An assessment and intervention study of aggressive behavior in cognitively impaired institutionalized elderly

Aggressive behavior is a common problem among elder persons suffering from dementia. It puts themselves, and other persons around them at risk of being injured.1 This qualitative study observed four individuals with Senile Dementia of the Alzheimer's Type (SDAT) who were living in a long term care facility and demonstrated a great deal of aggressive behavior It assessed these individuals for a baseline of behaviors, made environmental changes, and assessed the results. The interventions were successful in decreasing the amount and intensity of the aggressive behavior in three of the individuals studied. The pattern of aggressive behavior and possible causes of this behavior seemed to originate from distinct causes in each of these individuals.2

Distress experienced by nurses in response to the challenging behaviour of residents - evidence from German nursing homes

AIMS AND OBJECTIVES

The aim of this research is to investigate the degree of distress experienced by nurses in response to the challenging behaviour of nursing home residents (residents' challenging behaviour) and their impact on nurses individual resources (general health, burnout and work ability).

BACKGROUND

Because of the increasing and ageing population of nursing home residents, professional nursing care faces several challenges. One highly prevalent issue among nursing home residents is the so-called 'challenging behaviour'. However, to date, 'challenging behaviour' has not yet been recognised as an occupational stressor, and the extent of the impact of 'challenging behaviour' on nurses' well-being and functioning is not well understood.

DESIGN

Cross-sectional study.

METHOD

Self-report questionnaire data collected from 731 registered nurses and nursing aides in 56 German nursing homes were used in a secondary data analysis. The level of residents' challenging behaviour-related distress that nurses experienced was assessed using a scale consisting of nine questions. Validated instruments were used for the assessment of individual resources.

RESULTS

The mean score for residents' challenging behaviour-related distress was 41·3 (SD 21·2). Twenty-seven per cent of all nurses reported over 50 residents' challenging behaviour. Residents' challenging behaviour had a significant impact on all three measures of individual resources. Specifically, nurses exposed to frequent residents' challenging behaviour reported a significantly lower quality of general health, reduced workability and high burnout levels.

CONCLUSION

Our findings indicate that residents' challenging behaviour-related distress is a significant work place stressor for nurses in nursing homes with a clear impact on general health, the risk of burnout and work ability.

RELEVANCE TO CLINICAL PRACTICE

Our findings suggest that residents' challenging behaviour is a stressor for nurses in nursing homes. Further scientific and practical attention is necessary from the point of view of working conditions for nurses. The development of preventive concepts for nursing staff and residents is recommended.

Dissonance in the dining room: a study of social interaction in a special care unit

This study is a multi-method, intrinsic case study of social interaction in a special care unit (SCU) for cognitively impaired older persons. It is found that residents are capable of developing a range of social bonds even though the SCU in question is found to have several organizational and physical factors that unwittingly thwart its therapeutic potential. These limitations are illuminated by consideration of the congruence between the conceptualization of the dining areas held by staff and that held by residents as revealed through the process of negotiation occurring in social interaction. The study adopts an environment-behavior perspective following the theoretical development of Lawton (1986) and merges it with the qualitative approach to place pursued by Goffman (1961) and Gubrium (1978). It is suggested that a focus on place as a unit of analysis offers potential for bridging Quality of Life with the cognitively impaired.