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Developing effective educational approaches for Liaison Old Age Psychiatry teams: a literature review of the learning needs of hospital staff in relation to managing the confused older patient

Published online by Cambridge University Press:  15 December 2009

Andrew Teodorczuk ,
Mark Welfare ,
Sally Corbett  and
Elizabeta Mukaetova-Ladinska
Andrew Teodorczuk*
Affiliation:
Education Centre, Northumbria Healthcare Trust, North Tyneside Hospital, U.K.
Mark Welfare
Affiliation:
Education Centre, Northumbria Healthcare Trust, North Tyneside Hospital, U.K.
Sally Corbett
Affiliation:
Education Centre, Northumbria Healthcare Trust, North Tyneside Hospital, U.K.
Elizabeta Mukaetova-Ladinska
Affiliation:
Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, U.K.
*
Correspondence should be addressed to: Dr Andrew Teodorczuk, Northumbria Healthcare Trust, North Tyneside Hospital, North Shields, NE29 8NH, U.K. Phone: +44 191 203 1200; Fax: +44 191 293 4160. Email: Andrew.Teodorczuk@ncl.ac.uk.
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Abstract

Background: Deficiencies in the knowledge, skills and attitudes of all healthcare professionals working within the general hospital contribute towards the suboptimal care of older hospitalized patients with confusion. In the U.K., policy dictates that Liaison Old Age Psychiatry teams deliver effective education to general hospital clinical staff. The purpose of this paper is to review the literature concerning the learning needs of healthcare professionals in relation to managing confusion in the older patient in order to inform effective educational approaches for Liaison Old Age Psychiatry teams.

Methods: A broad range of medical and educational databases were searched. Identified English language studies were selected for further analysis if they had a specific educational focus in the hospital setting and then further subdivided into intervention and naturalistic studies. The impact of intervention studies was evaluated by Kirkpatrick's system. Learning needs, as determined from the naturalistic studies, were mapped to identify themes.

Results: 13 intervention studies were identified. Despite a high level of effectiveness for educational interventions, it was unclear what the active components were. A further 23 naturalistic studies were identified; their findings focused on knowledge gaps, diagnostic behaviors and experiences, attitudes and training issues. Few studies specifically researched learning needs or the educational role of liaison teams. Conspicuous by its absence was reference to relevant educational theories.

Conclusions: The findings of this review can be incorporated in the planning of local curricula by Liaison Teams in order to design educational strategies. There is a need for further research, especially studies exploring the learning needs of all healthcare professionals.

