CHCAC318B | Work | Implementing A Training Session For Management

Discuss the implementing a training and education session for management of challenging behaviours in dementia patient among care staffs in aged care setting.

Answer:

Introduction:

Dementia is one of the mental disorders whose prevalence is increasing day by day and it is leading to great burden for health care staffs and reduction in quality of life of affected people. According to the World Alzheimer Report (2015) report, an estimated 4.8 million people were living with dementia in 2015 and the number is going to reach 75 million in 2030. The highest rate of increase is most likely to be seen in developing countries and those with the highest number of ageing population such as China, India, South Asia and the Pacific regions. It is also estimated that the prevalence rate will increase to 131.5 million in 2050. Hence, considering this trend, dementia is going to be a major problem in the developing regions of the world. One major issue is that health care professionals are not equipped with the desired skills to understand the complex symptoms of patient and provide optimal care (Baboolal et al. 2018). In such situation, lack of experienced staff is further going to deteriorate health outcomes of people admitted in health care setting. As it is liability of health care workers to reduce symptoms and supporting high quality living in people, taking steps to understand the effectiveness of staff training and education on management challenging behaviours of people with dementia is important.

Project aim, rationale and significance of the project:

The project aims to achieve the following objectives:

• To evaluate gap in knowledge related to dementia care
• To implement staff training program and understand the impact of training on patient outcome
• To understand the impact of training health care professionals outcome
• To evaluate confidence and skills of staffs in managing challenging behaviour of people with dementia.

The main outcomes expected from this project are as follows:

• The implementation of the project in aged care setting would help to identify level of knowledge of staffs regarding dementia care and its management
• It is expected that the confidence level of staffs will increase and stress level will decrease by participating in training and education session.

Context and setting

Background (Literature review):

Another cluster randomized controlled trial investigated about the effectiveness of stepwise multidisciplinary intervention addressing challenging behaviour in advanced dementia. The intervention group staffs received stepwise comprehensive multidisciplinary training and the control group received training on dementia management and pain without the multidisciplinary component. The staffs were provided training of five meetings related to physical and assessment skills to identify unmet needs of individual. The positive effect of this intervention was that it improved agitation, depression and other neuropsychiatric symptoms of patient. As depression and agitation are some symptoms that present major challenges to geriatrist, psychiatrist and neurologist, the evidence provides solution to improve the skills of these health care professionals (Pieper et al., 2016). However, despite these findings, certain limitations or gaps in research methodology affected the validity of the study. For example, the residents were unaware of the intervention and only the research assistant was blinded to the intervention. Therefore, the fidelity of the training procedure was doubtful. These limitations need to be resolved in future research.

The review of research study revealed evaluation of the effectiveness of educational programs by means of a systematic review too. The significance of this study was that it looked to examine those studies that reduced the burden of caregivers of elderly patients with dementia. Dementia patients most commonly exhibit behavioural symptoms like agitation, delusions and hallucinations. Dementia caregivers are burdened by the increase in such behavioural changes in patient. Such behavioural and psychological symptoms not just increase prognosis but also worsens prognosis and cost associated with care. Hence, to address the issue, () examined research evidence regarding the effectiveness of educating in reducing care giving burden. Seven randomized controlled trial was evaluated which compared with standard delivery care. The evidences suggested that education and supports have positive effect on reducing caregiver burden. The reliability of the evidence was also understood from low risk of bias in studies. The knowledge level and coping strategies of caregivers improved and it reduced depressive symptoms in patient. Some limitation of the studies was that inappropriate measurement techniques and population composition was used. Hence, this evidence points out to the need for conducting studies with more appropriate research designs and better description about the intervention.

Project Design

Samples:

Assessment of knowledge:

Implementation of training and education program:

Reassessment of knowledge and performance:

The reassessment of the knowledge of the staffs regarding dementia care was done again by conducting survey using the DKAT 2 tool. The outcome and effectiveness of the education and training session was judged by the outcome of the survey response. In addition, to further understand the effectiveness of training staffs, each staffs were observed regarding how they interacted with patients, managed challenging behaviours and the response of patient. The observation of staff was done 10 days before and after the intervention. I analyzed the video recordings of patients and added comments after seeing the videos.

Outcome:

The initial survey with the staffs using the DKAT tool revealed certain misconceptions related to dementia. The survey response was an important data that helped to plan appropriate intervention to increase competence of staffs and increase patient’s satisfaction with care. The scores given by the tool ranged from 0 to 21 and higher scores indicated greater dementia knowledge. Staffs were also asked regarding their age and work experience. A total of 30 health care professionals completed the DKAT tool questionnaire and the survey before the intervention revealed that only five health care professionals could achieve high score of 20-21. Significant correlation was also found between age, work experience and knowledge of staffs. This is said because high scores were obtained for those health care professionals who had more than three year experience in working with dementia patients. However, in case of experience staffs also, poor conception related to management of dementia was found. For example, for the question ‘Are you confident enough to manage the challenging behaviours in dementia care at your workplace?’, even experienced staffs were reluctant in saying ‘yes’. Very few staffs expressed confidence. In addition, the response of participants related to dementia care such as changing the environment, identify pain in patients also revealed poor knowledge among health care staffs.

Discussion:

Limitations:

Conclusion:

This project report gave an insight into the manner in which the project was implemented to address care giving burden in dementia and revealed about the outcomes that were achieved after implementing a training and education program in health care setting. Implementing this project was important because as a staff working in age care setting in Australia, I myself have seen many staffs complaining about distress and poor satisfaction with job because of inability to control challenging behaviours of dementia patient. The significance of the project is also understood from the review of research literature. However, certain gaps such as lack of consideration of training needs and assessment of factors contributing to unmet needs reduced the reliability of evidence. Hence, taking cure from the gaps, this project was planned. The education session was found to positively influence skills and confidence of staffs in providing dementia care. Implementing this project also enhanced my report writing skills, critical thinking skills, reflective skills and time management skills.

References:

Baboolal, N., Davis, G., Stewart, R., Ramesar, J., & McRae, A. (2018). Comparisons between different elements of reported burden and common mental disorder in caregivers of ethnically diverse people with dementia in Trinidad. PloS one, 13(7), e0201165. Doi: ps://doi.org/10.1371/journal.pone.0201165

De Vriendt, P., Cornelis, E., Desmet, V., Vanbosseghem, R. and Van de Velde, D., 2018. Quality in dementia care: A cross sectional study on the Bio-Psycho-Social competencies of health care professionals. PloS one, 13(2), p.e0191440. https://doi.org/10.1371/journal.pone.0191440

George, J., Long, S., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. Journal of the Royal Society of Medicine, 106(9), 355–361. https://doi.org/10.1177/0141076813476497

Pieper, M. J., Francke, A. L., van der Steen, J. T., Scherder, E. J., Twisk, J. W., Kovach, C. R., & Achterberg, W. P. (2016). Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: a cluster randomized controlled trial. Journal of the American Geriatrics Society, 64(2), 261-269. doi: 10.1111/jgs.13868

Resnik, D. B. (2011). What is ethics in research & why is it important. National Institute of Environmental Health Sciences, 1-10. Retrieved from: https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm