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Lise Elisabeth Buma,1– 3 Hanne Tuntland,4 Matthew Parsons,5,6 Sandra Zwakhalen,1,2 Silke F Metzelthin1,2 1Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; 2Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands; 3Cicero Zorggroep, Brunssum, the Netherlands; 4Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway; 5School of Health, University of Waikato, Hamilton, New Zealand; 6Te Whatu Ora Health New Zealand Waikato District, Hamilton, New ZealandCorrespondence: Lise Elisabeth Buma, Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands, Tel +31-(0) 88 388 7092, Email l.buma@maastrichtuniversity.nlPurpose: Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequence, healthcare providers and organizations often lack knowledge to implement and align reablement to their national and local context. This study aimed to collect data on goal-setting and achievement, and multidisciplinary collaboration within reablement services to provide insight into how these processes inform reablement practice as well as to explore the experiences of healthcare professionals in Norway, New Zealand, and the Netherlands.Material and Methods: A qualitative exploratory design was used comprising three focus group interviews with 20 healthcare professionals (nursing and allied health) involved in reablement programs from the three countries. Purposive sampling was employed considering a mix of gender, age and educational level.Results: Findings reflected healthcare

The detection and treatment of pain is hampered by cognitive disorders. In this review we discuss the epidemiology of pain in cognitive disorders, and elaborate further on the current state of the art on pain in these populations. We will specifically highlight current gaps and recommendations for the future for the following knowledge domains: 1) Biology and neuropathology, 2) Assessment and evaluation, 3) Treatment and management, and 4) Contextual factors such as the organization and education. We identify the following knowledge gaps: 1) (Biology): Do pain experience and pain expressions change in different types of cognitive disorders, and how? 2) (Assessment): How to recognize, evaluate and assess pain, in case the self-report of pain is no longer reliable? 3) (Treatment): Which treatment possibilities are effective? How can we organize this in an interdisciplinary way? And how to monitor this? How can we ensure proper implementation of pain assessment and treatment in clinical practice? Specifically with regard to non-pharmacological treatment, how can we communicate observations from different disciplines, family members and clinicians to improve the detection of pain as well as treatment monitoring/evaluation? 4) (Contextual): How can we increase knowledge and skills on pain in cognitive impairment within educational training?.

Aims and objectives: To explore the perspectives of people with dementia on being cared for by others, on the future and on the end of life, and to evaluate the capability and willingness of participants to have these conversations.Background: Awareness about perspectives of people with dementia should decrease stigmatisation and improve their quality of life. Applying palliative care principles from an early stage is important to address diverse needs and to anticipate the future. Few studies investigate perspectives of people with dementia regarding palliative care, including advance care planning.DESIGN: Qualitative descriptive design.METHODS: We performed in-depth interviews with 18 community-dwelling persons with dementia in South-Limburg, the Netherlands. Transcripts were analysed using an inductive content analysis. Two authors coded the data and regularly compared coding. All authors discussed abstraction into categories and themes. We followed the COREQ reporting guidelines.Results: Five overarching themes derived from the interviews were as follows: (a) My life still has value and meaning, (b) I am my own unique individual, (c) I place my trust in other people, (d) The future worries me, and (e) I accept and embrace what life brings.Conclusions: Participants' thoughts about the future and the end of life involved feelings of ambiguity and anxiety, but also of contentment and resignation. Despite worrying thoughts of decline, participants primarily demonstrated resilience and acceptance. They expressed appreciation and trust towards those who care for them. They wished to be recognised as unique and worthy humans, until the end of life.Relevance to clinical practice: This study demonstrates capability and willingness of people with dementia to discuss the future and end-of-life topics. Public and professional awareness may facilitate opportunities for informal end-of-life discus

