School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
School of Nursing, Pennsylvania State University, University Park, Pennsylvania.
Int J Older People Nurs. 2019 Sep;14(3):e12244. doi: 10.1111/opn.12244. Epub 2019 May 24.
Five of the eight focus areas of Bowen's Feasibility Framework were utilised to assess the feasibility of implementing the Safe Walking Program (SWP) with people with severe dementia who wander in long-term care (LTC).
Dementia-related wandering in LTC is associated with adverse outcomes related to intensity (malnutrition, exhaustion and pain, injury) and type of walking (sleep deprivation, resident violence and elopement, death). There is little evidence guiding best practice for managing wandering in LTC.
The SWP involved a three-week trial of taking residents (n = 7) for a 30-min supervised walk, 30 min before individual peak walking activity periods (PWAP), outside the care facility. Quantitative (real-time observation and 24/7 Actigraph™ data: not reported here) and qualitative data were collected pre-, during and postintervention.
Feasibility to implement the SWP protocol was evaluated using a protocol fidelity checklist completed at the end of each scheduled intervention. Acceptability and sustainability of the programme were evaluated through staff interviews.
Eighty per cent of scheduled walks commenced and were completed, with 91% of walks lasting the full 30 min. Care staff reported benefits for participants and care staff. The perceived sustainability of the SWP in the LTC setting was impacted by the strict timing of the walk to coincide with participant's individual PWAP. The use of care staff to lead some scheduled walks was seen as interfering with care routines.
To enhance the acceptability/sustainability of the SWP in LTC, further testing of the importance of dose and timing is required. Consideration needs to be given to suggested modifications to the protocol.
The SWP is an acceptable and enjoyable activity for people with severe dementia who wander. Utilising walking tracks around the neighbourhood was perceived as being an important element of the programme.
利用 Bowen 可行性框架的八个重点领域中的五个，评估在长期护理（LTC）中患有严重痴呆症且经常徘徊的人群中实施安全行走计划（SWP）的可行性。
LTC 中与痴呆症相关的徘徊与行走的强度（营养不良、疲惫和疼痛、受伤）和类型（睡眠剥夺、居民暴力和逃跑、死亡）有关的不良后果有关。几乎没有证据可以指导 LTC 中管理徘徊的最佳实践。
SWP 包括对 7 名居民进行为期 3 周的试验，即在个人高峰行走活动期（PWAP）前 30 分钟，在护理设施外进行 30 分钟的监督行走。在干预前、期间和之后收集了定量（实时观察和 24/7 Actigraph™数据：此处未报告）和定性数据。
通过在每次预定干预结束时完成的协议保真度检查表，评估实施 SWP 协议的可行性。通过员工访谈评估该计划的可接受性和可持续性。
80%的预定行走开始并完成，91%的行走持续了整整 30 分钟。护理人员报告了参与者和护理人员的受益。SWP 在 LTC 环境中的可持续性受到行走时间严格与参与者个人 PWAP 吻合的影响。使用护理人员带领一些预定的行走被认为会干扰护理常规。
为了提高 SWP 在 LTC 中的可接受性/可持续性，需要进一步测试剂量和时间的重要性。需要考虑对方案的修改建议。
SWP 是一种对患有严重痴呆症且经常徘徊的人来说是可接受且令人愉悦的活动。利用附近的散步道被认为是该计划的一个重要组成部分。
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