What is the State of Organisational Compassion-Based Interventions Targeting to Improve Health Professionals' Well-Being? Results of a Systematic Review.

AIM: To identify and assess the state of knowledge regarding compassion-based interventions and outcomes, targeted to the organisational level, that aim to improve health professionals' well-being. DESIGN: Systematic review. DATA SOURCES: Using the PICO model, the clinical question and search strategy were structured. The searches were performed on 20 September 2022 and 26 December 2023 in the Scopus, CINAHL, EMBASE, PsycINFO and ProQuest Dissertations & Theses Global databases. Content analysis was applied to analyse data, and the PRISMA and SWiM guidelines were followed for reporting. RESULTS: Thirty-eight studies, mostly from the United Kingdom and the United States, met the inclusion criteria and were quality assessed and analysed. Compassion-based interventions that target the organisational level are quite new, thus representing a burgeoning initiative. In this review, many included quantitative studies revealed significant methodological challenges in effectively measuring organisational compassion (interpersonal relationships, organisational culture and retention/turnover). However, the review findings overall indicate that interpersonal connections between colleagues that foster a sense of community, through shared experiences, mindfulness and (self-)compassion practices and social activities, may be a protective factor for well-being. Further, the review emphasises the crucial role of management support in catalysing organisational changes to improve health professionals' well-being. CONCLUSION: Evidence strongly suggests that fostering human interconnectedness among health professionals is associated with enhanced well-being. Further rigorous studies are needed to validate these findings, clarify the organisational cultural aspects of compassion and develop an effective outcome measurement tool for organisational compassion. PRACTICE IMPLICATIONS: Organisational compassion-based interventions may help foster a culture of compassion within organisations, enhance health professionals' capacity for compassion and benefit both their well-being and the quality of care provided to patients and relatives. PATIENT CONTRIBUTIONS: This review is part of a larger project about compassion and includes two patient representatives (mothers of children with cancer) in the research team.

Quality improvement project (QIP): evaluating a pilot suicide awareness, screening and signposting training intervention for dental care professionals in a dental teaching hospital and school.

Scotland's 2022 suicide prevention strategy recommends building skills and knowledge among healthcare staff who play a role in preventing suicide. A quality improvement project (QIP) in relation to this was initiated because several patients attending dental appointments disclosed suicidal thoughts and/or plans to attempt death by suicide. Dental staff and students involved expressed feeling ill-equipped at how to manage this situation. This initial QIP aimed to establish routine screening, identification and signposting of dental outpatients identified as having an increased risk of suicide during attendance at any dental clinic within the Dental Hospital. Several Plan-Do-Study-Act (PDSA) cycles ensued. First, to understand the problem, a scoping literature search on the role of dental professionals in preventing suicide and the availability of suicide risk awareness training frameworks for non-medical healthcare staff revealed few publications and no identified training frameworks. This was PDSA1. To gain insight into the local culture in relation to the QIP aims, two further cycles were undertaken. These examined whether dental patients were routinely screened for mental health conditions, and dental staff and student attitudes. Screening activity was measured, a new medical history intervention was implemented and a significant improvement in the number of patients being screened was seen (PDSA2). At the time of writing, the newly introduced medical history form is now used routinely to screen all outpatients attending the Dental Hospital, where 60 000 outpatients' appointments are delivered annually. PDSA3 sought dental staff and student views on whether suicide risk awareness is part of their role. This found suicide risk awareness is considered part of the dental professionals' role, but a lack of training, and a desire for training was expressed. With no suitable training frameworks, PDSA4 aimed to design, implement and evaluate a pilot training educational intervention by a clinical psychologist. Sixteen dental care professionals attended the workshop. To measure training effectiveness, participants completed pre-training (baseline) and post-training questionnaires to assess their self-efficacy around suicide awareness. Improvements in self-efficacy following training occurred across all domains, demonstrating a successful intervention which can be upscaled.

Perceptions of organization, job attitudes, challenges, and solutions among medical school administrative staff.

PURPOSE: Staff is essential to the university's efficient administrative operations, which are critical for education, research, and service. Medical schools, often independent, need specialized administrative elements. This study explores how medical school staff perceives the organization using the Six-Box model and evaluates their perceived organizational support, job satisfaction, and organizational commitment based on the concept of job attitudes. METHODS: This study employs a mixed-methods approach, integrating quantitative and qualitative data via a convergent parallel design. It simultaneously collects and analyzes data from a survey and consensus workshop for medical school staff. The survey data were statistically analyzed (IBM SPSS ver. 25.0; IBM Corp., USA), and the workshop discussions were subjected to content analysis. The findings combined provide a comprehensive understanding of the medical school administrative system. RESULTS: Quantitative analysis revealed purpose (3.80) as the highest-rated organizational perception and rewards (2.72) as the lowest. Similarly, job satisfaction was highest (3.63) in job attitudes, while perceived organizational support (2.96) was the lowest. Group differences were observed by gender, enrollment capacity, and contract type (p<0.05). In qualitative research, keywords appeared in relation to their experiences within the medical school organization, encompassing doctor training, emotional responses, administrative features, personal attributes, and cultural influences. Overload, faculty issues, and communication gaps are obstacles. Strategies for overcoming these challenges focus on improving staff treatment, resource allocation, training, and communication channels. CONCLUSION: This study was conducted to explore a broad understanding of the administration of medical schools. Findings suggest challenges with workload, communication, and organizational support. We propose a dedicated medical school administrative system, improved work conditions, and enhanced communication.

Identification of statewide core competencies for new graduate nurses at the beginning of practice and after a 12-month nurse residency program.

AIM: To inform the development of statewide core competencies for new graduate nurses at the beginning of their professional career and after completing a 12-month nurse residency program. BACKGROUND: Although studies have attempted to clarify the expected core competencies of new graduate nurses at the beginning of their professional career, results are mixed. Additionally, nurse residency program competency expectations vary. DESIGN: A retrospective cross-sectional study using a purposive sample of a national nurse residency program database. METHODS: Wilcoxon Signed Rank tests compared retrospective self-report data between January 1st 2017 and December 31st 2019, from 2916 acute care hospital new graduate nurses working in the state of Maryland, USA, to examine their perceptions of competency at hire and after completing a nationally standardized 12-month nurse residency program. The study used six domains from the Casey Fink Graduate Nurse Experience Survey© 2006 and the Vizient/AACN Nurse Residency Program™ Progression survey. RESULTS: New graduate nurses' self-report of competency increased from a mean score of 4.81 at the beginning of a nurse residency program to 6.67 after completion of 12-month nurse residency program (scale of 0-10). At the beginning of a nurse residendy program, new graduate nursesreported a low level of comfort in three of the six survey domains: communication and leadership, high-intensity skills and patient safety. At 12 months, new graduate nurses reported higher levels of comfort in all six survey domains, with statistically significant increases (Wilcoxon Signed Rank test, α =0.05). CONCLUSIONS: Four domains for ongoing competency development were identified for the nurse residency program curriculum-communication and leadership, patient safety, complex patient assignments and end-of-life care-with the expectation that new graduate nurses achieve competency at program completion. New graduate nurses' perceptions corroborated findings from a statewide study of academicians and practice leaders, thus helping to develop realistic core competencies for new graduate nurses entering the workforce and after completing a 12-month nurse residency program.

Effectiveness of the 'SELF-program' on nurses' activity encouragement behavior and nursing home resident's ADL self-reliance; a cluster-randomized trial.

BACKGROUND: Nurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the 'SELF-program': a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents. OBJECTIVE: The aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living. METHOD: The program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported. RESULTS: Twenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88-8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67-7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = -0.25; p = .07; 95 % CI -2.21 - 0.09) and at six months (d = -0.29; p = .07; 95 % CI -3.22 - 0.11). CONCLUSION: The SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation. TRIAL-REGISTRATION: The study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.

At the break point: What needs to change for antimicrobial stewardship program pharmacists?

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature.

BACKGROUND: In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified? METHODS AND ANALYSIS: We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects. RESULTS: We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units. DISCUSSION: This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.

Managing Grief for Pharmacy Leaders.

Grief is everywhere and affects individuals and teams in many different ways. The negative effects may not only be felt by the individual, but they can disrupt a team or an entire organization. While grief is common, understanding how to interact with others who are grieving is not. As leaders within healthcare institutions, pharmacists encounter many individuals and teams that are experiencing grief. The sources of grief can arise from pharmacy team members, other healthcare providers, patients, or our own personal experiences. This literature review introduces grief, where it comes from, and how it is emotionally and physically expressed in individuals. It discusses grief's disruptive nature and how to effectively communicate with those grieving to limit disturbances to individual, team, and organizational performance. Understanding what grief is, how it manifests in individuals and teams, and how to navigate a grieving workplace are vital skills for pharmacy leaders and will enable a more productive workplace.

A comprehensive "real need" assessment, a step toward improving the quality of faculty development programs: A survey-based study in Hormozgan University of Medical Sciences.

