Nakanishi Miharu, Ziylan Canan, Bakker Ton, Granvik Eva, Nägga Katarina, Nishida Atsushi
Mental Health and Nursing Research Team, Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
Scand J Caring Sci. 2021 Jun;35(2):430-441. doi: 10.1111/scs.12854. Epub 2020 Apr 13.
A psychosocial dementia care programme for challenging behaviour (DEMBASE ) was developed in collaboration with a Swedish BPSD-registry team for in-home care services use in Japan. The programme consisted of a web-based tool for the continued assessment of challenging behaviours and interdisciplinary discussion meetings. Effectiveness of the adapted programme was verified through a cluster-randomised controlled trial. The Tokyo Metropolitan Government provided municipal funding to introduce the programme into daily practice beginning in April 2018.
To investigate both facilitators and barriers associated with programme implementation.
A secondary analysis of qualitative and quantitative data.
Data were collected in naturalistic long-term care settings from April 2018 to March 2019.
A total of 138 professionals and 157 people with dementia participated in the programme.
Challenging behaviour in persons with dementia was assessed by professionals using a total Neuropsychiatric Inventory score. Data on expected facilitators and barriers were extracted for qualitative analysis from a debriefing meeting between professionals.
Of the 157 persons with dementia, 81 (51.6%) received follow-up behavioural evaluations by March 2019. The average level of challenging behaviour was significantly reduced for 81 persons from baseline to their most recent follow-up evaluations. Facilitators included 'programme available for care managers', 'visualised feedback on professionals' work', 'affordable for providers and professionals' and 'media coverage'. Barriers included 'professionals from different organisations', 'unpaid work', 'operation requirement for municipalities' and 'conflict with daily benefit-oriented framework'.
A follow-up evaluation was not fully achieved. Further strategies to address barriers may include the development of a benefit-rewarding scheme for interdisciplinary discussion meetings, an e-learning system capable of substituting training course portions and a cross-municipality training course.
与瑞典具有挑战性的行为登记团队合作开发了一项针对具有挑战性的行为的社会心理痴呆症护理计划（DEMBASE），供日本的家庭护理服务使用。该计划包括一个用于持续评估具有挑战性的行为的网络工具和跨学科讨论会。通过一项整群随机对照试验验证了改编后计划的有效性。东京都政府提供市政资金，从2018年4月开始将该计划引入日常实践。
调查与计划实施相关的促进因素和障碍。
对定性和定量数据进行二次分析。
2018年4月至2019年3月在自然主义的长期护理环境中收集数据。
共有138名专业人员和157名痴呆症患者参与了该计划。
专业人员使用总的神经精神科问卷评分对痴呆症患者的具有挑战性的行为进行评估。从专业人员之间的汇报会议中提取有关预期促进因素和障碍的数据进行定性分析。
在157名痴呆症患者中，到2019年3月有81名（51.6%）接受了后续行为评估。从基线到最近的后续评估，81人的具有挑战性的行为平均水平显著降低。促进因素包括“护理经理可用的计划”、“对专业人员工作的可视化反馈”、“对提供者和专业人员来说负担得起”以及“媒体报道”。障碍包括“来自不同组织的专业人员”、“无薪工作”、“市政当局的运营要求”以及“与以日常福利为导向的框架冲突”。
后续评估未完全实现。解决障碍的进一步策略可能包括为跨学科讨论会制定福利奖励计划、能够替代培训课程部分的电子学习系统以及跨市培训课程。
