Background: Studies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden. Methods: Path analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation. Results: Mean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect. Conclusions: Unlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.

New educational approaches may be necessary to enhance competency in the new generation of students. Self-directed learning and blended coaching have been effective strategies to meet this challenge. However, there has been little research on self-directed learning programs using blended coaching (SDL_BC) in clinical practice. This study aimed to evaluate the effectiveness of a self-directed learning program using blended coaching among nursing students in clinical practice. A non-equivalent control group pretest-posttest non-synchronized intervention design was used. The participants were 91 students, comprising an experimental group (n = 44) and a control group (n = 47). The experimental group was trained using a self-directed learning program with blended coaching. The Self-Directed Learning Competency Questionnaire, Clinical Competency Questionnaire, and Numeric Rating Score for clinical practice satisfaction via a self-report were all used in the assessment. Descriptive statistics, independent t-tests and ANCOVA were used to evaluate self-directed learning competency, clinical competency, and clinical practice satisfaction. Students in the experimental group showed a significantly higher improvement in competency in the implementation of self-directed learning (F (1,89) = 4.27, p = 0.039) and higher satisfaction with clinical practice (t (89) = 3.10, p = 0.003) compared with those in the control group. These results provide evidence that a self-directed learning program using blended coaching is an effective educational approach to improve the implementation part of self-directed learning competency and clinical practice satisfaction among nursing students in clinical practice. Further research is required to investigate whether other variables are associated with clinical competency, competency in planning and evaluation of self-directed learning, or their long-term effects.

Chun N, et al. J Korean Acad Nurs. 2017 Oct;47(5):651-662. https://doi.org/10.4040/jkan.2017.47.5.651