Keywords

educationtraininglearning needsdementiadeliriumconfusionhospitalliaison
Type
Special Issue Articles
Information
International Psychogeriatrics , Volume 22 , Special Issue 6: Focus on training in psychogeriatrics , September 2010 , pp. 874 - 885
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Albert, S. M., Costa, R., Merchant, C., Small, S., Jenders, R. A. and Stern, Y. (1999). Hospitalization and Alzheimer's disease: results from a community-based study. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54, M267–271.CrossRefGoogle ScholarPubMed
Armstrong, S. C., Cozza, K. L. and Watanabe, K. S. (1997). The misdiagnosis of delirium. Psychosomatics, 38, 433–439.CrossRefGoogle ScholarPubMed
Armstrong-Esther, C. A., Browne, K. D. and McAffee, J. G. (1999). Investigation into nursing staff knowledge and attitude to dementia. International Journal of Psychiatric Nursing Research, 4, 489–497.Google ScholarPubMed
Atkin, K., Holmes, J. and Martin, C. (2005). Provision of care for older people with co-morbid mental illness in general hospitals: general nurses’ perceptions of their training needs. International Journal of Geriatric Psychiatry, 20, 1081–1083.Google ScholarPubMed
Aylward, S., Stolee, P., Keat, N. and Johncox, V. (2003). Effectiveness of continuing education in long-term care: a literature review. Gerontologist, 43, 259–271.Google ScholarPubMed
Baldwin, R., Pratt, H., Goring, H., Marriott, A. and Roberts, C. (2004). Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial. Age and Ageing, 33, 472–478.CrossRefGoogle ScholarPubMed
Berkowitz, H. L. (1981). House officer knowledgeability of organic brain syndromes: a pilot study. General Hospital Psychiatry, 3, 321–326.CrossRefGoogle Scholar
Billett, S. (1996). Towards a model of workplace learning: the learning curriculum. Studies in Continuing Education, 18, 43–58.CrossRefGoogle Scholar
Borbasi, S., Jones, J., Lockwood, C. and Emden, C. (2006). Health professionals’ perspectives of providing care to people with dementia in the acute setting: toward better practice. Geriatric Nursing, 27, 300–308.CrossRefGoogle ScholarPubMed
Brymer, C., Cavanagh, P., Denomy, E., Wells, K. and Cook, C. (2001). The effect of a geriatric education program on emergency nurses. Journal of Emergency Nursing, 27, 27–32.CrossRefGoogle ScholarPubMed
Carpenter, J. and Dickinson, H. (2008). Interprofessional Education and Training. Bristol: Policy Press.Google Scholar
Davis, D. A., Thomson, M. A., Oxman, A. D. and Haynes, R. B. (1992). Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA, 268, 1111–1117.CrossRefGoogle ScholarPubMed
Davis, D. A., Thomson, M. A., Oxman, A. D. and Haynes, R. B. (1995). Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA, 274, 700–705.CrossRefGoogle ScholarPubMed
Department of Health (2009). Living Well with Dementia. London: Stationery Office.Google Scholar
Dunnion, M. E. and Kelly, B. (2005). From the emergency department to home. Journal of Clinical Nursing, 14, 776–785.CrossRefGoogle Scholar
Ekman, S. L., Norberg, A., Viitanen, M. and Winblad, B. (1991). Care of demented patients with severe communication problems. Scandinavian Journal of Caring Sciences, 5, 163–170.CrossRefGoogle ScholarPubMed
Eriksson, C. and Saveman, B. I. (2002). Nurses’ experiences of abusive/non-abusive caring for demented patients in acute care settings. Scandinavian Journal of Caring Sciences, 16, 79–85.CrossRefGoogle ScholarPubMed
Feldman, J., Yaretzky, A., Kaizimov, N., Alterman, P. and Vigder, C. (1999). Delirium in an acute geriatric unit: clinical aspects. Archives of Gerontology and Geriatrics, 28, 37–44.CrossRefGoogle Scholar
Fessey, V. (2007). Patients who present with dementia: exploring the knowledge of hospital nurses. Nursing Older People, 19, 29–33.CrossRefGoogle ScholarPubMed
Fick, D. M., Hodo, D. M., Lawrence, F. and Inouye, S. K. (2007). Recognizing delirium superimposed on dementia: assessing nurses’ knowledge using case vignettes. Journal of Gerontology Nursing, 33, 40–47; quiz 48–49.CrossRefGoogle ScholarPubMed
Freeth, D. (2007). Interprofessional Education. Understanding Medical Education Booklet. Edinburgh: ASME.Google Scholar
