There are growing numbers of people living with dementia being admitted to acute care hospitals. Hospitalization for people living with dementia can be difficult and is often associated with negative outcomes. Nurses play a significant role in shaping the hospital experience of people living with dementia, and there have been efforts to design, implement and evaluate interventions to improve nursing care of people living with dementia. To synthesize evidence on the effectiveness of, and experiences with, nursing interventions to improve care of hospitalized people living with dementia. Mixed methods systematic review following the JBI convergent segregated approach to synthesis and integration of findings. The quantitative component considered studies that evaluated nursing interventions to improve the care of people living with dementia in hospital, comparing the intervention to usual care, other therapeutic modalities, or no comparator. The qualitative component considered studies that explored the experiences of nursing interventions from the perspectives of people living with dementia, caregivers, and nurses. A total of 8 databases were used to search for published and unpublished studies. Titles, abstracts, and full text selections were screened by two or more independent reviewers and assessed for methodological quality. A total of 38 studies were included in the review, 24 quantitative, 9 qualitative and 5 mixed method designs. Critical appraisal scores were moderate. All studies regardless of methodological quality were included in the review. Interventions were grouped as principally related to (1) dementia education for nurses, (2) technology, (3) nursing skills, and (4) physical environment. Outcomes are presented related to health outcomes of people living with dementia; nurses' knowledge, confidence, and self-efficacy; and health system outcomes. As the interventions were heterogeneous, a meta-analysis of quantitative findings was not possible. The qualitative analysis incorporated 60 findings from 12 studies and led to nine categories and two synthesized findings recognizing external influences on nurses' practice with people living with dementia and the importance of interventions to humanize nurses' work with people living with dementia. Integration of the quantitative and qualitative results demonstrates the need to recognize the role of organization- and unit-level factors in the design and implementation of effective interventions. There is limited high-quality evidence to demonstrate the effectiveness of interventions to improve nursing care of people living with dementia in hospital. Using approaches to intervention design and implementation that draw on models of behavior change and learning health systems may support effective change. PROSPERO 2021CRD42021230951.

中文翻译：

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改善医院痴呆患者护理的护理干预： 混合方法系统评价


越来越多的痴呆症患者被送往急症护理医院。痴呆症患者的住院治疗可能很困难，并且通常与负面结果有关。护士在塑造痴呆患者的医院体验方面发挥着重要作用，并且一直在努力设计、实施和评估干预措施，以改善痴呆患者的护理。综合关于护理干预的有效性和经验的证据，以改善住院痴呆患者的护理。混合方法系统评价遵循 JBI 收敛分离方法对结果进行综合和整合。定量部分考虑了评估护理干预以改善医院痴呆患者护理的研究，将干预与常规护理、其他治疗方式或无对照进行比较。定性部分考虑了从痴呆症患者、护理人员和护士的角度探索护理干预经验的研究。共使用 8 个数据库来检索已发表和未发表的研究。标题、摘要和全文选择由两名或两名以上独立审稿人筛选，并评估方法学质量。本综述共纳入 38 项研究，24 项定量设计，9 项定性设计，5 项混合方法设计。关键评价得分中等。所有研究，无论方法学质量如何，均纳入本综述。干预措施主要与（1）护士痴呆教育，（2）技术，（3）护理技能和（4）物理环境有关。 结果与痴呆患者的健康结果相关;护士的知识、信心和自我效能感;和卫生系统结果。由于干预措施具有异质性，因此无法对定量结果进行meta分析。定性分析纳入了 12 项研究的 60 个结果，并得出 9 个类别和 2 个综合结果，认识到外部影响护士与痴呆患者合作，以及干预措施对使护士与痴呆患者人性化工作的重要性。定量和定性结果的整合表明，需要认识到组织和单位层面因素在有效干预措施的设计和实施中的作用。有限的高质量证据证明干预措施对改善医院痴呆患者护理的有效性。使用借鉴行为改变和学习健康系统模型的干预设计和实施方法可能支持有效的变革。普罗斯佩罗 2021CRD42021230951。