).

You can access the framework here

Alternatively, the framework can be downloaded from the Skills for Health website

iSPACE – dementia friendly GP surgeries

iSPACE is helping surgeries improve support for patients with dementia and their carers | AHSN

iSPACE is a quality improvement and innovation programme delivered in GP surgeries in all parts of Hampshire, Dorset, Isle of Wight and south Wiltshire. The aim of iSPACE is to improve the pathway of patients with dementia and their carers through primary care.

The key to the spread of iSPACE is the engagement of staff teams and a recognition that people with dementia need a more personalised care plan and access to resources to help them and their carers to better manage the pathway.

Wessex Academic Health Science Network (AHSN) worked with Alzheimers charities, clinical commissioning groups (CCGs), Public Health England (PHE), Health Education England (HEE) and companies providing dementia services both within and outside the NHS to deliver this project. The AHSN delivered the project into 153 GP surgeries providing training, access to resources, meetings to encourage progress and physical resources such as funding for environmental changes and literature.

Patients reported feeling more supported by their surgery; carers reported a greater understanding of dementia from the surgery team and seeing the same clinician at each appointment. Dementia diagnosis rates increased (15.9% for people aged over 65), care planning increased by 26% for face to face reviews and 80% of surgeries now have a dementia noticeboard.

Full detail at The AHSN Network

Dementia Education: Does It Change Nursing Practice?

Although gerontological nurses are well positioned to care for older adults with dementia, barriers to implementing quality client care remain, including: limited knowledge, poor morale among care staff, lack of professional development opportunities, and unsuitability of acute care hospitals for this client group | Journal of Gerontological Nursing

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The solution most commonly offered is education. Many academic institutions, health care facilities, and even professional associations offer educational activities. The literature is rich with descriptions of activity formats, from workshops of less than 1 hour in duration to courses provided over 12 months or longer, offered in face-to-face format, print, or via online learning. Exceptional educational activities might be described as having a high degree of transference, meaning that the information learned in these activities can be easily applied to gerontological nursing practice.

Yet, I question whether these activities actually change nursing practice. Based on my review of the literature, most educational activities are evaluated in terms of attitude shifts, knowledge gained, and/or satisfaction with course content—few speak to changes in the quality of care provided to older adults with dementia. One reason may be that a large proportion of the published literature on the topic of dementia workforce education describes research studies, which are often by definition initiated by individuals external to a facility, time-limited, and not always sustainable. If we are to face the challenge of demographic aging and the projected increase it will bring in the number of older adults living with dementia, academic and health and human service organizations will need to ensure that their nursing workforce has the knowledge and, more importantly, the skills required to perform their work. However, the value of educational activities in determining clinical interventions and subsequently evaluating the direct effects of these interventions on outcomes for older adults with dementia has been limited.

Full reference: Hirst, S.P. (2017) Dementia Education: Does It Change Nursing Practice? Journal of Gerontological Nursing. Vol 43 (Issue 7) pp. 2-3

Dementia training programmes for staff working in general hospital settings

Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes | Aging & Mental Health 

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Objectives: This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes.

Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

Full reference: Scerri, A. et al. (2017) Dementia training programmes for staff working in general hospital settings – a systematic review of the literature. Aging & Mental Health. Vol. 21 (no. 8) pp.783-796

Dementia training programmes for staff working in general hospitals

Anthony Scerri , Anthea Innes & Charles Scerri. Dementia training programmes for staff working in general hospital settings – a systematic review of the literature |Aging & Mental Health Vol. 21 , Iss. 8, 2017.

Objectives: Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes. This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

Method: Literature from five databases were searched, based on a number of inclusion criteria. The selected studies were summarised and data was extracted and compared using narrative synthesis based on a set of pre-defined categories. Methodological quality was assessed.

Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes.

Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.