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

Article information

Res Community Public Health Nurs. 2019;30(3):295-306
Publication date (electronic) : 2019 September 12
doi : https://doi.org/10.12799/jkachn.2019.30.3.295
Da Eun Kim1, Hae Sagong2, Ju Young Yoon,3
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 2019 February 26; Revised 2019 June 11; Accepted 2019 July 01.

Abstract

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

General Characteristics of the Expert Panel (N=20)

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

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

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

References

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Article information Continued

Copyright © 2019 Korean Academy of Community Health Nursing

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.

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
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.