Practice of Horticultural Activities Training Program for the Staff in the Nursing Home

Objective: The purpose of this study was to examine the effects of an intervention of a horticultural activities training program for the staff in the nursing home. Methods: The participants (n=13) were the staff in the nursing home (nurses, care workers, occupational therapists). They were divided into six to seven people per group (a total of 2 groups). The training was carried out 90 min once a month. The training was carried out a practice and lecture. It was carried out a total of four times for each group. We conducted a questionnaire on training content after the training. Results: From the answers of the participants to the training content, participants showed almost satisfaction to the training content. Our results demonstrate the benefits of participation in a horticultural activities training program improved after the intervention. With regard to comments, Training content would lead to acquisition of knowledge about horticultural activities, and an increased motivation to care for dementia using of horticultural activities. Conclusions: We suggest that horticultural activities training program would lead to interest in horticultural activities for dementia to staffs, and increased motivation for the use of horticultural activities to staffs. However, the number of participants in this study was small. Therefore, further, involving a greater number of participants are necessary to confirm the effects of horticultural activities training program for the staff in the nursing home. Practice of Horticultural Activities Training Program for the Staff in the Nursing Home Publication History: Received: November 05, 2016 Accepted: December 12, 2016 Published: December 14, 2016


Introduction
Now the number of people with dementia is rapidly increasing with the increase of the number of elderly people. The number of people around the world living with dementia is predicted to rise to 135 million by 2050 [1]. Aging in Japan is advancing at a globally unprecedented rate, and there is a need to provide high quality nursing care for aged people. Treatment and effective prevention methods of Alzheimer's disease has not yet been discovered. Thus, in health-care settings such as nursing homes and day care centers, "nonpharmacologic" approaches are being introduced to help maintain the mental condition of elderly people with dementia [2]. Nonpharmacologic therapies include music, reminiscence, art, and reality orientation therapies, and have been shown to improve quality of life (QOL) and prevent disability among elderly people. Among these therapies, horticultural activities encourage interaction between people and plants [3]. The usefulness of horticultural activities in the field of dementia is beginning to be recognised by the scientific community. And it have reported psychologic [4], physical [5], social [6], and cognitive [7] benefits.
The authors have tried to develop a horticultural activities program for elderly patients with mild to moderate dementia [8]. And we have tried to examine the effects of an intervention of a horticultural activities program. These results suggested that this program is effective care method in order to improve vitality, cognitive function, and Behavioral and Psychological Symptoms of Dementia (BPSD) [9]. Further studies on the spread of horticultural activities for elderly people with dementia are needed. This time, the authors have developed a horticultural activities training program for the staff in the nursing home facility. The purpose of this study was to examine the effects of an intervention of a horticultural activities training program for the staff in the nursing home.

Participants
The participants (n=13) were the staff in the nursing home. The distribution of participants is shown in Table 1. The participants comprised nurses, care workers, occupational therapists. [2 men and 11 women]. They were divided into six to seven people per group (a total of 2 groups). The researchers explained the study's objectives and methods and that the potential participants had the freedom of choice to participate in the study.

Intervention methods
The training was carried out 90 min once a month. The training was carried out a practice and lecture. The basic session flow and schedule are shown in Table 2. It was carried out a total of four times for each group. We conducted a questionnaire on training content after the training.

Evaluation methods and statistical analyses
After completion of the program, we examined participants' learning needs and attitude changes, using five questionnaire:

Results
Answers of the participants to the training content are shown in Table 3. With regard to questionnaire 1, "Agree very much" and "Agree The training, there is a lecture and practice, I were able to learn happily.
Anytime soon, I felt that want to go horticultural activities.
Understanding of horticultural activities were deepened.
In the future, while evaluating the change of the residents, we want to go gardening activities.
In the future, we want to go gardening activities while evaluating the change of the nursing home residents.
The contents of the training is easy to understand, I could use immediately. considerably" had high values of more than 80.0%. For questionnaire 2, 3, 4, and 5, results for the values of participants who selected "Agree very much" and "Agree considerably" were 100.0%. With regard to comments, Training content would lead to acquisition of knowledge about horticultural activities, and an increased motivation to care for dementia using of horticultural activities.

Discussion
To increase the effectiveness and extent of horticultural activities program in dementia care settings, it is important to interact in a manner that alters the staff members' awareness and thereby behavior. This will enable staff members and participants to experience horticultural activities together, and staff members themselves would become interested in horticultural activities and thereby would identify a corresponding change in participants [9].
In this study, the authors have developed a horticultural activities training program for the staff in the nursing home. Then, we examined the effect of intervention of the program. From the answers of the participants to the training content, participants showed almost satisfaction to the training content.
Our results demonstrate the benefits of participation in a horticultural activities training program improved after the intervention. We suggest that horticultural activities training program would lead to interest in horticultural activities for dementia to staffs, and increased motivation for the use of horticultural activities to staffs. The major limitations of this study were the small number of participants. Therefore, further, involving a greater number of participants are necessary to confirm the effects of horticultural activities training program for the staff in the nursing home.

Limitations
The major limitations of this study were the small number of participants. Therefore, further, involving a greater number of participants are necessary to confirm the effects of horticultural activities training program for the staff in the nursing home.

Conclusions
The purpose of this study was to examine the effects of an intervention of a horticultural activities training program for the staff in the nursing home. We suggest that horticultural activities training program would lead to interest in horticultural activities for dementia to staffs, and increased motivation for the use of horticultural activities to staffs. In the future, it is necessary to confirm the effect of horticultural activities by the staff who received the training.