ABSTRACT: : The U.K. Department of Health recently proposed an international dementia strategy to enhance the quality of dementia care in acute hospital care settings. To implement such a strategy, it is necessary to first assess whether nurses have the knowledge and person-centered approach essential to enhancing hospital-based dementia care quality.
: The purpose of this study was to evaluate hospital nurse knowledge of and approach toward dementia care and to explore the relationship between nurse demographic characteristics and these two issues.
: We distributed a 16-item questionnaire on dementia care knowledge to 124 nurses at a teaching hospital in southern Taiwan. We also distributed to the same participants a 13-item questionnaire designed to assess the approach, either reality oriented or person centered, of participants in providing care to advanced dementia patients.
: The total mean score for participant dementia care knowledge was 10.8 (SD = 2.0). Results indicated that most nurses confused dementia with delirium. The advanced dementia care questionnaire suggested care tended to be reality oriented. Licensed registered nurses with more working experience had higher dementia care knowledge scores. Age and working experience both negatively correlated with a reality-oriented approach toward care.
: Most participants had accurate dementia care knowledge and tended to use a reality-oriented approach. Nurse competency in differentiating delirium from dementia should be enhanced. This study provided initial insight into the dementia care situation at a single hospital in southern Taiwan. Future studies should further explore the relationship between dementia care quality and hospital nurses' knowledge and approaches, respectively.
The journal of nursing research: JNR 09/2012; 20(3):197-207. · 0.69 Impact Factor
ABSTRACT: The aim of this study was to investigate the association between care activities and pain and restraint and pain in residents with dementia.
If pain in people with dementia is not identified or alleviated in a timely manner, it could lead to an adverse effect on their physical, mental, social health and quality of life. Care activities and restraint might cause pain, but little is known as to whether they are true risk-factors of pain in people with dementia.
A cross-sectional research design was employed.
One hundred and twelve people with dementia were chosen from two nursing homes located in northern Taiwan. The demographic and clinical data collected included diagnoses, analgesics, restraints, recent falls, etc. The severity of dementia was assessed using the Clinical Dementia Rating Scale. The researchers observed every participant immediately following instances of routine care and then recorded the level of pain using the Chinese version of the Pain Assessment in Advanced Dementia scale.
About 36·6% of the participants had a Chinese version of the Pain Assessment in Advanced Dementia scale score above two points and an overall mean score of 1·50 (SD 1·81) with a range from 0-8. Only one resident with dementia received regular analgesic. Pain level in residents with dementia that needed assisted care was higher than in residents who were able to move about freely. It showed a positive correlation between level of pain and the severity of dementia among residents. The major predictors for pain in residents with dementia included restraint, assisted bathing and assisted transfer.
The findings confirm the association between care activities and pain and between restraint and pain in residents with dementia.
Formal caregivers need to minimise the triggering of pain when they assist residents' daily activities and avoid unnecessary restraints, while offering personalised, conventional nursing care to residents with late-stage dementia.
Journal of Clinical Nursing 07/2011; 20(13-14):1849-57. · 1.12 Impact Factor
ABSTRACT: In Taiwan, breast cancer ranks as the most prevalent form of cancer in the female population. Some breast cancer patients are genetically predisposed to this disease. To assess the risk of hereditary breast cancer for breast cancer patients, nurses should collect client breast cancer family histories back to three to four generations. Nurses should also comprehensively assess client psychosocial problems prior to and after genetic testing, and employ appropriate communications skills to provide clients adequate information regarding the disease. Nurses should ensure that clients are adequately informed prior to deciding whether or not to proceed with BRCA1/BRCA2 testing. When a client is identified as a gene mutation carrier, nurses should explain to her regarding the implementation of a monitoring program and of the importance of long-term follow-up. Nurses should explain to carriers the possible effects and impacts of preventive surgery and preventive chemotherapy so that they may make considered decisions regarding whether and how to implement preventive procedures. Furthermore, nurses should treat client families as a unit, and encourage all family members to participate together in genetic counseling. Nurses should also provide family members with an understanding of preventive strategies. Nurses should improve their knowledge and skills in genomic nursing. We hope this article can provide useful information for nurses to provide care for hereditary breast cancer patients and their families.
Hu li za zhi The journal of nursing 04/2011; 58(2):81-6.
ABSTRACT: This paper is a report of the validity and reliability testing of the Chinese version of the Pain Assessment in Advanced Dementia Scale (PAINAD-C).
Pain is under-reported and under-treated for people with dementia, largely due to impairment of communication. An adequate instrument for assessment of pain in this population is essential to improving their quality of life and decreasing disability and behavioural disturbances, but none were found that were appropriate for these purposes.
The PAINAD-C was developed in three phases in 2006. First, back-translation was used to create the Chinese version, where five medical and nursing experts assessed content validity. Inter-rater reliability, internal consistency reliability and test-retest reliability were then examined. Finally, principal component analysis and known-group comparisons were used to test construct validity. Participants with dementia were selected from five licensed long-term care facilities in Taiwan. Direct observation was used to collect data.
Inter-rater reliability showed an intra-class correlation coefficient of 0.80-0.86, and a test-retest reliability intra-class correlation coefficient of 0.71. The internal consistency reliability was 0.55-0.66. Factor analysis of the PAINAD-C showed two factors that explained 62.48% of variance. The PAINAD-C scores showed statistically significant differences between the non-dementia group and the advanced dementia group as well as significant differences between activities and rest groups.
The PAINAD-C is useful in a clinical setting for people with advanced dementia for both research and practice. It is easy to use and is a comprehensive instrument.
Journal of Advanced Nursing 10/2010; 66(10):2360-8. · 1.48 Impact Factor