Nursing home caregivers’ explanations for and coping strategies with residents’ aggression: a qualitative study

Nursing Staff's Observations of BPSD Amongst Older Adults with Dementia Living in a Nursing Home: A Qualitative Study

The majority of older adults with dementia living in a nursing home exhibit behavioral and psychological symptoms of dementia (BPSD). This behavior is difficult for residents to cope with. Early recognition of BPSD is important in order to implement personalized integrated treatment, and nursing staff are in the unique position to consistently observe residents' behavior. The aim of this study was to explore nursing staff's experiences observing BPSD of nursing home residents with dementia. A generic qualitative design was chosen. Twelve semi-structured interviews were conducted with nursing staff members until data saturation. Data were analyzed using inductive thematic analysis. Four themes were identified: "group harmony" observations from a group perspective, focused on the disturbance of group harmony; an "intuitive approach", which involves observing unconsciously and without a set method; "reactive intervention", which refers to immediate removal of observed triggers without exploring the causes of behaviors; and "sharing information", which is delayed sharing of observed behavior with other disciplines. The current way in which nursing staff observe BPSD and share observations within the multidisciplinary team explain several existing barriers to achieving high treatment fidelity for BPSD with personalized integrated treatment. Therefore, nursing staff must be educated to structure their daily observations methodologically and interprofessional collaboration improved to share their information in a timely manner.

Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review

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.

Rushing Care by Care Aides Associated With Experiences of Responsive Behaviors From Residents in Nursing Homes

OBJECTIVES

Residents with cognitive impairment favor "slow care," so rushed care may cause additional responsive behaviors (eg, verbal threats, hitting) among residents. We assessed the association of rushed care (physical and social) by care aides with their experiences of responsive behaviors from residents.

DESIGN

Cross-sectional analysis of survey data.

SETTING AND PARTICIPANTS

A total of 3547 care aides (response rate: 69.97%) in 282 care units in a stratified random sample (health region, nursing home size, owner-operator model) of 87 urban nursing homes in Western Canada.

METHODS

Data collection occurred between September 2019 and February 2020. The dependent variables were care aide self-report of 4 types of verbal and physical responsive behavior (yes/no). The independent variables were care aide self-report of rushed physical care (count, range = 0-6) and rushed social care (yes/no). We conducted a 2-level random-intercept logistic regression with each dependent variable, controlling for care aide, care unit, and nursing home characteristics.

RESULTS

In their most recent shift, 2182 (61.5%) care aides reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task). When care aides rushed an additional physical care task, they had 8% higher odds of reporting having experienced yelling and screaming [odds ratio (OR) 1.08, 95% CI 1.01-1.15; P = .019]. When care aides rushed social care (talking with residents), they had 70% higher odds of reporting having experienced yelling and screaming (OR 1.70, 95% CI 1.28-2.25; P < .001). We observed the same pattern for the other types of responsive behaviors.

CONCLUSIONS AND IMPLICATIONS

Rushing of physical or social care tasks by care aides was associated with increased likelihood of responsive behaviors from residents. One approach to reducing both rushed care and resident responsive behaviors may be to improve the care environment for care aides and residents.

Psychosocial Predictors of Anxiety in Nursing Home Staff

OBJECTIVES

Although research shows that nursing home staff experience significant levels of stress and burnout, studies analyzing the relationship of psychosocial variables on their feelings of anxiety are scarce. This study aims to analyze the relationship between psychosocial variables and levels of anxiety among staff.

METHOD

Participants were 101 nursing home professionals. In addition to anxiety, socio-demographic variables, depersonalization, burden, relationship with families of the residents, and guilt about the care offered to the residents were assessed. A hierarchical regression analysis was carried out to analyze the contribution of the assessed variables to staff anxiety levels.

RESULTS

The obtained model explained 57% of the variance in anxious symptomatology. Guilt about the care offered and poor quality of the relationship with residents' family were associated with anxiety. Further, working at nursing homes where the staff report higher levels of anxiety symptoms, the presence of depersonalization and burden were also associated with anxiety.

CONCLUSION

The findings suggest that in addition to work-related variables (burden and burnout), problems with family members and guilt about the care offered are relevant variables for understanding staff's anxious symptomatology.

CLINICAL IMPLICATIONS

Interventions that address issues of guilt about the quality of care, and problematic relationships with family members of residents, may have potential to reduce staff anxiety and promote their well-being.

Use of parametric speaker for older people with dementia in a residential care setting: A preliminary study of two cases

Objective/Background

Older people with dementia often show behavioural and psychological symptoms of dementia such as agitation, aggression, and depression that affect their activities of daily living, and hence reduce the quality of life of their caregivers. The aim of this study was to investigate the effects of a new technological intervention-a parametric speaker, creating a narrow personal acoustic environment, which may reduce the manifestation of behavioural and psychological symptoms of dementia symptoms.

Methods

A parametric speaker was placed on the ceiling of a large day room, and personally selected pieces of music were provided in a narrow space just under the speaker during the intervention. Two older residents with behavioural and psychological symptoms of dementia participated in the experiment.

Results

Playing pieces of favorite music via the parametric speaker decreased their behavioural and psychological symptoms of dementia during the intervention. In addition, this intervention reduced the burden on caregivers. One of the advantages of using parametric speaker was being able to create a personal space in a common room.

Conclusion

We considered that the parametric speaker might be useful to reduce behavioural and psychological symptoms of dementia and the burden on caregivers, providing individualized rehabilitation for the improved quality of life of residents.

Exploring nursing staff views of responsive behaviours of people with dementia in long-stay facilities

WHAT IS KNOWN ON THE SUBJECT?: Caring for people with dementia and responsive behaviours is challenging; however, little is known of nurses' experiences of responsive behaviours. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: To demonstrate understanding nurses need to be aware of their own actions, thoughts, attitudes and reactions. Time, education and management support are essential in enabling a person-centred approach. A decision regarding the place of care is difficult to come to, and given the drive to a person-centred approach, there is a need to consider the views of people with dementia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing staff supporting people with dementia should engage more frequently in reflective practice, ongoing education and decision-making. Service providers/managers need to have an understanding of the complexities of caring for a person with dementia and responsive behaviours and provide their staff with relevant supports and education that is accessible to all staff.

ABSTRACT

Introduction Caring for people with dementia and responsive behaviours can challenge nurses, and little is known of their experiences. Aims To explore nurses' views of supporting people with dementia and responsive behaviours in long-stay facilities. Methods A qualitative descriptive study utilizing in-depth audio-recorded interviews of nine nurses, recruited from private and public care facilities. Qualitative content analyses conducted involving iterative comparisons of transcripts, summaries and memos, where coding, key quotes and tables were developed to determine themes. Results Four themes emerged: recognizing and understanding responsive behaviour, resources and interventions to support people with dementia and responsive behaviour, the impact of education on nursing practice and the care environment. Discussion Availability of staff, adequate time and financial restraints hinder nurses' ability to provide care. Access to ongoing education and being able to provide one-to-one care was valued as dementia-specific education changed nursing practice. Implications for practice Place of care was seen as dependent on the type of responsive behaviour in question, the duration of the behaviour and the impact of the behaviour on the person, other residents and staff. Dementia education needs to be accessible to all staff, and a collaborative approach is necessary in order to develop management guidelines and support strategies.

Japanese care workers' perception of dementia-related physically and psychologically aggressive behaviour symptoms

AIM

The purpose of this study was to explore Japanese care workers' attributions, beliefs and cultural explanations of physically and psychologically aggressive behaviour symptoms.

BACKGROUND

Physically and psychologically aggressive behaviour symptoms by older people with dementia have been associated with occupational stress among care workers in the United States and other Western countries and may contribute to staff turnover. However, few studies related to this issue have been conducted in Japan, where care worker reaction to physically and psychologically aggressive behaviour symptoms might be different because of cultural and customary differences in how care is provided for older people.

METHOD

This study reports on the results of three open-ended questions that were part of a larger study that explored Japanese care workers' experiences with aggressive behaviour symptoms in persons with dementia. Convenience sampling was used to recruit 137 care workers in 10 nursing homes in the northern and western areas of Japan. The answers to the open-ended questions were analysed using a content analysis.

FINDINGS

Most of the participants indicated that they believed that physically and psychologically aggressive behaviour symptoms came from residents' stress from dementia. Approximately, one-fourth of the participants responded that Japanese values such as chu (loyalty) and joge (hierarchy) influenced their work with residents with physically and psychologically aggressive behaviour symptoms. Seventeen participants (12%) commented either that they respected older people or that they respected older people as persons who had had many experiences in life. Interestingly, 43 responses (41.0%) indicated that physically and psychologically aggressive behaviour symptoms influenced quality of care positively, while, not surprisingly, about 30 responses indicated that those behaviour symptoms influenced quality of care negatively.

IMPLICATIONS FOR PRACTICE

Findings from this study indicate that the training and education needs to focus on understand and preventing the effects of stress for individuals living with dementia to reduce aggressive incidents and increase recruitment and retention of care workers.

Factors associated with resident aggression toward caregivers in nursing homes

PURPOSE

Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers' experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes.

DESIGN

A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study.

METHODS

Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied.

FINDINGS

The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 30-45 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 30-45 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04).

CONCLUSIONS

Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed.

CLINICAL RELEVANCE

The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.