Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective ...psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost.
This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory CMAI), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version NPI-NH), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale QUIS), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen's D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI -7.39, -1.15; Cohen's D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI -7.07,-2.02; Cohen's D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen's D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group.
These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting.
ISRCTN Registry ISRCTN62237498.
ABSTRACT Objective To understand entrepreneurship and entrepreneurial education in the context of postgraduate nursing. Method Qualitative study based on Grounded Theory. The theoretical sample ...consisted of 15 master’s and doctoral students and seven professors from a postgraduate nursing program at a university in southern Brazil. Individual interviews were conducted between August/2018 and February/2019 in a location defined by the participants, in general the University. The data were collected and analyzed simultaneously by initial and focused coding. Results Three categories and 11 subcategories emerged that, interrelated, represented the phenomenon “Glimpsing entrepreneurship and entrepreneurial education in postgraduate nursing”. Conclusion Entrepreneurship and entrepreneurial education, in the context of postgraduate nursing, were understood as incipient and promising processes. In this sense, it is necessary to intensify studies to demonstrate the entrepreneurial possibilities of the area.
RESUMEN Objetivo Comprender el emprendimiento y la educación emprendedora en el contexto del posgrado de enfermería. Método Estudio cualitativo basado en la Teoría Fundamentada. La muestra teórica estuvo compuesta por 15 estudiantes de maestría y doctorado y siete profesores de un programa de posgrado en enfermería de una Universidad del sur de Brasil. Las entrevistas individuales se realizaron entre agosto/2018 y febrero/2019 en un lugar definido por los participantes, en general la Universidad. Los datos se recopilaron y analizaron simultáneamente mediante codificación inicial y enfocada. Resultados Surgieron tres categorías y 11 subcategorías que, interrelacionadas, representaron el fenómeno “Vislumbrando el emprendimiento y la educación emprendedora en los posgrados de enfermería”. Conclusión El emprendimiento y la educación emprendedora, en el contexto del posgrado de enfermería, fueron entendidos como procesos incipientes y prometedores. En este sentido, es necesario intensificar los estudios para demostrar las posibilidades emprendedoras de la zona.
RESUMO Objetivo Compreender o empreendedorismo e a educação empreendedora no contexto da pós-graduação em enfermagem. Método Estudo qualitativo, do tipo Teoria Fundamentada nos Dados. A amostragem teórica foi composta por 15 estudantes de mestrado e doutorado e sete docentes de um programa de pós-graduação em enfermagem de uma Universidade do sul do Brasil. Realizaram-se entrevistas individuais entre agosto/2018 e fevereiro/2019 em local definido pelos participantes, em geral a Universidade. Os dados foram coletados e analisados simultaneamente por codificação inicial e focalizada. Resultados Emergiram três categorias e 11 subcategorias que, interrelacionadas, representaram o fenômeno “Vislumbrando o empreendedorismo e a educação empreendedora na pós-graduação em enfermagem”. Conclusão O empreendedorismo e a educação empreendedora, no contexto da pós-graduação em enfermagem, foram compreendidos como processos incipientes e promissores. Nesse sentido, é preciso que se intensifiquem estudos para demostrar as possibilidades empreendedoras da área.
råholm m‐b., hedegaard b.l., löfmark a. & slettebøå. (2010) Nursing education in Denmark, Finland, Norway and Sweden – from Bachelor’s Degree to PhD. Journal of Advanced Nursing 66(9), 2126–2137.
...Aim. This paper is a discussion of the similarities and differences in baccalaureate nursing education programme structures, content and pathways to postbaccalaureate education in the Scandinavian countries.
Background. For the last three decades nursing education internationally, as well as in the Scandinavian countries, has experienced ongoing reforms. The driving forces behind these reforms have been efforts for professional development within nursing and to harmonize higher education in several European countries.
Data sources. The data were collected by a critical review of the guiding principles, national directives and educational structures and content of Bachelor’s degree programmes from 1990 to 2008 and of further educational levels in the four Scandinavian countries.
Discussion. There are similarities as well as substantial differences in the educational structures, contents and lengths in the different nursing programmes. Nursing education is organized in the three cycles described in the Bologna Process, but there are differences regarding names and terms for degrees and allocation of European Credit Transfer System credits.
Implications for nursing. Policymakers need to consider more carefully the directives in the Bologna Declaration when planning and implementing nursing programmes at Bachelor’s and postgraduate levels. Knowledge of the content and structure of nursing education in these countries may enhance development and cooperation between institutions.
Conclusion. A challenge for the ministries of education in the Scandinavian countries is to compare and coordinate nursing educational programmes in order to enable nursing students, educators, researchers and nurses to study and work in Scandinavia, Europe or even globally.
The growing use of quick response (QR) codes has become a way to engage learners and promote critical thinking. QR codes are incorporated into a table top activity with codes placed onto a body map ...to guide users through a patient scenario. The codes are scanned to identify patient problems and anticipate care and a debrief session following the activity. This technology offers unlimited learning experiences and can be used in any disciplines of nursing.
Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various ...real-life situational experiences. However, simulation approaches fall along a continuum ranging from low-fidelity to high-fidelity simulation. The purpose of this study was to determine the effect size of simulation-based educational interventions in nursing and compare effect sizes according to the fidelity level of the simulators through a meta-analysis.
This study explores the quantitative evidence published in the electronic databases EBSCO, Medline, ScienceDirect, ERIC, RISS, and the National Assembly Library of Korea database. Using a search strategy including the search terms "nursing," "simulation," "human patient," and "simulator," we identified 2279 potentially relevant articles. Forty studies met the inclusion criteria and were retained in the analysis.
This meta-analysis showed that simulation-based nursing education was effective in various learning domains, with a pooled random-effects standardized mean difference of 0.70. Subgroup analysis revealed that effect sizes were larger for high-fidelity simulation (0.86), medium-fidelity simulation (1.03), and standardized patients (0.86) than they were for low-fidelity and hybrid simulations. In terms of cognitive outcomes, the effect size was the largest for high-fidelity simulation (0.50). Regarding affective outcome, high-fidelity simulation (0.80) and standardized patients (0.73) had the largest effect sizes.
These results suggest that simulation-based nursing educational interventions have strong educational effects, with particularly large effects in the psychomotor domain. Since the effect is not proportional to fidelity level, it is important to use a variety of educational interventions to meet all of the educational goals.
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