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Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model

Published online by Cambridge University Press:  21 December 2016

Elizabeth L. Sampson ,
Victoria Vickerstaff ,
Stephanie Lietz  and
Martin Orrell
Elizabeth L. Sampson*
Affiliation:
Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK Barnet Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK
Victoria Vickerstaff
Affiliation:
Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
Stephanie Lietz
Affiliation:
UCL Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Martin Orrell
Affiliation:
Institute of Mental Health, University of Nottingham, Nottingham, UK
*
Correspondence should be addressed to: Elizabeth L. Sampson, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. Phone: 020 7679 9730; Fax: 020 7679 9426. Email: e.sampson@ucl.ac.uk.
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Abstract

Background:

There are concerns about the quality of care that people with dementia receive in the general hospital. Staff report a lack of confidence and inadequate training in dementia care.

Methods:

A train-the-trainer model was implemented across eight acute hospital trusts in London via a large academic health and science network. Impact was evaluated using mixed methods. Data were collected at (a) individual level: “Sense of Competence in Dementia Care” (SCID), (b) ward level: Person Interaction and Environment (PIE) observations, (c) organization level: use of specific tools, i.e. “This Is Me,” (d) systems level: numbers and types of staff trained per trust. Results were analyzed with descriptive statistics and paired t-test with thematic framework analysis for PIE observations.

Results:

The number of staff trained per trust ranged from 67 to 650 (total 2,020). A total of 1,688 (85%) baseline questionnaires and 456 (27%) three month follow-up questionnaires were completed. Mean SCID score was 43.2 at baseline and 50.7 at follow-up (paired t-test, p < 0.001). All sub-scales showed a small increase in competence, the largest being for “building relationships.” Organizational level data suggested increased use of carer's passport, “This Is Me” documentation, dementia information leaflets, delirium screening scales, and pathways. PIE observations demonstrated improved staff–patient interactions but little change in hospital environments.

Conclusions:

There was a significant improvement in staffs’ sense of competence in dementia care and the quality of interactions with patients. More hospitals adopted person-centered tools and pathways. Work is required to investigate if these changes improve hospital outcomes for people with dementia.

Keywords

dementiainpatienttrainingeducationliaison
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 4 , April 2017 , pp. 605 - 614
Copyright
Copyright © International Psychogeriatric Association 2016 

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