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Boltz M, Van Haitsma K, Baier RR, Sefcik JS, Hodgson NA, Jao YL, Kolanowski A. Ready or Not: A Conceptual Model of Organizational Readiness for Embedded Pragmatic Dementia Research. Res Gerontol Nurs 2024:1-12. [PMID: 38598780 DOI: 10.3928/19404921-20240403-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take and scale-up of evidence-based dementia care practices across settings, diverse populations, and disease trajectories. Organizational readiness for implementation is a salient consideration when planning and conducting embedded pragmatic trials, in which interventions are implemented by provider staff. The current article examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of this construct. We offer a preliminary conceptual model for explicating and measuring organizational readiness and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Kolanowski A, Bowers B, Mueller C, Harrington C. RN Staffing Shortages in Nursing Homes: Nursing is Part of the Solution. J Gerontol Nurs 2024; 50:3-5. [PMID: 38015214 DOI: 10.3928/00989134-20231121-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Ann Kolanowski
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
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Kolanowski A, Bowers B, Mueller C, Harrington C. RN Staffing Shortages in Nursing Homes: Nursing Is Part of the Solution. Res Gerontol Nurs 2024; 17:3-5. [PMID: 38261626 DOI: 10.3928/19404921-20231121-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Ann Kolanowski
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania
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Gilmore‐Bykovskyi A, Griffin JM, Mueller KD, Parnia S, Kolanowski A. Toward harmonization of strategies for investigating lucidity in AD/ADRD: A preliminary research framework. Alzheimers Dement 2023; 19:343-352. [PMID: 35757902 PMCID: PMC9792622 DOI: 10.1002/alz.12709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
Episodes of lucidity (ELs) in Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization, and diverse approaches to operationalizing features of these events. To advance systematic investigation of ELs in AD/ADRD, there is a need for clarity and precision in labeling event attributes, markers, and specific measurement strategies that enable operational harmonization across distinct approaches to investigating the relatively broad and nascent phenomenon. To that end, we propose a preliminary research framework to guide harmonization of approaches to investigating ELs in AD/ADRD. Our goal is to provide an initial schematic that encourages uniform labeling of operational decisions about ELs.
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Affiliation(s)
- Andrea Gilmore‐Bykovskyi
- Department of Emergency Medicine, University of Wisconsin‐Madison School of Medicine & Public HealthMadisonWisconsinUSA
- UW Center for Health Disparities ResearchMadisonWisconsinUSA
| | - Joan M. Griffin
- Division of Health Care Delivery ResearchMayo ClinicRochesterMinnesotaUSA
- Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
| | - Kimberly D. Mueller
- University of Wisconsin‐Madison Department of Communication Sciences and DisordersMadisonWisconsinUSA
- Division of GeriatricsDepartment of MedicineUniversity of Wisconsin‐Madison School of Medicine & Public HealthMadisonWisconsinUSA
| | - Sam Parnia
- NYU Langone Medical CenterNew York CityNew YorkUSA
| | - Ann Kolanowski
- Penn State Ross and Carol Nese College of NursingState CollegePennsylvaniaUSA
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Morgan B, Foley K, Hodgson N, Kolanowski A, Strauch K, Zionts N, Dickson C, Degenholtz H. REVISITING THE TEACHING NURSING HOME: QUALITATIVE ANALYSIS OF NURSING STUDENTS’ CLINICAL EXPERIENCE. Innov Aging 2022. [PMCID: PMC9767055 DOI: 10.1093/geroni/igac059.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Revisiting the Teaching Nursing Home is a two-year pilot project to address the long-term care workforce shortage by introducing nursing students to geriatric nursing while also improving quality of care within nursing homes. The initiative has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Undergraduate and graduate nursing students at three Schools of Nursing participated in clinical experiences at regional nursing homes. Students completed an “activity feedback” form after each clinical rotation at the nursing home or related activity, such as a session about the 4Ms or quality improvement/assessment. The activity feedback form asked students to share their most important takeaway and suggestions for improvement. Data from 340 feedback forms was coded qualitatively using conventional and directed content analysis using the American Association of Colleges of Nursing (AACN) Essentials for Professional Nursing Education. Multiple coders and audit trials were used to establish rigor. Students’ takeaways encompassed 7 of 8 key concepts in the AACN Essentials; Knowledge for Nursing Practice, Person-Centered Care, and Interprofessional Partnerships were most frequently mentioned. Students provided numerous suggestions for improving their clinical experiences including facilitated learning from instructors and supported engagement with nursing home staff. In conclusion, the program addressed many of the core competencies designated by AACN. One recommendation that flows from these findings is to enhance the role of clinical preceptors in the nursing home setting to facilitate mentored training.
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Affiliation(s)
- Brianna Morgan
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kierra Foley
- Penn Nursing, Philadelphia, Pennsylvania, United States
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ann Kolanowski
- Penn State University, State College, Pennsylvania, United States
| | - Kim Strauch
- Penn School of Nursing, Philadelphia, Pennsylvania, United States
| | - Nancy Zionts
- Jewish Healthcare Foundation, Pittsburgh, Pennsylvania, United States
| | - Chelsea Dickson
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, United States
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Boltz M, Van Haitsma K, Baier R, Sefcik J, Hodgson N, Kolanowski A. A CONCEPTUAL MODEL OF ORGANIZATIONAL READINESS FOR IMPLEMENTATION OF EMBEDDED PRAGMATIC DEMENTIA RESEARCH. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Organizational readiness for implementation refers to the collective willingness and efficacy of people, processes, and internal and external contexts within study sites to implement an intervention; it is a salient consideration when planning and conducting embedded pragmatic trials. This paper examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of the construct. We synthesize the literature to offer a conceptual model for explicating and measuring organizational readiness for implementation and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. Our model was derived from the Consolidated Framework for Implementation Research (CFIR), and Weiner’s Determinants and Outcomes of Organizational Readiness for Change. We discuss how it can serve as a guide when planning and conducting embedded pragmatic implementation trials in settings that care for persons with dementia.
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Affiliation(s)
- Marie Boltz
- Penn State , Pennsylvania State University, Pennsylvania , United States
| | | | - Rosa Baier
- School of Public Health, Brown University , Providence, Rhode Island , United States
| | - Justine Sefcik
- Drexel University , Philadelphia, Pennsylvania , United States
| | - Nancy Hodgson
- University of Pennsylvania , Philadelphia, Pennsylvania , United States
| | - Ann Kolanowski
- Penn State University , Penn State University, Pennsylvania , United States
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Sillner A, Berish D, Mailhot T, Sweeder L, Fick D, Kolanowski A. DELIRIUM SUPERIMPOSED ON DEMENTIA IN POST-ACUTE CARE: NURSE DOCUMENTATION OF SYMPTOMS AND INTERVENTIONS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Delirium is common in older adults and across settings of care, including post-acute care (PAC). Nurses have an important role in identifying, preventing and managing delirium. Even though best practice guidelines highlight the need to accurately document delirium and to deliver non-pharmacological, nurse-driven interventions, it is unclear how this is done in PAC. The aim of this research was two-fold: 1) to describe how nurses document DSD symptoms in PAC nursing notes and 2) to determine if appropriate non-pharmacological nursing interventions are included in their documentation when DSD is present. The sample (N=281) was drawn from a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve-DSD) across 8 facilities. Participants tended to be white, female, and had a high-school education. A total of 115 participants (40.6%) had full delirium per the CAM upon admission to PAC, while the remainder 168 (59.4%) had subsyndromal delirium. All had a baseline of dementia. Symptoms of ‘Confusion or Acute Confusion’ were reported for more than 50% of patients. Approximately 90% of had the symptom ‘Confusion or Acute Confusion’ documented and this was also the most commonly documented symptom for which a nursing-driven intervention was provided. Overall delirium symptoms and interventions were poorly documented by nurses. Implications for future research and practice include understanding how the pandemic and subsequent resource deprivations impacted delirium documentation and intervention in this setting. Also there is a need for expanded nurse and other healthcare provider education.
