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Kobayashi M, Une S, Hara H, Honda M. The Impact of Training in Multimodal Communication Skills on Psychotropic Medication Use in Dementia Care. Cureus 2024; 16:e63413. [PMID: 38947140 PMCID: PMC11213625 DOI: 10.7759/cureus.63413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/02/2024] Open
Abstract
Aim This study aimed to assess the trends in psychotropic drug prescriptions among elderly residents with dementia following the continuous implementation of multimodal comprehensive care communication skills training for staff in a long-term care facility. Methods This retrospective single-center cross-sectional study utilized the database of an urban public hospital that included a long-term care facility. The data were collected from 2016 to 2020. All 130 staff members at the hospital (52 nurses, 48 professional caregivers, seven rehabilitation staff members, three physicians, and three pharmacists) initiated multimodal comprehensive care communication skills basic training from October 2014 to December 2015, which was followed by continuous monthly training until the end of 2020. Antipsychotic prescription rates for residents aged over 65 years with dementia were measured throughout the study period. Results A total of 506 eligible residents were identified, the median age was 86.0 years (IQR: 81.0-90.0), and 283 (55.9%) residents were females. The prescription rates for psychotropic drugs among residents with dementia decreased significantly (43.5% in 2016, 27.0% in 2020; p=0.01). Notably, the percentage of patients prescribed anxiolytics decreased significantly (from 4.7% to 0.0%), while the percentage of patients receiving antipsychotic drugs, hypnotics, antidepressants, or antiepileptic drugs remained unchanged over time. The prescription rates for antidementia drugs significantly decreased from 15.3% to 4.0%. Conclusion The prescription rates of psychotropic drugs were significantly reduced following multimodal comprehensive care communication skills training for staff at a long-term care facility. The improvement in communication skills among staff at long-term care facilities has a tangible impact on reducing drug use among elderly residents with dementia.
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Affiliation(s)
- Masaki Kobayashi
- Internal Medicine, Unity Hospital, Rochester Regional Health, Rochester, USA
- General Internal Medicine, Division of Geriatric Research, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
| | - Saki Une
- General Internal Medicine, Division of Geriatric Research, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
| | - Hisao Hara
- Internal Medicine, Koriyama Medical Care Hospital, Koriyama, JPN
| | - Miwako Honda
- General Internal Medicine, Division of Geriatric Research, National Hospital Organization Tokyo Medical Center, Tokyo, JPN
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Liu W, Chen Y. Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations. J Clin Nurs 2023; 32:3482-3495. [PMID: 35706419 PMCID: PMC9972876 DOI: 10.1111/jocn.16411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study examined the sequential relationships of food intake and the moderating role of the characteristics of intake and resident conditions. BACKGROUND Nursing home residents commonly experience insufficient food intake. While multilevel factors influence intake, evidence on sequential relationships is lacking. DESIGN The study was an observational study using secondary, behavioural analyses following the STROBE Statement. METHODS Videotaped observations (N = 160) collected from a dementia communication trial during 2011-2014 were coded using the refined Cue Utilisation and Engagement in Dementia Mealtime Video-coding Scheme during 2018-2019. The 160 videos involved 27 residents living with dementia and 36 staff in 9 nursing homes. Independent variables were the state (solid intake, liquid intake, no intake) of an intake episode occurring during mealtime (current episode), eating technique (resident-initiated, staff-facilitated) used in the next episode occurring after the current episode (subsequent episode), interval between adjacent episodes, and resident comorbidities and dementia stage. The dependent variable was the state of subsequent episode. RESULTS Successful liquid and solid intake increased odds of subsequent liquid and solid intake. Comorbidities were associated with decreased odds of subsequent liquid and solid intake for staff-facilitated episodes. When liquid intake occurred, staff-facilitation decreased odds of subsequent liquid intake; longer intervals between adjacent episodes increased odds of subsequent solid intake. CONCLUSION Food intake was strongly and sequentially associated, and such temporal relationships were dependent on characteristics of the intake process and resident conditions. RELEVANCE TO CLINICAL PRACTICE The study findings supported that initiating successful intake facilitates continuity of successful intake during mealtime. Behavioural interventions tailored by comorbidities that modify characteristics of the food intake process may improve food intake.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing, Iowa City, Iowa, USA
| | - Yong Chen
- Department of Industrial and Systems Engineering, The University of Iowa College of Engineering, Iowa City, Iowa, USA
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Liu W, Perkhounkova Y, Hein M. Person-centred and task-centred care: Impact on mealtime behaviours in nursing home residents with dementia. Int J Older People Nurs 2023; 18:e12512. [PMID: 36374224 PMCID: PMC9976786 DOI: 10.1111/opn.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/16/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia. METHODS This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression. RESULTS Staff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours. CONCLUSION This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.
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Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing Iowa City Iowa USA
| | | | - Maria Hein
- The University of Iowa College of Nursing Iowa City Iowa USA
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Shaw C, Ward C, Gordon J, Williams K, Herr K. Characteristics of elderspeak communication in hospital dementia care: Findings from The Nurse Talk observational study. Int J Nurs Stud 2022; 132:104259. [PMID: 35623154 PMCID: PMC10408664 DOI: 10.1016/j.ijnurstu.2022.104259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/28/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care. OBJECTIVES The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia. DESIGN A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia. SETTING Three hospital units in one Midwestern university hospital in the United States. PARTICIPANTS A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020. METHODS Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia. RESULTS Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: -0.02, -0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035). CONCLUSIONS Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed. TWEETABLE ABSTRACT This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.
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Affiliation(s)
- Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, Iowa, USA.
| | - Caitlin Ward
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA; Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Canada
| | - Jean Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Kristine Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa, USA
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Bilal Ahmed S, Obieta A, Santos T, Ahmad S, Elliot Ibrahim J. Effects of Nonpharmacological Interventions on Disruptive Vocalisation in Nursing Home Patients With Dementia—A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:718302. [PMID: 36188852 PMCID: PMC9397760 DOI: 10.3389/fresc.2021.718302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
Background Vocally disruptive behaviour is a common and difficult to treat condition in older residents with dementia. The aim of this systematic review is to evaluate the efficacy of nonpharmacological interventions in its management in persons with dementia residing in a nursing home. Methodology A systematic search was conducted using Ovid MEDLINE, CINAHL, and Cochrane databases and reference lists from relevant publications on various nonpharmacological approaches to manage vocally disruptive behaviour in nursing home residents. The method of appraisal was through the National Institutes of Health scoring for the Quality Assessment of controlled intervention studies. Inclusion criteria included residents of nursing homes over the age of 65 with dementia and disruptive vocalisation. Only randomised controlled trials published in English were included. Results A total of 5,606 articles were identified, which cover 501 trials, of which 23 were selected. There were fourteen studies observed to have an impact of clinical and statistical significance with interventions including (i) a multidimensional approach with different nonpharmacological interventions, (ii) multisensory stimulation, (iii) staff education and training, (iv) personalised bathing, and (v) pain recognition and appropriate management. Seven studies demonstrated no observable effect whereas two showed worsening in vocally disruptive behaviour. Conclusions Many aspects of vocally disruptive behaviour management are poorly understood. Limited empirical evidence supports the use of several nonpharmacological interventions to reduce it. There is more robust evidence to support the use of a tailored approach to management over the universal approach.
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Affiliation(s)
- Saad Bilal Ahmed
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
- *Correspondence: Saad Bilal Ahmed
| | - Alfredo Obieta
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Tamsin Santos
- Department of Geriatrics, Ballarat Health Services Ballarat, Queen Elizabeth Centre, Ballarat Central, VIC, Australia
| | - Saara Ahmad
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Joseph Elliot Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Melbourne, VIC, Australia
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Song Y, Mohamed Nassur A, Rupasinghe V, Haq F, Boström AM, Reid C, Andersen E, Wagg A, Hoben M, Goodarzi Z, Squires JE, Estabrooks CA, Weeks LE. Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review. THE GERONTOLOGIST 2022; 63:674-689. [PMID: 35094085 PMCID: PMC10167766 DOI: 10.1093/geront/gnac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.
Research Design and Methods
We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.
Results
From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.
Discussion and Implications
We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | | | - Fajr Haq
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Colin Reid
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary Alberta, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Liu W, Williams K, Batchelor M, Perkhounkova Y, Hein M. Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations. J Adv Nurs 2021; 77:1244-1257. [PMID: 33222218 PMCID: PMC7902310 DOI: 10.1111/jan.14647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 12/01/2022]
Abstract
AIMS To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics. DESIGN A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014. METHODS Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used. RESULTS Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics. CONCLUSIONS Staff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics. IMPACT Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.
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Affiliation(s)
- Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | | | - Melissa Batchelor
- School of Nursing, George Washington University, Washington, DC, USA
| | | | - Maria Hein
- College of Nursing, The University of Iowa, Iowa City, IA, USA
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Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use. J Am Med Dir Assoc 2019; 19:1129-1132. [PMID: 30471803 DOI: 10.1016/j.jamda.2018.09.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES An educational program to enhance communication in nursing home dementia care increased person-centered communication by staff and resulted in reduced resident behavioral symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate effects on resident antipsychotic medication use in participating nursing homes. The National Partnership to Improve Dementia Care set a goal of reducing antipsychotic medications in nursing homes by 15% during the study period. DESIGN A post hoc analysis of Nursing Home Compare data was used to evaluate change in antipsychotic medication rates in nursing homes receiving the communication education versus the corresponding statewide average change. SETTING AND PARTICIPANTS Eleven nursing homes participated in a cluster-randomized controlled trial from 2011 to 2013 in one Midwestern state. MEASURES Antipsychotic medication rates were abstracted from Nursing Home Compare data sets. Antipsychotic medication rates were compared for each participating nursing home for the 2 quarters before and the 2 quarters after the communication intervention. To control for other factors supporting reduction in antipsychotic use, changes in the participating nursing homes were compared to the state average change for the corresponding quarters using a 1-sample t test. RESULTS Antipsychotic medication use decreased on average by 4.88 percentage points (22.9%) in participating nursing homes compared to the state average decrease of 0.68 percentage points (2.7%) during the same period (P = .06). CONCLUSIONS A clinically meaningful reduction in antipsychotic medication usage occurred in the nursing homes that received communication education. Measurable changes in communication and behavioral symptoms were reflected in reductions in antipsychotic medication usage. Improving staff communication has the potential to reduce inappropriate antipsychotic medication use in long-term care.
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Interaction between Nursing Staff and Residents with Aphasia in Long-Term Care: A Mixed Method Case Study. Nurs Res Pract 2018; 2018:9418692. [PMID: 30631596 PMCID: PMC6304643 DOI: 10.1155/2018/9418692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/22/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia. Methods A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored. Results From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: (1) a focus on getting the task done with minimum interaction; (2) topics related to the task, but not necessary to get the task done; and (3) personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents' severity of aphasia nor the activity as such. Conclusions An endeavour to interact socially with the residents with aphasia influences the nurses' foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia.
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An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders. Rehabil Nurs 2018; 43:E25-E34. [DOI: 10.1097/rnj.0000000000000041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levy-Storms L, Harris LM, Chen X. A Video-Based Intervention on and Evaluation of Nursing Aides' Therapeutic Communication and Residents' Agitation During Mealtime in a Dementia Care Unit. J Nutr Gerontol Geriatr 2016; 35:267-281. [PMID: 27897609 DOI: 10.1080/21551197.2016.1238430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The researchers conducted a communication training intervention for certified nursing assistants (CNAs). The intervention aimed at improving CNAs' therapeutic techniques for relating to agitated residents during care. This study focused on an in-depth evaluation of mealtime interactions using videos. Sixteen CNAs and 16 residents living with dementia from one long-term care facility were videotaped during mealtime interactions before and after a therapeutic communication training program. Mixed-effect Poisson regression revealed no effect of the intervention as a whole on residents' refusals, but the intervention did improve CNAs' communication. Additional analyses using specific CNAs' therapeutic communication behaviors indicated a significant negative association with refusals at post-test but not pretest. The findings suggest some communication mechanisms for how the intervention positively influenced residents' refusals.
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Affiliation(s)
- Lené Levy-Storms
- a Departments of Social Welfare and Medicine/Geriatrics , University of California , Los Angeles , California , USA
| | - Lesley M Harris
- b Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA
| | - Xiao Chen
- c Center for Health Policy , University of California , Los Angeles , California , USA
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Abstract
Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.
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Massey M, Roter DL. Assessment of immigrant certified nursing assistants' communication when responding to standardized care challenges. PATIENT EDUCATION AND COUNSELING 2016; 99:44-50. [PMID: 26337004 DOI: 10.1016/j.pec.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Certified nursing assistants (CNAs) provide 80% of the hands-on care in US nursing homes; a significant portion of this work is performed by immigrants with limited English fluency. This study is designed to assess immigrant CNA's communication behavior in response to a series of virtual simulated care challenges. METHODS A convenience sample of 31 immigrant CNAs verbally responded to 9 care challenges embedded in an interactive computer platform. The responses were coded with the Roter Interaction Analysis System (RIAS), CNA instructors rated response quality and spoken English was rated. RESULTS CNA communication behaviors varied across care challenges and a broad repertoire of communication was used; 69% of response content was characterized as psychosocial. Communication elements (both instrumental and psychosocial) were significant predictors of response quality for 5 of 9 scenarios. Overall these variables explained between 13% and 36% of the adjusted variance in quality ratings. CONCLUSION Immigrant CNAs responded to common care challenges using a variety of communication strategies despite fluency deficits. PRACTICE IMPLICATIONS Virtual simulation-based observation is a feasible, acceptable and low cost method of communication assessment with implications for supervision, training and evaluation of a para-professional workforce.
