Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Care Planning Practices for Behavioural and Psychological Symptoms of Dementia in Residential Aged Care: A Pilot of an Education Toolkit Informed by the Aged Care Funding Instrument

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Care Planning Practices for Behavioural and Psychological Symptoms of Dementia in Residential Aged Care: A Pilot of an Education Toolkit Informed by the Aged Care Funding Instrument

Article excerpt

Increasingly in recent years, studies have explored barriers and facilitators to and theories of the successful implementation of research evidence into practice, under the field of evidence-based practice, knowledge translation and more recently implementation science (Ploeg, Davies, Edwards, Gifford, & Miller, 2007; Stetler, Ritchie, Rycroft-Malone, Schultz, & Charns, 2009; van Achterberg, Schoonhoven, Grol, & van Gaal, 2008). While acknowledging differences in these concepts, the key message across all three is the goal of closing the gap between research and prac- tice; that is, implementing good evidence into practice. One of the critical elements in the pro- cess of achieving the goal relates to the notion of integration of new evidence or intervention into routine practice (Ploeg et ah, 2007; Stetler et ah, 2009; van Achterberg et al., 2008). For instance, nationally and internationally, much has been written about the effects of person-centred-care for people with behavioural and psychological symptoms of dementia (BPSD) in residential care settings (Edvardsson, Winblad, & Sandman, 2008). It is yet to be established how to best sus- tain person-centred-care beyond a staff education programme such that it is embedded in everyday practice. Notably, it is often recommended that routinely collected data be used to identify an area of improvement for quality care and practice. No research to date has been identified that examines the utility of routine data collection in facilitating person centred approaches in the care of people with dementia.

The research team set out to explore a way of maintaining sustainability of person-centred- care in everyday practice in residential aged care (RAC) settings. It was believed that the recently introduced Aged Care Funding Instrument (ACFI) could be used to address this particular issue. The ACFI was introduced in 2008 as the means of allocating Australian Government sub- sidies to RAC providers (Australian Government Department of Health and Ageing, 2009). The ACFI was designed to improve the match of funding with needs of persons living in RAC settings. The ACFI consists of 12 care need questions contextually positioned within three domains of activities of daily living (ADL), behaviour supplement (BEH) and complex health care supplement (CHC), some of which have specified assessment tools (Australian Government Department of Health and Ageing, 2009). Information on the person's mental, behavioural and medical conditions is collected by staff of residential aged care facilities (RACF) to complete the ACFI, which categorises the persons' care needs as nil, low, medium or high (Australian Government Department of Health and Ageing, 2009).

Of the three ACFI domains, this study focussed on the ACFI-BEH as BPSD present a significant challenge for RACF staff (Davison, Hudgson, McCabe, George, & Buchanan, 2007; Kolanowski, Fick, Frazer, & Penrod, 2010). Researchers report problems associated with poor quality care and poor nursing documentation of person's care needs, particularly concerning BPSD, and suggest that they are often contributed by negative staff attitudes, lack of available staff time, and low skills and/or confidence in documenting psychosocial care needs of the person living with dementia (Dellefield, 2006; Hansebo, Kihlgren, & Ljunggren, 1999). Hansebo et al. (1999) iden- tified that while 87% of physical care needs were addressed in care plans, only 43% of mood and 58% of behavioural needs were addressed. This is an issue that needs to be addressed, since research has shown that accurate, individual and up-to- date care documentation promotes consistency among nurse and other team members involved in care (Voutilainen, Isola, & Muurinen, 2004) and also guides direct care staff in delivering indi- vidualised care that is aligned with the person's needs (Dellefield, 2006).

Our previous studies in the field suggest that staff collaboration and expert assistance in care of the person with BPSD are required for quality dementia care practice (Chenoweth & Jeon, 2007; Chenoweth et ak, 2009). …

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