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Affiliation(s)
- Andrea Sillner
- Pennsylvania State University Ross and Carol Nese College of Nursing , University Park, Pennsylvania , United States
| | - Diane Berish
- Pennsylvania State University , University Park, Pennsylvania , United States
| | | | - Logan Sweeder
- The Pennsylvania State University , State College, Pennsylvania , United States
| | - Donna Fick
- Penn State University , University Park, Pennsylvania , United States
| | - Ann Kolanowski
- Penn State University , Penn State University, Pennsylvania , United States
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Gilmore-Bykovskyi A, Griffin J, Mueller K, Parnia S, Kolanowski A. APPROACHES TO INVESTIGATING LUCIDITY IN ADRD: A PRELIMINARY RESEARCH FRAMEWORK TO GUIDE OPERATIONAL HARMONIZATION. Innov Aging 2022. [PMCID: PMC9770291 DOI: 10.1093/geroni/igac059.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Episodes of lucidity (EL) in Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), also termed “paradoxical lucidity,” have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization and diverse approaches to operationalizing features of these events. To advance systematic investigation of EL in AD/ADRD, there is a need for clarity and precision in labeling event attributes, markers, and specific measurement strategies that enable operational harmonization across distinct approaches to investigating the relatively broad and nascent phenomenon. To that end, we propose a preliminary research framework to guide harmonization of approaches to investigating EL in AD/ADRD. Our goal is to provide a systematized approach to characterizing operational decisions that facilitates comparability across different methodological approaches and measurement strategies while allowing for exploration of multiple definitional criteria, measurement standards, and interpretive approaches.
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Affiliation(s)
| | - Joan Griffin
- Mayo Clinic, Rochester, Minnesota, United States
| | - Kimberly Mueller
- University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Sam Parnia
- NYU Grossman School Of Medicine, New York, New York, United States
| | - Ann Kolanowski
- Penn State University, State College, Pennsylvania, United States
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Behrens LL, Boltz M, Sciegaj M, Kolanowski A, Jones JR, Paudel A, Van Haitsma K. Nursing Staff Perceptions of Outcomes Related to Honoring Residents' "Risky" Preferences. Res Gerontol Nurs 2022; 15:271-281. [PMID: 36214738 PMCID: PMC10189806 DOI: 10.3928/19404921-20220930-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff, Potential Harms to Residents, and Positive Shared Outcomes. These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [Research in Gerontological Nursing, 15(6), 271-281.].
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Madrigal C, Resnick B, Eshraghi K, Ellis J, Kolanowski A, Van Haitsma K. Testing the Reliability and Validity of the Revised Care Plan Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress in Persons With Dementia. Res Gerontol Nurs 2022; 15:303-311. [PMID: 36214737 DOI: 10.3928/19404921-20220930-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Checklist for Evidence of Person-Centered Care Approaches for Behavioral and Psychological Symptoms of Distress (BPSD) in Care Plans was developed to assess the person-centeredness of care plans for nursing home residents living with behavioral and psychological symptoms associated with dementia. The purpose of the current study was to evaluate the reliability and validity of a revised version of the Checklist. Data from a larger randomized clinical trial testing the implementation of the Evidence of Integration Triangle for BPSD were used. One hundred seventy-nine care plans for 103 residents were examined. Descriptive statistics, Rasch analysis, and inter-rater reliability were used. The Checklist demonstrated evidence of inter-rater reliability and validity based on model fit and acceptable INFIT and OUTFIT statistics. This study serves as pilot work for future Checklist use and validation efforts on a larger scale. Findings encourage a discourse on the inclusion of BPSD and person-centered approaches in care plans for those living with dementia. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Resnick B, Galik E, McPherson R, Boltz M, Van Haitsma K, Kolanowski A. Gender Differences in Disease, Function, and Behavioral Symptoms in Residents with Dementia. West J Nurs Res 2022; 44:812-821. [PMID: 34044668 PMCID: PMC8627520 DOI: 10.1177/01939459211018822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants were female (n = 640, 72%) and White (n = 618, 70%) with a mean age of 86.58 years (SD = 10.31). Differences by gender with regard to age, physical function, depressive symptoms, agitation/aggression, and resistiveness to care were tested using multivariate analysis of variance. Older females with moderate to severe dementia present with more depressive symptoms (anxiety, sadness, and somatic complaints) than males. Males present with more aggressive behavior and are more likely to receive anticonvulsants. Caregivers should focus on preventing and managing depressive symptoms including anxiety, sadness, and somatic complaints among older females and aggressive behavior in older males with dementia.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Rachel McPherson
