Continuing Education in Nursing Home Dementia Care
Condition: Dementia; Agitation
MeSH terms: Dementia; Psychomotor Agitation
Study type: Interventional

Summary: 
      This is a single-blinded controlled cluster-randomized intervention trial recruiting staff
      from 24 NHs in three counties in the region of Western Norway, randomly selected from the
      total NH population in the region. A cluster is defined as a working ward of a larger NH,
      without shared facilities or staff. The 24 NHs are randomized into two groups, for
      intervention (12) and control (12). One department in each is selected for intervention and
      data collection will take place also in one department in each of the NHs in the control
      group. Hence the analyzed units (clusters) are NH departments. The educational intervention
      (EI), Relation Related Care (RRC), consists of a two-day seminar and one hour monthly
      guidance for six months. A seven-month educational intervention will be performed, and due to
      ethical issues the control group will receive the same intervention after the second
      follow-up. Effects will be measured on resident and care staff level at baseline before
      randomization, after the intervention (7 months) and at follow-up (7 months later) of the
      intervention group.
    

Detailed description: 
      Purpose:

      Dementia is a major challenge for our society. In Norway, around 40 % of persons suffering
      from dementia live in nursing homes (NH), and the majority experiences severe functional
      impairments and complex needs including associated behavioral changes. International studies
      indicate that NH residents with cognitive impairment and high dependency are most likely to
      be restrained physically. There is evidence of various adverse effects such as injuries,
      reduced psychological well-being or decreased mobility related to the use of physical
      restraint. Moreover, in addition to ethical and professional arguments, there is evidence
      supporting that user-involvement and shared decision-making have positive effects for both
      residents and staff. The aim of the present study (MEDCED) is to carry out an educational
      intervention in care staff to test its potential effect on use of restraint in NH residents
      with dementia and increase job-satisfaction in care staff.

      Description:

      This is a single-blinded controlled cluster-randomized intervention trial recruiting staff
      from 24 NHs in three counties in the region of Western Norway, randomly selected from the
      total NH population in the region. A cluster is defined as a working ward of a larger NH,
      without shared facilities or staff. The 24 NHs are randomized into two groups, for
      intervention (12) and control (12). One department in each is selected for intervention and
      data collection will take place also in one department in each of the NHs in the control
      group. Hence the analyzed units (clusters) are NH departments. The educational intervention
      (EI), Relation Related Care (RRC), consists of a two-day seminar and one hour monthly
      guidance for six months. A seven-month educational intervention will be performed, and due to
      ethical issues the control group will receive the same intervention after the second
      follow-up. Effects will be measured on resident and care staff level at baseline before
      randomization, after the intervention (7 months) and at follow-up (7 months later) of the
      intervention group.

      An analysis of how many units needs to be included are based on 12+12 clusters. Two
      calculations have been performed. The first calculation is based on how big is the reduction
      in use of restraints. We assume in our model that there will be a 60 % reduction in use of
      restraints in the intervention group and 33 % reduction in the control group (Hawthorne
      effect). For this reason we need to include averagely 13 patients in each department/unit in
      order to achieve a statistical power of 0,8.

      Measures on resident will be collected by a skilled research nurse blind to the study. Care
      staff measures will be collected through a questionnaire distributed directly to the care
      staff, provided with a stamped envelope to return the questionnaire directly to the research
      group. In addition, department characteristics (like type of department, staff coverage,
      architecture) will be registered.

      A research team will lead the EI, and four facilitator teams each consisting of one nurse and
      one assistant professor from a nursing schools will be responsible for the EI of the
      decision-making model in the NHs. The Educational intervention will be carried out in two
      steps, firstly from researchers to the educators (EI 1) and secondly from the educators to
      the NH staff (EI 2)
    

Intervention name(s): Educational intervention
Intervention type(s): Behavioral
Intervention description(s): The educational intervention (EI), Relation Related Care (RRC), consists of a two-day seminar and one hour monthly guidance for six months. Course material, a book particularly designed for this intervention and dealing with person centered care and use of restraint, is distributed ahead of the course part of the intervention to all participants.
Intervention model: Single Group Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Dementia; Resident; Nursinghome; Use of restraint; Agitation