Background and Aims: Developing a framework to identify the "real" needs of faculty members, the gap between the current and desired conditions, would lead to an effective faculty development program (FDP) and improve higher education quality and health system promotion. For the first time in Iran, instead of needs assessment based on faculty members preferences or assessing needs only in a few areas, this study aimed to assess the difference between "self-rated level of skill" as the current condition and "perceived importance" as the expected condition, regarding all faculty roles and levels at Hormozgan University of Medical Sciences (HUMS). Methods: This study used a research-made questionnaire that included 73 items within nine domains. The content validity of the questionnaire was confirmed, and Cronbach's alpha coefficient ranged from 0.86 to 0.96 for domains. The census method was applied. Participants rated their current skill level and perceived importance for professional development of each item on a 10-anchor scale. Statistical software, SPSS 19, analyzed the data using descriptive statistics and analytic tests. Results: Significant differences existed among participants' ratings of skills and the importance of further training in various areas. Priority professional development domains were e-learning, curriculum development, personal development, program evaluation, leadership and management, student assessment, learning theories and teaching strategies, research and scholarship, and ethics and communication. Conclusion: Additional formal training is required, especially in e-learning and curriculum development, for most faculty members at HUMS to enhance their academic performance. This study is the first needs assessment in Iran based on gaps between current and desired conditions. Conducting a "real needs" assessment before initiating an FDP is necessary for its feasibility.

"It would be nice to have more than basic support": A learning needs assessment survey of midwifery faculty in low- and middle-income countries of the Asia Pacific region.

BACKGROUND: The provision of high-quality midwifery education relies on well-prepared educators. Faculty members need professional development and support to deliver quality midwifery education. AIM: To identify development needs of midwifery faculty in low- and middle-income countries of the Asia Pacific region, to inform program content and the development of guidelines for faculty development programs. METHODS: An online learning needs assessment survey was conducted with midwifery faculty from low- and middle-income countries in the Asia Pacific Region. Quantitative survey data were analysed using descriptive statistics. Textual data were condensed using a general inductive approach to summarise responses and establish links between research aim and findings. FINDINGS: One hundred and thirty-one faculty completed the survey and a high need for development in all aspects of faculty practice was identified. Development in research and publication was the top priority for faculty. Followed closely by leadership and management development, and then more traditional activities of teaching and curriculum development. Preferred mode of program delivery was a blended learning approach. DISCUSSION: Historically, programs of faculty development have primarily focussed on learning and teaching methods and educational development. Yet contemporary faculty members are expected to function in roles including scholarly activities of research and publication, institutional leadership and management, and program design and implementation. Unfortunately, programs of development are rarely based on identified need and fail to consider the expanded role expectation of contemporary faculty practice. CONCLUSION: Future midwifery faculty development programs should address the identified need for development in all expected faculty roles.

Competency domains for registered nurse preceptor professional development: Evidence from a modified e-Delphi study.

AIM: To develop an evidence-based framework of nurse preceptor competency domains and competency descriptors for use in nurse preceptor professional development. BACKGROUND: Nurse preceptors are registered nurses who coach, support and assess nursing students while simultaneously caring for patients. Working as both clinician and educator requires preceptors to develop additional skills. However, preceptor preparation is often overlooked and may not be evidence based. DESIGN: A modified e-Delphi study. METHODS: A three-phase e-Delphi method informed the study that was conducted between March and September 2023. In the first preparatory phase an expert group distilled the results of a previous literature review identifying seven preceptor competency domains and more than 200 competency descriptors. Two e-Delphi rounds followed. A 70% rater agreement response threshold was chosen as appropriate in this study. The CREDES reporting framework was followed. RESULTS: In the preparatory phase, the expert group (n=6) reached consensus on six preceptor domains and 57 preceptor descriptors. In Round 1, nurse preceptors (n= 89) rated the domains and descriptors using a four-point Likert scale; from not important to very important. Six domains and 34 competency descriptors were ranked as very important'. Round 2 participants (n=30) who opted in from Round 1 indicated their 100% agreement with the Round 1 results. The results reveal that preceptors resonate intuitively with the six domains Role model, Facilitator, Leader, Evaluator, Teacher and Coach and the related descriptors. CONCLUSION: The preceptor evidence-based competency framework offers registered nurse preceptors and their employers the opportunity to focus efforts in developing a nurse preceptor workforce. The framework can be used to design preceptor professional development and offers registered nurses a self-assessment tool to identify their preceptorship skills strengths and areas for development. If implemented in these ways the framework may benefit healthcare organisations to provide quality nurse preceptorship, thus enhancing the clinical learning experiences of nursing preceptees.