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, University Park, PA, USA
| | | | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, University Park, PA, USA
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Kolanowski A, Zhu S, Van Haitsma K, Resnick B, Boltz M, Galik E, Behrens L, Eshraghi K, Ellis J. 12-month trajectory and predictors of affect balance in nursing home residents living with dementia. Aging Ment Health 2022; 26:1686-1692. [PMID: 34253099 PMCID: PMC8752645 DOI: 10.1080/13607863.2021.1947964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives:Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The purpose of this study was to extend prior research by examining the pattern of well-being using affect balance, the ratio of positive to negative affect, in nursing home residents living with dementia over 12 months and its association to factors that could potentially influence resident well-being.Method:This study was a secondary analysis of baseline, 4 and 12-month data from a pragmatic clinical trial. A total of 536 residents with moderate to severe cognitive impairments from 55 nursing homes were included in the multivariable linear mixed model regression analyses.Results:Resident function, the number of registered nurse hours devoted to care in the facility, and the quality of staff interaction predicted higher affect balance over time after controlling for other variables.Conclusion:The findings provide support for the utility of affect balance as a meaningful outcome measure of well-being for persons living with dementia. In addition, results point to specific interventions (i.e. maintaining/improving resident function, providing adequate nurse staffing levels, and improving staff communications skills) that can serve as the focus for both research and practice to help residents live well with dementia. Clinicaltrials.gov (NCT03014570).
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Affiliation(s)
| | - Shijun Zhu
- Associate Professor & Statistician, University of Maryland School of Nursing, 655 West Lombard Street, Suite 402K, Baltimore, MD 21201
| | | | - Barbara Resnick
- Sonya Ziporkin Gershowitz Chair in Gerontology, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Marie Boltz
- Professor and Elouise Ross Eberly and Robert Eberly Endowed Chair, College of Nursing, Penn State, University Park, Pa. 16802
| | - Elizabeth Galik
- Professor, School of Nursing, University of Maryland, Baltimore MD 21218
| | - Liza Behrens
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Karen Eshraghi
- Project Director, College of Nursing, Penn State, University Park, Pa. 16802
| | - Jeanette Ellis
- Project Director, School of Nursing, University of Maryland, Baltimore MD 21218
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Carpenter JG, Scott WJ, Kononowech J, Foglia MB, Haverhals LM, Hogikyan R, Kolanowski A, Landis‐Lewis Z, Levy C, Miller SC, Periyakoil VJ, Phibbs CS, Potter L, Sales A, Ersek M. Evaluating implementation strategies to support documentation of veterans' care preferences. Health Serv Res 2022; 57:734-743. [PMID: 35261022 PMCID: PMC9264454 DOI: 10.1111/1475-6773.13958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously-ill veterans have care goals and LST decisions elicited and documented. DATA SOURCES Primary data from national databases for VA nursing homes (called Community Living Centers [CLCs]) from 2018 to 2020. STUDY DESIGN In one project, we distributed monthly feedback reports summarizing LST template completion rates to 12 sites as the sole implementation strategy. In the second involving five sites, we distributed similar feedback reports and provided robust external facilitation, which included coaching, education, and learning collaboratives. For each project, principal component analyses matched intervention to comparison sites, and interrupted time series/segmented regression analyses evaluated the differences in LSTDI template completion rates between intervention and comparison sites. DATA COLLECTION METHODS Data were extracted from national databases in addition to interviews and surveys in a mixed-methods process evaluation. PRINCIPAL FINDINGS LSTDI template completion rose from 0% to about 80% throughout the study period in both projects' intervention and comparison CLCs. There were small but statistically significant differences for feedback reports alone (comparison sites performed better, coefficient estimate 3.48, standard error 0.99 for the difference between groups in change in trend) and feedback reports + external facilitation (intervention sites performed better, coefficient estimate -2.38, standard error 0.72). CONCLUSIONS Feedback reports + external facilitation was associated with a small but statistically significant improvement in outcomes compared with comparison sites. The large increases in completion rates are likely due to the well-planned national roll-out of the LSTDI. This finding suggests that when dissemination and support for widespread implementation are present and system-mandated, significant enhancements in the adoption of evidence-based practices may require more intensive support.
