Esther Cabrera

Reasons for Institutionalization of People With Dementia: Informal Caregiver Reports From 8 European Countries

OBJECTIVES To explore reasons for institutionalization of people with dementia according to informal caregivers as well as variation in reasons between countries. DESIGN An explorative cross-sectional study was conducted in 8 European countries. SETTING Per country, a minimum of 3 long term care facilities, offering care and accommodation as a package, participated in this study. Participating countries were selected to represent different geographic areas in Europe. PARTICIPANTS Of the 791 informal caregivers involved in the RightTimePlaceCare project of people with dementia who were recently admitted to a long term care facility, 786 were included for this study. MEASUREMENTS As part of a semistructured interview, informal caregivers were asked the main reason for institutionalization in an open-ended question. Answers were categorized according to a conventional coding approach. All reasons were then quantified and tested. RESULTS Mainly patient-related reasons were stated, such as neuropsychiatric symptoms (25%), care dependency (24%), and cognition (19%). Neuropsychiatric symptoms were among the most often mentioned reasons in most countries. Besides patient-related reasons, caregiver burden and the inability of the informal caregiver to care for the patient were stated as reasons (both 15%). Further analyses showed countries differ significantly in reasons according to informal caregivers. Additionally, reasons were analyzed for spouses and child-caregivers, showing that spouses more often stated reasons related to themselves compared with child-caregivers. CONCLUSION Multiple reasons contribute to the institutionalization for people with dementia, with several factors that may influence why there were country differences. Variation in the organization of dementia care and cultural aspects, or the relationship between the informal caregiver and person with dementia may be factors influencing the reasons. Because of a wide variation in reasons between countries, no one-size-fits-all approach can be offered to guide informal caregivers when facing the possibility of institutionalization of the person with dementia.

New nursing education structure in Spain

Nursing education in Spain is developing rapidly in accordance with the European Union growth and within an international globalization movement. The purpose of this article is to present the new nursing education framework in Spain: A brief history together with its recent reform and developments. Since nursing education was integrated into the university level in 1977, the only academic recognition for such an education in Spain was the three year diploma degree. Nurses had to move into other disciplines in order to achieve academic growth or advance their nursing studies abroad. Currently and in compliance with the Bologna declaration for the Higher European Education Area, nursing education in Spain is being transformed into a program which recognizes bachelor, master and doctoral degrees in this field. In January 2005, the Spanish Government published the guidelines for the undergraduate, masters and doctoral levels, and finally, last October 2007, it established the regulations for the official university education. The current nursing specialties in Spain include family and community health nursing, midwifery, mental health nursing, geriatric nursing, health work nursing, medical care nursing and pediatric nursing. This new nursing education structure is expected to improve health care as well as nursing reliability and autonomy.

Best practices interventions to improve quality of care of people with dementia living at home

OBJECTIVE To identify effective interventions which improve quality of care for people with dementia (PwD) living at home. METHODS MEDLINE-(via PubMed), CINAHL, PsycINFO and ISI Web of Science databases were searched. INCLUSION CRITERIA (1) randomized controlled trials; (2) published in English-language, peer-reviewed journals between 1990 and 2012; (3) evaluated strategies to improve quality of care for PwD cared at home; and (4) participants older than 65. RESULTS 23 studies met inclusion criteria. All the studies aimed to improve PwD quality of care and most of them focused on PwD caregivers. Psychoeducational programs are the most frequently assessed interventions and multicomponent interventions produced the most promising results. CONCLUSION Due to the great variety of interventions describing specific samples and contexts, comparison of practice effectiveness is difficult. However, cognitive rehabilitation in PwD is effective when applied at an early stage of the disease. Case managers have demonstrated to reduce PwD institutionalization and the use of other community services. The studies were limited by sample heterogeneity, short follow-up or insufficiently detailed description. PRACTICE IMPLICATIONS To improve PwD homecare, health professionals should educate and support caregivers. Before specific interventional recommendations can be made, further research addressing the limitations of current studies is needed.

The impact of genetic counseling on knowledge and emotional responses in Spanish population with family history of breast cancer

OBJECTIVE To assess a genetic counseling intervention measuring the distress, cancer risk perception, anxiety, worry and level of knowledge in people with familial history of breast cancer. METHODS One group pre- and post-test design. A total of 212 individuals completed a baseline questionnaire, 88.6% completed a second questionnaire one month later and 75.4% six months later. RESULTS Counseling intervention significantly increased the knowledge level of the individuals who received genetic education and significantly decreased the cancer worry levels. Persons with low perception of their cancer risk also had low worry levels. There were no significant changes over time in cancer risk perception or in quality of life. CONCLUSION Counseling in a high risk population seems to decrease cancer worry and to increase cancer knowledge thus enabling a counselee to take well-informed decisions. Furthermore, according to our results, such interventions do not increase anxiety and do not modify the quality of life, but do not adjust their cancer risk perception. PRACTICE IMPLICATIONS Providing individuals at increased risk of breast cancer genetic services seem to enhance their understanding of breast cancer without causing adverse psychological effects or changes in their quality of life, and it could improve their preventive behaviours.

