Improving dementia care in nursing homes: experiences with a palliative care symptom-assessment tool (MIDOS).
BACKGROUND
In the past decade, the palliative care approach has been used in the care of frail older people living with debilitating chronic conditions, including dementia.


OBJECTIVE
To describe health professionals' experiences of assessing the symptoms of people with dementia using a cancer-patient-oriented symptom-assessment tool from a palliative care context.


METHODS
This was a qualitative study that used semi-structured interviews (n=13) with clinical staff in three nursing homes prior to and following the implementation of the Minimal Documentation system for Palliative care (MIDOS) tool for assessing symptoms over a period of 6 weeks.


RESULTS
Baseline interviews showed specific concerns about symptom assessment, such as uncertainty about underlying symptoms in residents who appeared to be in distress. After the implementation of the MIDOS tool, participants reported that daily use of the tool was perceived as helpful in evaluating symptoms other than pain and improved internal communication between staff regarding clinical decision making.


CONCLUSIONS
The MIDOS tool was perceived as a helpful and valuable complement to existing tools. Participants expressed some concerns regarding the subjective nature of perceiving symptoms and clinical decision making. The use of tools such as the MIDOS tool has the potential to enhance the quality of palliative care in dementia care.
Research Assistant, Department of Palliative Medicine, University Hospital RWTH Aachen University, Pauwelsstraße 57, 52074 Aachen, Germany.
Norbert
N
Krumm
Professor of Clinical Nursing (Palliative Care), Head of Discipline Childrens Nursing, and Director of Clinical Academic Partnership, UCD School of Nursing, Midwifery and Health Systems and Our Ladys Hospice and Care Services, UCD College of Health Scie.
Philip
P
Larkin
Lecturer, UCD School of Nursing, Midwifery and Health Systems, and Head of Education, All Ireland Institute of Hospice and Palliative Care Education & Research Centre, Our Ladys Hospice, Ireland.
Michael
M
Connolly
Head of Nursing, Aachen Caritas Services, Germany.
Peter
P
Rode
Professor of Palliative Medicine, Anaesthesiologist, Pain Specialist, and Acting Head of Department, Department for Palliative Medicine, University Hospital RWTH Aachen University, Germany.
Frank
F
Elsner
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis* / Q000451:nursing*; D005260:Female; D005858:Germany; D006707:Homes for the Aged / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000592:standards*; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards*; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards*