Effectiveness of a self‐management support program for Thais with type 2 diabetes: Evaluation according to the RE‐AIM framework

Delivering diabetes self‐management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer‐assisted instruction. The RE‐AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six‐month follow‐up. Over six months, adjusted mean changes of hemoglobin A1c (?0.14%, 95% confidence interval = ?0.02 to ?0.26, fasting plasma glucose (?6.37 mg/dL, ?1.95 to ?10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes.     

Beyond ‘person‐centred’ care: a new vision for gerontological nursing

Currently considerable emphasis is placed on the promotion of person‐centred care, which has become a watchword for good practice. This paper takes a constructively critical look at some of the assumptions underpinning person‐centredness, and suggests that a relationship‐centred approach to care might be more appropriate. A framework describing the potential dimensions of relationship‐centred care is provided, and implications for further development are considered.     

A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study

røsvik j., kirkevold m., engedal k., brooker d. & kirkevold ø . (2011) A model for using the VIPS framework for person‐centred care for persons with dementia in nursing homes: a qualitative evaluative study. International Journal of Older People Nursing 6 , 227–236 doi: 10.1111/j.1748‐3743.2011.00290.x Background. The ‘VIPS’ framework sums up the elements in Kitwood’s philosophy of person‐centred care (PCC) for persons with dementia as values, individualised approach, the perspective of the person living with dementia and social environment. There are six indicators for each element. Aim. To conduct an initial evaluation of a model aimed at facilitating the application of the VIPS framework. Design. Qualitative evaluative study. Methods. A model was trialled in a 9‐week pilot study in two nursing homes and evaluated in four focus groups using qualitative content analysis. Results. Five themes emerged: (1) Legitimacy of the model was secured when central roles were held by nurses representing the majority of the staff; (2) The model facilitated the staff’s use of their knowledge of PCC; (3) Support to the persons holding the internal facilitating roles in the model was needed; (4) The authority of the leading registered nurse in the ward was crucial to support the legitimacy of the model and (5) Form of organisation seemed to be of importance in how the model was experienced. Conclusion. The model worked best in wards organised with a leading registered nurse who could support an auxiliary nurse holding the facilitating function.     

Evaluating the effectiveness of the abilities-focused approach to morning care of people with dementia

sidani s., streiner d. & leclerc c. (2012) Evaluating the effectiveness of the abilities‐focused approach to morning care of people with dementia. International Journal of Older People Nursing 7 , 37–45 doi: 10.1111/j.1748‐3743.2011.00273.x Background and purpose. The abilities‐focused approach demonstrated efficacy in promoting engagement of residents with dementia in care. The extent to which these resident outcomes can be replicated when the abilities‐focused approach is implemented by nursing staff under the conditions of day‐to‐day practice was investigated in this study. The aim was to examine changes in resident outcomes before and after nursing staff’ implementation of the abilities‐focused approach and the contribution of this approach to resident outcomes. Methods. A one‐group pretest–post‐test design was used. Observational data were obtained from 65 residents with dementia. The data pertained to the implementation of abilities‐focused strategies during episodes of morning care and residents’ level of agitation, participation in morning care and physical and psychosocial functioning. Results. The number of abilities‐focused strategies used during morning care increased at post‐test. No clinically important changes in resident outcomes were observed over time. However, the implementation of some strategies was associated with residents’ participation in care and functioning at post‐test. The results provided preliminary evidence of the effectiveness of the abilities‐focused approach in maintaining functioning in people with dementia. Additional research is needed to understand the mechanism underlying the effects of this person‐centred approach to care on resident outcomes. Implications for practice. Implementation of the abilities‐focused approach assists people with dementia to participate in morning care.     

Narrative intelligence in nursing: Storying patient lives in dementia care

This paper examines narrative approaches to care within the context of dementia. It reviews the function of stories and explores some of the narrative genres that shape the cultural perceptions of dementia. We argue that narrative intelligence within healthcare is an important element in nurturing communal self‐identity for people living with dementia. Listening and responding to stories and the cultural framework that this encompasses is an embodied action that is not just related to cognitive recall but situates us within a cultural community. People with dementia may have challenges in maintaining narrative legitimacy in the face of fractured stories and incoherent narratives. Health professionals can offer support in reframing and presenting counterstories that maintain identities that can potentially be marginalised, silenced and open to narrative foreclosure. This process requires health professionals to be attentive and responsive to how patients with dementia and their supporters construct and position the stories they tell and the meaning(s) they attach to them.     

'Patient participation' in everyday activities in special care units for persons with dementia in Norwegian nursing homes

helgesen a.k., larsson m. & athlin e. (2010) ‘Patient participation’ in everyday activities in special care units for persons with dementia in Norwegian nursing homes. International Journal of Older People Nursing 5 , 169–178 Aim. The aim of this study was to explore ‘patient participation’ in everyday activities for persons with dementia living in special care units in nursing homes. Background. Studies about how ‘patient participation’ appears in the context of special care units for persons with dementia are lacking. Design. The study has an explorative design. Method. Grounded theory was chosen. Data collection was carried out by means of open observations and additional conversations with residents and personnel. Simultaneously, data analysis was performed with open, axial and selective coding. Findings. The findings showed that ‘patient participation’ concerned ‘A matter of presence’ as the core category. The other categories described as ‘presence of personnel’ and ‘presence of residents’, were strongly connected to the core category as well as to each other. Presence of personnel comprised three levels; being there in body, which required physical presence; being there in mind, which required presence with all senses based on knowledge and competence; and being there in morality which was understood as being fully present, as it was based on humanistic values and included the two other levels. Presence of residents comprised ‘ability and wish’ and ‘adaptation’. The presence of the personnel had a huge impact on the ability and will to participate of the residents. Organizational conditions concerning leadership, amount of personnel and routines as well as housing conditions concerning architecture and shared accommodation, could stimulate or hinder ‘patient participation’. Conclusions and implications. The study highlighted the great impact of the personnel’s presence in body, mind and morality on the participation capacity of the residents. The great importance of the nurse leaders was stressed, as they were responsible for organizational issues and served as role models. Group supervision of the personnel and their leaders would be an implication to propose, as these kinds of reflection groups offer opportunities to reflect on values, actions and routines.     

The Tri‐focal model of care: Advancing the teaching‐nursing home concept

Providing residential aged care is challenging because of the complexity of residents’ health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed ‘The Tri‐focal model of care’. This model was developed based on the concepts of ‘partnership‐centred care’, ‘positive work environment’ and the need for evidence‐based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching‐nursing home concept and the quality of residential aged care.