Background
Methods
Stage I. Development
Stage II. Judgement and quantification
1st evaluation: Expert panel
Measurement of content validity
Measurement of the content validity index
2nd evaluation: Workshop with health care workers
Stage III: Evaluation
Sample
Application of the IdA®
Data collection and analysis
Results
Stage I: Development
Domains | Version 1.0 (93 items) Prior to the expert evaluation as a result of Stage I, steps 1 & 2 | Version 2.0 (72 items) after expert evaluation as a result of Stage II, step 3 | Version 3.0 (89 items)* After evaluation by key persons in Stage II, step 4 | |||
---|---|---|---|---|---|---|
Dimensions | Number of items | Dimensions | Number of items | Dimensions | Number of items | |
PART 1 | ||||||
1. Assessment of the behaviour | Challenging behaviour | 18 | Challenging behaviour | 14 | Challenging behaviour | 14 |
PART 2 | ||||||
2. Health status & independence in everyday life | Cognitive status | 7 | Cognitive status | 11 | Cognitive status | 11 |
Physical health status | 5 | Physical health status and discomfort | 11 | Physical health status and discomfort | 10 | |
Physical discomfort | 13 | |||||
Independence in everyday life | 17 | Independence in everyday life | 1 | Independence in everyday life | 2 | |
3. Communication | Communication | 6 | Communication | 6 | Communication | 9 |
4. Personality & lifestyle before dementia | Personality & lifestyle before the onset of dementia | 8 | Personality & lifestyle before the onset of dementia | 8 | Personality & lifestyle before the onset of dementia | 8 |
5. Moods & emotions | Moods & emotions | 7 | Moods & emotions | 10 | Moods & emotions | 10 |
6. Environmental influences | Environmental influences | 11 | Environmental influences | 11 | Environmental influences | 11 |
PART 3 | ||||||
7. Summary | Overview and summary | 14 |
Stage 2: Judgement and quantification
1st evaluation: Expert panel
Characteristics of expert panel, N = 10 | |
---|---|
Gender | 3 men, 7 women |
Academic Disciplines (some with more than one degree) | 4 nursing/nursing science, 1 psychiatry/psychotherapy, 2 pedagogy/gerontology, 1 psycho-gerontology, 1 philosophy, 1 literature, 1 economics, 1 cultural studies |
Vocational training | 2 geriatric nurses, 5 nurses |
Position | 3 employed by the university/development and research institution (scientist, lecturer), 2 in leading positions in nursing homes, 2 working in quality development, 2 consultants in dementia care, 1 senior physician/freelancer |
Additional dementia-related training | 2 validation, dementia care mapping; 3 geriatric psychiatry/gerontology; 2 cognitive training, communication, organizational development and quality management; 1 palliative medicine |
General work experience | On average, 20 years (min 4; max 35) |
Work experience in dementia care | On average, 12 years (min 3; max 25) |
Practice with people with dementia: | |
Care of people with dementia | 9 experts |
Assessment instruments/process documentation | 9 experts |
Theoretical knowledge about: | |
Care of people with dementia | 10 experts |
Process documentation | 10 experts |
Assessment instruments in nursing | 9 experts |
Research experience: | |
In field of dementia | 4 experts |
With assessment instruments/process documentation | 3 experts |
Self-assessment of own expertise in the following: | |
Dementia care | Median 3a
|
Nursing assessment/documentation | Median 2a
|
Dimensions of IdA®, 1.0 | Relevance of Questions S-CVI/Ave | Clarity of Questions S-CVI/Ave | Significance of Answers S-CVI/Ave | Completeness of Answers S-CVI/Ave |
---|---|---|---|---|
1. Assessment of behaviour | 0.92 | 0.87 | 0.87 | 0.83 |
2. Cognitive status | 0.95 | 0.85 | 0.83 | 0.74 |
3. Physical health status | 1.00 | 0.90 | 0.88 | 0.79 |
4. Physical discomfort | 0.92 | 0.81 | 0.82 | 0.77 |
5. Independence in everyday life | 0.81 | 0.85 | 0.72 | 0.72 |
6. Communication | 0.93 | 0.91 | 0.81 | 0.83 |
7. Personality & lifestyle before the onset of dementia | 0.95 | 0.92 | 0.87 | 0.90 |
8. Mood & emotions | 0.87 | 0.64 | 0.80 | 0.80 |
9. Environmental influences | 0.85 | 0.81 | 0.80 | 0.76 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationc
|
1 | Type of behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
2 | Description of behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** |
3 | First occurrence of behaviour | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 8 | 8 | 1.00 | 0.004 | 1.00 | **** |
4 | Event before the occurrence of the behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** |