Twelve tips for developing and implementing an effective critical care simulation programme.

Simulation training in healthcare settings has become a valuable training tool. It provides an ideal formative assessment for interdisciplinary teaching. It provides a high fidelity and highly immersive environment where healthcare staff and students can practice developing their skills in a safe and controlled manner. Simulation training allows staff to practice skills that better prepare them for clinical emergencies, therefore possibly optimising clinical care. While the benefits of simulation education are well understood, establishing a programme for use by critical care staff is complex. Complexities include the highly specialised scenarios that are not typically encountered in non-critical care areas, as well as the need for advanced monitoring equipment, ventilation equipment etc. These 12 tips are intended to assist healthcare educators in navigating the complexities in the establishment of a critical care simulation programme, providing advice on selecting target audiences, learning outcomes, creating a critical care simulation environment and recommendations on evaluation and development of the programme.

A Reexamination of the Relationship between Training Practices and Welfare in the Management of Ambassador Animals.

There is an ethical need to document and develop best practices for meeting ambassador animals' welfare needs within the context of meeting zoo and aquarium program objectives. This is because ambassador animals experience direct and frequent contact with humans. This paper rigorously synthesizes behavioral research and theory, contemporary practices, and personal experiences to offer key concepts that can be applied to meet ambassador animal welfare needs. These key concepts include addressing an animal's recognition of choice and control, the use of the most positive and least intrusive effective interventions when training animals to participate in programming, and an overall reduction in aversive strategy use. Our model for increasing ambassador animal welfare focuses on seven main areas of concern, including the following: choosing the most suitable animal for the program; choosing the human with the right skills and knowledge for the program; using the most positive, least intrusive, effective training methods; developing a strong trusting relationship between trainer and animal; developing a comprehensive enrichment program; the need for institutional support; and creating opportunities for animals to practice species-appropriate behaviors. Our model will provide guidelines for improved ambassador animal welfare that can be refined with future research.

Designing a standardised emergency nurse career pathway for use across rural, regional and metropolitan New South Wales, Australia: A consensus process.

BACKGROUND: Emergency nurses are the first clinicians to see patients in the ED; their practice is fundamental to patient safety. To reduce clinical variation and increase the safety and quality of emergency nursing care, we developed a standardised consensus-based emergency nurse career pathway for use across Australian rural, regional, and metropolitan New South Wales (NSW) emergency departments. METHODS: An analysis of career pathways from six health services, the College for Emergency Nursing Australasia, and NSW Ministry of Health was conducted. Using a consensus process, a 15-member expert panel developed the pathway and determined the education needs for pathway progression over six face-to-face meetings from May to August 2023. RESULTS: An eight-step pathway outlining nurse progression through models of care related to different ED clinical areas with a minimum 172 h protected face-to-face and 8 h online education is required to progress from novice to expert. Progression corresponds with increasing levels of complexity, decision making and clinical skills, aligned with Benner's novice to expert theory. CONCLUSION: A standardised career pathway with minimum 180 h would enable a consistent approach to emergency nursing training and enable nurses to work to their full scope of practice. This will facilitate transferability of emergency nursing skills across jurisdictions.

Faculty development programmes in simulation-based teaching: An exploration of current practices.

Background and Aims: Simulation-based teaching (SBT) has become integral to healthcare education, offering a dynamic and immersive learning experience for bridging theoretical knowledge with real-world clinical practice. Faculty members play a crucial role in shaping the effectiveness of simulation-based education, necessitating the implementation of comprehensive faculty development programmes. This scoping review explores existing literature on training programmes for simulation-based teaching, focusing on strategies employed and the overall impact on educators and the quality of simulation-based education. Methods: The scoping review comprised five sequential steps: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarising, and reporting the results. The research questions focused on existing practices and approaches in faculty development for simulation-based teaching, challenges or barriers reported, and the effectiveness of utilised methods and strategies. Results: A systematic search of databases yielded 13 studies meeting inclusion criteria out of 1570 initially screened papers. These studies provided insights into various aspects of faculty development programmes, including their nature, duration, and participant profiles. Despite the diversity in approaches, detailed, specialty-specific programmes were scarce, especially in anaesthesiology. Challenges, while implicit, lacked explicit exploration. Most studies reported positive outcomes, emphasising achievement of learning objectives, appreciable course content, and relevance to teaching practices. Conclusion: This scoping review describes the existing literature regarding the faculty training or development programmes related to SBT. The programmes target various health professionals and have a wide range of durations. The need for such a programme targeting anaesthesiologists is emphasised.

Technology acceptance model perspective on the intention to participate in medical talents training in China.

Objectives: This study seeks to investigate the willingness of medical professionals to embrace training in sports medicine integrated talents, as well as the factors that influence their decision-making process. By utilizing technology acceptance models, the objective is to gain a comprehensive understanding of this phenomenon and provide valuable recommendations to facilitate the development of proficient integration of sports and medicine (ISM) talents. Methods: The questionnaire was developed through a comprehensive review of relevant literature and consultation with experts in the field. A cluster sampling method was employed to select medical professionals from various medical institutions in Guangxi Zhuang Autonomous Region (Guangxi) who had participated in ISM talent training. The collected data were analyzed using the AMOS structural equation model, ensuring a rigorous and systematic approach to data analysis. Results: A total of 403 questionnaires were collected in this survey, and 8 out of the 9 research hypotheses formulated for the model variables were found to be supported. Perceived usefulness, perceived ease of use, subjective norm and training satisfaction were identified as significant factors influencing the behavioral intention of medical professionals to engage in ISM talent training (P < 0.05). The path coefficients for these factors were 0.17, 0.16, 0.31 and 0.24, respectively. Conclusion: In order to enhance the effectiveness of training for ISM talents, it is imperative for relevant departments to collaborate and focus on improving the perceived usefulness, perceived ease of use, and training satisfaction. By doing so, we can effectively harness the subjective initiative of medical professionals, thereby increasing their willingness to participate in training programs. This, in turn, will contribute to the cultivation of "high-quality, high-level" ISM talents that are essential for the betterment of society.

Effects of governmental support on clinical nurse educators in South Korea: A repeated cross-sectional study.

AIM: To assess the effectiveness of the Clinical Nurse Educator Support Project and offer valuable insights for supporting nursing education. BACKGROUND: Allocating clinical nursing educators is crucial for supporting novice nurses' transition into the clinical setting and improving their performance. INTRODUCTION: In 2019, the Ministry of Health and Welfare in South Korea implemented the Clinical Nurse Educator Support Project, which involves governmental financial support for the employment of clinical nurse educators. METHODS: This study employed a repeated cross-sectional design to assess the project outcomes. Following the framework of the Kirkpatrick Evaluation Model, secondary data from annual self-program evaluation reports were analyzed to assess program satisfaction, clinical adaptation, and turnover rates of novice nurses. The "Strengthening the Reporting of Observational Studies in Epidemiology checklist" guided the reporting of the study. RESULTS: The project played a pivotal role in enhancing the quality of nursing education. Novice nurses' program satisfaction and clinical adaptation consistently remained high or exhibited an increase. The project led to a decrease in turnover rate among novice nurses, while the coronavirus 2019 pandemic resulted in increased turnover rates due to limited clinical practice opportunities for nursing students. CONCLUSION: Government support for clinical nurse educators has positively impacted the institutionalization of nursing education. The pressing need is to prioritize not only the enhancement of nursing education quality and the improvement of nurses' working conditions but also the development of healthcare policies and programs to effectively respond to unforeseen challenges and crises. IMPLICATIONS FOR NURSING POLICY: Government and healthcare institutions must collaborate to strengthen clinical education, crucial for novice nurses' clinical adaptation. Prioritizing the improvement of nursing education quality and nurses' working conditions is essential. Continuous research and evaluation of the Clinical Nurse Educator Support Project is imperative to assess its impact and make necessary adjustments.

Dementia-Inclusive Choices for Exercise Toolkit: Impact on the Knowledge, Perspectives, and Practices of Exercise Providers.

Physical activity improves the well-being of persons living with dementia but few exercise programs include them. The Dementia-Inclusive Choices for Exercise (DICE) toolkit aims to improve exercise providers' understanding of dementia and ability to support persons living with dementia in physical activity. We evaluated the co-designed DICE toolkit with exercise providers using a mixed-methods approach comprising pre/post questionnaires and interviews and reflection diaries. Among 16 participants, self-efficacy for exercise delivery to persons living with dementia and both knowledge and attitudes toward dementia significantly improved. Thematic analysis suggested participants (a) had a deeper understanding of the variability of dementia, (b) were planning for equitable access for persons living with dementia, (c) planned to promote social connection through exercise, and (d) were optimistic for future engagement with persons living with dementia. The DICE toolkit may improve exercise providers' knowledge and confidence to plan proactively to support persons living with dementia in programs and services.