京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22382号 / 社医博第104号 / 新制||社||医11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 髙橋 良輔, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

No description available.

No description available.

Background: Dementia progression is an active subject in Sweden and the world, that makes it more than important for nurses to adjust the work and care to these patients. Nurses have a responsibility, to keep the care personal to the patient’s needs, but also keeping the care patient safe by following related laws. Patients who have dementia or a relative to a patient with dementia describes the importance of the help the nurses bring when they meet each other in different environments. Aim: The aim of this study is to describe nurses’ experiences of caring for patients with dementia. Method: A literature review based of on Friberg, with an analysis of 11 qualitative articles and 2 quantitative articles. Results: The analysis showed 4 subjects, the importance of knowledge, the importance of communication, the importance of person-centered care and lastly the importance of recourses in the care environment. Conclusion: The connections that got made was mainly about how communication needed more experience than what the nurses had. Different methods were used to make sure the care that was given to the patients are safe and person-centered, but also costume made or the patient’s own needs and diagnosis, this was something that the nurses found inadequate. The effects from the workload made obstacles for the nurses while giving care to patients, because of that the necessary recourses needed to be available for the nurses to ease the care work for both patients and their relatives. When nurses had different aspects about the dementia care environment it related to what patients and relatives experienced, both similarities and differences.

Parkinson’s disease (PD) is frequently compounded by neruropsychiatric complications, increasing disability. The combined effect of motor and mental status on care-dependency in PD outpatients is not well characterized. We conducted a cross-sectional study of 1449 PD outpatients. The assessment comprised the Montgomery–Asberg Depression Rating Scale (MADRS) and the diagnostic criteria for dementia. PD severity and treatment complications were rated using Hoehn and Yahr staging and the Unified Parkinson’s Disease Rating Scale (UPDRS) IV. The acknowledged level of care-dependency was documented. Care-dependency was present in 18.3% of all patients. A total of 13.9% had dementia, 18.8% had depression, and 14.3% had both. Regression analyses revealed increasing effects of age, PD duration, and PD severity on care-dependency in all three mental-disorder subgroups with the strongest effects in patients with depression only. Depressed patients with antidepressive treatment still had significantly higher PD severity, higher MADRS and UPDRS-IV scores but were not more likely to be care-dependent than non-depressed patients. Older age, longer duration and increased severity of PD contribute to care-dependency in patients with untreated depression. Treatment of depression is associated with lower rates of care-dependency.

Information Technology (IT) plays a vital role in improving health care systems by enhancing the quality, efficiency, safety, security, collaboration and informing decision making. Dementia, a decline in mental ability which affects memory, concentration and perception, is a key issue in health and social care, given the current context of an aging population. The quality of dementia care is noted as an international area of concern. Dementia Care Mapping (DCM) is a systematic observational framework for assessing and improving dementia care quality. DCM has been used as both a research and practice development tool internationally. However, despite the success of DCM and the annual generation of a huge amount of data on dementia care quality, it lacks a governance framework, based on modern IT solutions for data management, such a framework would provide the organisations using DCM a systematic way of storing, retrieving and comparing data over time, to monitor progress or trends in care quality. Data Governance (DG) refers to the implications of policies and accountabilities to data management in an organisation. The data management procedure includes availability, usability, quality, integrity, and security of the organisation data according to their users and requirements. This novel multidisciplinary study proposes a comprehensive solution for governing the DCM data by introducing a data management framework based on a data warehousing approach. Original contributions have been made through the design and development of a data management framework, describing the DCM international database design and DCM data warehouse architecture. These data repositories will provide the acquisition and storage solutions for DCM data. The designed DCM data warehouse facilitates various analytical applications to be applied for multidimensional analysis. Different queries are applied to demonstrate the DCM data warehouse functionality. A case study is also presented to explain the clustering technique applied to the DCM data. The performance of the DCM data governance framework is demonstrated in this case study related to data clustering results. Results are encouraging and open up discussion for further analysis.

Background: The Public Health Agency of Canada published a strategic document recognising the elements associated with person-centred dementia care, including interactions with stakeholders and research mandates. One essential element identified was advanced therapies, containing non-pharmacological interventions, such as creative arts-based interventions. Objective: This thesis investigates the impact of creative arts-based interventions on individuals with dementia, living in residential care through a scoping review (ScR) and a mixed-methods systematic review (MMSR). Methods: The ScR surveyed the current literature base to identify which creative arts-based interventions improved the personhood, quality of life and well-being of persons with dementia (PwD); five studies were included. The MMSR explored the impact of dance interventions on the symptoms of dementia on persons with Alzheimer’s disease and related dementias, as dance was unrepresented in the ScR; three studies were included. Both reviews were narratively synthesized due to the heterogeneity in the results. Results: Each included study spoke of the impact the creative arts had on the PwD and which element(s) of their health improved. Results also showed that the creative arts were beneficial for the personhood of the PwD (ScR) and for decreasing symptoms while promoting the person (MMSR). Conclusion: We must continue to look past the condition and recognize that creativity, psychosocial needs, and creative arts are all interconnected in promoting the personhood of PwD. Creative arts-based interventions can be designed to promote the individual creativity of the person and showcase their intact abilities.

Background: There is significant concern about nurse burnout in nursing homes. There has been little research to investigate whether training in person-centred care and supervision can reduce nursing home nurses’ burnout. Aims: To adapt training to be suitable for nursing home nurses and evaluate the impact of training and supervision on burnout and related outcomes. Study Design: Focus groups with nursing home nurses were used to inform adaptation of the training. Mixed methods were used to evaluate the impact of training and supervision employing a convergent parallel design, including a Randomised Controlled Trial with quantitative measures (primary outcome measure: the Maslach Burnout Inventory) to assess effectiveness and exploration of subjective experience using qualitative interviews. The findings of the RCT and qualitative interviews were then compared to determine the convergences and divergences. Findings: The training was adapted to include content on leadership and stress management. Hypotheses that the interventions would reduce burnout and impact on other quantitative outcomes were not supported. Qualitative interviews with nursing home nurses about training indicated that the nurses reported reduced burnout, enhanced self-efficacy, reduced isolation, better team working, more informed person centred dementia care and enhanced leadership. Nurses’ views on the impact of supervision included a range of benefits. There was convergence between quantitative measurement and subjective experience indicting significant levels of burnout, but divergence in terms of the impact of training in person-centred care and supervision. Conclusions: My study demonstrates that burnout is a significant issue for nursing home nurses in the UK. There was divergence in my findings in terms of the impact of training in person-centred care and supervision. The hypotheses about training and supervision having positive impact on burn-out were rejected. However, the qualitative findings suggest that nursing home nurses experienced positive benefits from the person-centred training and supervision, in particular on their sense of burnout, their approach to care and leadership skills. Recommendations are made regarding research, training and policy to address burnout in nursing home nurses. / Burdett Charitable Trust of Nursing

There is a lack of technology that facilitates knowledge sharing in the medical sector. In several countries there is a shortage of medical staff with the proper education to take care of patients suffering from dementia. However, modern mobile and web technology pave the way for new online knowledge sharing platforms which could help remedy this problem. This study investigates how an interface of a mobile e-library, aimed at sharing dementia-related knowledge, could be created. It also examines how care workers perceive it and if they could be willing to adopt the technology in the future. This thesis project was carried out at Svenskt Demenscentrum, a non-profit organization with the purpose of disseminating and collecting knowledge concerning dementia. The prototype was designed using the double diamond process. This included an initial literature study and state-of-the-art analysis, which was followed by two workshops with professional care workers. The final design was created iteratively with feedback from a focus group. A total of four sessions with the focus group were organized. The final prototype was evaluated using the Technology Acceptance Model (TAM) model. 12 participants took part in the user tests, all had previously taken care of patients suffering from dementia. The findings of the user tests suggest that the users perceived the interface as both useful and easy to use. This finding also indicates that the users, according to the TAM model, would be willing to adopt the technology if fully developed. All of the participants found the application fitting for smartphone devices. Some suggestions regarding further implementations of the interface included the addition of an onboarding process for those less familiar with modern design conventions and the inclusion of a social forum or discussion page that would allow for a direct knowledge exchange between the users. / Det finns en brist på teknologier som förenklar kunskapsdelning inom den medicinska sektorn. I flera länder har det dokumenterats en tilltagande brist vårdpersonal med tillräcklig utbildning för att ta hand om patienter som lider av demens. Kunskapsdelning kan underlättas med mobila onlineplattformar, utvecklade for att användare ska kunna dela expertis med varandra. Den här studien undersöker hur gränssnittet till ett mobilt e-bibliotek, med mal att dela demensrelaterade kunskaper, skulle kunna utvecklas. Den undersöker även om vårdpersonal och släktingar till demenssjuka kan förväntas anamma teknologin i framtiden. Detta masterarbete utfördes i samarbete med Svenskt Demenscentrum, en stiftelse som arbetar för att samla, strukturera och sprida kunskap om demens.  En prototyp for gränssnittet designades efter 'double Diamond'-modellen. Detta inkluderade genomförandet av en litteraturstudie, en 'state-of-the-art'-analys samt två workshops med professionell vårdpersonal. Den slutgiltiga designen togs fram iterativt med feedback från en fokusgrupp. Totalt organiserades fyra sessioner med fokusgruppen.  Den slutgiltiga prototypen utvärderades sedan efter 'Technology Acceptance'-modellen (TAM). Tolv deltagare rekryterades till användartesterna, alla med tidigare erfarenhet av demensvård, som vårdarbete eller släktingar. Resultatet från testerna antydde att användarna uppfattade prototypgranssnittet som både användbart och lättanvänt. I enlighet men TAM-modellen, implicerar detta att målgruppen är mottaglig för att använda en full implementation av teknologin. Alla deltagare uppfattade även prototypen som lämplig för 'smartphone'-enheter. Testdeltagarna lyfte även fram ett antal rekommendationer gällande vidareutvecklingen av gränssnittet. Bland annat föreslogs det att en 'onboarding'-process skulle kunna implementeras samt en diskussionssida; eller dylikt som skulle tillåta användarna att delta i ett direkt kunskapsutbyte med varandra.

No / Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.