Qualifications for nurses for the care of patients with dementia and support to their caregivers: A pilot evaluation of the dementia care management curriculum
Introduction
Due to the increasing number of elderly people, a substantial rise in the number of people with dementia (PwD) is predicted for the future. A high proportion of PwD require assistance in nursing care and support (Weyerer, 2005). Since many caregivers also need support in caring for their relatives with dementia, the role of the nursing profession in caring for PwD and their relatives will become ever more important. However, managing PwD in the primary health care setting requires a further, specialized qualification for nurses. In addition to their vocational training, nurses need to acquire skills for the specific field of work in the ambulatory, network-based care for PwD. This stresses the importance of advanced training options focused on dementia, with the aims to improve the care for the PwD and to support the caregivers. Currently, there are a range of advanced training options in dementia but the majority focused on specific aspects for caring of PwD (e.g., case management, communication, or nursing interventions). An advanced training option, which addresses all aspects of dementia care management in primary care (e.g., diagnostic, medical and non-medical therapy options, nursing interventions, case management, inter-professional cooperation), is still missing. Such training requires transparent cooperation of all stakeholders in the network, as well as close cooperation between nurses and the general practitioners. While general practitioners supervise diagnostic measures and treatment, nurses should take over a coordinating function. They analyze the nursing care, medical, and social needs and identify existing deficits. Primary tasks include (1) an assessment of the domestic care situation, (2) need assessment of PwD, (3) support needs of the caregivers, and (4) monitor PwD and their caregivers. Further tasks include prevention measures to delay the progression of dementia and to mitigate its consequences for the PwD’s daily life. Based on their specialized dementia competencies and detailed knowledge about regional care and support options, nurses should coordinate an individual care plan for PwD and their caregivers. Apart from general practitioners, the following professions need to be involved: specialists in neurology, specialists in psychiatry, outpatient care, physiotherapy, ergotherapy, but also social workers, care support points, and support groups.
Section snippets
Background
In industrial countries, dementia is the fourth most common cause of death after cardiovascular diseases, cancer, and cerebrovascular diseases. In 2008, more than 5.2 m people were living with dementia in the US. Caregivers provide care for an average of 16.6 h a day at home (Haupt et al., 2004). Furthermore, if only five percent of the current caregivers are no longer able to support their PwD in a primary health care setting in the US, a significant increase in nursing home places is expected (
Methods
In the evaluation, the following aspects were examined: (a) importance of the tasks of a DCM, (b) importance of the qualification contents, (c) identification of gaps, and (d) suggestions for improvement. The importance of the DCM tasks assessed in order to draw conclusions regarding the need of curriculum contents and qualification hours. The aim was to identify points for revision of the curriculum contents and to further develop the DCM qualification.
Participants
A total of five nurses (n = 3 female, n = 2 male) participated in the first theoretical and practical implementation of the DCM qualification. All participants had completed a vocational nursing training (n = 4 nursing care, n = 1 elderly care), and three nurses had an additional qualification as Nursing Home Managers. All participants had previously participated in advanced trainings related to dementia.
A total of 33 lecturers were involved in the first theoretical DCM qualification. The average age
Discussion
The evaluation study was planned as an integral part of the development of the DCM qualification from the very start. Its ultimate goal was to adequately prepare nurses to best support PwD in a primary health care setting. The summative evaluation concept allows for an overall assessment of the DCM qualification from the different perspective of nurses and lectures. Both nurses and lecturers assessed the curriculum structure and contents predominantly as positive.
This study does have some
Conclusion
The structured evaluation presented in this study renders a Germany-wide implementation of the DCM concept attractive. Currently, the DCM concept is prepared for a model project to implement DCM in routine care in Germany. Thereby, the competition of the DCM qualification will be a precondition for nurses to take over tasks as a DCM. By developing a DCM qualification for the nursing profession and the associated expansion of competencies for dementia care, the health care support for demented
Contributions
Development of the study design: AD, JRT, WH
Data collection: AD
Data management: AD
Data analysis: AD
Data interpretation: AD, JRT, WH
Drafting the manuscript: AD
Critical review of the manuscript: JRT, TE, WH
Funding Statement
The study is funded by the German Center for Neurodegenerative Diseases (DZNE) and the University Medicine Greifswald.
Trial Registration
NCT01401582
Acknowledgments
The developing process and pilot implementation of the DCM curriculum was accompanied and supported by several experts from different fields. These include listed in alphabetical order: Dirk Battermann, Georgia Böwing, Thomas Fiß, Axel Goepel, Siegfried Huhn, Doreen Köster, Andreas Krüger, Daniela Oertel, Christiane Reppenhagen, Andrea Richau, Micheline Richau, Hagen Rogalski, and Jan Erik Waschk.
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