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Table 1 Description of the Family centered Function-focused Care (Fam-FFC) intervention

From: Reducing disability via a family centered intervention for acutely ill persons with Alzheimer’s disease and related dementias: protocol of a cluster-randomized controlled trial (Fam-FFC study)

Component

When delivered

By whom

Description

I. Environmental and Policy Assessment

Beginning of the study (during the first month of study); at completion of the implementation

Fam-FFC research nurse with unit champions; recommendations for change discussed with administration

Possible modifications include development of policies for: labeling glasses/hearing aids, uninterrupted quiet times, FCG involvement in rounds, and bedside white boards to promote FCG/patient communication with the interdisciplinary team; and access to hearing amplifiers, magnifiers, activity cart/ supplies; mobility devices; noise trackers; snacks and fluids

II. Staff Education and Training (delivery options include: instructor-led PowerPoint presentations, web-based training, and one on-one review)

Beginning of the study (during the first 2 months of study)

Fam-FFC research nurse on intervention units; alternate nurse on control units

Content includes:

• dementia, delirium, functional decline etiology, cognitive and functional assessment, patient communication, and evidence-based approaches to prevent cascade iatrogenesis

• hospital experience and responses of the patient/family

• function-focused care (rationale, incorporating FFC into routine care, specific techniques/ equipment, safety considerations, goal setting/ discharge planning)

• partnerships with families (assessment of preferences, active listening, information-sharing, care planning, promoting advocacy and patient/ family engagement in decision-making, discharge planning)

III. FamPath Care Pathway

During the 12 months of implementation

Fam-FFC research nurse

Components of FamPath include:

• information on the admitting condition, diagnostics, and treatment

• family/patient education: provided in lay terms (cueing and motivating techniques, support of physical activity, meals, cognitive stimulation, behavioral support, and safety) linked to joint FCG/ nurse assessment (baseline cognition, physical function and social profile)

• jointly developed bedside goals [69] and treatment plans (updated daily) and discharge checklist

• coaching of primary nurse to communicate and provide a copy of the FamPath plan to post-acute providers

• post-acute follow-up to provide ongoing education and modification of the function-focused care plan (within 48 h of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months)

IV. Ongoing Training and Motivation of Nursing Staff

Following initial education of the staff; during 12 months of implementation

Fam-FFC research nurse mentors the unit champions and nursing staff

Components include:

• assistance to champions and nurses is provided on consented patients to: (a) complete the physical capability assessments [70], (b) establish and update FFC goals with input from FCGs/patients (Goal Attainment Scale) [69] and (c) develop a care plan with FCG/ patient addressing factors that impede FFC (e.g., acute illness, sedation, pain, fear/anxiety, pain, apathy, NPS, depression)

• support of the unit champions to mentor nursing staff (RN, LPN, nursing assistants) includes: (a) role-modeling; (b) highlighting staff role models and positive opinion leaders; (c) garnering support by sharing success stories with nursing council and administration; (d) maintaining Fam-FFC bulletin board with updates /educational reinforcement; and (e) observing nursing staff during care interactions using the Function Focused Care Behavior Checklist [71], providing feedback to staff

  1. Legend: Fam-FCC Family centered Function-focused Care, FCG family caregiver, LPN licensed practical nurse, NPS neuropsychiatric symptoms, RN research nurse