Implementation of dementia communication skills training in acute hospitals : a longitudinal, mixed-methods case study evaluation [In Press]

Abstract

Purpose People with dementia occupy c.25% of acute hospital beds. Being in hospital can lead to distress in people with dementia, exacerbated by the difficult acute hospital environment and lack of staff preparedness to meet their often-complex needs. Acute hospital staff identify supporting distressed patients with dementia as a practice challenge. Communication skills training can improve interaction quality and staff confidence, however little communication research to date has been conducted in acute hospitals. This study aimed to implement a communication skills training programme for preventing and responding to distress in patients with dementia in acute hospitals, and to assess its impact. Methods A longitudinal, mixed-methods, multiple case study design was employed in six wards across three English acute hospitals. The Kirkpatrick training evaluation framework (reaction to training, impact on knowledge and confidence, behaviours and outcomes for patients and staff) underpinned the study, with qualitative observational and interview, and quantitative survey and outcomes data collected immediately pre, post and 1-3 months post training. The [redacted] communication skills training programme included three communication trainables identified in an earlier conversation analysis study phase. It was delivered over two half-days, by local clinical educators, upskilled via a train-the-trainer programme. Findings A total of 145 staff attended at least one half-day of training. Delivery was feasible, however practical challenges with training organisation and freeing up staff to attend occurred. Staff who found it engaging and relevant to their role, valued its interactive content and the opportunity for reflection and implementation of skills between sessions. A statistically significant increase was found pre- to immediate post-training on staff communication knowledge (CI 0.01-1.2) and confidence in caring for people with dementia (CI 4.9-7.3). Staff reported a range of areas of learning aligned to the trainables. Over 90% of staff said they planned to implement the training in practice and many provided concrete examples of application. Challenges in applying the specific communication principals taught to wider practice situations were identified by some staff. Impact on observed patient agitation levels and staff communication practices were challenging to evidence objectively in the context of the acute hospital environment. Conclusion/original contribution It is feasible, although challenging, to deliver empirically based communication skills training to support acute hospital staff to better care for patients with dementia who may become distressed. It can lead to perceived increases in knowledge and confidence to support distress in this population. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.