Ee-Yuee Chan

Background: Reminiscence improves cognitive functions in persons with dementia (PWD) and strengthens familial relationships. However, the extent of dyadic reminiscence (caregivers’ involvement in delivering reminiscence), which impacts how interventions are designed for optimal home delivery, remains poorly mapped. Objective: This scoping review mapped literature regarding dyadic home-based reminiscence interventions. Methods: Six databases were searched for empirical studies. Two independent reviewers conducted screening and data extraction, followed by descriptive content analysis. Results: Thirty studies were included. Caregiver involvement formed a “continuum of engagement” across three broad categories: (i) observers of the PWD, (ii) co-creators of shared materials, and (iii) facilitators of reminiscence-based therapeutic strategies. Key outcomes included quality of life, dyadic relational experience, and PWD neuropsychiatric symptoms. Conclusion: Caregivers should be recognised as active partners capable of shaping and enhancing intervention outcomes. Future research should prioritise exploring home-based reminiscence interventions that integrate caregiver participation as a core design element.

Background: Caregiver education is fundamental to dementia care, yet novice caregivers often receive large amounts of information immediately following diagnosis, when emotional adjustment and learning readiness may influence engagement. Less is known about how caregivers engage with, understand and apply dementia‐related information in this period. This study explored caregivers' experiences of receiving and applying information during nurse‐led dementia counselling, using Cognitive Load Theory as one interpretive lens alongside broader Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping. Methods: A secondary qualitative descriptive study was conducted using semi‐structured interview data from 11 novice dementia caregivers recruited from a tertiary hospital's outpatient geriatric clinic. Data were analysed using reflexive thematic analysis, with multiple theoretical frameworks serving as sensitising lenses to inform interpretation. Results: Three themes were identified: (1) ‘ Navigating Informational Demands in Early Dementia Caregiving ,’ reflecting difficulties engaging with complex information during emotional distress and uncertainty; (2) ‘ Building Understanding Through Practical Experience and Repetition ’, describing how caregivers gradually applied and contextualised information through practice and repeated exposure; and (3) ‘ Preferences for Accessible , Individualised and Integrated Dementia Education ’, highlighting preferences for staged, personalised, multimodal, and integrated educational support. Emotional readiness, prior experience, practical relevance and accessible support systems were identified as important influences on caregivers' learning experiences. Discussion: Post‐diagnostic learning was shaped by the interaction between emotional adjustment, informational demands and available support. Findings suggest that dementia counselling may be better supported through staged, personalised and multimodal approaches rather than single information‐dense encounters. While Cognitive Load Theory offered one useful perspective, the findings more broadly reflected emotional, relational and transitional experiences, better understood through the complementary lenses of Meleis' Transition Theory and Lazarus and Folkman's Transactional Model of Stress and Coping, with practical implications for psychogeriatric nursing and post‐diagnostic caregiver support.

As primary end-users, nurses’ intention or motivation to use the hospital electronic medical records can influence its adoption and effective usage. This study explores nurses’ intention to use the Next Generation Electronic Medical Record, a novel electronic medical record implemented in Singapore, as compared to first-generation systems. Cross-sectional surveys were conducted at 2 time points in a tertiary hospital where nurses were surveyed using the Unified Theory of Acceptance and Use of Technology to capture their intention to use the first-generation and novel systems. Welch t test was used to compare means between time points. Multivariable regression analysis was used to determine the predictors of nurses’ intention to use the novel system. At each time point, 1152 and 723 nurses responded, where most were registered nurses aged 31 to 40 years old. Positive predictors include performance expectancy, effort expectancy, and social influence, while negative predictors include technological savviness and nursing designation. Effort expectancy, the perceived ease of use, was the strongest predictor. This study found that nurses’ intentions remained positive across time points. Key predictors like effort expectancy could be targeted to promote effective use of the novel electronic medical record. Suggested strategies include continuous, robust training and involving end-users in the design and implementation process.

