BackgroundAccess to palliative and end-of-life care for people with dementia living in nursing ho... more BackgroundAccess to palliative and end-of-life care for people with dementia living in nursing homes is suboptimal. Nursing home staff require training in palliative care for dementia to equip them with knowledge and skills to deliver high quality care. ObjectiveThe primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.Subjects & setting1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. MethodsRandomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.Staff from intervention nursing ho...
Background
People with dementia have unique palliative and end-of-life needs. However, access to ... more Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.
Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.
Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.
Subjects & setting 1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.
Methods Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.
Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.
Results At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.
Conclusion This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.
Good preparation for surgical procedures has been linked to better performance and enhanced learn... more Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their...
Women and birth : journal of the Australian College of Midwives, Jan 25, 2015
Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. Howev... more Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (mi...
Clinicians require specific skills to teach or supervise students in the workplace; however, ther... more Clinicians require specific skills to teach or supervise students in the workplace; however, there are barriers to accessing faculty member development, such as time, cost and suitability. The Clinical Supervision Support Across Contexts (ClinSSAC) programme was designed to provide accessible interprofessional educator training to clinical supervisors across a wide range of clinical settings. In Australia there are increasing numbers of health care students, creating pressure on existing placements. Students are now increasingly learning in community settings, where clinicians have traditionally had less access to faculty member development. An interprofessional team collaborated in the development and implementation of ClinSSAC. A total of 978 clinicians participated in a face-to-face, interactive, introductory module to clinical supervision; 672 people accessed the equivalent online core module, with 23 per cent completing all activities. Additional profession-and discipline-specific modules were also developed. Formal project evaluation found that most participants rated the workshops as helpful or very helpful for their roles as clinical supervisors. Interdisciplinary learning from the workshops was reported to enable cross-discipline supervision. Large participant numbers and favourable ratings indicate a continuing need for basic training in education. Key factors to workshop success included expert facilitators, the interprofessional context and interactive model. The online modules were an important adjunct, and provided context-specific resources, but the low online completion rate suggests protected face-to-face time for faculty member development is still required. Programmes such as ClinSSAC have the capacity to promote interprofessional education and practice. There are barriers to accessing faculty member development, such as time, cost and suitability.
Peer assisted learning (PAL) is well documented in the medical education literature. In this pape... more Peer assisted learning (PAL) is well documented in the medical education literature. In this paper, the authors explored the role of PAL in a graduate entry medical program with respect to the development of professional identity. The paper draws on several publications of PAL from one medical school, but here uses the theoretical notion of legitimate peripheral participation in a medical school community of practice to shed light on learning through participation. As medical educators, the authors were particularly interested in the development of educational expertise in medical students, and the social constructs that facilitate this academic development.
Evidence for the use of a patient-centred model for interviewing is well established in the West.... more Evidence for the use of a patient-centred model for interviewing is well established in the West. There is much less evidence for the application of the model in other cultural settings. This paper describes the impact of a communication skills (CS) course for doctors (n = 32) working in government outpatient clinics in Hong Kong. Emphasis is placed on the cultural relevance of the patient-centred interview (PCI) and educational techniques. Knowledge scores increased immediately after the course and again 8 weeks later (p < 0.001). Participants held favourable attitudes at the outset of the course and these were largely maintained. Qualitative data suggests that the doctors' competence in CS increased. The PCI model was perceived as relevant to the practices of these doctors. Barriers preventing the implementation of this approach related to organizational rather than cultural factors. The educational strategies were well received, suggesting that adult Chinese learners are n...
The quality of psychosocial assessment of children in consultations varies widely. One reason for... more The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and ...