Difference Between Received and Expected Knowledge of Patients Undergoing Knee or Hip Replacement in Seven European Countries

The purpose of the study was to examine received and expected knowledge of patients with knee/hip arthroplasty in seven European countries. The goal was to obtain information for developing empowering patient education. The data were collected (during 2009-2012) from patients (n = 943) with hip/knee arthroplasty prior to scheduled preoperative education and before discharge with the Received Knowledge of hospital patient scale (RKhp) and Expected Knowledge of hospital patient scale (EKhp). Patients’ knowledge expectations were high but the level of received knowledge did not correspond to expectations. The difference between received and expected knowledge was higher in Greece and Sweden compared with Finland (p < .0001, p < .0001), Spain (p < .0001, p = .001), and Lithuania (p = .005, p = .003), respectively. Patients’ knowledge expectations are important in tailoring patient education. To achieve high standards in the future, scientific research collaboration on empowering patient education is needed between European countries.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES To describe and compare the CMs role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN A case study design. PARTICIPANTS AND SETTING A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care.

Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.

The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: A prospective observational cohort study.

BACKGROUND Dementia is a progressive neurological disorder that causes a high degree of dependency. This dependency has been defined as an increased need for assistance due to deterioration in cognition and physical functioning, and changes in behavior. Highly dependent people with dementia are more likely to be institutionalized. OBJECTIVES To investigate the association between specific categories of physical dependency and the presence of neuropsychiatric symptoms in people with dementia admitted to a long-term care institution. DESIGN A prospective observational cohort study. SETTINGS Home care and long-term care institutions in eight European countries. PARTICIPANTS People with dementia living at home but at risk of institutionalization and recently institutionalized people with dementia. METHOD Baseline and 3-month follow-up interviews were performed between November, 2010 and April, 2012. The sample consisted of 116 recently institutionalized dementia sufferers and 949 people with dementia still living at home. Physical dependency was measured using the Katz Activity of Daily Living index, and neuropsychiatric symptoms were assessed through The Neuropsychiatric Inventory. Specific categories of dependency were analyzed by performing a logistic regression analysis. This followed examination of baseline characteristics to define the degree of physical dependency, as factors associated with institutionalization, and evaluation of the same characteristics at 3-month follow-up to detect changes in the degree of physical dependency and neuropsychiatric symptoms associated with recent admission to a long-term care institution. RESULTS Toileting, dressing and continence dependency was higher in institutionalized people than in those receiving home-care. Delusion, hallucination, agitation, anxiety, apathy, motor-disturbances, night-time behavior and eating disorders were also worse in the institutionalized. Logistic regression analysis showed that independent factors significantly associated with being recently institutionalized were toileting (odds ratio=2.3; 95% confidence interval=1.43-3.71) and motor disturbances (odds ratio=1.81; 95% confidence interval=1.15-2.87). CONCLUSIONS This study supports the association between type and degree of physical dependency in people with dementia and long-term institutionalization. Institutionalization is associated with physical dependency and the presence of neuropsychiatric symptoms.

Version espanola de la Cancer Worry Scale (Escala de Preocupacion por el Cancer: adaptacion cultural y analisis de la validez y la fiabilidad)

BACKGROUND AND OBJECTIVES The worry for falling ill has been described as a key element in the change of preventive attitudes. Levels of cancer worry not well fitted have been associated with inadequate adherence to preventive strategies. There is not a Spanish validated scale to evaluate the degree of worry for the cancer in our population. The aim of the present study was to perform the cross cultural adaptation and validation of the Cancer Worry Scale described by Lerman. PATIENTS AND METHOD A translation, re-translation of the Cancer Worry Scale to Spanish was done. Validation of the Spanish scale was performed by means of the factorial analysis of principal components with the rotation varimax test in a sample of 200 healthy women with family history of breast cancer. RESULTS The Escala de Preocupación por el Cáncer (EPC) is the Spanish version of the Cancer Worry Scale and it contains 6 items with a total value ranging from 6 (minimal worry) to 24 (maximum worry). The analysis of content validity demonstrated that the EPC is conceptually equivalent to the original scale. The factorial analysis showed a unique factor that explains 53.07% of the variance confirming the unique dimension. The EPC presented good reliability test - re-test with an Intraclass Correlation Coefficient of 0.777. The Cronbachs alpha was 0.835 for the complete of the scale. CONCLUSIONS The EPC is a validated Spanish scale to measure the cancer worry in healthy individuals, which shows a correct content validity and reliability.Background and objectives: The worry for falling ill has been described as a key element in the change of preventive attitudes. Levels of cancer worry not well fitted have been associated with inadequate adherence to preventive strategies. There is not a Spanish validated scale to evaluate the degree of worry for the cancer in our population. The aim of the present study was to perform the cross cultural adaptation and validation of the Cancer Worry Scale described by Lerman. Patients and method: A translation, re-translation of the Cancer Worry Scale to Spanish was done. Validation of the Spanish scale was performed by means of the factorial analysis of principal components with the rotation varimax test in a sample of 200 healthy women with family history of breast cancer.

Clinical practice models in nursing education: implication for students' mobility.

BACKGROUND In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. AIMS The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. METHODS A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. RESULTS Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. CONCLUSIONS A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience.