Factors Influencing the Implementation of Non-Pharmacological Interventions for Behavioural and Psychological Symptoms of Dementia in Residential Aged-Care Homes: A Systematic Review and Qualitative Evidence Synthesis: A systematic review

IF 4 Q1 SOCIAL SCIENCES, INTERDISCIPLINARY
Hunduma Dinsa Ayeno, Gizat M. Kassie, Mustafa Atee, Tuan Nguyen
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引用次数: 0

Abstract

Background

Non-pharmacological interventions (NPIs) are the primary approaches to the management of behavioural and psychological symptoms of dementia (BPSD), but studies have indicated that there is a suboptimal implementation. Although there are several studies on the factors influencing NPI implementation for BPSD at residential aged-care homes (RACHs), there has not been a comprehensive qualitative systematic review on the topic.

Objectives

This systematic review aimed to examine the qualitative studies that investigate the factors influencing the implementation of NPIs for managing BPSD in RACHs.

Search Methods

Systematic searches were conducted up until 31 December 2023 using five databases: MEDLINE, EMCARE, EMBASE, CINAHL complete and APA PsycINFO.

Selection Criteria

This systematic review included qualitative studies and qualitative data from mixed-method studies on the implementation of NPIs for RACH residents with dementia experiencing BPSD. The research question and inclusion criteria for this review included the components of PICo: Population (aged-care residents with dementia), Phenomenon of interest (factors influencing implementation of NPIs) and Context/setting (RACHs).

Data Collection and Analysis

After screening and extracting the data, the methodological limitations were assessed using the Joanna Briggs Institute System for the Unified Management, Assessment, and Review of Information (JBI SUMARI) quality assessment tool. JBI SUMARI meta-aggregative synthesis was used to synthesise the data. The extracted findings were categorised into the 10 Theoretical Domain Framework domains: knowledge, skills, environmental context and resources, social influences, reinforcement, emotions, intentions, beliefs about consequences, social and professional roles and beliefs about capability. Confidence in the output of qualitative research synthesis (CONQual) was used to assess the credibility and dependability of the synthesised findings.

Main Results

Twenty-four studies were included, from which factors influencing NPI implementation were extracted. Study participants included RACH managers, RACH care staff, families of aged-care residents with dementia and volunteers. Amongst the studies specifying the gender of participants, there were 352 females (84.4%) and 46 males (15.6%). The method of data collection for the included studies consisted of eighteen interviews, five focus group discussions and one qualitative survey. All except one study had a quality assessment score of at least 60% based on the JBI SUMARI quality assessment tool. However, all studies were included regardless of the result of the quality assessment result. These studies spanned the period from 2010 to 2022 and were mostly conducted in the United Kingdom, Australia, the United States and Canada. Twenty-four synthesised findings were identified (13 high, 7 moderate and 4 low ConQual scores). Examples of factors influencing the implementation of NPIs were collaboration amongst care staff and families of residents with dementia, belief in the efficacy of interventions, staffing, staff time constraints, funding, familiarity with the interventions, organisational support, communication amongst the care staff and with families of residents with dementia, education and training for the care staff and families of residents with dementia and familiarity with the residents with dementia.

Authors' Conclusions

This systematic review highlights and synthesises factors influencing the implementation of NPIs for managing BPSD in RACHs. Key factors include collaboration amongst staff and families, organisational support, staffing, education and staff familiarity with both the interventions and residents. Strengthening these areas could enhance the care outcomes for aged-care residents with dementia. For decision-makers, these insights suggest the need for comprehensive strategies to improve NPI implementation. This could include ensuring appropriate staffing levels, enhancing collaboration, allocating adequate funds, providing training, strengthening organisational support and improving the quality of information exchange amongst care staff, between care staff and volunteers and families of residents with dementia. For researchers, the findings from this systematic review could provide valuable insights including the need to explore strategies to overcome barriers to NPI implementation, especially investigating innovative models for staffing and collaborative practice, examining the effectiveness of different education and training approaches, and exploring organisational policies and support mechanisms that can enhance the implementation of NPIs.

Abstract Image

影响安老院痴呆行为和心理症状非药物干预实施的因素:系统综述和定性证据综合:系统综述
背景:非药物干预(NPIs)是治疗痴呆症(BPSD)行为和心理症状的主要方法,但研究表明,实施方法并不理想。虽然有一些研究是关于影响居家敬老院BPSD实施NPI的因素,但尚未对该主题进行全面的定性系统回顾。目的:本系统综述旨在对影响乡村地区实施npi治疗BPSD的因素进行定性研究。检索方法系统检索至2023年12月31日,检索数据库为MEDLINE、EMCARE、EMBASE、CINAHL complete和APA PsycINFO。本系统综述包括定性研究和混合方法研究的定性数据,这些研究是关于RACH地区患有BPSD的痴呆居民实施npi的。本综述的研究问题和纳入标准包括PICo的组成部分:人口(患有痴呆症的老年护理居民)、感兴趣的现象(影响npi实施的因素)和环境/环境(RACHs)。在筛选和提取数据后,使用乔安娜布里格斯研究所信息统一管理、评估和审查系统(JBI SUMARI)质量评估工具对方法局限性进行评估。采用JBI SUMARI元聚合综合方法对数据进行综合。提取的结果被归类为10个理论领域框架领域:知识、技能、环境背景和资源、社会影响、强化、情感、意图、对结果的信念、社会和职业角色以及对能力的信念。对定性研究综合结果的置信度(conquest)用于评估综合结果的可信度和可靠性。主要结果纳入24项研究,从中提取影响NPI实施的因素。研究参与者包括RACH经理、RACH护理人员、老年痴呆症患者家属和志愿者。在指定参与者性别的研究中,女性352例(84.4%),男性46例(15.6%)。纳入研究的数据收集方法包括18次访谈,5次焦点小组讨论和1次定性调查。根据JBI SUMARI质量评估工具,除一项研究外,所有研究的质量评估得分至少为60%。然而,无论质量评价结果如何,所有的研究都被纳入。这些研究的时间跨度从2010年到2022年,主要在英国、澳大利亚、美国和加拿大进行。确定了24项综合结果(13项高、7项中、4项低征服者得分)。影响国家行动计划实施的因素包括护理人员和痴呆症患者家属之间的合作、对干预措施有效性的信念、人员配备、工作人员时间限制、资金、对干预措施的熟悉程度、组织支持、护理人员和痴呆症患者家属之间的沟通、对护理人员和痴呆症患者家属的教育和培训以及对痴呆症患者的熟悉程度。本系统综述强调并综合了影响在乡村地区实施npi来管理BPSD的因素。关键因素包括工作人员和家庭之间的合作、组织支持、人员配备、教育以及工作人员对干预措施和居民的熟悉程度。加强这些领域可以提高老年痴呆症患者的护理效果。对于决策者来说,这些见解表明需要制定全面的战略来改善新产品导入的实施。这可能包括确保适当的人员配备水平,加强合作,分配足够的资金,提供培训,加强组织支持,提高护理人员之间,护理人员与志愿者以及痴呆症患者家属之间的信息交流质量。 对于研究人员来说,这一系统综述的结果可以提供有价值的见解,包括探索克服NPI实施障碍的战略的必要性,特别是研究人员配备和合作实践的创新模式,检查不同教育和培训方法的有效性,以及探索可以加强NPI实施的组织政策和支持机制。
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来源期刊
Campbell Systematic Reviews
Campbell Systematic Reviews Social Sciences-Social Sciences (all)
CiteScore
5.50
自引率
21.90%
发文量
80
审稿时长
6 weeks
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