A Delphi Study for Developing a Person-centered Dementia Care Online Education Program in Long-term Care Facilities

Da Eun Kim; Hae Sagong; Ju Young Yoon

doi:10.12799/jkachn.2019.30.3.295

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Kim, Sagong, and Yoon: A Delphi Study for Developing a Person-centered Dementia Care Online Education Program in Long-term Care Facilities

Original Article

J Korean Acad Community Health Nurs 2019;30(3):295-306.

Published online: 12 September 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.3.295

A Delphi Study for Developing a Person-centered Dementia Care Online Education Program in Long-term Care Facilities

Da Eun Kim¹, Hae Sagong², Ju Young Yoon³

¹Visiting Scholar, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA

²Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea

³Associate Professor, College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Yoon, Ju Young College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8817, Fax: +82-2-766-1852, E-mail: yoon26@snu.ac.kr

Received 26 February 2019 Revised 11 June 2019 Accepted 1 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

There has been a growing recognition that person-centered care enhances the quality of life of nursing home residents with dementia. This study was conducted to develop a person-centered dementia care online education program for direct care staff in long-term care facilities.

Methods

Delphi method with expert group was used to validate contents. We developed 61 draft items based on literature review. Twenty experts participated in consecutive three round surveys including 5-point Likert scale questions and open-ended questions. Based on experts’ opinions, the content validity ratio for content validity and the coefficient of variation for stability were calculated.

Results

Three-round Delphi surveys and additional feedback from the expert panel established a consensus of core contents: 1) dementia (7 categories), 2) person-centered care (6 categories), 3) communication (8 categories), and 4) behavioral and psychological symptoms of dementia (6 categories). Specific sub-categories in each category were differentiated according to the job qualifications (65 sub-categories for registered nurses, 64 sub-categories for nursing aids, and 41 sub-categories for personal care workers).

Conclusion

This delphi study identified person-centered dementia education curricula, in which the person-centered approach should be a key policy priority in Korean long-term care system. Now it is urgently needed to develop education programs utilizing online platforms that enable efficient and continuous learning for long-term care staff, which can contribute to behavior changes in the person-centered dementia care approach and improvement of care quality in long-term care facilities.

Keywords: Dementia, Education, Caregivers, Long-term care, Delphi technique

References

1. Brooker D. What is person-centred care in dementia? Reviews in Clinical Gerontology. 2003; 13(3):215–222. https://doi.org/10.1017/S095925980400108X.

2. Flesner MK. Person-centered care and organizational culture in long-term care. Journal of Nursing Care Quality. 2009; 24(4):273–276. https://doi.org/10.1097/NCQ.0b013e3181b3e669.

3. Fazio S, Pace D, Flinner J, Kallmyer B. The fundamentals of person-centered care for individuals with dementia. The Gerontologist. 2018; 58(suppl_1):S10–S19. https://doi.org/10.1093/geront/gnx122.

4. Moyle W, Venturto L, Griffiths S, Grimbeek P, McAllister M, Oxlade D, et al. Factors influencing quality of life for people with dementia: A qualitative perspective. Aging & Mental Health. 2011; 15(8):970–977. https://doi.org/10.1080/13607863.2011.583620.

5. Yoon JY, Roberts T, Bowers BJ, Lee JY. A review of person-centered care in nursing homes. Journal of Korean Gerontological Society. 2012; 32(3):729–745.

6. Barbosa A, Sousa L, Nolan M, Figueiredo D. Effects of person-centered care approaches to dementia care on staff: A systematic review. American Journal of Alzheimer's Disease & Other Dementias®. 2015; 30(8):713–722. https://doi.org/10.1177/1533317513520213.

7. Hunter PV, Hadjistavropoulos T, Thorpe L, Lix LM, Malloy DC. The influence of individual and organizational factors on person-centred dementia care. Aging & Mental Health. 2016; 20(7):700–708. https://doi.org/10.1080/13607863.2015.1056771.

8. Health Care Interactive®. CARES® online dementia care training, certification, and credentialing [Internet]. Health Care Interactive ®;Minnesota: 2018. [cited 2018 Apr 1]. Available from:. https://www.hcinteractive.com/CARES.

9. Dobbs D, Hobday J, Roker R, Kaas MJ, Molinari V. Certified nursing assistants' perspectives of the CARES® activities of daily living dementia care program. Applied Nursing Research. 2018; 39:244–248. https://doi.org/10.1016/j.apnr.2017.11.016.

10. Social Care Institute for Excellence. Dementia [Internet]. Social Care Institute for Excellence;London: 2018. [cited 2018 Mar 20]. Available from:. https://www.scie.org.uk/dementia.

11. National Health Insurance. Dementia professional education 19-1 education notice [Internet]. Wonju: National Health Insurance;2019. [cited 2019 Februrary 01]. Available from:. https://www.longtermcare.or.kr/npbs/d/m/000/moveBoardView?menuId=npe0000002581&bKey=B0150&zoomSize=.

12. National Institute of Dementia. Specialized training for dementia [Internet]. Seoul: National Institute of Dementia;2018. [cited 2018 Jan 2]. Available from:. https://www.nid.or.kr/study/introduce2.aspx.

13. Korean Nurses Association. 2018 Specialized training for dementia [Internet]. Seoul: Korean Nurses Association;2018. [cited 2018 June 10]. Available from:. http://www.koreanurse.or.kr/board/board_read.php?board_id=edu_plan&member_id=admin&exec=&no=164&category_no=&step=0&tag=&sgroup=157&sfloat=&position=3&mode=&find=&search=.

14. Lee JS. Delphi method. Seoul: Kyoyook Book;2001. p. 138.

15. Rowe G, Wright G, Bolger F. Delphi: A reevaluation of research and theory. Technological Forecasting and Social Change. 1991; 39(3):235–251. https://doi.org/10.1016/0040-1625(91)90039-I.

16. Ludwig B. Predicting the future: Have you considered using the Delphi methodology. Journal of Extension. 1997; 35(5):1–4.

17. Pizzacalla A, Montemuro M, Coker E, Martin LS, Gillies L, Robinson K, et al. Gentle persuasive approaches: Introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium. Orthopaedic Nursing. 2015; 34(2):101–107. https://doi.org/10.1097/NOR.0000000000000127.

18. Alzheimer's Association. Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes [Internet]. Chicago, IL: Alzheimer's Association;2009. [cited 2018 April 10]. Available from:. https://www.alz.org/national/documents/brochure_DCPRphases1n2.pdf.

19. Alzheimer Society of Canada. Guidelines for care: Person-centred care of people with dementia living in care homes [Internet]. Toronto, Ontario: Alzheimer Society of Canada;2011. [cited 2018 April 10]. Available from:. https://alzheimer.ca/sites/default/files/files/national/culture-change/culture_exec_summary_e.pdf.

20. The Japanese Society for Dementia Care. Dementia Care Textbook Generalities. 1st ed.Hwang JY, translator. Tokyo: The Japanese Society for Dementia Care;2010.

21. McCormack B, McCance TV. Development of a framework for person-centred nursing. Journal of Advanced Nursing. 2006; 56(5):472–479. https://doi.org/10.1111/j.1365-2648.2006.04042.x.

22. Blackhall A, Hawkes D, Hingley D, Wood S. VERA framework: Communicating with people who have dementia. Nursing Standard. 2011; 26(10):35–39. https://doi.org/10.7748/ns2011.11.26.10.35.c8818.

23. Hsu CC, Sandford BA. The Delphi technique: Making sense of consensus. Practical Assessment, Research & Evaluation. 2007; 12(10):1–8.

24. Lawshe CH. A quantitative approach to content validity. Personnel Psychology. 1975; 28(4):563–575. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x.

25. Tible OP, Riese F, Savaskan E, von Gunten A. Best practice in the management of behavioural and psychological symptoms of dementia. Therapeutic Advances in Neurological Disorders. 2017; 10(8):297–309. https://doi.org/10.1177/1756285617712979.

26. Suh HK, Choi HJ. An analysis of caregivers' recognition of communication problems in patients with dementia. Journal of Speech-Language & Hearing Disorders. 2010; 19(3):1–18.

27. Machiels M, Metzelthin SF, Hamers JPH, Zwakhalen SMG. Interventions to improve communication between people with dementia and nursing staff during daily nursing care: A systematic review. International Journal of Nursing Studies. 2017; 66:37–46. https://doi.org/10.1016/j.ijnurstu.2016.11.017.

28. Song JA, Kim YK, Kim H. Educational needs on behavioral and psychological symptoms of dementia among certified nursing caregivers in nursing homes. Journal of Korean Gerontological Nursing. 2012; 14(3):220–232.

29. Sunwoo D. Development directions for long term care program in Korea. Health and Welfare Policy Forum. 2013; 195:64–75.

30. Song JA, Kim H, Kim YK, Park JW. Effects of a web-based education program designed for nursing home caregivers to enhance the management of behavioral psychological symptoms of dementia (BPSD). Journal of Korean Gerontological Nursing. 2013; 15(3):192–204.

Table 1.

General Characteristics of the Expert Panel (N=20)

Variables	Categories	n (%) or M±SD
Age (year)		49.05±7.57
Gender	Male	8 (40.0)
	Female	12 (60.0)
Education	Bachelor degree	1 (5.0)
	Master degree	2 (10.0)
	Doctoral degree	17 (85.0)
Specialty area	Nursing	9 (45.0)
	Social welfare	5 (25.0)
	Medicine	2 (10.0)
	Occupational therapy	2 (10.0)
	Others	2 (10.0)
Work experiences in long-term care settings(year)		14.17±5.46

Table 2.

Results of the 1st Round Delphi (N=20)

Contents	Categories	Sub-categories	Nursing staff (RN or NA)			Personal care worker
Contents	Categories	Sub-categories	M±SD	CVR	CV	M±SD	CVR	CV
I. Dementia	1. Type	1) Alzheimer's disease	4.90±0.31	1.00	0.06	4.35±0.59	0.90	0.13
		2) Vascular dementia	4.90±0.31	1.00	0.06	4.35±0.59	0.90	0.13
		3) Others	4.55±0.69	0.80	0.15	3.55±0.89	-0.20	0.25
	2. Cause and risk factor	1) Causes of dementia	4.74±0.73	0.80	0.15	4.00±0.92	0.40	0.23
		2) Risk factors of dementia	4.68±0.75	0.80	0.16	4.00±0.92	0.40	0.23
	3. Screening and	1) Early signs of dementia	4.90±0.31	1.00	0.06	4.30±0.87	0.70	0.20
	diagnosis	2) Mild cognitive impairment	4.85±0.49	0.90	0.10	3.80±1.06	0.30	0.28
		3) Dementia screening test	4.85±0.37	1.00	0.08	3.00±1.21	-0.20	0.40
		4) Diagnosis of dementia	4.65±0.67	0.80	0.14	2.50±0.89	-0.70	0.36
	4. Stage	1) CDR (clinical dementia rating)	4.58±0.61	0.80	0.13	2.74±0.93	-0.70	0.34
		2) GDS (global deterioration scale)	4.60±0.60	0.90	0.13	2.80±0.95	-0.60	0.34
	5. Symptom	1) Cognitive symptoms	4.95±0.22	1.00	0.05	4.70±0.47	1.00	0.10
		2) BPSD	4.95±0.23	0.90	0.05	4.75±0.44	1.00	0.09
	6. Treatment	1) Pharmacologic treatment	4.70±0.57	0.90	0.12	2.79±1.03	-0.50	0.37
		2) Person-centered non-pharmacological approach	4.75±0.64	0.80	0.13	4.00±1.12	0.50	0.28
II. Person-centered care	1. Understanding of person-centered care	1) Definition	4.90±0.31	1.00	0.06	4.70±0.05	1.00	0.10
		2) Major components	4.90±0.31	1.00	0.06	4.55±0.61	0.90	0.13
	2. Background of person-centered care in Korea	1) Need for quality improvement	4.70±0.57	0.90	0.12	4.25±0.97	0.50	0.23
		2) Human rights issues in LTCF	4.80±0.52	0.90	0.11	4.70±0.57	0.90	0.12
	3. International trend	USA, Europe, Japan, etc.	4.60±0.60	0.90	0.13	3.55±0.83	0.10	0.23
	4. Application	1) Person-centered environment	4.90±0.31	1.00	0.06	4.40±0.60	0.90	0.14
		2) Person-centered care practice	4.85±0.49	0.90	0.10	4.60±0.50	1.00	0.11
		3) Organization management	4.65±0.59	0.90	0.13	3.10±0.79	-0.70	0.25
	5. Outcomes	Resident, staff and organization outcomes	4.45±0.69	0.80	0.15	3.75±0.85	0.20	0.23
	6. Current status in Korea	Status of research and practical application	3.70±1.26	0.30	0.34	2.50±1.19	-0.50	0.48
III. Communication	1. Understanding of communication	1) Definition of communication	4.60±0.68	0.80	0.15	4.40±0.75	0.70	0.17
		2) Importance of effective communication	4.75±0.44	1.00	0.09	4.55±0.61	0.90	0.13
	2. Person-centered communication	1) Definition of person-centered communication	4.75±0.55	0.90	0.12	4.50±0.76	0.70	0.17
		2) Person-centered approach	4.80±0.52	0.90	0.11	4.70±0.57	0.90	0.12
	3. Prerequisites for person-centered communication	1) Environment	4.70±0.47	1.00	0.10	4.40±0.68	0.80	0.15
		2) Attitude	4.80±0.41	1.00	0.09	4.60±0.68	0.80	0.15
		3) Skill	4.80±0.41	1.00	0.09	4.60±0.60	0.90	0.13
	4. Consideration	1) Do's	4.95±0.22	1.00	0.05	4.80±0.41	1.00	0.09
		2) Don'ts	4.95±0.22	1.00	0.05	4.85±0.37	1.00	0.08
	5. Person-centered communication by dementia stage	1) Early stage	4.75±0.55	0.90	0.12	4.65±0.59	0.90	0.13
		2) Mid stage	4.75±0.55	0.90	0.12	4.65±0.61	0.90	0.13
		3) Late stage	4.80±0.52	0.90	0.11	4.55±0.61	0.90	0.13
		4) End of life stage	4.80±0.52	0.90	0.11	4.50±0.69	0.80	0.15
	6. Application	1) Validation therapy	4.70±0.47	1.00	0.10	4.25±0.85	0.50	0.20
		2) VERA communication	4.70±0.47	1.00	0.10	4.30±0.80	0.60	0.19
	7. Alternative communication method	1) Definition	4.50±0.69	0.80	0.15	4.00±0.80	0.20	0.22
		2) Types	4.50±0.69	0.80	0.15	4.00±0.80	0.40	0.20
IV. BPSD	1. Understanding of BPSD	1) Definition	4.75±0.44	1.00	0.09	4.00±0.86	0.30	0.21
		2) Mechanism and related factors	4.70±0.47	1.00	0.10	3.65±0.81	-0.10	0.22
		3) BPSD by dementia stage	4.70±0.66	0.80	0.14	4.40±0.75	0.70	0.17
	2. Person-centered approach for BPSD	1) Individualized care	4.80±0.41	1.00	0.09	4.50±0.61	0.90	0.13
		2) Social and physical environment	4.65±0.59	0.90	0.13	4.25±0.91	0.40	0.21
		3) Non-pharmacological approach and prevention	4.75±0.55	0.90	0.12	4.10±0.91	0.30	0.22
		4) A culture of caring that prioritizes quality of life	4.70±0.57	0.90	0.12	4.25±0.85	0.50	0.20
		5) Staff training	4.63±0.60	0.80	0.13	4.40±0.75	0.70	0.17
	3. Person-centered care process for BPSD	1) Assessing characteristics of symptoms	4.85±0.34	1.00	0.08	4.25±0.91	0.60	0.21
		2) Identifying the antecedents of behaviors	4.85±0.34	1.00	0.08	4.00±0.97	0.30	0.24
		3) Developing appropriate coping strategies	4.90±0.31	1.00	0.06	4.60±0.60	0.90	0.13
		4) Evaluating and modifying care plans	4.80±0.41	1.00	0.09	3.25±1.12	-0.30	0.34
	4. Person-centered approach by type of symptom	1) Aggression	4.90±0.31	1.00	0.06	4.70±0.57	0.90	0.12
		2) Agitation	4.90±0.31	1.00	0.06	4.70±0.57	0.90	0.12
		3) Psychosis	4.90±0.31	1.00	0.06	4.65±0.59	0.90	0.13
		4) Wandering	4.90±0.31	1.00	0.06	4.70±0.57	0.90	0.12
		5) Apathy	4.90±0.31	1.00	0.06	4.65±0.59	0.90	0.13
		6) Depression	4.90±0.31	1.00	0.06	4.65±0.59	0.90	0.13
	5. PI	Antidepressants, antipsychotics, etc.	4.65±0.59	0.90	0.13	2.80±0.95	-0.70	0.34

CVR=content validity ratio; CV=coefficient of variation; RN=registered nurse; NA=nurse aid; BPSD=behavioral and psychological symptoms of dementia; LTCF=long-term care facility; PI=Pharmacological intervention.

Table 3.

Results of the 2nd/3rd Round Delphi (N=19)

Contents Category	Sub-category	2nd Round									3rd Round
		RN			NA			PCW			RN			NA			PCW
		M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV
I. Dementia
1. Type	1) Alzheimer's disease	4.95±0.23	1.00	0.05	4.63±0.50	1.00	0.11	4.37±0.60	0.89	0.14	4.95±0.23	1.00	0.05	4.67±0.49	0.89	0.10	4.37±0.50	1.00	0.11
	2) Vascular dementia	4.95±0.23	1.00	0.05	4.58±0.51	1.00	0.11	4.26±0.56	0.89	0.13	4.95±0.23	1.00	0.05	4.67±0.49	0.89	0.10	4.26±0.45	1.00	0.11
	3) Others	4.74±0.45	1.00	0.10	3.89±0.94	0.26	0.24	-	-	-	4.89±0.32	1.00	0.06	4.06±0.64	0.58	0.16	-	-	-
2. Cause and risk factor	1) Causes of dementia	4.89±0.32	1.00	0.06	4.58±0.61	0.89	0.13	-	-	-	4.95±0.23	1.00	0.05	4.83±0.38	0.89	0.08	-	-	-
	2) Risk factors of dementia	4.89±0.32	1.00	0.06	4.58±0.61	0.89	0.13	-	-	-	4.95±0.23	1.00	0.05	4.74±0.45	1.00	0.10	-	-	-
3. Screening and diagnosis	1) Early signs of dementia	4.89±0.32	1.00	0.06	4.42±1.02	0.79	0.23	4.47±0.61	0.89	0.14	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.53 (0.51)	1.00	0.11
	2) Mild cognitive impairment	4.89±0.46	0.89	0.09	4.21±0.03	0.68	0.25	-	-	-	4.95±0.23	1.00	0.05	4.63±0.50	1.00	0.11	-	-	-
	3) Dementia screening test	5.00±0.00	1.00	0.00	4.32±0.89	0.68	0.21	-	-	-	5.00±0.00	1.00	0.00	4.68±0.48	1.00	0.10	-	-	-
	4) Dementia diagnosis test	4.84±0.37	1.00	0.08	3.58±1.07	0.05	0.30	-	-	-	5.00±0.00	1.00	0.00	3.84±0.9	0.58	0.23	-	-	-
4. Stage	1) CDR (Clinical Dementia Rating)	4.89±0.32	1.00	0.06	3.68±0.89	0.26	0.24	-	-	-	5.00±0.00	1.00	0.00	3.68±0.89	0.37	0.24	-	-	-
	2) GDS (Global Deterioration Scale)	4.89±0.32	1.00	0.06	3.68±0.89	0.26	0.24	-	-	-	5.00±0.00	1.00	0.00	3.79±0.85	0.58	0.23	-	-	-
5. Symptom	1) Cognitive disorder symptoms	4.95±0.23	1.00	0.05	4.74±0.45	1.00	0.10	4.63±0.50	1.00	0.11	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.68±0.48	1.00	0.10
	2) BPSD	4.95±0.23	1.00	0.05	4.74±0.45	1.00	0.10	4.47±0.77	0.89	0.17	4.95±0.23	1.00	0.05	4.89±0.32	1.00	0.06	4.79±0.42	1.00	0.09
6. Treatment	1) Pharmacologic treatment	4.89±0.32	1.00	0.06	4.16±0.50	0.89	0.12	-	-	-	5.00±0.00	1.00	0.00	4.16±0.37	1.00	0.09	-	-	-
	2) Person-centered	5.00±0.00	1.00	0.00	4.63±0.50	1.00	0.11	4.11±0.57	0.79	0.14	5.00±0.00	1.00	0.00	4.79±0.42	1.00	0.09	4.22±0.55	0.79	0.13
	non-pharmacologic approach
7. Comprehension	1) Dementia policy and system^†	4.74±0.56	1.00	0.12	3.84±0.83	0.37	0.22	3.47±0.96	-0.05	0.28	4.94±0.24	1.00	0.05	3.89±0.51	1.00	0.15	-	-	-
	2) Dementia family^†	4.95±0.23	1.00	0.05	4.63±0.50	1.00	0.11	4.37±0.83	0.79	0.19	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.06	4.88±0.33	0.79	0.07
II. Person-centered care
1. Understanding of	1) Definition	5.00±0.00	1.00	0.00	4.63±0.50	1.00	0.11	4.58±0.51	1.00	0.11	5.00±0.00	1.00	0.00	4.78±0.43	0.89	0.09	4.74±0.45	1.00	0.10
person-centered care	2) Major components	5.00±0.00	1.00	0.00	4.68±0.48	1.00	0.10	4.58±0.51	1.00	0.11	5.00±0.00	1.00	0.00	4.84±0.37	1.00	0.08	4.74±0.45	1.00	0.10
2. Background of person-centered care in Korea	1) Need for quality improvement	4.84±0.37	1.00	0.08	4.37±0.60	0.89	0.14	4.26±0.81	0.58	0.19	5.00±0.00	1.00	0.00	4.37±0.50	1.00	0.11	4.16±0.50	0.89	0.12
	2) Human rights issues in LTCF	4.95±0.23	1.00	0.05	4.68±0.48	1.00	0.10	4.58±0.51	1.00	0.11	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08
3. International trend	USA, Europe, Japan, etc.	4.58±0.61	0.89	0.13	4.11±0.66	0.68	0.16	-	-	-	4.79±0.42	1.00	0.09	4.16±0.37	1.00	0.09	-	-	-
4. Application	1) Person-centered environment	4.95±0.23	1.00	0.05	4.50±0.51	1.00	0.11	4.37±0.50	1.00	0.11	4.95±0.23	1.00	0.05	4.68±0.48	1.00	0.10	4.32±0.48	1.00	0.11
	2) Person-centered care practice	4.95±0.23	1.00	0.05	4.74±0.45	1.00	0.10	4.58±0.51	1.00	0.11	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.74±0.45	1.00	0.10
	3) Organization management	4.89±0.32	1.00	0.06	3.53±0.70	0.26	0.20	-	-	-	5.00±0.00	1.00	0.00	3.79±0.42	0.58	0.11	-	-	-
5. Outcomes	Resident, staff and organization outcomes	4.89±0.32	1.00	0.06	3.79±0.92	0.47	0.24	-	-	-	4.95±0.23	1.00	0.05	3.95±0.40	0.79	0.10	-	-	-
6. Current status in Korea	Status of research and practical application	4.32±0.58	0.89	0.13	3.32±1.00	0.05	0.30	-	-	-	4.37±0.60	0.89	0.14	3.79±0.54	0.68	0.14	-	-	-

^† Items added from 2nd delphi; RN=registered nurse; NA=nurse aid; PCW=personal care worker; CVR=content validity ratio; CV=coefficient of variation; BPSD=behavioral and psychological symptoms of dementia; LTCF=long-term care facility.

Table 3.

Results of the 2nd/3rd Round Delphi (Continued) (N=19)

Contents Category	Sub-category	2nd Round									3rd Round
		RN			NA			PCW			RN			NA			PCW
		M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV	M±SD	CVR	CV
III. Communication
1. Understanding of communication	1) Definition of communication	4.79±0.54	0.89	0.11	4.63±0.50	1.00	0.11	4.47±0.70	0.79	0.16	4.89±0.46	0.89	0.09	4.74±0.45	1.00	0.10	4.63±0.50	1.00	0.11
	2) Importance of effective communication	4.84±0.50	0.89	0.10	4.68±0.48	1.00	0.10	4.68±0.58	0.89	0.12	5.00±0.00	1.00	0.00	4.89±0.32	1.00	0.06	4.79±0.42	1.00	0.09
2. Person-centered communication	1) Definition of person-centered communication	4.89±0.32	1.00	0.06	4.79±0.42	1.00	0.09	4.58±0.61	0.89	0.13	5.00±0.00	1.00	0.00	4.89±0.32	1.00	0.06	4.63±0.50	1.00	0.11
	2) Person-centered approach	4.95±0.23	1.00	0.05	4.89±0.32	1.00	0.06	4.79±0.42	1.00	0.09	5.00±0.00	1.00	0.00	4.89±0.32	1.00	0.06	4.84±0.37	1.00	0.08
3. Prerequisites for person-centered communication	1) Environment	4.89±0.32	1.00	0.06	4.53±0.51	1.00	0.11	4.11±0.88	0.37	0.21	5.00±0.00	1.00	0.00	4.58±0.51	1.00	0.11	-	-	-
	2) Attitude	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.68±0.48	1.00	0.10	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08
	3) Skill	5.00±0.00	1.00	0.00	4.79±0.42	1.00	0.09	4.68±0.48	1.00	0.10	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08
4. Consideration	1) Do's	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	5.00±0.00	1.00	0.00	5.00±0.00	1.00	0.00
	2) Don'ts	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	5.00±0.00	1.00	0.00	5.00±0.00	1.00	0.00
5. Person-centered communication by dementia stage	1) Early stage	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.74±0.45	1.00	0.10	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09
	2) Mid stage	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.79±0.42	1.00	0.09	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.89±0.32	1.00	0.06
	3) Late stage	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.74±0.45	1.00	0.10	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08
	4) End of life stage	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.74±0.45	1.00	0.10	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09
6. Application	1) Validation therapy	4.84±0.37	1.00	0.08	4.58±0.51	1.00	0.11	4.21±0.56	0.47	0.20	5.00±0.00	1.00	0.00	4.74±0.45	1.00	0.10	4.32±0.58	0.89	0.13
	2) VERA communication	4.79±0.42	1.00	0.09	4.58±0.51	1.00	0.11	4.32±0.67	0.79	0.16	5.00±0.00	1.00	0.00	4.63±0.50	1.00	0.11	4.26±0.56	0.89	0.13
7. ACM	1) Definition	4.79±0.42	1.00	0.09	4.37±0.68	0.79	0.16	-	-	-	5.00±0.00	1.00	0.00	4.42±0.51	1.00	0.11	-	-	-
	2) Types	4.79±0.42	1.00	0.09	4.37±0.68	0.79	0.16	-	-	-	5.00±0.00	1.00	0.00	4.37±0.50	1.00	0.11	-	-	-
8. TPC^†	Training PCWs	4.79±0.71	0.89	0.15	3.68±0.82	0.16	0.22	N/A	N/A	N/A	4.89±0.32	1.00	0.06	3.74±0.45	0.47	0.12	N/A	N/A	N/A
IV. BPSD
1. Understanding of BPSD	1) Definition	4.84±0.37	1.00	0.08	4.58±0.51	1.00	0.11	-	-	-	5.00±0.00	1.00	0.00	4.68±0.48	1.00	0.10	-	-	-
	2) Mechanism and related factors (need-driven dementia-compromised behavior model)	4.79±0.42	1.00	0.09	4.21±0.71	0.68	0.17	-	-	-	5.00±0.00	1.00	0.00	4.42±0.51	1.00	0.11	-	-	-
	3) BPSD by dementia stage	4.95±0.23	1.00	0.05	4.89±0.32	1.00	0.06	4.63±0.50	0 1.00	0.11	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.63±0.50	1.00	0.11
2. Person-centered approach for	1) Individualized care	5.00±0.00	1.00	0.00	4.84±0.50	0.89	0.10	4.63±0.60	0.89	0.13	5.00±0.00	1.00	0.00	5.00±0.00	1.00	0.00	4.79±0.42	1.00	0.09
	2) Social and physical environment	4.89±0.32	1.00	0.06	4.63±0.50	1.00	0.11	4.11±0.81	0.47	0.20	5.00±0.00	1.00	0.00	4.68±0.48	1.00	0.10	4.11±0.74	0.58	0.18
BPSD	3) Non-pharmacological approach and prevention	4.89±0.32	1.00	0.06	4.74±0.45	1.00	0.10	4.11±0.81	0.47	0.20	5.00±0.00	1.00	0.00	4.84±0.37	1.00	0.08	4.11±0.74	0.58	0.18
	4) A culture of caring that prioritizes quality of life	4.68±0.48	1.00	0.10	4.58±0.69	0.79	0.15	4.37±0.76	0.68	0.17	4.84±0.37	1.00	0.08	4.79±0.42	1.00	0.09	4.63±0.50	1.00	0.11
	5) Staff training	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.53±0.51	1.00	0.11	5.00±0.00	1.00	0.00	5.00±0.00	1.00	0.00	4.74±0.45	1.00	0.10
3. Person-centered care process for BPSD	1) Assessing characteristics of symptoms	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.47±0.61	0.89	0.14	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.58±0.61	0.89	0.13
	2) Identifying the antecedents of behaviors	4.95±0.23	1.00	0.05	4.58±0.51	1.00	0.11	-	-	-	5.00±0.00	1.00	0.00	4.84±0.37	1.00	0.08	-	-	-
	3) Developing appropriate coping strategies	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.58±0.61	0.89	0.13	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.53±0.61	0.89	0.14
	4) Evaluating and modifying care plans	4.89±0.32	1.00	0.06	4.21±0.79	0.58	0.19	-	-	-	5.00±0.00	1.00	0.00	4.26±0.45	1.00	0.11	-	-	-
4. Person-centered approach by type of symptom	1) Aggression	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.74±0.56	0.89	0.12	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.89±0.46	0.89	0.09
	2) Agitation	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.68±0.58	0.89	0.12	4.95±0.23	1.00	0.05	4.95±0.23	1.00	0.05	4.84±0.50	0.89	0.10
	3) Psychosis	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.68±0.58	0.89	0.12	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.74±0.56	0.89	0.12
	4) Wandering	4.95±0.23	1.00	0.05	4.84±0.37	1.00	0.08	4.74±0.56	0.89	0.12	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.89±0.46	0.89	0.09
	5) Apathy	4.95±0.23	1.00	0.05	4.79±0.42	1.00	0.09	4.58±0.61	0.89	0.13	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.79±0.54	0.89	0.11
	6) Depression	4.74±0.93	0.89	0.20	4.84±0.37	1.00	0.08	4.58±0.61	0.89	0.13	5.00±0.00	1.00	0.00	4.95±0.23	1.00	0.05	4.89±0.46	0.89	0.09
5. PI	Antidepressants, antipsychotics, etc.	4.89±0.32	1.00	0.06	4.16±0.76	0.58	0.18	-	-	-	5.00±0.00	1.00	0.00	4.16±0.50	0.89	0.12	-	-	-
6. TPA^†	Training PCWs	4.89±0.32	1.00	0.07	3.53±1.02	0.05	0.29	N/A	N/A	N/A	5.00±0.00	1.00	0.00	3.74±0.45	0.47	0.12	N/A	N/A	N/A

^† Items added from 2nd delphi; RN=registered nurse; NA=nurse aid; PCW=personal care worker; CVR=content validity ratio; CV=coefficient of variation; ACM=alternative communication method; TPC=training for person-centered communication; BPSD=behavioral and psychological symptoms of dementia; PI=pharmacological intervention; TPA=training for person-centered approach.

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