title: Attitudes to dementia and dementia care held by nursing staff in U.K. "non-EMI" care homes: what difference do they make?
abstract: BACKGROUND
  There is doubt about the value of training in dementia care in U.K. nursing homes. We decided to estimate the association between nursing staff's attitudes to dementia and dementia care and their recognition of cognitive impairment in residents and other indicators of care practice in nonspecialist nursing homes derived from a probability sample of 445 residents in South-East England, and to relate this to previous training.
  
  
  METHODS
  Prospective survey. The most senior nurse on duty was interviewed about each resident sampled, about their own training and experience, their attitude to restriction of egress and covert medication use, and asked to complete the Attitudes to Dementia Questionnaire (ADQ) and the dementia Care Styles Questionnaire (CSQ). Nurses were also asked about care practices in relation to restriction of egress and covert medication use in the home. Residents were interviewed using the Mini-mental State Examination (MMSE).
  
  
  RESULTS
  One hundred and fifty-eight nurses were interviewed. Increased person-centered attitudes seem to be associated with better recognition of cognitive impairment independent of training and experience. The espousal of restrictive practices was also associated with better recognition, but only when analysis included nurses reporting on only one impaired resident.
  
  
  CONCLUSIONS
  More person-centered attitudes are associated with better recognition of cognitive impairment, despite perverse U.K. regulatory incentives; the need for training and support in developing person-centered dementia care for staff in "non-Elderly Mentally Infirm" ("non-EMI") care homes is supported by these results.
authors.affiliation: Institute of Psychiatry, London, UK. alastair.macdonald@kcl.ac.uk
authors.forename: A J D
authors.initials: AJ
authors.lastname: Macdonald
authors.forename: R T
authors.initials: RT
authors.lastname: Woods
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003072:Cognition Disorders / Q000451:nursing / Q000523:psychology; D003479:Curriculum; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D004739:England; D005851:Geriatric Nursing / Q000193:education; D006707:Homes for the Aged; D006801:Humans; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D009723:Nurse-Patient Relations; D009733:Nursing Diagnosis; D009735:Nursing Homes; D009740:Nursing Staff / Q000523:psychology*; D009745:Nursing, Supervisory; D011446:Prospective Studies; D011594:Psychometrics