Table 1.
Summary of Literature Review Findings.
| Authors (country) | Type | NHs (#) | Learner | N (Female %) | Aim | Topic | Pre and post measurement | Analysis | Staff outcomes | Patient outcomes |
|---|---|---|---|---|---|---|---|---|---|---|
| Arco and Du Toit (2006) (Australia) | Mixed Methods; Multiple baseline | 1 | NAs | Staff: 4 (100) | To examine effects of on-the job feedback after staff training and to verify prior findings that competence was maintained after on-the-job feedback was ceased | Behavior modification | Observations Mon-Fri for 26 weeks. Baseline: observations up to 90 minutes. Over course of study: decreased to <60 minutes | Sum of resident behavior and consequences. Social validation questionnaire | Increased ability to cope with resident behaviors; increased competency | Increased positive behaviors |
| Resident: 1 (100) | ||||||||||
| Ballard et al. (2018) (U.K.) | RCT | 69 | Care staff | Residents: 553 (70.71) | To evaluate the efficacy of a PCC and psychosocial intervention on QoL, agitation, and antipsychotic use in people with dementia living in NHs and to determine its cost | Resident QoL and behavior | Baseline and at 9 months | ANCOVA | Increase in positive care interactions (p = .003) | Increase in QoL (p = .0042), improvement in agitation (p = .0076), and neuropsychiatric symptoms (p < .001) in residents with moderately severe dementia. No reduction in antipsychotic usage, global deterioration, unmet needs, pain, or mood |
| Bökberg et al. (2019) (Sweden) | Pre- and post-test experimental design | 20 | Assistant nurse, RNs, OTs, PTs, frontline managers | Staff: 365 (94.79) | To assess whether an educational intervention can effect staff perception of providing PCC for palliative persons in NHs | PCC | T = 0 and 3 months after intervention (9 months from T = 0) | Within-group comparisons, Wilcoxon signed rank test, subgroup analyses within the intervention group, Pearson χ² test or Fisher’s exact test, Mann-Whitney U-test, Kruskal-Wallis test, and a univariate logistic regression analysis | No improvement on any of the subscales and measures | – |
| Burgio et al. (2001) (U.S.A) | Mixed methods experimental design | 5 | NAs | Staff: 64 (84.38) | To examine communication skills training and use of memory books in improving communication between NAs and residents | Communication | Baseline, after intervention | ANOVA; ANCOVAs | Increased knowledge (p < .05); improved communication skills (p < .05); increased amount of positive statements to resident (p < .05); increased verbal interaction with residents (p = .02); no change in amount of time spent with resident; maintenance at 2 months f/u | Increased positive interactions (p = .01); increased independence in self-care (p = .04); no change in coherent verbal interactions |
| Residents: 67 (74.63) | ||||||||||
| Burgio et al. (2002) (U.S.A) | RCT | 2 | NAs | Staff: 85 (91.56) | To evaluate a behavior management skills training program for improving NA behavioral skill performance and any resulting effects on residents’ behaviors | Behavior management | Baseline, immediately after and 3 and 6 months after intervention | Cronbach’s α, ANOVA, ANCOVA | Increased knowledge (p < .001); decreased ineffective behavioral management techniques (p < .05), not maintained at f/u; improvement in six out of seven measured communication skills (p < .05), maintained at f/u (p < .05) | Decrease in agitation (p < .05) maintained at f/u |
| Residents: 79 (61.00) | ||||||||||
| Chang et al. (2006) (Taiwan) | Quasi-experimental | 2 | NAs | Staff: 67 (97.01) | To observe the feeding behaviors of NAs after implementation of a feeding skills training program | Feeding skills | Immediately before and after training program, and 4 weeks later | Cronbach’s α, ANOVA, ANCOVA | Increased knowledge (p < .001). No change in attitude or perceived behavior control. Increased intention frequency (p < .05) although no change in intention belief | – |
| Residents: 36 (N/A) | ||||||||||
| Crogan and Evans (2001) (U.S.A) | Pre- and post-test experimental | 1 | NAs | Staff: 20 (N/A) | To measure NAs’ knowledge of nutritional care | Nutritional care | Before and after training | Performance observation | No statistical difference between pre and posttest scores. No improvement in essential principles of care. Improvement in 10 problematic areas while problems persisted in all other areas. | – |
| Dassel et al. (2020) (U.S.A) | Pre- and post-test experimental design | 20 | RNs, NAs, OTs, informal caregivers, students, admin, faculty | Staff: 94 (81.90) | To improve the care of residents with ADRD through community-based education for interprofessional team members | Dementia | Before and after training | Paired t-tests, Cronbach’s alpha | Increased knowledge (p < .01); satisfaction with relevance and applicability of training to practice | – |
| Ghandehari et al. (2013) (Canada) | Mixed methods experimental | Two large health regions | Nurses, special care aides | Staff: 131 (N/A) | To examine a pain assessment/management PE program aimed at improving staff beliefs, attitudes, and overall knowledge | Pain assessment and management | 2 weeks before PE, after three educational sessions and 2 weeks after completion of PE | χ² tests, ANOVA, Tukey’s honestly significant difference (HSD) tests, QSR NVivo, thematic analysis comprised the framework for examining the data | Increased knowledge (p < .001) and improved pain beliefs (p < .009) | – |
| Greene et al. (2018) (U.K) | Pre- and post-test experimental design | 2 | HCAs, RNs, catering or domestic staff, activity co-ordinators, PTs, OTs, and management | Staff: 161 (N/A) | To design, deliver and evaluate a hydration training session for care home staff that developed their knowledge and skills | Hydration | Before and after training | Wilcoxon signed-rank test of evaluation form. Qualitative data (field notes) | Increased knowledge re: dehydration (p = .000). | – |
| Huang and Wu (2008) (Taiwan) | Pre- and post-test experimental | 3 | NAs | Staff: 40 (100) | To test a hand-hygiene intervention for NAs in LTC on outcomes for NAs (knowledge, behavior) and residents (infection rate) | Hand hygiene | Before (pre-test), 1 month after (post-test I), and 3 months after (post-test II) training. Last self-report collected at 3 months post training. Behavior observed for 30 minutes during one 8 hours shift at pretest and post-test II | Descriptive statistics (means, SDs, frequencies, and percentages), paired t-test, McNemar test, χ²-test, and logistic regression test | Increased knowledge of hand hygiene (p < .001); NAs with more years of education were more likely to improve their knowledge. Increased rates of hand hygiene (p < .001). | Reduced infection rate (p < .001) |
| Huizing et al. (2006) (Netherlands) | Cluster RCT | 1 | Nurses | Residents:144 (71.53) | To investigate an educational intervention and its effect on the use of physical restraints in psycho-geriatric NH residents | Physical restraints | Baseline and 1 month post-intervention | Frequency tables, means, χ² test, t-test, Fisher’s exact test, McNemar tests, and gain scores, logistic regression analysis | No change in use, intensity, number or types of restraints used. No change in time of day when restraint used. | Decreased risk of restraint use. Increased depression. Decreased cognitive status |
| Janssens et al. (2016) (Belgium) | Cluster RCT | 12 | Nurses and NAs | Staff: 259 (95) | To explore the impact of an oral healthcare protocol, in addition to education, on nurses’ and NAs oral health-related knowledge and attitude | Oral health and hygiene | Baseline and 6 months after the start of the study | Bivariate analyzes, nonparametric tests, Mann–Whitney U-test, Wilcoxon matched-pairs signed-rank test, linear mixed-model analyzes, post hoc power calculation | Increased knowledge (p < .0001), no change in attitudes; nurses demonstrated more knowledge although less favorable attitude versus NAs. Overall better attitude on psychogeriatric ward versus mixed ward | – |
| Jones et al. (2004) (U.S.A) | Mixed methods experimental | 12 | 25% RN, 26%. LPN, and 49% PSW | Staff: 628 (N/A) | To develop a culturally competent intervention to improve NH pain practices, improve staff knowledge and attitudes about pain, improve pain practices in NHs and improve NH pain policies and procedures | Pain | Staff: before and after training. Residents: quarterly (before, during and after) | ANOVAs, GLMs, GEEs, χ² tests, focus groups, interviews, observations | Subtle increase in knowledge and attitudes. Decline in perceived barriers | Decreased reports of constant pain (p < .001). Improved pain reassessments (p < .05) No difference in overall pain reporting and acute moderate/severe pain. |
| Residents: 1,899 (N/A) | ||||||||||
| Kemeny et al. (2006) (U.S.A) | Multiple baseline | 1 | NAs and nurses | Staff: 77 (92) | To describe experiential techniques used by Project RELATE in training for PCC, and NAs’ and nurses’ response | PCC | After each session and 2 months after | Likert scale; percent correct; effect size, d-scores | Favorable reactions to implement training in practice (p < .05); NAs reported more favorable reactions versus nurses. Increased knowledge (more so in nurses vs. NAs) (p < .05). Retention of knowledge 2 months later (p < .05). Increased confidence | – |
| Leone et al. (2013) (France) | Mixed methods experimental | 16 | Psychologists, physicians, nurses, practical nurses, agent of hospital service | Staff: 563 (N/A) | To evaluate the effectiveness of staff education for the management of apathy in older adults with dementia | Apathy | Baseline, at the end of the training program (week 4) and 3 months later (week 17) | Quantitative evaluation: change in AI–C scores, NPI–NH, Katz ADL Scale and on the two observation scales, mean comparisons using t-test; χ² test; multiple linear regression analysis | Improved knowledge although not significant | Improvements in emotional blunting (p < .01). More self-sufficient in “dressing” and “transferring” (p < .05) on Katz ADL Scores. Increase in affective and psychotic symptoms (p < .01). No change in number of drugs prescribed |
| Residents: 230 (79.5) | ||||||||||
| Mackenzie and Peragine (2003) (Canada) | Quasi-experimental | 1 | RNs, RPNs, HCAs, privately paid caregiver | Staff: 41 (92.68) | To describe the development and outcome of a stress and burnout relieving intervention by enhancing self-efficacy in managing challenging teams, residents, and family situations. Secondary purpose is to present a self-efficacy inventory to measure the effectiveness of the intervention | Managing stress and self-efficacy | Before, immediately after, and 3 months after | t-test and χ² analyzes; ANCOVAs | Similar knowledge between groups at post-test; at 3 months f/u INT group had increased knowledge (p < .01). Increased self-efficacy (p < .01). Increased feelings of personal accomplishment (p < .05) not maintained at f/u | – |
| Magai et al. (2002) (U.S.A) | RCT | 3 | Nursing staff | Staff: 20 (100) | To assess a nonverbal sensitivity training program on the care provided to dementia patients and on staff caregiver well-being | Nonverbal communication | Baseline and 4 × 3 week intervals | Repeated measures ANOVAs, Wilks’s lambda | Improved affective state; improved BSI scores (p < .01) | Increased positive affect (p < .05), which converged with control groups at f/u |
| Residents: 91 (93) | ||||||||||
| McAiney et al. (2007) (Canada) | Pre- and post-test experimental | 439 | RNs, RPNs, SWs, and other health disciples | Staff: 1,076 (N/A) | To describe an education program for the management of mental health problems in LTC and the evaluation of its impact and sustainability | Mental health | Before start of program, and 6 weeks after | Frequencies, percentages, ranges, means, standard deviations, paired t-tests | Increased confidence (p < .001), understanding and assessment of mental health problems (p < .01). Increased confidence and use of assessment tools (p < .01) | – |
| Peterson et al. (2002) (U.S.A) | Pre- and post-test experimental | 6 | NAs, LPNs, RNs, SW, admins, music therapist, porter | Staff: 72 (93.1) | To evaluate the effect of an educational course on dementia on staff knowledge, stress, and self-esteem | Dementia | Baseline, immediately after and 6 to 8 weeks after training | Pearson correlation, General Linear Model, Cramer’s V | Increased knowledge in all groups, although only significant in those with prior training (p = .004; no significant change in stress or self-esteem scores | – |
| Peterson et al. (2004) (U.S.A) | Pre- and post-test experimental | 1 | NAs, RNs, LPNs | Staff: 35 (N/A) | To develop an ergonomics training program for selected NAs at a state-run veterans’ home to decrease musculoskeletal disorders | Ergonomics | 3 months before training, at the end of the training program and 1 month after training | Two-paired student’s t-test; ANOVA | Increased knowledge (p < .001). No change in level of stress for risk factors, pain or discomfort, or perceived general health | – |
| Resnick et al. (2009) (U.S.A) | RCT | 12 | NAs | Staff: 523 (93) | To describe the implementation process of the educational component of the restorative care intervention, the outcomes and the effect on NA knowledge | Restorative care | Baseline and immediately after intervention | (SD = 2.7, F = 280.4, p < .05) | Increased knowledge re: restorative care (p < .05) | – |
| Rosen et al. (2002) (U.S.A) | RCT | 3 | RNs, LPNs and NAs | Staff: 279 (N/A) | To design and assess a curriculum of staff training on depression and dementia | Depression/dementia | Before each training session and after final session | χ² test; Kolmogorov-Smirnov (K-S) test; Mann-Whitney (M-W) tests; Wilcoxon rank sum test, ANOVA, posthoc pair-wise comparisons | Increased knowledge in all sites but significant in computer site (p < .005) | – |
| Scerri and Scerri (2019) (Malta) | Pre- and post-test experimental | – | Nursing offices, deputy charge nurses, staff nurses, and enrolled nurses | Staff: 214 (68.2) | To investigate a dementia training program on nursing staff working in public nursing/residential homes on their knowledge, attitudes, and confidence | Dementia | Beginning of the first session and the end of the last session | Shapiro-Wilk test, independent sample t-test, ANOVA, post-hoc Tukey’s test, Pearson correlation test, Pearson Chi-square, Cohen’s d, stepwise regression analysis | Increased knowledge (p < .001). Improved staff attitude (p = .001). Increased confidence (p = .017). Training found to have a cumulative effect | – |
| Smith et al. (2013) (U.S.A) | Mixed methods experimental | 13 | RNs and LPNs | Staff: 24 (N/A) | To describe a CD-based depression training program and its use and feasibility of nurses using it with older adults in their care, and to evaluate training-related outcomes among those residents | Depression | Baseline and at 8, 12, and 16 weeks | t-tests and χ² analyzes, linear mixed modeling, non-parametric Kruskal-Wallis test | No difference between groups in method of training. Improved knowledge, care and outcomes | Improved depression scores from baseline to f/u (p < .001). Decreased pain in all groups (p = .006); f/u tests suggests that only usual care group pain improved significantly (p < .01). No improvement in QoL or anxiety scores |
| Residents:50 (76) | ||||||||||
| Soderlund et al. (2014) (Sweden) | Mixed methods experimental | 1 | RNs, LPNs, NAs | Staff: 12 (100) | To explore nurses’ experiences of attending a VM training program and to describe ratings of the work climate among the entire nursing staff | Communication style | Before and after intervention | Descriptive statistics | Difficulty changing communication style. Increased self-reflection. Increased positive interactions. Increased confidence. Improved work environment | – |
| Williams et al. (2016) (U.S.A) | Pre- and post-test experimental | 2 | CNAs, LPNs, RNs | Staff:26 (88.46) | To facilitate the implementation of oral health protocols in NHs | Oral health | 3 months before and 3 months after intervention. Retrospective chart review 1/month with the intervention for 3 months | Likert survey, Cronbach’s α test, Wilcoxon signed rank test, McNemar’s test | Increased feelings of responsibility on resident to make referral (p = .02). Increased confidence in performing oral assessments (p = .009) and identifying oral conditions that need referrals (p = .03) | Increased dental referrals (p = .0018) |
| Residents:176 (N/A) | ||||||||||
| Wils et al. (2017) (Belgium) | Mixed methods experimental | 1 | Nursing staff | Staff: 13 (84.62) | To assess the effect of an education program on the registration of care goals in a NH with dementia residents and to explore the views of staff on advance care planning | ACP | Baseline and 12 months | ANOVA, F-statistic | Increased communication regarding ACP with resident and appointed representative (p < .02). Increased care goal planning (p = .05) | Increased conversations about ACP (p = .00) |
| Residents: 124 (72.58) | ||||||||||
| Yasuda and Sakakibara (2017) (Japan) | One group repeated measures | 1 | Care staff | Staff: 40 (N/A) | To determine how educational intervention for care staff can help to improve the status of residents with dementia | Dementia | Baseline, 1 month later and after intervention | Wilcoxon signed-rank test, DCM data processing, ME value | – | Increased WIB values (p < .001). Increased social interactions in DCM (p = .041) |
| Residents: 40 (77.5) |
Note. Abbreviations used based on order of appearance: NH = nursing home; NA = nursing assistant; RCT = randomized control trial; PCC = person centered care; QoL = quality of life; RN = registered nurse; OT = occupational therapist; PT = physical therapist; ADRD = Alzheimer’s disease and related dementias; PE = pain education; HCA = healthcare aide; LTC = long term care; LPN = licensed practical nurse; PSW = personal support worker; AI-C = Apathy Inventory–Clinician version; NPI-NH = neuropsychiatric inventory-nursing home version; ADL = activities of daily living; SW = social worker; CTN = control group; INT = intervention group; ACP = advanced care planning; DCM = dementia care mapping; ME value = mood and engagement value; WIB = well-being and ill-being.