Clinical trial NCT01280890: Person- Centred Care Among Nursing Home Patients With Dementia
Official title: Person-centred Care and Dementia Care Mapping Among Nursing Home Patients - a 10 Months Randomised Controlled Intervention Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Dementia
Agitation
Keywords: Dementia
Nursing home
Person-centred Care
Staff training
Lead sponsor: Norwegian Centre for Ageing and Health
Sponsor class: OTHER
Collaborators: name: The Research Council of Norway
First posted: 2011-01-21
Enrollment: 624
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Dementia is a common and devastating disease in the elderly. No cure exist and there is an increasing need for care. To improve knowledge on how to provide better care for the patients with dementia in nursing homes, the investigators will carry out a controlled trial using two forms of education and developmental interventions towards the nursing home care staff: a structured framework (VIPS) and dementia care mapping (DCM)to develop person-centred care in a 10 months randomised controlled study. In accordance with the knowledge found in the literature the investigators hypothesize that both VIPS framework and DCM will be more effective than a traditional educational program about dementia provided to the staff in nursing homes. The positive effects will be seen as reduced agitation in patients, less use of psychotropic drugs and improved quality of life. Using VIPS framework and DCM will also have a better effect on staffs' well-being than traditional education in dementia. The aim of the study is to confirm or reject these hypotheses.

Detailed description: This is a controlled intervention trial with three groups of staff recruited from 15 nursing homes in the city of Oslo. The intervention will be carried out over 10 months. Randomization will be done at institutional level. Before randomization all patients in the participating nursing homes should be screened for dementia. This will be done by interviewing the registered nurses in the nursing homes using the Clinical dementia rating scale (CDR), Neuropsychiatric inventory (NPI-Q), Cornell scale for depression in dementia (CSDD). In addition information from the records will be used. Diagnosis of dementia will be made according to ICD-10 criteria, using a diagnostic algorithm that is evaluated in an ongoing nursing home study.

The nursing homes will be randomized in tree groups. Group A - Applying the VIPS- framework to develop Person Centred Care (PCC) and milieu therapy. The staff will be introduced to the model for applying the VIPS-framework to promote PCC in the daily care. A manual including films with information and examples will be distributed to all staff. Two auxiliary nurses are appointed as resource persons (RP) from each ward and one registered nurse (RN) from each nursing home will be trained as coach. The RPs and the leading registered nurse (RN) will plan and lead weekly consensus meetings with the staff in the ward using the VIPS-framework in discussions of concrete care situations. The researches will receive monthly written standard reports on attendance and contents of the consensus meetings from the RPs and can be contacted for support when necessary.

Group B - using Dementia Care Mapping (DCM) developing Person Centred Care and milieu therapy All staff and leaders in the nursing home will be introduced to the DCM- process in a presentation of the method and person centred care as a value base for DCM. A group of 3-5 staff members from each nursing home will be trained as DCM basic users. Dementia Care Mappings (4-6 hours) will be made in each unit in the nursing homes and feed-back (1, 5 hours) will be given to the staff within a week after the mapping. Based on the findings and the reflections in the feed-back session, action plans on how to develop care to selected patients and/or to the group of patients, will be created in the units. The project leader will be responsible for the introduction, mapping and feed-back sessions and give the necessary supervision to create action plans. The leaders and staff in the nursing home units will be responsible for the implementation of the changes to develop practice.The DCM-process will be repeated after 6-8 months

Group C (control group) - traditional education Lectures made as 5 DVD films lasting for 30 minutes, will be given to the nursing home staff on three themes: types of dementia, legal aspects of use of restraints and challenging behavior

The staff in group A and B will receive the same lectures as the staff in the control group.

Effect will be measured on patient and staff level, and measurements will be done at baseline and after 10 months of intervention. Data will be collected by research assistants, who will not take part in the three different intervention programs and not be employed by the nursing homes that are included in the study.

Eligibility criteria: Inclusion Criteria:

* Persons with dementia living in nursing homes
* A score of 1,2 or 3 on the Clinical Dementia Rating Scale (CDR)
* The nursing staff in the wards where the patients are

Exclusion Criteria:

* Result from the inclusion criteria

Primary outcomes:
measure: Change in agitation at 10 months from baseline using Brief Agitation Rating Scale
timeFrame: After 10 months
Secondary outcomes:
measure: Neuropsychiatric Inventory (NPI-Q)
timeFrame: After 10 months
measure: Cornell scale for depression in dementia
timeFrame: After 10 months
measure: Quality of life in Alzheimer's Disease (QUALID)
timeFrame: After 10 months
measure: Use of psychotropic drugs
timeFrame: After 10 months
measure: Clinical Dementia Rating Scale (CDR)
timeFrame: After 10 months
measure: Lawton maintenance scale
timeFrame: After 10 months
measure: Person-centred Care Assessment Tool (P-CAT)
timeFrame: after 10 months
measure: QPSNordic
timeFrame: After 10 months
measure: Stress of Conscience Questionaire (SCQ)
timeFrame: After10 months
Other outcomes:
Locations:
Study officials:
affiliation: Norwegian Centre for Ageing and Health
name: Knut Engedal, Dr.med
role: PRINCIPAL_INVESTIGATOR
References: