Care programs aimed at improving quality of life for older people with dementia in Australian residential aged care facilities (RACF) are limited.
Generally, few interventions target this population at risk of invisibility, social isolation, and loneliness as they approach end of life.1 Knowledge of dementia in residential aged care staff is known to be variable and inadequate2, which includes knowledge of palliative care and pain assessment of people with advanced dementia.3,4
Namaste Care is a multisensory program dedicated to the care of older persons living with dementia as they approach end of life. Underpinned by a palliative approach, Namaste Care is a structured, evidence-based, person-centred and multisensory program for people living with advanced dementia.
Before adopting this program in an aged care facility in Tasmania, academic staff delivered an education workshop on the dementia trajectory and the Namaste Care program.
To date, there has been little evaluation done in the Australian context on workforce education and training to ensure the success of the Namaste Care program or the benefits of education in improving staff’s overall dementia care knowledge, skills and competence before program implementation.
This project aimed to evaluate the effects of education and training about the dementia trajectory, person-centred care and the Namaste CareTM program on staff’s dementia knowledge, attitudes, perceived skills and competence in end of life dementia care in one RACF in Northern Tasmania.
Project outline
A mixed-methods design collected pre-test, post-test quantitative data using three validated survey instruments, the Questionnaire on Palliative Care for Dementia (Knowledge and Attitudes) qPAD,5 the Palliative Approach for Nursing Assistants (PANA_Skills Questionnaire),6 and the Sense of Competence in Dementia Care Staff (SCIDS).7 Interviews and a focus group with key staff collected qualitative data following the education intervention. This comprised intensive four-hour workshop sessions conducted over three days to staff (n=35) in one residential aged care facility (RACF) in Tasmania.
Results
After the workshop there were small but significant increases in scores for qPAD knowledge (z =-2.913, p = .004) and attitudes (z = -3.001, p = .003), and PANA_Skills (z = -2.205, p = .027]. The qPAD attitude score increased the most (median 44 to median 50). Median qPAD knowledge and PANA_Skills both increased by 2 points. SCIDS total and subscale scores were not significantly different, except for one subscale Building Relationships (z = -2.456, p = .014).
Conclusion
Raising awareness about changed behaviours and symptoms associated with unmet needs in people with dementia addressed gaps in understanding and learning opportunities for staff to consider residents in their care. Simulation of the experiences that Namaste Care offers taught staff new skills to connect with residents, including how to provide physical comfort, use expressive touch, and engage a person’s senses to promote pleasure, happiness and comfort,8 while preparing staff for the difference a Namaste Care program can make to residents, staff and families when introduced into the service.
References
1 Moyle W, et al. Dementia and loneliness: an Australian perspective. Journal of Clinical Nursing, 2011. 20(9-10): p. 1445-1453.
2 Robinson A, et al. Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia. Journal of Palliative Care, 2014. 30(3): p. 158-165.
3 Chen IH, et al. Palliative care for advanced dementia: Knowledge and attitudes of long-term care staff. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 2018. 27(3-4): p. 848-858.
4 Luckett T, et al. Australian long-term care personnel’s knowledge and attitudes regarding palliative care for people with advanced dementia. Dementia (London, England), 2019: p. 1471301219886768-1471301219886768.
5 Long C, et al. Development of the questionnaire on palliative care for advanced dementia (qPAD). American Journal of Alzheimer’s Disease & Other Dementias, 2012. 27(7): p. 537-43.
6 Karacsony S, et al. An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities. BMC Palliative Care, 2019. 18(61): p. 1-15.
7 Schepers AK, et al. Sense of Competence in Dementia Care Staff (SCIDS) scale: development, reliability, and validity. International Psychogeriatrics, 2012. 24(7): p. 1153-1162.
8 Karacsony S and Abela MRL. Stimulating sense memories for people living with dementia using the Namaste Care program: What works, how and why? Journal of Clinical Nursing, 2021.
Authors:
Dr Sara Karacsony is in the School of Nursing, College of Health and Medicine at the University of Tasmania
Dr Claire Eccleston is at the Wicking Dementia Research and Education Centre, College of Health and Medicine at the University of Tasmania
Dr Melissa Abela is at the Wicking Dementia Research and Education Centre, College of Health and Medicine at the University of Tasmania