Background: The acute nature of COVID-19 and its effects on society in terms of social distancing and quarantine regulations affect the provision of palliative care for people with dementia who live in long-term care facilities. The current COVID-19 pandemic poses a challenge to nursing staff, who are in a key position to provide high-quality palliative care for people with dementia and their families.Objective: To formulate practice recommendations for nursing staff with regard to providing palliative dementia care in times of COVID-19.Design and method: A rapid scoping review following guidelines from the Joanna Briggs Institute. Eligible papers focused on COVID-19 in combination with palliative care for older people or people with dementia and informed practical nursing recommendations for long-term care facilities. After data extraction, we formulated recommendations covering essential domains in palliative care adapted from the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care.Data sources: We searched the bibliographic databases of PubMed, CINAHL and PsycINFO for academic publications. We searched for grey literature using the search engine Google. Moreover, we included relevant letters and editorials, guidelines, web articles and policy papers published by knowledge and professional institutes or associations in dementia and palliative care.Results: In total, 23 documents (7 (special) articles in peer-reviewed journals, 6 guides, 4 letters to editors, 2 web articles (blogs), 2 reports, a correspondence paper and a position paper) were included. The highest number of papers informed recommendations under the domains 'advance care planning' and 'psychological aspects of care'. The lowest number of papers informed the domains 'ethical care', 'care of the dying', 'spiritual care' and 'bereavement care'. We found no papers that informed the 'cultural aspects of ca

Aims and objectivesTo describe and discuss the Basic Care Revisited (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. BackgroundWhile basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. DesignDiscussion paper MethodThe discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called Basic Care Revisited (BCR) as a solution to move forward and improve basic nursing care. DiscussionTo prioritise basic nursing care, we propose a research programme entitled Basic Care Revisited that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Relevance to clinical practiceRevaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes.

Objectives: The aim of this study was to explore the remaining abilities of people with dementia (PwD) in performing daily activities. Method: Informal carers of community-residing PwD were recruited across England via mail out and carer support groups. Carers completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 to rate the PwD's initiative and performance of daily activities. Six complex instrumental activities of daily living (IADLs) were selected: shopping, preparing a hot drink, using the telephone, preparing a cold meal, house work, and engaging in social activities, all of which were broken down into three sub-tasks. Data were analysed using Chi-square tests and linear regression analysis, assessing the contributions of hours of IADL care, hours of supervision, and dementia stage for each activity. Results: 581 carers of people with mild, moderate, and severe dementia completed the questionnaire. The ability to perform individual activities deteriorated from mild to moderate to severe dementia, with PwD remaining the most able to perform subtasks of preparing a hot drink and a cold meal. Subtask performance varied across activities, with some better maintained than others across severity stages. Linear regression models showed that hours of supervising PwD explained a greater proportion of the variance of each IADL than IADL care hours. Conclusion: PwD should be supervised to continue engaging in activities, thereby avoiding performing everything for the PwD. Findings can have implications for PwD living in nursing homes, and future research should explore the remaining IADL abilities of nursing home residents.

Objectives: The aim of this study was to explore the remaining abilities of people with dementia (PwD) in performing daily activities. Method: Informal carers of community-residing PwD were recruited across England via mail out and carer support groups. Carers completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 to rate the PwD's initiative and performance of daily activities. Six complex instrumental activities of daily living (IADLs) were selected: shopping, preparing a hot drink, using the telephone, preparing a cold meal, house work, and engaging in social activities, all of which were broken down into three sub-tasks. Data were analysed using Chi-square tests and linear regression analysis, assessing the contributions of hours of IADL care, hours of supervision, and dementia stage for each activity. Results: 581 carers of people with mild, moderate, and severe dementia completed the questionnaire. The ability to perform individual activities deteriorated from mild to moderate to severe dementia, with PwD remaining the most able to perform subtasks of preparing a hot drink and a cold meal. Subtask performance varied across activities, with some better maintained than others across severity stages. Linear regression models showed that hours of supervising PwD explained a greater proportion of the variance of each IADL than IADL care hours. Conclusion: PwD should be supervised to continue engaging in activities, thereby avoiding performing everything for the PwD. Findings can have implications for PwD living in nursing homes, and future research should explore the remaining IADL abilities of nursing home residents.

