A systematic literature review of attachment relationships between paid caregivers and people with dementia, and an empirical study of staff skill development in supporting people with dementia

Sleep, Katie 2020. A systematic literature review of attachment relationships between paid caregivers and people with dementia, and an empirical study of staff skill development in supporting people with dementia. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

BACKGROUND: The prevalence of dementia in the UK is increasing and due to its complexities, those with a diagnosis often require support from professional caregivers. It is therefore important to explore the factors related to paid caregivers, which facilitate effective care provision for people with dementia. This thesis aims to inform evidence-based practice of paid caregivers. Attachment theory has long been applied to informal caregivers’ relationships, from the perspective of the person with dementia, or that of the caregiver, but infrequently from the perspective of the dyad. Evidence shows informal caregiver attachments impact psychological, physical and social wellbeing for both caregiver and care-recipient. This review systematically appraised and synthesised the extant literature on the role of attachment in professional caregiver relationships. Factors associated with paid caregivers’ delivery of effective care for people with dementia have been researched, and policies developed to guide service provision. However, both can be criticised for lacking theoretical and methodological rigour, and making recommendations which are difficult to implement in practice. This empirical research examines factors staff perceive are important for dementia caregiving. AIMS: The aims of this thesis were to answer the following two research questions: - What is the role of the professional caregiver in attachment relationships with people with dementia? - What are the key factors that healthcare staff perceive to be important for developing skill in working with people with dementia? METHODS: The literature review was completed in accordance with PRISMA guidance. Search terms and inclusion/exclusion criteria were defined and articles gathered through a systematic search of databases, Google Scholar and a search of references and citation lists. The review consists of a descriptive synthesis, quality assessment and narrative synthesis. National Health Service (NHS) staff (N=10) who had experience working with adults were recruited to participate in an expert panel for the empirical research. A three round Delphi was undertaken, commencing with an open-ended question on the factors needed to develop skill in working with people with dementia; themes were analysed and key factors identified. In Round II, participants rated the importance of each key factor. In Round III, feedback on collective ratings were provided, and the panel again rated importance. FINDINGS: The systematic review identified ten relevant articles, of varying methodology and quality. On appraisal there was significant lack of high-quality extant literature. Articles of moderate quality and methodological diversity were included to ensure a systematic, replicable approach. A model was developed, linking attachment relationships of paid caregivers, with the factors that influence them, and their mechanisms. This is advanced tentatively due to the quality issues in the literature. The contributions of the empirical research expert panel led to the generation of 24 key factors, which grouped into four clusters. Three key factors reached consensus, and a further 12 key factors achieved at least 70% agreement. The clusters were ranked from most, to least important, with the following results: ‘Training and Work Environment’; ‘Personal Characteristics’; ‘Approach to Work’; and ‘Life Experience’. Agreement was reached on the order of importance, with consensus on the position of ‘Life Experience’. The key factors achieving consensus (‘Training’, ‘Patience’ and ‘Communication’), represented three out of the four clusters. IMPLICATIONS: The systematic review is the first of its kind, drawing together the literature on attachment relationships with people with dementia, developed by paid caregivers in their roles. The proposed model aligns with attachment theory tenets, and offers a number of theoretical, clinical and research implications. However, limitations should be considered: the evidence base is small; this review includes articles of varying vintage; quality; methodology; culture; and care giving role (e.g. nurse, manager). There are clinical implications for both staff recruitment and retention including: valuing qualities of empathy and self-awareness; meeting employee basic needs; creating a positive working culture; adequate training and supervision; knowledge of policy and guidance; and matching client and caregiver, where possible. This evidence base requires more modern, peer-reviewed studies, using robust outcome measures, assessment tools, and theoretical foundation. The presented empirical results derive from a homogeneous expert panel of NHS staff, offering evidence-based implications to service provision in that healthboard. The limitations of this study are acknowledged, with a small expert panel, high attrition rate, and the likelihood of a self-selecting bias. Findings suggest the following should be considered priorities for service provision: developing effective training programmes with a practical element; protected time for peer support and supervision; a values-based recruitment approach that is weighted towards personal qualities, rather than work experience or qualifications; fostering a work environment of continual learning, involving all relevant stakeholders; and being considerate of personal circumstance, promoting a healthy work life balance. There are opportunities for future research to apply this methodology with staff in other health and social care settings.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	1 April 2021
Last Modified:	31 Mar 2022 01:30
URI:	https://orca.cardiff.ac.uk/id/eprint/140234

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