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Affiliation(s)
- Meredith Massey
- National Center for Health Statistics, Hyattsville, MD, USA; Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Impact of caregivers' behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: an interactional perspective. Int Psychogeriatr 2015; 27:1861-73. [PMID: 26165352 DOI: 10.1017/s104161021500099x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The role played by various physical and verbal behaviors of professional caregivers in the onset of resistiveness to care (RTC) and collaborative behaviors of nursing home residents with dementia was assessed in a daily hygienic care routine context. METHODS Two hundred and forty hygienic care routines, observed in eight nursing home residents, were analyzed with a video-assisted systematic observation methodology and a sequential statistical analysis strategy. RESULTS Caregiver and care recipient behaviors are interdependent in the hygienic care routine context. Physical instrumental behavior, neutral, negative and positive statements, positive and negative instructions, and verbal distraction emitted by caregivers are significantly and moderately associated with the onset of RTC in persons with dementia (PWD), but the strength of relationships observed depends on the care recipient's behavior prior to the caregiver's action. Positive instructions are moderately associated with the onset of collaboration in residents with preserved language abilities. However, for residents with severe language impairment, these same instructions were linked to RTC behaviors. CONCLUSIONS Although antecedents to RTC can be identified, the risk that caregiver behaviors trigger resistive responses is higher when care recipients are already exhibiting RTC, and is low when no particular behavior or collaboration is shown. Antecedents to collaboration are also identified and discussed. Although different caregiver behaviors may be more or less likely to elicit resistiveness or collaboration, it is the pre-existing state of the care recipient that will determine its reaction to the caregiver's behavior. Clinical implications emerging from these influential findings are elaborated.
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Gilmore-Bykovskyi AL, Roberts TJ, Bowers BJ, Brown RL. Caregiver Person-Centeredness and Behavioral Symptoms in Nursing Home Residents With Dementia: A Timed-Event Sequential Analysis. THE GERONTOLOGIST 2015; 55 Suppl 1:S61-6. [PMID: 26055782 PMCID: PMC4492066 DOI: 10.1093/geront/gnu164] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/02/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Evidence suggests that person-centered caregiving approaches may reduce dementia-related behavioral symptoms; however, little is known about the sequential and temporal associations between specific caregiver actions and behavioral symptoms. The aim of this study was to identify sequential associations between caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and the temporal variation within these associations. DESIGN AND METHODS Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed using timed-event sequential analysis. RESULTS Although caregiver actions were predominantly person-centered, we found that resident behavioral symptoms were significantly more likely to occur following task-centered caregiver actions than person-centered actions. IMPLICATIONS Findings suggest that the person-centeredness of caregivers is sequentially and temporally related to behavioral symptoms in individuals with dementia. Additional research examining the temporal structure of these relationships may offer valuable insights into the utility of caregiver person-centeredness as a low-cost strategy for improving behavioral symptom management in the NH setting.
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Affiliation(s)
- Andrea L Gilmore-Bykovskyi
- Geriatric Research Education and Clinical Center, William S Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin. University of Wisconsin-Madison School of Nursing.
| | - Tonya J Roberts
- Geriatric Research Education and Clinical Center, William S Middleton Hospital, United States Department of Veterans Affairs, Madison, Wisconsin. University of Wisconsin-Madison School of Nursing
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Williams K, Herman R, Bontempo D. Comparing audio and video data for rating communication. West J Nurs Res 2013; 35:1060-73. [PMID: 23579475 DOI: 10.1177/0193945913484813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Video recording has become increasingly popular in nursing research, adding rich nonverbal, contextual, and behavioral information. However, benefits of video over audio data have not been well established. We compared communication ratings of audio versus video data using the Emotional Tone Rating Scale. Twenty raters watched video clips of nursing care and rated staff communication on 12 descriptors that reflect dimensions of person-centered and controlling communication. Another group rated audio-only versions of the same clips. Interrater consistency was high within each group with Interclass Correlation Coefficient (ICC) (2,1) for audio .91, and video = .94. Interrater consistency for both groups combined was also high with ICC (2,1) for audio and video = .95. Communication ratings using audio and video data were highly correlated. The value of video being superior to audio-recorded data should be evaluated in designing studies evaluating nursing care.
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Affiliation(s)
- Kristine Williams
- University of Kansas, School of Nursing, 3901 Rainbow Boulevard, MS 4043, Kansas City, KS 66160, USA.
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McGilton KS, Sorin-Peters R, Sidani S, Boscart V, Fox M, Rochon E. Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care. BMC Geriatr 2012; 12:61. [PMID: 23050517 PMCID: PMC3538737 DOI: 10.1186/1471-2318-12-61] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/05/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient's needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients' quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff's attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. METHODS/DESIGN A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. DISCUSSION The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with patients and to minimize agitation associated with considerable stress. The improvement of these interactions will lead to a reduction of agitation, which has the additional significance of increasing patients' well-being, quality of life, and satisfaction with care. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01654029.
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Affiliation(s)
- Katherine S McGilton
- Department of Research, Toronto Rehabilitation Institute-UHN, E.W, Bickle Centre for Complex Continuing Care, 130 Dunn Avenue, Toronto, Ontario, M6K 2R7, Canada
- L. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada
| | - Riva Sorin-Peters
- Private Practice, Speech-Language Pathology, Thornhill, Ontario, L4J 5J2, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Veronique Boscart
- School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, 299 Doon Valley Drive, Kitchener, Ontario, N2G 4M4, Canada
| | - Mary Fox
- School of Nursing, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
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Ishii S, Streim JE, Saliba D. A Conceptual Framework for Rejection of Care Behaviors: Review of Literature and Analysis of Role of Dementia Severity. J Am Med Dir Assoc 2012; 13:11-23.e1-2. [DOI: 10.1016/j.jamda.2010.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/31/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
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Padilla R. Effectiveness of Interventions Designed to Modify the Activity Demands of the Occupations of Self-Care and Leisure for People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011; 65:523-31. [DOI: 10.5014/ajot.2011.002618] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
A systematic review of evidence for the effectiveness of modification of activity demands in the care of people with Alzheimer’s disease (AD) was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The review included 10 articles addressing occupations of self-care and leisure. No reports related to work and social participation were located. Results suggest that evidence for this intervention’s effectiveness is strong. Four practice principles were derived from this appraisal: (1) Occupational therapy programs should be individualized to elicit the person’s highest level of retained skill and interest, (2) cues used while assisting people with AD to complete tasks should be short and provide clear direction, (3) compensatory strategies in the form of environmental modifications and simple adaptive equipment should be specifically implemented on the basis of the unique needs of the person, and (4) caregiver training and involvement are essential in implementing individualized programs.
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Affiliation(s)
- René Padilla
- René Padilla, PhD, OTR/L, FAOTA, is Associate Dean for Academic and Student Affairs, Office of Academic and Student Affairs, Criss III Building, Suite 154, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178;
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Vocally disruptive behavior (VDB) in the institutionalized elderly: A naturalistic multiple case report. Arch Gerontol Geriatr 2011; 52:e110-6. [DOI: 10.1016/j.archger.2010.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 08/17/2010] [Accepted: 08/19/2010] [Indexed: 11/18/2022]
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Barrick AL, Sloane PD, Williams CS, Mitchell CM, Connell BR, Wood W, Hickman SE, Preisser JS, Zimmerman S. Impact of ambient bright light on agitation in dementia. Int J Geriatr Psychiatry 2010; 25:1013-21. [PMID: 20104513 PMCID: PMC3711022 DOI: 10.1002/gps.2453] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effect of ambient bright light therapy (BLT) on agitation among institutionalized persons with dementia. METHODS High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light. Sixty-six older persons with dementia participated. Outcome measures included direct observation by research personnel and completion by staff caregivers of the 14-item, short form of the Cohen-Mansfield Agitation Inventory (CMAI). RESULTS Analyses of observational data revealed that for participants with mild/moderate dementia, agitation was higher under AM light (p = 0.003), PM light (p < 0.001), and All Day light (p = 0.001) than Standard light. There was also a trend toward severely demented participants being more agitated during AM light than Standard light (p = 0.053). Analysis of CMAI data identified differing responses by site: the North Carolina site significantly increased agitation under AM light (p = 0.002) and PM light (p = 0.013) compared with All Day light while in Oregon, agitation was higher for All Day light compared to AM light (p = 0.030). In no comparison was agitation significantly lower under any therapeutic condition, in comparison to Standard lighting. CONCLUSIONS Ambient bright light is not effective in reducing agitation in dementia and may exacerbate this behavioral symptom.
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Affiliation(s)
- Ann Louise Barrick
- Department of Psychology, University of North Carolina at Chapel Hill and Central Regional Hospital, NC, USA.