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This article aims to conceptualize experienced quality of post-acute and long-term care for older people as perceived by care recipients. An iterative literature review and consultations with stakeholders led to the development of the INDividually Experienced QUAlity of Long-term care (INDEXQUAL) framework. INDEXQUAL presents the process of an individual care experience consisting of a pre (expectations), during (experiences), and post (assessment) phase. Expectations are formed prior to an experience by personal needs, past experiences, and word-of-mouth. An experience follows, which consists of interactions between the players in the caring relationships. Lastly, this experience is assessed by addressing what happened and how it happened (perceived care services), how this influenced the care recipient's health status (perceived care outcomes), and how this made the care recipient feel (satisfaction). INDEXQUAL can serve as a framework to select or develop methods to assess experienced quality of long-term care. It can provide a framework for quality monitoring, improvement, and transparency. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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This article aims to conceptualize experienced quality of post-acute and long-term care for older people as perceived by care recipients. An iterative literature review and consultations with stakeholders led to the development of the INDividually Experienced QUAlity of Long-term care (INDEXQUAL) framework. INDEXQUAL presents the process of an individual care experience consisting of a pre (expectations), during (experiences), and post (assessment) phase. Expectations are formed prior to an experience by personal needs, past experiences, and word-of-mouth. An experience follows, which consists of interactions between the players in the caring relationships. Lastly, this experience is assessed by addressing what happened and how it happened (perceived care services), how this influenced the care recipient's health status (perceived care outcomes), and how this made the care recipient feel (satisfaction). INDEXQUAL can serve as a framework to select or develop methods to assess experienced quality of long-term care. It can provide a framework for quality monitoring, improvement, and transparency. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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Process evaluation of a washing-without-water trial Background: An alternative bathing method with disposable wash-gloves shows some advantages compared to traditional bathing. However, in a review with a focus on traditional bathing of immobile patients no significant difference was found in patient-related variables with washing-without-water (www). Therefore, a cross-over trial was developed in a skills-lab setting to compare the effects on quality of www with traditional bed bathing. To gain more insight into process elements, an evaluation was performed alongside the cross-over trial. Aim: The aim was to provide insights into process experiences with first-year students of the Bachelor School of Nursing, who were exposed to the www cross-over trial. Method: A qualitative study was conducted using semi-structured interviews with 14 first-year students and two observers. All interviews were audiotaped and transcribed verbatim into NVivo-11 software. A framework adopted by Saunders (2005) guided data into a thematic approach, in which four compromised process elements were assessed, namely: reach and recruitment, dose delivered and received, context, and fidelity. Results: Main findings show that the recruitment procedure was not successful enough to obtain a required number of students in the trial study. Participated students were satisfied with the constructive design of procedural activities. Students assessed similarities of the skills lab setting within the reality of practice. Conclusion: This process evaluation provides useful information to guide future research into new bathing methods with nursing-students. The complexity can be found in the recruitment of eligible students, effective strategies must be considered within the perception of these younger participants. Recommendations: Improving recruitment can be achieved through research integration into planned school activities with presentations in smaller student groups. Also, the adoption of social

Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities.Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool.Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response.Conclusion: Fulfilling PwD's need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care.

Process evaluation of a washing-without-water trial Background: An alternative bathing method with disposable wash-gloves shows some advantages compared to traditional bathing. However, in a review with a focus on traditional bathing of immobile patients no significant difference was found in patient-related variables with washing-without-water (www). Therefore, a cross-over trial was developed in a skills-lab setting to compare the effects on quality of www with traditional bed bathing. To gain more insight into process elements, an evaluation was performed alongside the cross-over trial. Aim: The aim was to provide insights into process experiences with first-year students of the Bachelor School of Nursing, who were exposed to the www cross-over trial. Method: A qualitative study was conducted using semi-structured interviews with 14 first-year students and two observers. All interviews were audiotaped and transcribed verbatim into NVivo-11 software. A framework adopted by Saunders (2005) guided data into a thematic approach, in which four compromised process elements were assessed, namely: reach and recruitment, dose delivered and received, context, and fidelity. Results: Main findings show that the recruitment procedure was not successful enough to obtain a required number of students in the trial study. Participated students were satisfied with the constructive design of procedural activities. Students assessed similarities of the skills lab setting within the reality of practice. Conclusion: This process evaluation provides useful information to guide future research into new bathing methods with nursing-students. The complexity can be found in the recruitment of eligible students, effective strategies must be considered within the perception of these younger participants. Recommendations: Improving recruitment can be achieved through research integration into planned school activities with presentations in smaller student groups. Also, the adoption o

