NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
Int J Geriatr Psychiatry. 2011 Jul;26(7):723-32. doi: 10.1002/gps.2586. Epub 2010 Nov 11.
To study the effects of introducing a nursing guideline on depression in residents with dementia of psychogeriatric nursing home wards.
A multi-center controlled clinical trial with randomization at ward level was used to study the effects of the guideline introduction. Nursing teams were trained in applying the guideline to their own residents diagnosed with depression in dementia. Key elements of the nursing guideline are increasing individualized pleasant activities and decreasing unpleasant events. Participating residents were 97 residents diagnosed with dementia and comorbid depression, from 18 psychogeriatric nursing home wards, in 9 Dutch nursing homes. Measurements took place at pre-test, post-test and follow-up. Primary outcome was severity of depression measured with the MDS/RAI-Depression Rating Scale (DRS) and the Cornell Scale for Depression in Dementia. Secondary outcome is mood as measured by the FACE-observation scale.
Compliance with the nursing guideline was moderate. Despite this, residents on the experimental wards showed a significant reduction in depression on the DRS. With the Cornell scale a reduction of depression was found as well, although not significantly different from that in the control group. No effects on observed mood were found.
This study shows significant reductions in depression severity by introducing a nursing guideline on psychogeriatric nursing home wards. Better compliance with the guideline could probably enlarge the effects. Some ways to achieve enhanced compliance are: (1) additionally train non-certified nurse assistants, and (2) emphasize necessary conditions for successful introduction of the guideline to nursing team managers.
研究引入护理指南对精神科养老院病房老年痴呆症患者抑郁的影响。
采用多中心对照临床试验，在病房层面进行随机分组，研究指南引入的效果。护理团队接受了将指南应用于自己病房中被诊断为痴呆合并抑郁症的居民的培训。护理指南的关键要素是增加个体化的愉快活动，减少不愉快事件。参与研究的居民是来自 9 家荷兰养老院的 18 个精神科养老院病房的 97 名被诊断为痴呆合并抑郁症的居民。测量在预测试、后测试和随访时进行。主要结局是用 MDS/RAI-抑郁评定量表（DRS）和康奈尔痴呆抑郁量表（Cornell Scale for Depression in Dementia）测量的抑郁严重程度。次要结局是通过 FACE 观察量表测量的情绪。
对护理指南的依从性中等。尽管如此，实验组的居民在 DRS 上的抑郁程度显著降低。在康奈尔量表上也发现了抑郁程度的降低，尽管与对照组没有显著差异。没有发现对观察到的情绪有影响。
本研究表明，在精神科养老院病房引入护理指南可显著降低抑郁严重程度。更好地遵守指南可能会扩大效果。提高依从性的一些方法是：（1）额外培训非认证的护士助理，（2）向护理团队管理人员强调成功引入指南的必要条件。