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill
| | | | - C. Madeline Mitchell
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Bettye Rose Connell
- Rehabilitation Research and Development Center of Excellence, Atlanta Veterans Affairs Medical Center, Division of Geriatrics, Emory University, Atlanta, GA
| | - Wendy Wood
- Department of Occupational Therapy, Colorado State University
| | - Susan E. Hickman
- School of Nursing, Oregon Health & Science University, Portland, Oregon, Indiana University, Indianapolis, Indiana
| | - John S. Preisser
- School of Public Health, University of North Carolina at Chapel Hill
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and School of Social Work, University of North Carolina at Chapel Hill
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McGilton K, Sorin-Peters R, Sidani S, Rochon E, Boscart V, Fox M. Focus on communication: increasing the opportunity for successful staff-patient interactions. Int J Older People Nurs 2010; 6:13-24. [DOI: 10.1111/j.1748-3743.2010.00210.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fukaya Y, Koyama S, Kimura Y, Kitamura T. Education to promote verbal communication by caregivers in geriatric care facilities. Jpn J Nurs Sci 2009; 6:91-103. [PMID: 20021578 DOI: 10.1111/j.1742-7924.2009.00128.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Our previous study divided the verbal communication between caregivers and elderly residents at geriatric care facilities into Type I communication (to elicit activities of daily living) and Type II communication (conversation that occurs in normal social life) and found that Type II communication promotes utterances by elderly residents. This study conducted an education intervention to promote Type II talking by caregivers and evaluated the results. METHODS At three geriatric care facilities, 243 caregivers who might care for 36 elderly residents experienced training involving lectures and group discussion to understand the importance of Type II talking and how to apply it to their daily work. A statistical comparison was applied to the changes in Type II talking duration from before the intervention, 1 week after the intervention, and 3 months after the intervention to evaluate the effect of the educational intervention. RESULTS At two facilities, the Type II talking duration increased significantly from before the educational intervention to 1 week after the intervention and remained higher after 3 months. However, the educational intervention's effect was not clear at one facility. There was no significant difference in the elderly persons' total utterance duration, but it increased from before the intervention to 1 week after the intervention. CONCLUSION After the educational intervention, the amount of Type II talking by the caregivers increased significantly 1 week after the intervention for two facilities, but although the amount of Type II talking was higher at 3 months than before the intervention, it was not as high as 1 week after the intervention.
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Affiliation(s)
- Yasuko Fukaya
- School of Health Sciences, Tokai University, Kanagawa, Japan.
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McGilton KS, Boscart V, Fox M, Sidani S, Rochon E, Sorin-Peters R. A Systematic Review of the Effectiveness of Communication Interventions for Health Care Providers Caring for Patients in Residential Care Settings. Worldviews Evid Based Nurs 2009; 6:149-59. [DOI: 10.1111/j.1741-6787.2009.00155.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herman RE, Williams KN. Elderspeak's influence on resistiveness to care: focus on behavioral events. Am J Alzheimers Dis Other Demen 2009; 24:417-23. [PMID: 19692706 DOI: 10.1177/1533317509341949] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resistiveness to care (RTC) in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home (NH) staff increases the probability of RTC in older adults with dementia. The current analysis used general sequential querier (GSEQ) software to analyze behavior sequences of specific behavioral events. We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying). Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors thereby increasing the quality of care to these residents. The results clearly demonstrate that sequential analysis of behavioral events is a useful tool in examining complex communicative interactions and targeting specific problem behaviors.
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Affiliation(s)
- Ruth E Herman
- University of Kansas School of Nursing, Kansas City, Kansas 66160, USA
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Levy-Storms L. Therapeutic communication training in long-term care institutions: recommendations for future research. PATIENT EDUCATION AND COUNSELING 2008; 73:8-21. [PMID: 18656320 DOI: 10.1016/j.pec.2008.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Revised: 05/02/2008] [Accepted: 05/25/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this review is to critique contemporary experimental research and to recommend future directions for research interventions on nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in institutional long-term care settings. METHODS This literature review covers 13 journal articles (1999-2006) and focuses on the strengths and weaknesses of experimental research interventions to improve nursing aides' therapeutic communication with older adults who have cognitive impairment and/or dementia in long-term care settings. RESULTS Based on this review, recommendations for improved experimental designs include a minimum of two groups with one being a control and randomization of subjects at the care unit level, an average 3-5h of total training, a minimum of a 6-month total evaluation period, and objective outcomes relevant to both nursing aides and residents. Findings from studies in this review indicate that the following therapeutic communication techniques can be taught and can benefit staffs and older adults' quality of life: verbal and non-verbal communication behaviors including open-ended questions, positive statements, eye contact, affective touch, and smiling. CONCLUSIONS Some evidence exists to support that nursing aides can improve their therapeutic communication during care. PRACTICE IMPLICATIONS Nursing aides need not only more training in therapeutic communication but also ongoing, dedicated supervision in psychosocial aspects of care.
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Affiliation(s)
- Lené Levy-Storms
- University of California, Los Angeles, Schools of Public Affairs and Medicine, Departments of Social Welfare & Medicine/Geriatrics, Borun Center for Gerontological Research, Los Angeles, CA, USA.
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Abstract
BACKGROUND Vocally disruptive behavior (VDB) in the elderly is a common condition, especially in people with dementia, but difficult to treat. It may occur in as many as 40% of nursing home residents. This study is a review of the existing literature on this condition. METHOD The literature review was conducted using PubMed (particularly Medline and the Cochrane database) and reference lists from relevant publications in English, French, and German. RESULTS Most studies are small and no conclusive prevalence data are available. Many biological and psychosocial treatments have been advocated, but most studies are little more than anecdotal case reports. It is evident that VDB can have deleterious consequences on others and the patients themselves, although no studies specifically examine the range or the pervasiveness of VDB. Etiopathogenic research on VDB is still in its infancy. CONCLUSIONS Most aspects surrounding VDB are insufficiently understood. The heterogeneity and multiple contributive factors regarding VDB suggest quite convincingly that a panoply of different interventions tailored to the individual's needs will be required to overcome VDB and the suffering related to it.
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Williams KN, Herman R, Gajewski B, Wilson K. Elderspeak communication: impact on dementia care. Am J Alzheimers Dis Other Demen 2008; 24:11-20. [PMID: 18591210 DOI: 10.1177/1533317508318472] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.
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Affiliation(s)
- Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Visser SM, McCabe MP, Hudgson C, Buchanan G, Davison TE, George K. Managing behavioural symptoms of dementia: effectiveness of staff education and peer support. Aging Ment Health 2008; 12:47-55. [PMID: 18297478 DOI: 10.1080/13607860701366012] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study was designed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members' attitudes about working with people with dementia and level of burnout. Staff from three aged care facilities participated in the study (n=52). These facilities were randomly assigned to one of two intervention groups or a control group. Staff assigned to the intervention groups received an eight-week behaviourally-based programme. Staff from one aged care facility also participated in a peer support group designed to reinforce educational material and facilitate positive changes among staff members. Behavioural symptoms displayed by residents (n=76) in each of the facilities were also assessed. Assessments were conducted at pre-intervention, post-intervention, three- and six-month follow-up. The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life. Education or peer support also did not impact on staff members' level of burnout. There was, however, a change in staff members' attitudes about working with people with dementia. Possible explanations for these findings and implication for further research are considered.
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Affiliation(s)
- S M Visser
- School of Psychology, Deakin University, Victoria, Australia
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Carpiac-Claver ML, Levy-Storms L. In a manner of speaking: communication between nurse aides and older adults in long-term care settings. HEALTH COMMUNICATION 2007; 22:59-67. [PMID: 17617014 DOI: 10.1080/10410230701310307] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Older adults in long-term care facilities have few opportunities for emotionally meaningful social interactions with noninstitutional social ties; yet having such relationships is a basic human need that affects well-being. Among institutional social ties, affective communication can enhance relationships between residents and nurse aides, who provide most of their care. This naturalistic study identifies types and examples of nurse aide-initiated communication with long-term care residents during mealtime assistance in the context of residents' responses. Verbal and nonverbal communication from videos of nurse aides and residents in two skilled nursing facilities (n = 17) and an assisted living facility (n = 6) were transcribed. The transcripts were coded and the data were organized into categories using grounded theory methods. Although substantial content emphasized instrumental communication (i.e., prompts to eat and/or drink), 4 types of affective communication initiated by nurse aides emerged: "personal conversation," "addressing the resident," "checking in," and "emotional support/praise." These results suggest that affective verbal communication needs further development in terms of scope and depth to optimize residents' well-being. The specific examples of nurse aides' affective verbal communication with residents from these findings can be incorporated and expanded on in nurse aide training programs to improve the way nurse aides relate to residents during care provision.
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Bharani N, Snowden M. Evidence-based interventions for nursing home residents with dementia-related behavioral symptoms. Psychiatr Clin North Am 2005; 28:985-1005, x. [PMID: 16325737 DOI: 10.1016/j.psc.2005.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nipali Bharani
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA.
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Boustani M, Zimmerman S, Williams CS, Gruber-Baldini AL, Watson L, Reed PS, Sloane PD. Characteristics Associated With Behavioral Symptoms Related to Dementia in Long-Term Care Residents. THE GERONTOLOGIST 2005; 45 Spec No 1:56-61. [PMID: 16230750 DOI: 10.1093/geront/45.suppl_1.56] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This article describes care for behavioral symptoms related to dementia (BSRD) and identifies their potential correlates among 347 residents with dementia living in 45 assisted living facilities and nursing homes from four states. The prevalence of BSRD was associated with staff training and resident cognition, mood, mobility, and psychotropic use. Attention to staff training and depression management might improve BSRD.
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Affiliation(s)
- Malaz Boustani
- Regenstrief Institute, Inc., and Indiana University Center for Aging Research, Indianapolis, IN 46202-2872, USA.
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Abstract
BACKGROUND Agitation and passivity are behavioral symptoms exhibited by 90% of nursing home residents with dementia. They account for many poor health outcomes, caregiver burden, and increased costs of long-term care. OBJECTIVES This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior (NDB) model: activities matched to skill level only; activities matched to style of interest only; and a combination of both (NDB-derived) for responding to the behavioral symptoms of dementia. METHODS Thirty participants were randomly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables. Trained research assistants, blind to condition match, implemented each condition for 12 consecutive days. Measures of engagement (time on task and participation), affect, and behavioral symptoms (agitation and passivity) were taken from videotape recordings of each session. Mood was measured with the Dementia Mood Picture Test. The primary analysis method was mixed-model analysis of variance. RESULTS Significantly more time on task, greater participation, more positive affect, and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline. Agitation and negative affect improved under all treatments compared with baseline. There was no significant change in mood. DISCUSSION The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia. These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment.
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Affiliation(s)
- Ann M Kolanowski
- School of Nursing, The Pennsylvania State University, University Park, USA.
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McMinn B, Draper B. Vocally disruptive behaviour in dementia: development of an evidence based practice guideline. Aging Ment Health 2005; 9:16-24. [PMID: 15841828 DOI: 10.1080/13607860512331334068] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vocally Disruptive Behaviour (VDB) is a term that includes screaming, abusive language, moaning, perseveration, and repetitive and inappropriate requests. It is one of the most challenging behaviours for nursing home staff, caregivers for people with dementia, and other nursing home residents. As with other behavioural disturbances, multiple causal factors have been identified in the literature and individual cases may have a number of interacting factors. There is a lack of consensus about how to treat VDB. Systematic treatment studies are few and there is a lack of empirical data supporting the effectiveness of specific interventions commonly used in clinical practice. This hinders clinicians and may result in the use of inappropriate treatments. Our aim was to systematically review the literature in order to develop a practice guideline for the assessment and management of VDB. The review will examine the typology, risk factors and management of VDB.
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Affiliation(s)
- B McMinn
- Centre for Mental Health Studies, Newcastle, NSW, Australia.
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FUKAYA Y, SUZUKI K, SHITITA K. Predictors and correlates of the frequency and the length of verbal communications between nursing staff and elderly residents in geriatric care facilities. Jpn J Nurs Sci 2004. [DOI: 10.1111/j.1742-7924.2004.00019.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Gerontological nurses promote health and successful aging for a growing population of older adults. Care providers unknowingly may communicate messages of dependence, incompetence, and control to older adults by using elderspeak, a speech style similar to baby talk, that fails to communicate appropriate respect. This article describes a communication training program that significantly reduced the use of elderspeak by nursing assistants and led t more respectful, less controlling, and equally as caring communication between nursing assistants and nursing home residents. Strategies to use in evaluating and enhancing interpersonal communication with older clients are provided. Therapeutic communication is a critical tool for nurses who provide health care to the growing populati of older adults.
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Somboontanont W, Sloane PD, Floyd FJ, Holditch-Davis D, Hogue CC, Mitchell CM. Assaultive Behavior in Alzheimer's Disease: IDENTIFYING IMMEDIATE ANTECEDENTS DURING BATHING. J Gerontol Nurs 2004; 30:22-9; quiz 55-6. [PMID: 15471060 DOI: 10.3928/0098-9134-20040901-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To identify immediate antecedents of bathing-related physical assaults against caregivers by nursing home residents with Alzheimer's disease and related disorders, videotapes of nursing home residents who physically assaulted nursing assistants during baths were analyzed. Caregiver behaviors that occurred significantly (p < .01) more often during the 5 seconds preceding an assault included: calling the resident by name, confrontational communication, invalidation of the resident's feelings, failure to prepare the resident for a task, disrespectful speech, any touch, absence of physical restraint, and hurried pace of bath. Assaults were significantly more likely when caregivers sprayed water without a verbal prompt; the resident's feet, axilla, or perineum were touched; residents exhibited signs of temperature discomfort; and multiple caregivers were present. Improved caregiver training and individualized, gentler bathing methods should be investigated as methods of reducing assaults.
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Affiliation(s)
- Wilaipun Somboontanont
- Faculty of Nursing, Department of Community Health Nursing, Mahidol University, Bangkok, Thailand
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