Stil delier komt veel voor onder oudere ziekenhuispatiënten. Ongeveer 29 tot 64% van alle ouderen in het ziekenhuis ontwikkelt een delier; het merendeel van hen ontwikkelt een stil delier. Stil delier wordt vaak niet of laat herkend en de prognose is slechter dan bij een geagiteerd delier. Psychotische klachten, angst en lijden komen bij een stil delier even vaak voor als bij een geagiteerd delier. De richtlijn van het Nederlands Huisartsen Genootschap en de multidisciplinaire richtlijn van de Nederlandse Vereniging voor Klinische Geriatrie verschillen in hun advies over de medicamenteuze behandeling van stil delier. In onderzoeken naar de werking van antipsychotica werd tot nu toe geen onderscheid gemaakt tussen verschillende types delier. Antipsychotica dienen bij een patiënt met een stil delier slechts overwogen te worden wanneer alle niet-medicamenteuze opties geprobeerd zijn, er geen evidente en oplosbare oorzaak voor het delier gevonden wordt en de patiënt zichtbaar lijdt onder de psychotische klachten.

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Stil delier komt veel voor onder oudere ziekenhuispatiënten. Ongeveer 29 tot 64% van alle ouderen in het ziekenhuis ontwikkelt een delier; het merendeel van hen ontwikkelt een stil delier. Stil delier wordt vaak niet of laat herkend en de prognose is slechter dan bij een geagiteerd delier. Psychotische klachten, angst en lijden komen bij een stil delier even vaak voor als bij een geagiteerd delier. De richtlijn van het Nederlands Huisartsen Genootschap en de multidisciplinaire richtlijn van de Nederlandse Vereniging voor Klinische Geriatrie verschillen in hun advies over de medicamenteuze behandeling van stil delier. In onderzoeken naar de werking van antipsychotica werd tot nu toe geen onderscheid gemaakt tussen verschillende types delier. Antipsychotica dienen bij een patiënt met een stil delier slechts overwogen te worden wanneer alle niet-medicamenteuze opties geprobeerd zijn, er geen evidente en oplosbare oorzaak voor het delier gevonden wordt en de patiënt zichtbaar lijdt onder de psychotische klachten.

Aims and objectivesTo describe and discuss the Basic Care Revisited (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. BackgroundWhile basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care. DesignDiscussion paper MethodThe discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called Basic Care Revisited (BCR) as a solution to move forward and improve basic nursing care. DiscussionTo prioritise basic nursing care, we propose a research programme entitled Basic Care Revisited that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity. Relevance to clinical practiceRevaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes.

Objective: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities.Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool.Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response.Conclusion: Fulfilling PwD's need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care.

Process evaluation of a washing-without-water trial Background: An alternative bathing method with disposable wash-gloves shows some advantages compared to traditional bathing. However, in a review with a focus on traditional bathing of immobile patients no significant difference was found in patient-related variables with washing-without-water (www). Therefore, a cross-over trial was developed in a skills-lab setting to compare the effects on quality of www with traditional bed bathing. To gain more insight into process elements, an evaluation was performed alongside the cross-over trial. Aim: The aim was to provide insights into process experiences with first-year students of the Bachelor School of Nursing, who were exposed to the www cross-over trial. Method: A qualitative study was conducted using semi-structured interviews with 14 first-year students and two observers. All interviews were audiotaped and transcribed verbatim into NVivo-11 software. A framework adopted by Saunders (2005) guided data into a thematic approach, in which four compromised process elements were assessed, namely: reach and recruitment, dose delivered and received, context, and fidelity. Results: Main findings show that the recruitment procedure was not successful enough to obtain a required number of students in the trial study. Participated students were satisfied with the constructive design of procedural activities. Students assessed similarities of the skills lab setting within the reality of practice. Conclusion: This process evaluation provides useful information to guide future research into new bathing methods with nursing-students. The complexity can be found in the recruitment of eligible students, effective strategies must be considered within the perception of these younger participants. Recommendations: Improving recruitment can be achieved through research integration into planned school activities with presentations in smaller student groups. Also, the adoption o