Meyer and Land (2003) describe threshold concepts as being &amp;amp;amp;amp;amp;amp;quot;akin... more Meyer and Land (2003) describe threshold concepts as being &amp;amp;amp;amp;amp;amp;quot;akin to a portal, opening up a new and previously inaccessible way of thinking about something.&amp;amp;amp;amp;amp;amp;quot; As a consequence, threshold concepts have a transformational potential and may lead to an associated change in identity. The successful completion of pediatric surgical training in the United Kingdom is a lengthy and complex professional journey in which trainees emerge as consultants with a professional identity. We sought to explore how &amp;amp;amp;amp;amp;amp;quot;threshold concepts&amp;amp;amp;amp;amp;amp;quot; applied to pediatric surgical training with a view to identifying elements that were &amp;amp;amp;amp;amp;amp;quot;troublesome.&amp;amp;amp;amp;amp;amp;quot; Semistructured interviews were conducted. Transcripts were generated from audio recordings and thematically analyzed by the authors. Constant comparison was used to refine themes. Participants were purposively recruited across all years of training. A total of 8 pediatric surgical trainees participated in the study. Approval from obtained from the Human Research Ethics committee. Although there is overlap between themes, analysis revealed &amp;amp;amp;amp;amp;amp;quot;troublesome&amp;amp;amp;amp;amp;amp;quot; areas of training related to knowledge (breadth and rarity of some conditions), clinical judgment (shifting expectation of independence), technical skills (accessing opportunities), transitions between roles (increasing responsibility and remoteness of support), relationships with trainers, and the effect of negative experiences. Viewing trainees&amp;amp;amp;amp;amp;amp;#39; experiences of surgical training through the lens of &amp;amp;amp;amp;amp;amp;quot;threshold concepts&amp;amp;amp;amp;amp;amp;quot; provides insight to the importance of viewing the curriculum in a holistic way. Negative experiences in training were an important catalyst for development, inducing a fundamental change in perception, which might be characterized as a rupture of a &amp;amp;amp;amp;amp;amp;quot;meaning frame.&amp;amp;amp;amp;amp;amp;quot; Trainees in pediatric surgery can be viewed as moving to a mature specialist identity via a transitional state-liminality, from entry into specialist training.
ABSTRACT To evaluate a culture-specific videotape on how to &#39;break bad news&#39; and ... more ABSTRACT To evaluate a culture-specific videotape on how to &#39;break bad news&#39; and another videotape produced by a western university, and to determine if the language of presentation influenced the students&#39; perceived abilities to execute basic skills. Third year medical students at the Faculty of Medicine, the University of Hong Kong. Longitudinal study with experimental design. Two instructional tapes on breaking bad news; one using Chinese speaking role models and one using English. In both groups, self-efficacy summed scores increased from 26.8 (95% CI = 25.9-27.7) at the pre-test to 29.0 (95% CI = 28.4-29.6). The biggest changes occurred in perceived self-efficacy regarding specific skills. However, students using the Chinese tape rated skills as more useful than those using the English tape. The videotapes were useful in teaching communication skills. Culturally relevant audiovisual materials were more effective.
The use of mobile robotic units for teleconsultation means that the clinician&amp;amp;amp;amp... more The use of mobile robotic units for teleconsultation means that the clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cognitive and attention skills are divided between tele-operation of the robotic unit and the consultation with the patient. We developed a communication guide based on evidence-based patient-centred interviewing and telephone conferencing skills. The communication guide was tested by five trainee surgeons in a pre- and post-test design. Each surgeon completed three simulated patient consultations. After reading the communication guide, trainees completed three further consultations. The trainees rated authenticity, degree of difficulty, familiarity of clinical presentation and confidence in using telepresence to manage the consultations. Their mean scores were 3.0-4.6, 2.2-4.0, 4.4-4.8 and 3.2-4.2 respectively (maximum possible score 5). The simulated patients rated their satisfaction with communication. Their ratings suggested that there were areas for communication skills development with mean scores ranging from 8.2 to 11.4 (maximum possible score = 15). Although we do not yet know enough about communicating with real patients using mobile robotic units, the communication guide appeared to be useful in our simulated interactions.
BackgroundAccess to palliative and end-of-life care for people with dementia living in nursing ho... more BackgroundAccess to palliative and end-of-life care for people with dementia living in nursing homes is suboptimal. Nursing home staff require training in palliative care for dementia to equip them with knowledge and skills to deliver high quality care. ObjectiveThe primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.Subjects & setting1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. MethodsRandomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.Staff from intervention nursing ho...
Background
People with dementia have unique palliative and end-of-life needs. However, access to ... more Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.
Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.
Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.
Subjects & setting 1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.
Methods Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.
Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.
Results At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.
Conclusion This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.
Good preparation for surgical procedures has been linked to better performance and enhanced learn... more Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their...
Women and birth : journal of the Australian College of Midwives, Jan 25, 2015
Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. Howev... more Birth at home is a safe and appropriate choice for healthy women with a low risk pregnancy. However there is a small risk of emergencies requiring immediate, skilled management to optimise maternal and neonatal outcomes. We developed and implemented a simulation workshop designed to run in a home based setting to assist with emergency training for midwives and paramedical staff. The workshop was evaluated by assessing participants' satisfaction and response to key learning issues. Midwifery and emergency paramedical staff attending home births participated in a simulation workshop where they were required to manage birth emergencies in real time with limited availability of resources to suit the setting. They completed a pre-test and post-test evaluation form exploring the content and utility of the workshops. Content analysis was performed on qualitative data regarding the most important learning from the simulation activity. A total of 73 participants attended the workshop (mi...
Clinicians require specific skills to teach or supervise students in the workplace; however, ther... more Clinicians require specific skills to teach or supervise students in the workplace; however, there are barriers to accessing faculty member development, such as time, cost and suitability. The Clinical Supervision Support Across Contexts (ClinSSAC) programme was designed to provide accessible interprofessional educator training to clinical supervisors across a wide range of clinical settings. In Australia there are increasing numbers of health care students, creating pressure on existing placements. Students are now increasingly learning in community settings, where clinicians have traditionally had less access to faculty member development. An interprofessional team collaborated in the development and implementation of ClinSSAC. A total of 978 clinicians participated in a face-to-face, interactive, introductory module to clinical supervision; 672 people accessed the equivalent online core module, with 23 per cent completing all activities. Additional profession-and discipline-specific modules were also developed. Formal project evaluation found that most participants rated the workshops as helpful or very helpful for their roles as clinical supervisors. Interdisciplinary learning from the workshops was reported to enable cross-discipline supervision. Large participant numbers and favourable ratings indicate a continuing need for basic training in education. Key factors to workshop success included expert facilitators, the interprofessional context and interactive model. The online modules were an important adjunct, and provided context-specific resources, but the low online completion rate suggests protected face-to-face time for faculty member development is still required. Programmes such as ClinSSAC have the capacity to promote interprofessional education and practice. There are barriers to accessing faculty member development, such as time, cost and suitability.
Peer assisted learning (PAL) is well documented in the medical education literature. In this pape... more Peer assisted learning (PAL) is well documented in the medical education literature. In this paper, the authors explored the role of PAL in a graduate entry medical program with respect to the development of professional identity. The paper draws on several publications of PAL from one medical school, but here uses the theoretical notion of legitimate peripheral participation in a medical school community of practice to shed light on learning through participation. As medical educators, the authors were particularly interested in the development of educational expertise in medical students, and the social constructs that facilitate this academic development.
Evidence for the use of a patient-centred model for interviewing is well established in the West.... more Evidence for the use of a patient-centred model for interviewing is well established in the West. There is much less evidence for the application of the model in other cultural settings. This paper describes the impact of a communication skills (CS) course for doctors (n = 32) working in government outpatient clinics in Hong Kong. Emphasis is placed on the cultural relevance of the patient-centred interview (PCI) and educational techniques. Knowledge scores increased immediately after the course and again 8 weeks later (p < 0.001). Participants held favourable attitudes at the outset of the course and these were largely maintained. Qualitative data suggests that the doctors' competence in CS increased. The PCI model was perceived as relevant to the practices of these doctors. Barriers preventing the implementation of this approach related to organizational rather than cultural factors. The educational strategies were well received, suggesting that adult Chinese learners are n...
The quality of psychosocial assessment of children in consultations varies widely. One reason for... more The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and ...
Meyer and Land (2003) describe threshold concepts as being &amp;amp;amp;amp;amp;amp;quot;akin... more Meyer and Land (2003) describe threshold concepts as being &amp;amp;amp;amp;amp;amp;quot;akin to a portal, opening up a new and previously inaccessible way of thinking about something.&amp;amp;amp;amp;amp;amp;quot; As a consequence, threshold concepts have a transformational potential and may lead to an associated change in identity. The successful completion of pediatric surgical training in the United Kingdom is a lengthy and complex professional journey in which trainees emerge as consultants with a professional identity. We sought to explore how &amp;amp;amp;amp;amp;amp;quot;threshold concepts&amp;amp;amp;amp;amp;amp;quot; applied to pediatric surgical training with a view to identifying elements that were &amp;amp;amp;amp;amp;amp;quot;troublesome.&amp;amp;amp;amp;amp;amp;quot; Semistructured interviews were conducted. Transcripts were generated from audio recordings and thematically analyzed by the authors. Constant comparison was used to refine themes. Participants were purposively recruited across all years of training. A total of 8 pediatric surgical trainees participated in the study. Approval from obtained from the Human Research Ethics committee. Although there is overlap between themes, analysis revealed &amp;amp;amp;amp;amp;amp;quot;troublesome&amp;amp;amp;amp;amp;amp;quot; areas of training related to knowledge (breadth and rarity of some conditions), clinical judgment (shifting expectation of independence), technical skills (accessing opportunities), transitions between roles (increasing responsibility and remoteness of support), relationships with trainers, and the effect of negative experiences. Viewing trainees&amp;amp;amp;amp;amp;amp;#39; experiences of surgical training through the lens of &amp;amp;amp;amp;amp;amp;quot;threshold concepts&amp;amp;amp;amp;amp;amp;quot; provides insight to the importance of viewing the curriculum in a holistic way. Negative experiences in training were an important catalyst for development, inducing a fundamental change in perception, which might be characterized as a rupture of a &amp;amp;amp;amp;amp;amp;quot;meaning frame.&amp;amp;amp;amp;amp;amp;quot; Trainees in pediatric surgery can be viewed as moving to a mature specialist identity via a transitional state-liminality, from entry into specialist training.
ABSTRACT To evaluate a culture-specific videotape on how to &#39;break bad news&#39; and ... more ABSTRACT To evaluate a culture-specific videotape on how to &#39;break bad news&#39; and another videotape produced by a western university, and to determine if the language of presentation influenced the students&#39; perceived abilities to execute basic skills. Third year medical students at the Faculty of Medicine, the University of Hong Kong. Longitudinal study with experimental design. Two instructional tapes on breaking bad news; one using Chinese speaking role models and one using English. In both groups, self-efficacy summed scores increased from 26.8 (95% CI = 25.9-27.7) at the pre-test to 29.0 (95% CI = 28.4-29.6). The biggest changes occurred in perceived self-efficacy regarding specific skills. However, students using the Chinese tape rated skills as more useful than those using the English tape. The videotapes were useful in teaching communication skills. Culturally relevant audiovisual materials were more effective.
The use of mobile robotic units for teleconsultation means that the clinician&amp;amp;amp;amp... more The use of mobile robotic units for teleconsultation means that the clinician&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s cognitive and attention skills are divided between tele-operation of the robotic unit and the consultation with the patient. We developed a communication guide based on evidence-based patient-centred interviewing and telephone conferencing skills. The communication guide was tested by five trainee surgeons in a pre- and post-test design. Each surgeon completed three simulated patient consultations. After reading the communication guide, trainees completed three further consultations. The trainees rated authenticity, degree of difficulty, familiarity of clinical presentation and confidence in using telepresence to manage the consultations. Their mean scores were 3.0-4.6, 2.2-4.0, 4.4-4.8 and 3.2-4.2 respectively (maximum possible score 5). The simulated patients rated their satisfaction with communication. Their ratings suggested that there were areas for communication skills development with mean scores ranging from 8.2 to 11.4 (maximum possible score = 15). Although we do not yet know enough about communicating with real patients using mobile robotic units, the communication guide appeared to be useful in our simulated interactions.
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Papers by Debra Nestel
People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.
Objective
The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.
Design
Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.
Subjects & setting
1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.
Methods
Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.
Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.
Results
At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.
Conclusion
This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.
People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.
Objective
The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.
Design
Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside.
Subjects & setting
1304 people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.
Methods
Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.
Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.
Results
At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.
Conclusion
This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.