Fuller, A., Hodkinson, H., Hodkinson, P. and Unwin, L. (2005). Learning as peripheral participation in communities of practice: a reassessment of key concepts in workplace learning. British Educational Research Journal, 31, 49–68.CrossRefGoogle Scholar
Harding, R., Martin, C. and Holmes, J. (2008). Dazed and confused: making sense of delirium after hip fracture. International Journal of Geriatric Psychiatry, 23, 984–986.CrossRefGoogle ScholarPubMed
Hobson, J. P., Coyle, J. M., Leeds, L. and Meara, R. J. (2001). Health professionals’ knowledge about Alzheimer's disease. International Journal of Geriatric Psychiatry, 16, 822–823.CrossRefGoogle ScholarPubMed
Holden, J., Jayathissa, S. and Young, G. (2008). Delirium among elderly general medical patients in a New Zealand hospital. Internal Medicine Journal, 38, 629–634.CrossRefGoogle Scholar
Hutchinson, L. (1999). Evaluating and researching the effectiveness of educational interventions. BMJ, 318, 1267–1269.CrossRefGoogle ScholarPubMed
Inouye, S. K., Acampora, D., Miller, R. L., Fulmer, T., Hurst, L. D. and Cooney, L. M. Jr. (1993). The Yale Geriatric Care Program: a model of care to prevent functional decline in hospitalized elderly patients. Journal of the American Geriatrics Society, 41, 1345–1352.CrossRefGoogle Scholar
Inouye, S. K., Foreman, M. D., Mion, L. C., Katz, K. H. and Cooney, L. M. Jr. (2001). Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Archives of Internal Medicine, 161, 2467–2473.CrossRefGoogle ScholarPubMed
Jewell, D., Turpie, I., Patterson, C., Lewis, D. and Baxter, J. (2003). A one minute survey of learning needs for Regional Geriatric Program Central Personnel. Geriatrics and Aging, 6, 59–61.Google Scholar
Kales, H. C., Kamholz, B. A., Visnic, S. G. and Blow, F. C. (2003). Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. Journal of Geriatric Psychiatry and Neurology, 16, 32–38.CrossRefGoogle Scholar
Kaufmann, D. (2003). Applying educational theory in practice. In Cantillon, P. (ed.), ABC of Learning and Teaching in Medicine. London: BMJ Books.Google Scholar
Kelly, A. V. (2004). The Curriculum: Theory and Practice. London: Sage.Google ScholarPubMed
Kirkpatrick, D. L. (1994). Evaluating Training Programs: The Four Levels. San Francisco: Berrett-Koehler.Google Scholar
Lave, J. and Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Lockyer, J. (1998). Needs assessment: lessons learned. Journal of Continuing Education in the Health Professions, 18, 190–192.CrossRefGoogle Scholar
Lundstrom, M., Edlund, A., Karlsson, S., Brannstrom, B., Bucht, G. and Gustafson, Y. (2005). A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. Journal of the American Geriatrics Society, 53, 622–628.CrossRefGoogle ScholarPubMed
Marcantonio, E. R., Simon, S. E., Bergmann, M. A., Jones, R. N., Murphy, K. M. and Morris, J. N. (2003). Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery. Journal of the American Geriatrics Society, 51, 4–9.Google ScholarPubMed
Marshall, M. (1999). “They should not really be here” – people with dementia in the acute sector. Age and Ageing, 28 (Suppl. 2), 9–11.CrossRefGoogle Scholar
McCarthy, M. (2003a). Situated clinical reasoning: distinguishing acute confusion from dementia in hospitalized older adults. Research in Nursing and Health, 26, 90–101.CrossRefGoogle ScholarPubMed
McCarthy, M. (2003b). Detecting acute confusion in older adults: comparing clinical reasoning of nurses working in acute, long-term, and community health care environments. Research in Nursing and Health, 26, 203–212.CrossRefGoogle ScholarPubMed
McCartney, J. R. and Palmateer, L. M. (1985). Assessment of cognitive deficit in geriatric patients: a study of physician behavior. Journal of the American Geriatrics Society, 33, 467–471.CrossRefGoogle ScholarPubMed
Milisen, K. et al. (2001). A nurse-led interdisciplinary intervention program for delirium in elderly hip-fracture patients. Journal of the American Geriatrics Society, 49, 523–532.CrossRefGoogle ScholarPubMed
Miller, J., Campbell, J., Moore, K. and Schofield, A. (2004). Elder care supportive interventions protocol: reducing discomfort in confused, hospitalized older adults. Journal of Gerontological Nursing, 30, 10–8; quiz 54–55.CrossRefGoogle ScholarPubMed
National Audit Office (2007). Improving Services and Support for People with Dementia. London: National Audit Office.Google Scholar
National Institute for Health and Clinical Excellence (2006). Dementia: Supporting People with Dementia and their Carers in Health and Clinical Care. NICE Clinical Guideline 42. London: NICE.Google Scholar
Naughton, B. J., Saltzman, S., Ramadan, F., Chadha, N., Priore, R. and Mylotte, J. M. (2005). A multifactorial intervention to reduce prevalence of delirium and shorten hospital length of stay. Journal of the American Geriatrics Society, 53, 18–23.CrossRefGoogle ScholarPubMed
Nolan, L. (2007). Caring for people with dementia in the acute setting: a study of nurses’ views. British Journal of Nursing, 16, 419–422.CrossRefGoogle ScholarPubMed
Normann, H. K., Asplund, K. and Norberg, A. (1999). Attitudes of registered nurses towards patients with severe dementia. Journal of Clinical Nursing, 8, 353–359.CrossRefGoogle ScholarPubMed
Palmateer, L. M. and McCartney, J. R. (1985). Do nurses know when patients have cognitive deficits? Journal of Gerontological Nursing 11, 6–7, 10–12, 15–16.CrossRefGoogle ScholarPubMed
Pulsford, D., Hope, K. and Thompson, R. (2007). Higher education provision for professionals working with people with dementia: a scoping exercise. Nurse Education Today, 27, 5–13.CrossRefGoogle ScholarPubMed
Rockwood, K. (1999). Educational interventions in delirium. Dementia and Geriatric Cognitive Disorders, 10, 426–429.CrossRefGoogle ScholarPubMed
Rockwood, K., Cosway, S., Stolee, P., Kydd, D., Carver, D., Jarrett, P. and O'Brien, B. (1994). Increasing the recognition of delirium in elderly patients. Journal of the American Geriatrics Society, 42, 252–256.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2005). Who Cares Wins: Improving the Care of Elderly People Admitted to General Hospital. London: Royal College of Psychiatrists. Available at: http://www.bgs.org.uk/PDF%20Downloads/WhoCaresWins.pdf.Google Scholar
Ryan, D., Blackburn, P., Lawley, D., Ellis, A., Musil, J. and Kendrick, D. (1995). Depression and dementia in geriatric inpatients: diagnostic comparisons between psychiatrists, geriatricians and test scores. International Journal of Geriatric Psychiatry, 10, 447–456.CrossRefGoogle Scholar
Schiro, M. (2008). Curriculum Theory: Conflicting Visions and Enduring Concerns. Thousand Oaks, CA: Sage.Google Scholar
Simon, L., Jewell, N. and Brokel, J. (1997). Management of acute delirium in hospitalized elderly: a process improvement project. Geriatric Nursing, 18, 150–154.Google ScholarPubMed
Smith, S. (2007). Raising the profile of older people's care in hospital through training. Nursing Older People, 19, 27–31.CrossRefGoogle ScholarPubMed
Somerfield, M. R., Weisman, C. S., Ury, W., Chase, G. A. and Folstein, M. F. (1991). Physician practices in the diagnosis of dementing disorders. Journal of the American Geriatrics Society, 39, 172–175.CrossRefGoogle ScholarPubMed
Speciale, S., Bellelli, G. and Trabucchi, M. (2005). Staff training and use of specific protocols for delirium management. Journal of the American Geriatrics Society, 53, 1445–1446.CrossRefGoogle ScholarPubMed
Tabet, N., Hudson, S., Sweeney, V., Sauer, J., Bryant, C., Macdonald, A. and Howard, R. (2005). An educational intervention can prevent delirium on acute medical wards. Age and Ageing, 34, 152–156.CrossRefGoogle ScholarPubMed
Teodorczuk, A., Welfare, M., Corbett, S. and Mukaetova-Ladinska, E. (2009). Education, hospital staff and the confused older patient. Age and Ageing, 38, 252–253.CrossRefGoogle ScholarPubMed
Tolson, D., Smith, M. and Knight, P. (1999). An investigation of the components of best nursing practice in the care of acutely ill hospitalized older patients with coincidental dementia: a multi-method design. Journal of Advanced Nursing, 30, 1127–1136.CrossRefGoogle ScholarPubMed
Wanich, C. K., Sullivan-Marx, E. M., Gottlieb, G. L. and Johnson, J. C. (1992). Functional status outcomes of a nursing intervention in hospitalized elderly. Image: Journal of Nursing Scholarship, 24, 201–207.Google ScholarPubMed
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