PurposeThe shift in nursing home care for patients with dementia from traditional task-driven environments towards patient-centered small-scale environments has implications for nursing practice. Information about its implications for nursing staff is lacking, and only a few studies have addressed staff perceptions. We sought to explore staff perceptions of required skills and to determine differences in job satisfaction, motivation, and job characteristics of staff working in both care settings.DesignA secondary data analysis was conducted. The data source used was drawn from a larger study testing the effects of small-scale living (Verbeek etal., 2009).MethodsNursing staff working on a permanent basis and who were directly involved in care were eligible to participate in the study. Data on job satisfaction, motivation, and job characteristics of nursing staff working in typical small-scale and traditional care environments were derived using a questionnaire. Data were analyzed using descriptive statistics. Differences between nursing staff job satisfaction, motivation, and job characteristics were tested using multilinear regression analysis.FindingsIn total, 138 staff members were included (81 staff members working in traditional nursing home wards and 57 staff members working in small-scale nursing home wards). The findings showed that in typical small-scale nursing homes, job satisfaction and job motivation were significantly higher compared to those in typical traditional nursing homes. Job autonomy and social support were also significantly higher, while job demands were significantly lower in these small-scale nursing homes. Social support was found to be the most significant predictor of job motivation and job satisfaction in both types of typical nursing homes. Nursing staff working in traditional care environments more often expressed the intention to switch to small-scale environments.ConclusionsBased on the findings of thi

Background: To provide adequate nursing care it is important for nursing staff to communicate effectively with people with dementia. Due to their limited communication skills, people with dementia have difficulties in understanding communication and expressing themselves verbally. Nursing staff members often report communication difficulties with people with dementia, which emphasises the urgent need for interventions to improve their communication with people in this specific target group.Objectives: To provide an up-to-date overview of communication interventions that are applicable during daily nursing care activities, irrespective of care setting, and to describe the effects on communication outcomes in people with dementia and nursing staff.Design: Systematic literature reviewData sources: The Cochrane Library, CINAHL, PsycINFO, and Pubmed databases were searched for all articles published until the 23rd of February 2016.Review methods: Papers were included, if: (1) interventions focused on communication between nursing staff and people with dementia and were applicable during daily nursing care; (2) studies were (randomised) controlled trials; (3) papers were written in English, Dutch, or German. Data were extracted on content and communication outcomes of interventions, and on methodological quality of the studies. The data extraction form and methodological quality checklist were based on the Method Guidelines for Systematic Reviews for the Cochrane Back Review Group.Results: Six studies on communication interventions were included. All of the studies incorporated a communication skills training for nursing staff with a broad range in frequency, duration and content. In addition, there was wide variation in the communication outcome measures used. Four studies measured non-verbal communication, all found positive effects on at least some of the communication outcomes. Four studies measured verbal communication, of which

Objectives: Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.Design: Longitudinal observation study.Setting: Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities).Participants: A total of 115 nursing home residents at baseline, 100 at follow-up.Measurements: Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity.Results: In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P <.001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (

The aim of this cross-sectional study was to explore the role of nursing staff in residents' activities. Nursing home residents (n = 723) were observed in their wards, randomly five times for one minute between 7 a.m. and 11 p.m. Resident's (in)activity and the role of nursing staff or others in this activity were recorded. Roles were defined as 'taking over the activity', 'giving support', or 'supervision'. Nurse observers were interviewed to obtain insight into their observation-experiences. Residents were observed in activities of daily living in 31% of all 3282 observations, and inactive in 57%. Nursing staff provided support in 51% of the observations and took over activities in 45%: supervision was rarely observed (4%). Nurse observers who knew the residents reported that a large part of activities were taken over unnecessarily. Based on these results, nursing staff are recommended to provide more supervision and support to optimize residents' activities and independence. (C) 2016 Elsevier Inc. All rights reserved.

