Adaptation and Piloting for Hospice Social Workers of Aliviado Dementia Care, a Dementia Symptom Management Program
Adaptation and Piloting for Hospice Social Workers of Aliviado Dementia Care, a Dementia Symptom Management Program
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DOI：
10.1177/1049909120962459
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发表时间：
2020-10-05
影响因子：
1.9
通讯作者：
Brody, Abraham A.
中科院分区：
文献类型：
--
作者：
Jones, Tessa M.;Brody, Abraham A.
背景：45%的安宁疗护病人目前有阿尔茨海默病或相关疾病的原发性或继发性诊断。然而，很少有项目专门关注于协助临终关怀医院为痴呆症患者提供循证症状管理。目的：调整和试点Aliviado痴呆症护理的培训部分，这是一项痴呆症症状管理质量改进计划，最初是为家庭医疗保健开发的，供社会工作者作为临终关怀跨学科团队的一部分使用。设计：采用前瞻性岗前设计，在基线、立即和培训后1个月测量知识、信心和态度。采用配对t检验和重复测量方差分析进行分析。对象：目前在美国从事临终关怀社会工作者，至少有1年的工作经验。测量方法：痴呆症状知识评估和培训后继续教育评估表。结果：共纳入46例受试者，其中26例完成了第一次后测，23例完成了两次后测。护理PLWD的知识和信心基线水平较差。培训后发生了显著的改善，特别是对痴呆（BPSD）的行为和心理症状实施非药物干预（增加16.64%,p < 0.0001），以及对管理行为症状（16.86%,p = 0.01）和抑郁（25.18%,p < 0.0001）的信心。随着时间的推移，更改得到了维护。所有受访者都对节目的质量和内容非常满意或满意。结论：Aliviado痴呆护理培训模块成功地为安宁疗护社工量身定制，显著提高了老年痴呆症患者行为症状护理的知识和信心。未来的工作将会检查更大的项目，包括这个培训，是否可以随后改善病人在临终关怀中的结果。
Background: Forty-five percent of hospice patients currently have a primary or secondary diagnosis of Alzheimer's disease or related disorders. However, few programs have focused specifically on assisting hospices in providing evidence-based symptom management to persons living with dementia (PLWD). Objective: To adapt and pilot the training component of Aliviado Dementia Care, a dementia symptom management quality improvement program originally developed for home healthcare, for use by social workers as part of the hospice interdisciplinary team. Design: A prospective pre-post design was utilized, measuring knowledge, confidence, and attitudes at baseline, and immediately and 1-month post-training. Analysis was performed using paired t-tests and repeated measures ANOVA. Subjects: Hospice social workers currently practicing in the United States with at least 1 year of experience. Measurements: The Dementia Symptom Knowledge Assessment and a post-training continuing education evaluation form. Results: Forty-six subjects were enrolled, of whom 26 completed the first post-test and 23 both post-tests. There was a poor baseline level of knowledge and confidence in caring for PLWD. Significant improvements occurred following training, particularly in implementing non-pharmacologic interventions for behavioral and psychological symptoms of dementia (BPSD) (16.64% increase, p < .0001) and confidence in managing behavioral symptoms (16.86%, p = .01) and depression (25.18%, p < .0001). Changes were maintained over time. All respondents were either very satisfied or satisfied with the quality and content of the program. Conclusions: The training modules of Aliviado Dementia Care were successfully tailored for use by hospice social workers, showing significant improvement in knowledge and confidence in caring for behavioral symptoms in PLWD. Future work will examine whether the larger program, including this training, can subsequently improve patient outcomes in hospice.