Aims: This review aims to explore instructional approaches employed in teaching complex procedural skills among caregivers. Design: Integrative Review. Data Sources: Electronic searches were conducted across seven databases: CINAHL, PubMed, OVID, ScienceDirect, Web of Science, ProQuest Central and Google Scholar. Manual searches of references within relevant studies were also performed. Original, peer‐reviewed studies published in English between 2014 and 2025 were reviewed. Methods: The Whittemore and Knafl method of integrative review was utilised to comprehensively examine literature encompassing various methodological designs. 17 articles that examined the learning of procedural skills among caregivers were included. Results: The optimal approach to enhancing caregivers' knowledge, competence and confidence involves a learner‐centric training model involving multiple phases. Effective caregiving begins with a thorough preparation of the caregiver, which is key to ensuring the success of the training programme. Next, knowledge can be imparted through diverse learning approaches and paradigms to cater to individual learning styles. Subsequently, the translation of knowledge gained to hands‐on practice, deepens understanding and enhances caregivers' practical skills competency. Finally, confidence is built through providing opportunities and platforms for repeated practice, leading to mastery and increased confidence over time. Conclusions: While specific learning pedagogies were not highlighted in the literature, the instructional approaches summarised in the existing literature closely resembled an existing teaching pedagogy: Peyton's Four‐Step Approach. This approach is a stepwise teaching framework that has been widely used in healthcare teaching. The approaches used in the studies align with this approach and future interventions should consider designing their training accordingly to enhance its efficacy. Impact: A well‐designed training programme fosters caregiver resilience and preparedness, enabling them to navigate challenges effectively and sustainably. Future research could focus on creating an all‐encompassing caregiver training that integrates the various approaches. Its feasibility and effectiveness in improving the caregiver preparation process could then be assessed. Patient or Public Contribution: No patient or public contribution.

Singapore is experiencing both an ageing population and a decreasing birth rate, with fewer adults to care for older adults. Caregiving for older adults can be taxing, and hence, caregivers need support. Using previous literature and the study team’s interactions with caregivers, a multicomponent intervention, consisting of a mobile application, fall detection and response service, and peer support program, was conceptualized. To better understand the needs and challenges of caregivers and to determine the potential usefulness of the multicomponent intervention, the study team engaged ward nurses and Community Health Team (CHT) members, two groups of stakeholders that regularly interact with caregivers in their work, using a modified Delphi technique. Ward nurses and CHT members each formed one Delphi panel and answered statements specific to their panel over two rounds. Nineteen ward nurses and 15 CHT members participated. The final participation rate for both rounds was 100% (19/19) for ward nurses and 93% (14/15) for CHT members. A total of 17/30 statements (57%) and 10/32 statements (31%) reached consensus for ward nurses and CHT members, respectively. Ward nurses agreed that (a) caregivers will benefit from a one‐stop digital resource library (84%), (b) the importance of having a wide array of localized information for this digital resource (79%–89%) and (c) several challenges associated with caregiver training (74%–79%). The CHT members agreed that (a) caregivers do not receive adequate support outside their immediate family (86%), (b) caregivers struggle to manage care recipients’ behaviours and emotions (80%), and (c) there is a lack of relevant community resources for caregivers (71%–93%). The agreements indicated the feasibility of certain components of the intervention. Refinements to the multicomponent intervention were also made based on the findings.

Background: Set against the backdrop of a rapidly ageing population and growing emphasis on the importance of ageing-in-place, family members often assume the role of a caregiver. Navigating through a complex healthcare system while simultaneously juggling the daily care needs of their care-recipients, caregivers often become worn out by the intense caregiver stress and burden, neglecting their own well-being. This translates to adverse health and economic outcomes such as prolonged hospital stays and increased nursing home placement of care-recipients. Seeking to better support caregivers, we developed a theory of change to guide the design and implementation of a caregiver support programme – Project Carer Matters. Methods: We applied theory of change methodology to explain how the Project’s interventions were hypothesised to lead to their identified short-to-long term goals, drawing on a causal analysis based on available evidence. The theory of change was developed with insights garnered from previous research studies conducted on caregiver stress, stakeholder engagement sessions and multiple dialogues with clinical experts and hospital leaders. Results: Our final theory of change is the result of the evaluation of the Project in its pilot phase. It is populated with the resources, activities and short-to-long term outcomes that can be attributed or linked to the Project. Multiple meetings and discussion with stakeholders over the pilot prompted frequent practice of the Plan, Do, Study, Act model to refine the ongoing implementation process and the theory of change itself. Conclusions: A theory of change is essential in guiding the design, implementation and evaluation of a complex health care intervention such as Project Carer Matters. The development of the theory of change is a journey and not a resultant product. This journey has also led us to learn that 1) a theory of change needs to be dynamic and ever evolving with time and context, 2) the perspectives of relevant stakeholders need to be included in this process to ensure the feasibility and sustainability of the project in the long run and 3) frequent stakeholder engagements are essential in enabling the implementation team to fine-tune the Project in an effective manner. Trial registration: ClinicalTrials.gov, NCT05205135, registered on 24/01/2022.

Introduction: Family members caring for a person living with dementia (PWD) can experience caregiver burden, leading to psychological distress if unmanaged. It's essential for healthcare professionals, especially nurses to identify caregivers at risk of stress and depression, triggering prompt management during their contact with caregivers of PWD. The study team developed an evidence-based caregiver burden-mastery hybrid assessment and intervention decision matrix (CHAT-MI) for caregivers of PWD and examined its feasibility of use. Objective: To determine the feasibility and usability of implementing the CHAT-MI assessment-decision matrix tool in an outpatient setting in Singapore. Methods: CHAT-MI was developed through earlier research, research evidence, clinical guidelines, and expert opinion. A multimethod study was conducted in a Singapore outpatient memory clinic from November 2020 to January 2021. Caregivers of PWD who attended the clinic self-administered the assessment tool to determine their burden and personal mastery levels. Clinicians used a decision matrix to guide interventions based on the assessments. Feedback was gathered from both caregivers and clinicians through surveys and semistructured interviews. Results: Thirty-four caregivers and six clinicians participated in the study. Caregivers found the burden-mastery assessment tool relatively easy to use and understand and helpful. Clinicians found the assessment-decision matrix tool acceptable, feasible, and useful, enhancing standard care by providing insights into caregivers’ current coping capabilities. Clinicians shared that junior clinicians could benefit from CHAT-MI to better detect caregiving stress and deliver interventions. Nevertheless, more can be done to train clinicians in the understanding of the concept of mastery (i.e., perceived control over life events) to help clinicians better engage and support caregivers. Conclusion: CHAT-MI was found to be relatively brief and can aid the outpatient clinic setting. This suggests that such an evidence-based assessment cum intervention can be considered for use in a real-world clinical setting to aid both caregivers and clinicians.

Background: Set against the backdrop of a rapidly ageing population and growing emphasis on the importance of ageing-in-place, family members often assume the role of a caregiver. Navigating through a complex healthcare system while simultaneously juggling the daily care needs of their care-recipients, caregivers often become worn out by the intense caregiver stress and burden, neglecting their own well-being. This translates to adverse health and economic outcomes such as prolonged hospital stays and increased nursing home placement of care-recipients. Seeking to better support caregivers, we developed a theory of change to guide the design and implementation of a caregiver support programme – Project Carer Matters. Methods: We applied theory of change methodology to explain how the Project’s interventions were hypothesised to lead to their identified short-to-long term goals, drawing on a causal analysis based on available evidence. The theory of change was developed with insights garnered from previous research studies conducted on caregiver stress, stakeholder engagement sessions and multiple dialogues with clinical experts and hospital leaders. Results: Our final theory of change is the result of the evaluation of the Project in its pilot phase. It is populated with the resources, activities and short-to-long term outcomes that can be attributed or linked to the Project. Multiple meetings and discussion with stakeholders over the pilot prompted frequent practice of the Plan, Do, Study, Act model to refine the ongoing implementation process and the theory of change itself. Conclusions: A theory of change is essential in guiding the design, implementation and evaluation of a complex health care intervention such as Project Carer Matters. The development of the theory of change is a journey and not a resultant product. This journey has also led us to learn that 1) a theory of change needs to be dynamic and ever evolving with time and context, 2) the perspectives of relevant stakeholders need to be included in this process to ensure the feasibility and sustainability of the project in the long run and 3) frequent stakeholder engagements are essential in enabling the implementation team to fine-tune the Project in an effective manner. Trial Registration: ClinicalTrials.gov, NCT05205135, registered on 24/01/2022.