The aim of this cross-sectional study was to explore the role of nursing staff in residents' activities. Nursing home residents (n = 723) were observed in their wards, randomly five times for one minute between 7 a.m. and 11 p.m. Resident's (in)activity and the role of nursing staff or others in this activity were recorded. Roles were defined as 'taking over the activity', 'giving support', or 'supervision'. Nurse observers were interviewed to obtain insight into their observation-experiences. Residents were observed in activities of daily living in 31% of all 3282 observations, and inactive in 57%. Nursing staff provided support in 51% of the observations and took over activities in 45%: supervision was rarely observed (4%). Nurse observers who knew the residents reported that a large part of activities were taken over unnecessarily. Based on these results, nursing staff are recommended to provide more supervision and support to optimize residents' activities and independence. (C) 2016 Elsevier Inc. All rights reserved.

Background: To provide adequate nursing care it is important for nursing staff to communicate effectively with people with dementia. Due to their limited communication skills, people with dementia have difficulties in understanding communication and expressing themselves verbally. Nursing staff members often report communication difficulties with people with dementia, which emphasises the urgent need for interventions to improve their communication with people in this specific target group.Objectives: To provide an up-to-date overview of communication interventions that are applicable during daily nursing care activities, irrespective of care setting, and to describe the effects on communication outcomes in people with dementia and nursing staff.Design: Systematic literature reviewData sources: The Cochrane Library, CINAHL, PsycINFO, and Pubmed databases were searched for all articles published until the 23rd of February 2016.Review methods: Papers were included, if: (1) interventions focused on communication between nursing staff and people with dementia and were applicable during daily nursing care; (2) studies were (randomised) controlled trials; (3) papers were written in English, Dutch, or German. Data were extracted on content and communication outcomes of interventions, and on methodological quality of the studies. The data extraction form and methodological quality checklist were based on the Method Guidelines for Systematic Reviews for the Cochrane Back Review Group.Results: Six studies on communication interventions were included. All of the studies incorporated a communication skills training for nursing staff with a broad range in frequency, duration and content. In addition, there was wide variation in the communication outcome measures used. Four studies measured non-verbal communication, all found positive effects on at least some of the communication outcomes. Four studies measured verbal communication, of which

PurposeThe shift in nursing home care for patients with dementia from traditional task-driven environments towards patient-centered small-scale environments has implications for nursing practice. Information about its implications for nursing staff is lacking, and only a few studies have addressed staff perceptions. We sought to explore staff perceptions of required skills and to determine differences in job satisfaction, motivation, and job characteristics of staff working in both care settings.DesignA secondary data analysis was conducted. The data source used was drawn from a larger study testing the effects of small-scale living (Verbeek etal., 2009).MethodsNursing staff working on a permanent basis and who were directly involved in care were eligible to participate in the study. Data on job satisfaction, motivation, and job characteristics of nursing staff working in typical small-scale and traditional care environments were derived using a questionnaire. Data were analyzed using descriptive statistics. Differences between nursing staff job satisfaction, motivation, and job characteristics were tested using multilinear regression analysis.FindingsIn total, 138 staff members were included (81 staff members working in traditional nursing home wards and 57 staff members working in small-scale nursing home wards). The findings showed that in typical small-scale nursing homes, job satisfaction and job motivation were significantly higher compared to those in typical traditional nursing homes. Job autonomy and social support were also significantly higher, while job demands were significantly lower in these small-scale nursing homes. Social support was found to be the most significant predictor of job motivation and job satisfaction in both types of typical nursing homes. Nursing staff working in traditional care environments more often expressed the intention to switch to small-scale environments.ConclusionsBased on the findings of thi

Objectives: Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.Design: Longitudinal observation study.Setting: Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities).Participants: A total of 115 nursing home residents at baseline, 100 at follow-up.Measurements: Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity.Results: In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P <.001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (