Connecting Actors With the Introduction of Mobile Technology in Health Care Practice Placements (4D Project): Protocol for a Mixed Methods Study.

BACKGROUND: The learning process in clinical placements for health care students is a multifaceted endeavor that engages numerous actors and stakeholders, including students, clinical tutors, link teachers, and academic assessors. Successfully navigating this complex process requires the implementation of tasks and mentorships that are synchronized with educational and clinical processes, seamlessly embedded within their respective contexts. Given the escalating number of students and the rising demand for health care services from the general population, it becomes imperative to develop additional tools that support the learning process. These tools aim to simplify day-to-day clinical practice, allowing a concentrated focus on value-based activities. This paper introduces a project funded by the European Commission that involves 5 European countries. The project's objective is to comprehensively outline the entire process of development and ultimately implement mobile technology in practice placements. The project tackles the existing gap by constructing tailored mobile apps designed for students, teachers, tutors, and supervisors within each participating organization. This approach leverages practice-based learning, mobile technology, and technology adoption to enhance the overall educational experience. OBJECTIVE: This study aims to introduce mobile technology in clinical practice placements with the goal of facilitating and enhancing practice-based learning. The objective is to improve the overall effectiveness of the process for all stakeholders involved. METHODS: The "4D in the Digitalization of Learning in Practice Placement" (4D Project) will use a mixed methods research design, encompassing 3 distinct study phases: phase 1 (preliminary research), which incorporates focus groups and a scoping review, to define the problem, identify necessities, and analyze contextual factors; phase 2 (collaborative app development), which involves researchers and prospective users working together to cocreate and co-design tailored apps; and phase 3, which involves feasibility testing of these mobile apps within practice settings. RESULTS: The study's potential impact will primarily focus on improving communication and interaction processes, fostering connections among stakeholders in practice placements, and enhancing the assessment of training needs. The literature review and focus groups will play a crucial role in identifying barriers, facilitators, and factors supporting the integration of mobile technology in clinical education. The cocreation process of mobile learning apps will reveal the core values and needs of various stakeholders, including students, teachers, and health care professionals. This process also involves adapting and using mobile apps to meet the specific requirements of practice placements. A pilot study aimed at validating the app will test and assess mobile technology in practice placements. The study will determine results related to usability and design, learning outcomes, student engagement, communication among stakeholders, user behavior, potential issues, and compliance with regulations. CONCLUSIONS: Health care education, encompassing disciplines such as medicine, nursing, midwifery, and others, confronts evolving challenges in clinical training. Essential to addressing these challenges is bridging the gap between health care institutions and academic settings. The introduction of a new digital tool holds promise for empowering health students and mentors in effectively navigating the intricacies of the learning process. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53284.

Validation of the Spanish Version of the Double Knowledge Expectations and Received Knowledge Significant Other Scale for Informal Caregivers of People with Dementia (KESO-DEM/RKSO-DEM).

Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received knowledge for informal caregivers of people with dementia (KESO-DEM/RKSO-DEM), the analysis of the dimensional structure of the instrument, its validity and reliability, and temporary stability was carried out. An analysis of criterion and construct validity, internal consistency, and test−retest stability was performed. The evaluation of the interrelation between dimensions was statistically significant. Regarding internal consistency, the scale values were good both for the scale totals and for each dimension of knowledge, with Cronbach's alpha coefficients of 0.97. For criterion validity, all items showed temporal stability for both questionnaires (p < 0.05). The availability of a valid, reliable tool for the measurement of expected and received knowledge in caregivers of people with dementia allows an approach based on the real needs of the family and the patient. It is important to design care protocols for people with dementia that are adapted to their needs and expectations and to their non-curative treatment, to improve the emotional well-being of patients and informal caregivers.

Perception of the Online Learning Environment of Nursing Students in Slovenia: Validation of the DREEM Questionnaire.

At the time of the outbreak of the coronavirus pandemic, several measures were in place to limit the spread of the virus, such as lockdown and restriction of social contacts. Many colleges thus had to shift their education from personal to online form overnight. The educational environment itself has a significant influence on students' learning outcomes, knowledge, and satisfaction. This study aims to validate the tool for assessing the educational environment in the Slovenian nursing student population. To assess the educational environment, we used the DREEM tool distributed among nursing students using an online platform. First, we translated the survey questionnaire from English into Slovenian using the reverse translation technique. We also validated the DREEM survey questionnaire. We performed psychometric testing and content validation. I-CVI and S-CVI are at an acceptable level. A high degree of internal consistency was present, as Cronbach's alpha was 0.951. The questionnaire was completed by 174 participants, of whom 30 were men and 143 were women. One person did not define gender. The mean age of students was 21.1 years (SD = 3.96). The mean DREEM score was 122.2. The mean grade of student perception of learning was 58.54%, student perception of teachers was 65.68%, student academic self-perception was 61.88%, student perception of the atmosphere was 60.63%, and social self-perception of students was 58.93%. Although coronavirus has affected the educational process, students still perceive the educational environment as positive. Nevertheless, there is still room for improvement in all assessed areas.

Validity and reliability of the Spanish caregiver reaction assessment scale for caregivers of people with dementia.

AIM: Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. METHODS: The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. RESULTS: Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ-5D (r = -.43), that is, a greater impact on health correlated with lower health-related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of .804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from .683 to .729 (p < .001). CONCLUSION: The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties.

Instruments for Patient Education: Psychometric Evaluation of the Expected Knowledge (EKhp) and the Received Knowledge of Hospital Patients (RKhp).

PURPOSE: In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients' expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial). PATIENTS AND METHODS: The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009-2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development. RESULTS: Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care. CONCLUSION: EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.

Informal Caregivers' Roles in Dementia: The Impact on Their Quality of Life.

The constantly changing process of caring for a person with dementia affects the informal caregivers' role due to its psychosocial impact. This cross-sectional study aimed to analyze the impact of the Person with Dementia informal caregiver's role caregiver to a person with dementia on the self-perceived quality of life (QoL) of the caregiver. In total, 160 informal caregivers were recruited between January and December 2019. Informal caregivers' quality of life was assessed using the European Quality of Life 5-Dimension scale, burden with the Zarit Burden Scale, emotional wellbeing using the General Health Questionnaire, and caregiver reactions using Caregiver Reaction Aspects. Patients' cognitive impairment was assessed with the Mini-Mental State Examination, their quality of life using Quality of Life in Alzheimer's Disease, and neuropsychiatric symptoms using the Neuropsychiatric Inventory. Outcomes were studied using the Pearson correlation coefficient and ANOVA test. Most informal caregivers' outcomes were significantly associated with their quality of life. Male informal caregivers have a slightly better quality of life than female caregivers (p < 0.001). Caregiver burden (p < 0.001), psychological wellbeing (p < 0.001) and negative aspects of caregiving on health (p < 0.001) correlated moderately with informal caregivers' quality of life. Factors associated with dementia, including the course of the illness and its severity with the presence of neuropsychiatric symptoms can negatively affect the informal caregiver's role and produce a low self-perception of quality of life; thus, social and professional support for informal caregivers is essential.

Emotions of Orthopaedic Arthroplasty Patients: A European Survey.

METHODS: This was a pre/post-observational study examining patients' emotions before and during elective knee or hip replacement surgery for osteoarthritis in seven European Union countries to identify factors related to better emotional status at discharge. INSTRUMENTS: In addition to demographic data, information was collected on quality of life (EuroQoL five-dimension questionnaire), hospital expectations (Knowledge Expectations of Hospital Patients Scale), symptoms, and experienced emotions. ANALYSIS: Total negative emotions scores at baseline and discharge were transformed into median values. Multivariate analysis identified the baseline factors related to better emotional status at discharge. RESULTS: Patients (n = 1,590), mean age 66.7 years (SD = 10.6), had a significant reduction in the frequency of total negative emotions at discharge as compared with baseline. The multivariate model showed better health status (odds ratio [OR] = 1.012; p = .004), better emotional status at baseline (≥24 points), and shorter duration of hospital stay (OR = 0.960; p = .011) as independent factors associated with better emotional status at discharge (OR = 4.297; p = .001). CONCLUSIONS: Patients undergoing elective knee or hip replacement surgery for osteoarthritis improve their emotional status during hospitalization, with fewer negative emotions at discharge. Good emotional status, feeling of higher health status at baseline, and shorter hospitalization were independently associated with better emotional status at discharge.

Necesidades formativas percibidas al envejecer. Cómo afrontar un envejecimiento saludable / Educational perceived needs when aging. How to face a healthy aging

Objetivo: Explorar necesidades formativas percibidas por las personas mayores de 60 años al envejecer y conocer los beneficios o barreras de participar en cursos de formación dirigidos a ellos. Metodología: Estudio cualitativo con grupos focales realizado en áreas básicas de salud y un centro social de Mataró (Barcelona). Se estudiaron 29 sujetos divididos en: personas mayores de 60 años que acudían a un centro de atención primaria y personas mayores de 60 de una asociación de personas mayores. Se organizaron 4 grupos focales estratificados por segmentos. Se transcribieron las grabaciones elaborando categorías, se codificaron y analizaron. Resultados: Los participantes tenían vidas plenas, apoyos emocionales y vínculos positivos con su comunidad y familia. Manifestaron que es importante planificar el envejecimiento y actividades para realizar al jubilarse. Conclusión: Es necesario recibir formación al envejecer. Principales barreras: obligación de cuidar, falta de tiempo y coste económico

Objective: To explore formative needs perceived by people older than 60 years when aging and to know the benefits and/or barriers of participating in training courses focused on them. Methods: Qualitative study with focus groups made in basic areas of primary care and a social center of Mataró (Barcelona).29 subjects were studied, divided into: people over 60 years attending a primary care center and people over 60 belonging to an association of elderly. 4 focus groups stratified by segments were organized. The recordings were transcribed elaborating categories, they were codified and analyzed. Results: The participants had full lives, emotional support and positive links with their community and family. They stated that it is important to plan aging and activities to do when retiring. Conclusions: To receive training is needed when aging. Main barriers: obligation to take care of, lack of time, economic cost

Empowering education of arthroplasty patients' significant others in three Southern European countries.

AIMS AND OBJECTIVES: To examine the relationship between significant others' expected and received knowledge and their background characteristics in three Mediterranean countries (Cyprus, Greece, Spain), all of which deal with economic restrictions, have similar social support systems with the family members acting as family caregivers, and cultural similarities. BACKGROUND: Significant others' role is a key element in the older patients' postoperative recovery. However, people who take care of persons older than 65 years, as persons undergoing arthroplasty, are usually old themselves and need special support. DESIGN: Multicentre, descriptive, correlational study. METHODS: Data were collected preoperatively from 189 and postoperatively from 185 significant others using the Knowledge Expectations and the Received Knowledge of Significant Others Scales during 2010-2012. RESULTS: Approximately one-fourth of the significant others were older than 65 years. Their knowledge expectations were not adequately addressed in any of the countries; they expected to be educated more on biophysiological issues and received the lowest knowledge regarding financial issues. The highest difference between expected and received knowledge was found in Greece and the lowest in Cyprus. Significant others may be less prepared for dealing with situations at home due to the knowledge difference between expected and received knowledge. CONCLUSIONS: Significant others receive less education comparing to what they expect; therefore, they are not prepared for dealing with problematic situations during their old relative's recovery. This is especially important in Mediterranean countries, where family members often provide patient care. IMPLICATIONS FOR PRACTICE: As health care is changing towards active participation of patients and family, it is important that nurses provide the education needed, as lower education may lead to poor patient outcomes and higher education may lead to significant others' anxiety. Nurses may keep in mind that older significant others do not report higher knowledge difference, but may have lower expectations.

Knowledge expectations of orthopaedic patients.

AIM: To describe and compare knowledge expectations and received knowledge in elective orthopaedic surgery patients. BACKGROUND: Population aging, increasing incidence of osteoarthritis, the growing number of surgical procedures, and reduced clinical stays underline the need for a new approach to patient education. DESIGN: This study has a descriptive, comparative design. METHODS: Data were collected from 263 patients who had total hip and knee replacement elective surgery during 3 years (2009-2012) in 5 public hospitals in Spain. The Knowledge Expectation of Hospital Patients and the Received Knowledge of Hospital Patients Scales were used to collect data. The questionnaires were filled before hospital admission, at discharge and at follow-up 6 to 7 months later. RESULTS: Surgical patients received less knowledge than they expected. Patients' expectations were only met in the functional dimension. At follow-up, patients reported that they perceived having acquired more knowledge during their hospital stay than they reported at the time of discharge. Knowledge expectations and knowledge received were related to employment status, gender, and previous contact experience with the hospital. CONCLUSION: Knowledge expectations were not met, and results showed the need to improve education for orthopaedic patients throughout the perioperative process, not only during hospitalization.

Nursing interventions in adult patients with oropharyngeal dysphagia: a systematic review.

BACKGROUND: Oropharyngeal dysphagia is a geriatric syndrome of high prevalence. It requires screening, diagnosis and specific care to avoid possible complications. The objective of this study is to perform a systematic review of the literature to know what interventions are performed by nursing professionals in the care of adult patients with OD. METHODS: A systematic literature review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guideline. Included are observational and analytical scientific studies on the interventions nurses made in the assessment and screening of OD secondary to age and/or neurodegenerative diseases, as well as nursing interventions in patient's care and diagnosis in the electronic databases of Medline, SCOPUS and CINALH. RESULTS: A total of 51 articles were included: 10 observational studies, 29 experimental studies and 12 systematic reviews. 66.7% studies talked about the interventions to patients with OD secondary to ICTUS. 82.05% was performed in a hospital setting. In 49.01% of the articles, nurses are mentioned as participants in the interventions. CONCLUSION: Screening and clinical assessment of OD for an early diagnosis are the interventions performed by the most prevalent nursing professionals found in the literature, mainly in the OD, due to ICTUS and in the hospital setting. Further research on interventions by nursing professionals is needed in this area.

Costs and Burden Associated With Loss of Labor Productivity in Informal Caregivers of People With Dementia: Results From Spain.

AIMS: We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients' clinical variables. METHODS: Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups: (1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach. RESULTS: The cost for LLP was 378&OV0556;/month or 4.536&OV0556;/year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting. CONCLUSION: Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.

Aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia / Application of the Balance of Care model in decision-making regarding the best care for patients with dementia

Objetivo: Describir la aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia en el contexto español. Métodos: Se utilizó el modelo Balance of Care, que consistió en 1) la descripción del perfil de los casos más habituales de personas con demencia y sus cuidadores, 2) la identificación del emplazamiento más adecuado (domiciliario o centro sociosanitario) para cada caso, 3) el diseño de planes de cuidados específicos para cada caso, y 4) la evaluación del coste de los planes de cuidados. Resultados: En el diseño de los casos participaron 1641 personas con demencia y sus cuidadores de ocho países europeos. La evaluación de los casos la realizaron 20 profesionales expertos en demencia de distintos ámbitos asistenciales. En España, los resultados indican que inicialmente el lugar más idóneo para cuidar de las personas con demencia es el domicilio, pero en los casos con mayor dependencia para las actividades de la vida diaria el centro sociosanitario era el emplazamiento con mejor prestación de cuidados. Los recursos escogidos en el plan de cuidados fueron ayuda profesional para realizar las actividades de la vida diaria e instrumentales, centro de día, equipo de atención domiciliaria, apoyo económico, enfermera de enlace y trabajador/a social. Discusión: El modelo Balance of Care permite evaluar de manera sistemática, objetiva y mediante un equipo multidisciplinario el emplazamiento más adecuado para las personas con demencia. Se deberían incluir otras intervenciones coste-eficientes para mejorar la situación domiciliaria de estas personas (AU)

Objective: To describe the implementation of the Balance of Care model in decision-making regarding the best care for patients with dementia in Spain. Methods: The Balance of Care model was used, which consists of (1) describing the profile of the typical cases of people with dementia and their caregivers, (2) identifying the most suitable care setting for each of the cases (home-care or long-term care institution), (3) designing specific care plans for each case, and (4) evaluating the cost of the proposed care plans. Results: A total of 1,641 people with dementia and their caregivers from eight European countries were used in the case design. The evaluation of cases was conducted by 20 experts in different medical fields of dementia. In Spain, the results indicated that initially the most suitable placement to take care of people with dementia was the home, however in cases with higher dependency in activities of daily living, the long-term care setting was the best option. For the best care plan, the following resources were chosen: professional help to perform basic activities; day center; multidisciplinary home care team; financial support; community nurse; and social worker. Discussion: The Balance of Care method allows us to assess the most appropriate place of care for people with dementia systematically, objectively and with a multidisciplinary team. Other cost-effective interventions should be integrated in patients with dementia care in order to improve home care (AU)

Desarrollo de un nuevo modelo de Practicum. Reto y oportunidad de formar en roles avanzados en el Grado de Enfermería / Development of a new Practicum model. Challenge and opportunity to form in advanced roles in the Nursing Degree

El propósito de la educación en Enfermería es formar profesionales con actitudes, habilidades y conocimientos necesarios para llevar a cabo sus funciones de manera eficiente. Cada vez hay mayor demanda de profesionales de enfermería más competentes para el manejo de información, uso de nuevas tecnologías y aplicación de intervenciones complejas en el cuidado de las personas en diferentes entornos de cuidado. Para dar respuesta a esta demanda, desde la Escuela Superior de Ciencias de la Salud Tecnocampus, se apuesta por modelo de Practicum avanzado más integrador y acorde a la formación teórica y práctica, que permita al estudiante una visión holística, ya no tanto de las patologías concretas, sino de los procesos asistenciales en forma de itinerarios. El trabajo que aquí se presenta tiene el objetivo de dar a conocer este modelo y las herramientas evaluadoras del estudiante utilizadas durante el mismo

The purpose of the Nursing Education is to train nurses with skills, attitudes, aptitudes and knowledge to enable them to develop their function in an efficient manner. An increasing demand of nurses more competent to a data-management system, to use new technologies and application of complex interventions on different places of nursing care, is requested. To respond to this demand, the Escuela Superior de Ciencias de la Salud Tecnocampus (ESCST), has been emphasized for an advanced and integrative Practicum Model in accordance with the theoretical and practical training, that it enables students to have an holistic view. Not just of specific pathologies, but also the assistance processes by means of form of itinerary. The work that is presented has the aim to make know this model and which are evaluation tools that are used during the development for the assessment of student's practical training

[Application of the Balance of Care model in decision-making regarding the best care for patients with dementia]. / Aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia.

OBJECTIVE: To describe the implementation of the Balance of Care model in decision-making regarding the best care for patients with dementia in Spain. METHODS: The Balance of Care model was used, which consists of (1) describing the profile of the typical cases of people with dementia and their caregivers, (2) identifying the most suitable care setting for each of the cases (home-care or long-term care institution), (3) designing specific care plans for each case, and (4) evaluating the cost of the proposed care plans. RESULTS: A total of 1,641 people with dementia and their caregivers from eight European countries were used in the case design. The evaluation of cases was conducted by 20 experts in different medical fields of dementia. In Spain, the results indicated that initially the most suitable placement to take care of people with dementia was the home, however in cases with higher dependency in activities of daily living, the long-term care setting was the best option. For the best care plan, the following resources were chosen: professional help to perform basic activities; day center; multidisciplinary home care team; financial support; community nurse; and social worker. DISCUSSION: The Balance of Care method allows us to assess the most appropriate place of care for people with dementia systematically, objectively and with a multidisciplinary team. Other cost-effective interventions should be integrated in patients with dementia care in order to improve home care.

Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

PURPOSE: Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. METHODS: Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. FINDINGS: There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. CONCLUSION: There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.

INFOSA intervention for caregivers of the elderly, an experimental study.

An experimental study was carried out in a geriatric hospital unit (pre-discharge at home) with repeated observations taken at baseline, on study completion and six months post-intervention to analyze the impact of a psychoeducational intervention INFOSA addressed to caregivers who support dependent elderly people, on burden, psychological distress and perceived support. Univariate regression models showed that the participants in the experimental group had less burden (OR 35, IC 95% 7.47-163.99) and emotional distress (OR 149.5, IC 95% 15. 57-1435.52) than participants in the control group. Odds ratios effect were statistically significant at post-test and six-month follow-up. The INFOSA intervention reduced burden and emotional distress and enhanced caregivers' perceived social support in the short-term, suggesting that applying the intervention for an extended period could maintain the positive effect in the long-term.

What Makes Institutional Long-Term Care the Most Appropriate Setting for People With Dementia? Exploring the Influence of Client Characteristics, Decision-Maker Attributes, and Country in 8 European Nations.

OBJECTIVES: To explore the extent to which client characteristics, decision-maker attributes, and country influence judgments of institutional long-term care (ILTC) appropriateness for people with dementia. DESIGN, SETTING, AND PARTICIPANTS: A total of 161 experts in dementia care from 8 European countries reviewed a series of 14 vignettes representing people with dementia on the cusp of ILTC admission and indicated the most appropriate setting in which to support each case in a simple discrete choice exercise: own home, very sheltered housing, residential home, or nursing home. At least 16 experts participated in each country (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the United Kingdom). MEASUREMENTS: Descriptive statistics were used to characterize the experts and their placement preferences. Logistic regression modeling was used to explore the extent to which the sociodemographic and clinical characteristics of people with dementia, and the profession, workplace, and country of decision-makers were associated with ILTC recommendation. RESULTS: Client characteristics, decision-maker attributes, and country all seemed to play a part in influencing professionals' perceptions of the appropriateness of ILTC for people with dementia. Expert decision-makers were more likely to recommend ILTC for individuals who required help with mobility or had multiple care needs, and appeared to give more weight to carers' than clients' wishes. Community-based social workers were less likely than other professional groups to favor ILTC placement. Experts in Finland, Germany, and the United Kingdom were less likely to recommend ILTC than experts in France, the Netherlands, and Estonia; experts in Sweden and Spain took an intermediate position. CONCLUSION: This study provides new understanding of the factors that shape professionals' perceptions of ILTC appropriateness and highlights the need to construct multifaceted models of institutionalization when planning services for people with dementia. It also has several important clinical implications (including flagging interventions that could decrease the need for ILTC), and provides a basis for enhancing professionals' decision-making capabilities (including the greater involvement of clients themselves).