5 | Time at which the behaviour occurs | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
6 | Duration of the behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
7 | Frequency of the behaviour | 10 | 10 | 1.00 | 0.001 | 1...00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** |
8 | Area in which the behaviour occurs | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
9 | Person present when the behaviour occurs | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
10 | Events directly before the behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** |
11 | Events directly after the behaviour | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 8 | 8 | 1.00 | 0.004 | 1.00 | **** |
12 | Helpful interventions | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 5 | 0.50 | 0.246 | 0.34 | * | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** |
13 | Behaviour unpleasant for the resident | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
14 | Danger for the person with dementia | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
15 | Behaviour unpleasant for the resident or for other residents | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** |
16 | Danger for other residents | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 11 | 9 | 0.82 | 0.027 | 0.81 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
17 | Impact on carers | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
18 | Danger for carers | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
S-CVI/AVE 0.92 | S-CVI/AVE 0.87 | **** | S-CVI/AVE 0.87 | S-CVI/AVE 0.83 | |||||||||||||||||||||
S-CVI/UA 0.56 | S-CVI/UA 0.22 | S-CVI/UA 0.28 | S-CVI/UA 0.17 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the item | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationad
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Diagnosis of dementia | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
2 | Type of dementia | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
3 | Dementia stage | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** |
4 | Memory functions | 8 | 6 | 0.75 | 0.109 | 0.72 | *** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
5 | Long-term memory | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 9 | 9 | 1 00 | 0.002 | 1.00 | **** | 7 | 6 | 0.86 | 0.055 | 0.85 | **** |
6 | Short-time memory | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
7 | Orientation | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
S-CVI/AVE 0.95 | S-CVI/AVE 0.85 | S-CVI/AVE 0.83 | S-CVI/AVE 0.74 | ||||||||||||||||||||||
S-CVI/UA 0.71 | S-CVI/UA 0.14 | S-CVI/UA 0.33 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationad
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Physical impairment | 9 | 9 | 1.0 | 0.002 | 1.0 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | - | - | - | - | - | - | - | - | - | - | - | - |
2 | Mobility-related impairment | 10 | 10 | 1.0 | 0.001 | 1.0 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
3 | Food intake | 10 | 10 | 1.0 | 0.001 | 1.0 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
4 | Limitations with bowel or bladder function | 10 | 10 | 1.0 | 0.001 | 1.0 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.176 | 0.76 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** |
5 | Other physical limitations | 10 | 10 | 1.0 | 0.001 | 1.0 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
S-CVI/AVE 1.0 | S-CVI/AVE 0.90 | S-CVI/AVE 0.88 | S-CVI/AVE 0.79 | ||||||||||||||||||||||
S-CVI/UA 1.0 | S-CVI/UA 0.40 | S-CVI/UA 0.00 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Dependence in movement | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | - |
2 | Resources in movement | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | *** |
3 | Dependence in personal hygiene | 10 | 7 | 0.70 | 0.117 | 0.66 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | **** |
4 | Resources in personal hygiene | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | **** |
5 | Dependence in dressing | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | *** |
6 | Resources in dressing | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
7 | Dependence in nutrition | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
8 | Resources in nutrition | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
9 | Dependence in elimination | 10 | 10 | 1.00 | 0.001 | 1.00 | *** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
10 | Resources in elimination | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
11 | Dependence in leisure time activities | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** |
12 | Resources in leisure time | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | *** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** |
13 | Dependence in social contacts | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
14 | Resources in social contacts | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** |
15 | Other dependencies | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 5 | 0.50 | 0.246 | 0.34 | * | 10 | 5 | 0.50 | 0.246 | 0.34 | * |
16 | Other resources | 9 | 5 | 0.56 | 0.246 | 0.41 | ** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 5 | 0.56 | 0.246 | 0.41 | ** | 9 | 5 | 0.56 | 0.246 | 0.41 | ** |
17 | Burden through dependencies | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
S-CVI/AVE 0.81 | S-CVI/AVE 0.85 | **** | S-CVI/AVE 0.72 | S-CVI/AVE 0.72 | |||||||||||||||||||||
S-CVI/UA 0.12 | S-CVI/UA 0.24 | S-CVI/UA 0.00 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pb
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Health problems generic | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | - | - | - | - | - | - | - | - | - | - | - | - |
2 | Pain | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
3 | Depression | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 8 | 8 | 1.00 | 0.004 | 1.00 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
4 | Hallucination/delusion | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
5 | Sleep | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
6 | Bowel elimination | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
7 | Urinary elimination | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
8 | Thirst/hunger | 8 | 8 | 1.00 | 0.004 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
9 | Need for movement | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
10 | Breathing/circulatory problems | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
11 | Discomfort | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 5 | 0.50 | 0.246 | 0.34 | * | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** |
12 | Other relevant health problems | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** | 8 | 5 | 0.63 | 0.219 | 0.52 | ** | 8 | 6 | 0.75 | 0.109 | 0.72 | *** |
13 | Side effects of medication | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** |
S-CVI/AVE 0.92 | S-CVI/AVE 0.81 | **** | S-CVI/AVE 0.82 | S-CVI/AVE 0.77 | |||||||||||||||||||||
S-CVI/UA 0.62 | S-CVI/UA 0.15 | S-CVI/UA 0.08 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | To express oneself verbally | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
2 | To understand verbal communication | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
3 | To understand written language | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
4 | Hearing | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
5 | Vision | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
6 | Communication of wishes and needs | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** |
S-CVI/AVE 0.93 | S-CVI/AVE 0.91 | S-CVI/AVE 0.81 | S-CVI/AVE 0.83 | ||||||||||||||||||||||
S-CVI/UA 0.67 | S-CVI/UA 0.67 | S-CVI/UA 0.16 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Personality prior to the onset of dementia | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
2 | Stress and frustration tolerance | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
3 | Coping with stressful situations before the onset of dementia | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
4 | Past situations or events related to negative emotions | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 10 | 1.00 | 0.001 | 1.00 | **** |
5 | Past situations or events related to positive emotions | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** |
6 | Leisure activities preferred by the resident prior to dementia | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** |
7 | Type of job/housework before dementia | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** |
8 | Important routine rhythms or established daily rituals | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 8 | 8 | 1.00 | 0.004 | 1.00 | **** |
S-CVI/AVE 0.95 | S-CVI/AVE 0.92 | S-CVI/AVE 0.87 | S-CVI/AVE 0.90 | ||||||||||||||||||||||
S-CVI/UA 0.50 | S-CVI/UA 0.50 | S-CVI/UA 0.13 | S-CVI/UA 0.38 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationad
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Boredom | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
2 | Anxiety | 10 | 10 | 1.00 | 0.001 | 1.00 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
3 | Exhaustion | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
4 | Impression of loneliness or isolation | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
5 | Trusting relationships | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 5 | 0.50 | 0.246 | 0.34 | * | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 6 | 0.60 | 0.205 | 0.50 | ** |
6 | Amount of occupation | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 5 | 0.50 | 0.246 | 0.34 | * |
7 | Type of occupation | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** |
S-CVI/AVE 0.87 | S-CVI/AVE 0.64 | S-CVI/AVE 0.80 | S-CVI/AVE 0.80 | ||||||||||||||||||||||
S-CVI/UA 0.29 | S-CVI/UA 0.50 | S-CVI/UA 0.00 | S-CVI/UA 0.00 |
Relevance of the questions | Clarity of the questions | Meaningfulness of the answers | Completeness of the answers | ||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
No | Content of the items | Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
| Number of experts | Number of ratings of 3 or 4 | I-CVIa
| pc
b
|
k*
c
| Evaluationd
|
1 | Surroundings | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | 8 | 5 | 0.63 | 0.219 | 0.52 | ** | - | - | - | - | - | |||||||
2 | Lighting | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 5 | 0.50 | 0.246 | 0.34 | * |
3 | Noises | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
4 | Smells | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** |
5 | Stimuli | 10 | 8 | 0.80 | 0.044 | 0.79 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 7 | 5 | 0.71 | 0.164 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
6 | Atmosphere | 10 | 6 | 0.60 | 0.205 | 0.50 | ** | 9 | 6 | 0.67 | 0.164 | 0.60 | *** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** | 10 | 8 | 0.80 | 0.044 | 0.79 | **** |
7 | Security | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
8 | Private space | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
9 | Opportunities for contact | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 9 | 0.90 | 0.010 | 0.90 | **** | 10 | 7 | 0.70 | 0.117 | 0.66 | *** |
10 | Significant carer/caregivers | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** | 9 | 9 | 1.00 | 0.002 | 1.00 | **** |
11 | Continuity of being in contact with significant carer | 8 | 7 | 0.88 | 0.031 | 0.87 | **** | 8 | 7 | 0.88 | 0.031 | 0.87 | 9 | 7 | 0.78 | 0.070 | 0.76 | **** | 9 | 8 | 0.89 | 0.018 | 0.89 | **** | |
S-CVI/AVE 0.85 | S-CVI/AVE 0.81 | S-CVI/AVE 0.80 | S-CVI/AVE 0.76 | ||||||||||||||||||||||
S-CVI/UA 0.09 | S-CVI/UA 0.09 | S-CVI/UA 0.10 | S-CVI/UA 0.10 |
Dimension | Guiding questions | Content of dimension |
---|---|---|
Part 1 Description of the behaviour
| ||
Assessment of challenging behaviour | Which type of challenging behaviour is observed? | Naming and description of the behaviour; description of the circumstances under which the behaviour occurs; quantification of behaviour; denomination of the consequences of the behaviour |
Part 2 Capturing the triggers of the behaviour
| ||
Cognitive status | Could the challenging behaviour be explained by the type or stage of dementia? Could the identified cognitive impairments explain the challenging behaviour? | Events from the past, information about oneself, present living situation, sense of time, orientation in important rooms, complete activities, recognition of important everyday items, recall of information received a day or less before, recognition of important everyday items |
Physical health status & discomfort | Could the identified physical impairment or discomfort somehow be related to the challenging behaviour? | Mobility, fluid and food intake, excretion functions, sleep, vital physical functions, depression, pain, delusions/hallucinations, medications with adverse side effects |
Independence in everyday life | Could the identified stressful/burdening dependencies in everyday life activities have provoked the challenging behaviour? | Emotional burden/stress of care dependencies and care interventions |
Communication | Could the identified comprehension/communication difficulties have triggered/provoked the challenging behaviour? Is it possible that the behaviour itself presents a form of communication and to explain the behaviour accordingly? | Hearing/seeing well, language of communication, comprehensibility of speech, quality of verbal communication, understanding of verbal/written communication, contact with others, communication of personal wishes/desires |
Personality & lifestyle before the onset of dementia | Could the challenging behaviour be an expression of the resident’s personality? Could the challenging behaviour be related to past life events or the person’s former lifestyle? Could the challenging behaviour be a reaction to stress? | Personality before the onset of dementia, stress tolerance, frustration tolerance, management of stressful situations before dementia; Events connected with negative emotions or threatening events, events associated with positive impact/emotions, leisure time before the onset of dementia, occupation, daily rhythm/daily rituals with unique importance |
Mood & emotions | Could the challenging behaviour be an expression of certain moods and emotions? Could the challenging behaviour serve as self-stimulation? | Fear, tiredness/exhaustion, closer relationship to the resident, relationship showing confidence, safety, times without occupation, boredom, occupational activities/leisure time activities/structure of the day not matching the residents´ personal preferences |
Environmental influences | Could the challenging behaviour be related to certain environmental characteristics? Could the challenging behaviour be related to a lack of sense of security and familiarity? Could staff structure have an impact on the challenging behaviour? | Lighting, noise in the surroundings, smells, furnishing, privacy, contact with others, positive stimuli/stimulations, preference of caregiver, continuity of primary caregivers |
2nd evaluation: Workshop with health care workers
Sample
Results
Stage III evaluation
Sample
Characteristics of the sample n = 60 | |
---|---|
Women, n [%] n = 56 | 50 [89] |
Age, n [%], years, n = 51, 8 missing | |
Up to 19 | 1 [2] |
20–24 | 5 [10] |
25–29 | 8 [16] |
30–34 | 3 [6] |
35–39 | 1 [1] |
40–44 | 10 [20] |
45–49 | 8 [16] |
50–54 | 9 [17] |
55–59 | 3 [6] |
60 and over | 3 [6] |
Profession n [%], n = 55, 5 missing | |
Registered nurses | 23 [42] |
Nursing aides | 22 [40] |
Other | 10 [18] |
Working hours per week, x [SD], n = 53, 7 missing | 28.8 [9.3] |
Results
Structure of the IdA®
Structural aspects | Items | Agreement | n |
---|---|---|---|
Clarity | Very clear | 68% | 57 |
Meaningfully constructed | 70% | 57 | |
Not too inconvenient | 66% | 56 | |
Allows prompt access to resident information | 61% | 56 | |
Meaningfulness | Contains only information relevant to care | 42% | 57 |
No double documentation needed | 49% | 56 | |
Completeness | Complete | 81% | 57 |
Length/scope | Not too detailed | 53% | 57 |
Not time consuming | 29% | 57 | |
Not too extensive | 42% | 57 | |
Comprehensibility | Clear language | 75% | 56 |
Does not require comprehensive training | 53% | 58 | |
Not too complicated | 69% | 57 | |
Requirements | Requires knowledge of dementia | 60% | 58 |
Completed only by registered nursing staff | 33% | 58 |
Benefits of the IdA® for daily care
Aspects of daily care | Items | Agreement | n |
---|---|---|---|
Time | Does not reduce valuable time for care | 53% | 58 |
Information aid | Provides information about residents’ bio-psycho-social information | 80% | 56 |
The IdA® can be read by others | 55% | 58 | |
Communication aid | Is helpful for communication with colleagues | 60% | 58 |
Is helpful for communication with other health care workers | 46% | 57 | |
Planning aid | Supports planning of care | 64% | 58 |
Evaluation aid | Indicates good care | 36% | 58 |
Memory aid | Is a good memory aid | 67% | 58 |
The IdA® as a tool for decision making
Benefit for decision making | Agreement | n = |
---|---|---|
The IdA® has encouraged me to think more intensively about the residents’ behaviour | 71% | 59 |
The IdA® contains factors that I had never thought about in the context of residents’ problem behaviour | 66% | 59 |
I see a relationship between the IdA® and my daily work | 64% | 58 |
By using the IdA®, I see the behaviour of the residents with dementia from another perspective | 63% | 59 |
With the IdA®, I can better describe the residents’ problem behaviour to others | 58% | 59 |
Planning interventions to address the residents´ behaviour is easier with the information provided by the IdA® | 47% | 58 |
My behaviour towards the residents has changed since the introduction of the IdA® | 47% | 58 |
The IdA® provides information about the residents that I did not know before | 45% | 58 |
Since the introduction of the IdA®, I have a better understanding of the behaviour of the residents with dementia | 44% | 57 |
I feel that the behaviour of the residents has changed positively since the introduction of the IdA® | 26% | 58 |
The IdA® gives me the opportunity to express the individuality of the resident with dementia | 74% | 58 |