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Affiliation(s)
- Joan G. Carpenter
- Organizational Systems and Adult HealthUniversity of Maryland School of NursingBaltimoreMarylandUSA,Corporal Michael J. Crescenz VAMCPhiladelphiaPennsylvaniaUSA,Department of Biobehavioral Health SciencesUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | | | - Jennifer Kononowech
- Center for Clinical Management ResearchVA Ann Arbor Health Care SystemAnn ArborMichiganUSA
| | - Mary Beth Foglia
- Veterans Health AdministrationNational Center for Ethics in Health CareWashingtonDistrict of ColumbiaUSA,School of Medicine, Department of Bioethics and HumanitiesUniversity of WashingtonSeattleWashingtonUSA
| | - Leah M. Haverhals
- Denver‐Seattle Center of Innovation, Rocky Mountain Regional VA Medical CenterVA Eastern Colorado Health Care SystemAuroraColoradoUSA,Division of Health Care Policy and Research, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Robert Hogikyan
- Department of Internal Medicine, Division of Geriatric and Palliative MedicineUniversity of MichiganAnn ArborMichiganUSA,GRECCVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Ann Kolanowski
- Penn StateRoss & Carol Nese College of NursingUniversity ParkPennsylvaniaUSA
| | | | - Cari Levy
- Denver‐Seattle Center of Innovation, Rocky Mountain Regional VA Medical CenterVA Eastern Colorado Health Care SystemAuroraColoradoUSA,Division of Health Care Policy and Research, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Susan C. Miller
- Brown University School of Public HealthWarwickRhode IslandUSA
| | - V. J. Periyakoil
- Health Economics Resource Center (HERC)VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA,Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ciaran S. Phibbs
- Health Economics Resource Center (HERC)VA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA,Stanford University School of MedicineStanfordCaliforniaUSA
| | - Lucinda Potter
- Veterans Health AdministrationNational Center for Ethics in Health CareWashingtonDistrict of ColumbiaUSA
| | - Anne Sales
- Center for Clinical Management ResearchVA Ann Arbor Health Care SystemAnn ArborMichiganUSA,Sinclair School of NursingUniversity of MissouriColumbiaMissouriUSA
| | - Mary Ersek
- Corporal Michael J. Crescenz VAMCPhiladelphiaPennsylvaniaUSA,Department of Biobehavioral Health SciencesUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA,Leonard Davis InstitutePhiladelphiaPennsylvaniaUSA
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14
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K. Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia. J Nurs Care Qual 2022; 37:282-288. [PMID: 34775420 PMCID: PMC9095753 DOI: 10.1097/ncq.0000000000000606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. PURPOSE The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. METHODS This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. RESULTS Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. CONCLUSIONS Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore (Drs Resnick and Galik and Ms Ellis); and Pennsylvania State University, University Park (Drs Haitsma, Kolanowski, Boltz, and Behrens and Ms Eshraghi)
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15
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Harris M, Kolanowski A, Greenberg S. The Making of Nurse Leaders in the Nursing Home. Nurs Clin North Am 2022; 57:171-178. [PMID: 35659980 DOI: 10.1016/j.cnur.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse leaders are first and foremost, registered nurses. Nursing leadership is critical for improving the care and quality of life for older adults. Visionary nurse leaders collaborate, motivate, influence, and inspire the achievement of values and goals to improve the quality of life for older adults in long-term care. Professional registered nurses are transformational servant nurse leaders who hold the key to nursing home reform.
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Affiliation(s)
- Melodee Harris
- University of Arkansas for Medical Sciences, College of Nursing, 4301 West Markham Street, Slot #529, Little Rock, AR 72205, USA.
| | - Ann Kolanowski
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, PA 16802, USA
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16
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Kolanowski A, Heid AR, Behrens L, Riley K, Madrigal C, Boltz M, Van Haitsma K, Resnick B, Galik E, Ellis J, Eshraghi K. Community Goal Setting and Attainment: Organizational Characteristics and Indicators of Staff Adoption. J Gerontol Nurs 2022; 48:5-12. [PMID: 35511062 DOI: 10.3928/00989134-20220404-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In residential care communities (CCs), implementation strategies can improve the use of person-centered approaches for residents' behavioral symptoms of distress. We examined staff perceptions of how well their organizational goals for achieving person-centered care (PCC) were met following implementation of the strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Distress. We also identified organizational characteristics and indicators of staff adoption associated with perceived goal attainment. Goal attainment was evaluated by staff using goal attainment scaling (GAS) at the completion of the implementation trial in 26 CCs. Correlations, t tests, and linear regression were used to determine which factors were associated with goal attainment. Total time spent with the research facilitator, stable staff group membership, and presence of a survey deficiency during the study period explained 63% of the variance in goal attainment. Staff can set achievable organizational goals to improve PCC for residents' behavioral symptoms of distress. [Journal of Gerontological Nursing, 48(5), 5-12.].
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Renn CL, Dorsey SG. Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia. Front Pain Res (Lausanne) 2022; 2:757654. [PMID: 35295523 PMCID: PMC8915686 DOI: 10.3389/fpain.2021.757654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black, from 55 nursing were included in this study. The Winsteps statistical program was used to perform the Rasch analysis and evaluate the reliability and validity of the measure based on internal consistency, infit and outfit statistics, mapping, and a differential item functioning (DIF) analysis. The AMOS statistical program was used for confirmatory factor analysis. The findings supported the reliability and validity of the PAINAD when used with these individuals and demonstrated that there was no evidence of invariance between the Black and White residents. All the items fit the model, but there was not a good spread of the items across the pain level of the participants. The majority of the participants (75%) were so low in pain signs or symptoms that they could not be differentiated. Based on the clinical practice and observations, it is recommended that additional items can be added to the measure such as observing the individual for evidence of resisting care, retropulsion when trying to stand, hitting or kicking when turning in bed, hitting or kicking when transferring from bed to chair, hitting or kicking when ambulating, or hitting or kicking when raising arms, less engagement with others, and decreased participation in the activities previously enjoyed.
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Affiliation(s)
- Barbara Resnick
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | | | - Ann Kolanowski
- Pennsylvania State University, University Park, PA, United States
| | - Elizabeth Galik
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Marie Boltz
- Pennsylvania State University, University Park, PA, United States
| | - Jeanette Ellis
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Liza Behrens
- Pennsylvania State University, University Park, PA, United States
| | - Karen Eshraghi
- Pennsylvania State University, University Park, PA, United States
| | - Cynthia L Renn
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Susan G Dorsey
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Renn C, Dorsey SG. The Relationship Between Pain, Function, Behavioral, and Psychological Symptoms of Dementia and Quality of Life. Pain Manag Nurs 2022; 23:55-61. [PMID: 34353739 PMCID: PMC8807789 DOI: 10.1016/j.pmn.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/17/2021] [Accepted: 07/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study evaluated the association between age, sex, comorbidities, cognition, and administration of opioids with pain and the impact of all of these variables plus function, agitation, resistiveness to care, and depression on quality of life among residents in nursing home with severe dementia. DESIGN This was a descriptive study using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia implementation study. METHODS Model testing was done using structural equation modeling. The sample included 553 residents from 55 nursing homes with a mean age of 83.88 (standard deviation = 10.44) and mean Brief Interview of Mental Status of 4.30 (standard deviation = 3.50). RESULTS There were significant associations showing those who were older, male, had fewer comorbidities, better cognition, and were black were more likely to have pain. Pain, in combination with the demographic and descriptive variables, explained 32% of the variance in function, 75% of the variance in depression, 88% of the variance in agitation, 98% of the variance in resistiveness to care, and 92% of the variance in quality of life. The model however did not show a good fit to the data. SETTING The study was done in 55 nursing homes in Maryland and Pennsylvania. PARTICIPANTS/SUBJECTS A total of 553 residents were included in the study. CONCLUSIONS The model did not have a good fit with the data which likely was due to the lack of variance in outcomes. The hypothesized paths, with the exception of opioid use, were significant.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Kimberly VanHaitsma
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Marie Boltz
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Karen Eshraghi
- Pennsylvania State University, Nursing Sciences Building, University Park, Pennsylvania
| | - Cynthia Renn
- University of Maryland School of Nursing, Baltimore, Maryland
| | - Susan G Dorsey
- University of Maryland School of Nursing, Baltimore, Maryland
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Mast BT, Ertle EM, Kolanowski A, Mountain G, Moniz‐Cook E, Halek M. Person‐centered assessment of apathy and resistance to care in people living with dementia: Review of existing measures. A&D Transl Res & Clin Interv 2022; 8:e12316. [PMID: 35910667 PMCID: PMC9322820 DOI: 10.1002/trc2.12316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022]
Abstract
Introduction The review described in this paper builds upon the Dementia Care Practice Recommendations (DCPR) published by the Alzheimer's Association in 2018 and addresses behavior change and the need for targeted outcome measures that evolve from person‐centered frameworks and help evaluate interventions. Apathy and resistance to care (RTC) are two specific behavioral expressions of unmet need or distress exhibited by people living with dementia, which are upsetting to formal and family caregivers and compromise quality of life for people living with dementia. Methods We conducted literature searches of major databases (PsycInfo, PubMed, EBSCO, CINAHL) for papers examining apathy and RTC constructs in samples of people living with dementia. Reliability and validity coefficients were reviewed and reported, along with examination of whether each measure facilitates contextual understanding of behavior. Results Three stand‐alone measures of RTC and ten measures of apathy were identified and reviewed. The RTC measures demonstrated good psychometric properties but do not include the perspective of the person living with dementia or contextual aspects of the behavior. The identified apathy measures demonstrated fair to good psychometric properties, and although there is greater consideration of context, none adequately include the perspective of the person living with dementia. Discussion Although reliable and valid measures have been developed to measure apathy and RTC in people living with dementia, there is greater need for conceptually driven measurement of behavior context and for tools that elicit and include the perspective of the person living with dementia.
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Affiliation(s)
- Benjamin T. Mast
- Psychological & Brain Sciences University of Louisville Louisville Kentucky USA
| | - Emilee M. Ertle
- Psychological & Brain Sciences University of Louisville Louisville Kentucky USA
| | | | | | - Esme Moniz‐Cook
- Faculty of Health Sciences University of Hull Cottingham Rd Hull HU7 6RX UK
| | - Margareta Halek
- School of Nursing Science Witten/Herdecke University Witten Germany
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Behrens L, Riley K, Boltz M, Kolanowski A, Van Haitsma K. Facilitators and Barriers to Implementation of the EIT-4-BPSD Intervention. Innov Aging 2021. [PMCID: PMC8682353 DOI: 10.1093/geroni/igab046.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to explore the perceptions of stakeholders (site champions, administrators, and front-line, social service, and activity staff) regarding the EIT-4-BPSD implementation strategy, including its utility, and the barriers and facilitators to implementation in real-world settings. A process evaluation included qualitative data from focus groups conducted with 93 stakeholders of 21 nursing homes (NHs) that implemented the EIT-4-BPSD strategy. Data were analyzed using a conventional content analysis. Emerging codes were sorted into categories then organized in meaningful clusters based on the domains of the RE-AIM framework. Challenges, facilitators, and contextual factors explain variability in implementation of EIT-4-BPSD strategy among NHs in six key categories: multi-stakeholder engagement, multi-level outcomes, process adaptations, uptake and utility of EIT resources, adoption barriers and facilitators, and future planning. Overall, stakeholders reported that the EIT-4-BPSD strategy can be successfully implemented in NHs and is helpful in improving staffs’ approach to BPSD.
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Affiliation(s)
- Liza Behrens
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park , Pennsylvania, United States
| | - Kiernan Riley
- Penn State University, College Station, Pennsylvania, United States
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Ann Kolanowski
- Penn State, University Park, Pennsylvania, United States
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Behrens L, Boltz M, Kolanowski A, Sciegaj M, Abbott K, Madrigal C, Van Haitsma K. Nursing Staff Perceptions of Risk Outcomes in Delivering Preference-Based Person-Centered Care. Innov Aging 2021. [PMCID: PMC8679328 DOI: 10.1093/geroni/igab046.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Effective management of the perceived risks associated with delivering preference-based person-centered care (PBPCC) is historically challenging for nursing home staff. Existing research lacks the granularity needed to guide clinicians who fear negative health and safety outcomes for residents. This study examined direct-care nursing staff perceptions of outcomes associated with delivering PBPCC. Participants (N=27) worked in NHs experiencing 6-12 health citations, were mostly female (85%), and represented diverse ages, race, education, and collective work experience in NHs. Content analysis of verbatim transcripts from 12 focus groups identified an overarching theme of: “person-centered outcomes related to risk engagement”; and sub-themes of: harms to staff (e.g. fear, frustration, guilt); harms to residents (e.g. negative moods and behaviors, physical discomfort); and positive shared outcomes (e.g. building nurse-resident relationships, positive care environment). Implications for risk management that improves quality of care and life outcomes in a post-COVID era will be discussed.
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Affiliation(s)
- Liza Behrens
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park , Pennsylvania, United States
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Ann Kolanowski
- Penn State, University Park, Pennsylvania, United States
| | - Mark Sciegaj
- Penn State University, University Park, Pennsylvania, United States
| | | | - Caroline Madrigal
- Providence VA Medical Center, Providence VA Medical Center, Rhode Island, United States
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22
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Ertle E, Mast B, Mountain G, Kolanowski A, Moniz-Cook E, Halek M. Person-Centered Assessment of Behavior Changes in People With Dementia. Innov Aging 2021. [PMCID: PMC8968430 DOI: 10.1093/geroni/igab046.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Behavioral and psychological symptoms of dementia are increasingly being reconceptualized as expressions of distress and unmet needs. Measures that evaluate context are needed to increase our understanding of factors that influence these expressions. This review evaluated measures for two common behavioral states that are experienced as challenging for caregivers: apathy and resistance to care. A systematic literature search identified measures of apathy or resistance to care for people living with dementia. Eight measures of apathy and three measures of resistance to care were identified. Reliability and validity of these measures were evaluated using the COSMIN framework, as well as reported contextual factors within which the behavior occurs. The identified measures had fair to good reliability and validity in people living with dementia. However, available measures need to move beyond symptomatic constructs for this complex paradigm, and toward the varied interpersonal and contextual factors associated with behavioral expression.
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Affiliation(s)
- Emilee Ertle
- University of Louisville, Louisville, Kentucky, United States
| | - Benjamin Mast
- University of louisville, louisville, Kentucky, United States
| | - Gail Mountain
- University of Bradford, West Yorkshire, England, United Kingdom
| | - Ann Kolanowski
- Penn State, University Park, Pennsylvania, United States
| | | | - Margareta Halek
- Witten/Herdecke University, Witten, Nordrhein-Westfalen, Germany
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K. Reliability and Validity of the Cornell Scale for Depression in Dementia and Invariance Between Black Versus White Residents in Nursing Homes. J Am Med Dir Assoc 2021; 23:1236-1241.e3. [PMID: 34896057 DOI: 10.1016/j.jamda.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to expand on prior work testing invariance on several depression measures in community-based older adults and explore the psychometric properties and evidence of invariance between racial groups based on the Cornell Scale for Depression in Dementia. DESIGN This was a descriptive measurement study. SETTING AND PARTICIPANTS This was a secondary data analysis using baseline data from 2 studies: Testing the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms Associated with Dementia and the study Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents with Dementia. Combined, 67 nursing homes participated from 2 states and 889 residents were recruited. The mean age of the participants was 86.58 (SD 10.31) and most were women (72%) and White (70%). METHODS This was a descriptive study, and a Rasch analysis was done to establish reliability based on internal consistency and evidence of differential item functioning (DIF) across races. Validity was based on item fit and model testing with structural equation modeling to compare models between White and Black participants. RESULTS There was evidence of internal consistency (alpha coefficient of 0.98) and no significant evidence of DIF. The item related to suicide had a high logit and did not significantly load onto the measurement model for Black individuals. There was not a good spread of the items across the concept of depression. The model had a better fit with the items when used with White versus Black participants. CONCLUSIONS AND IMPLICATIONS The findings indicate that it would be helpful to add some additional items that reflect depressive symptoms among this population. Further, the findings serve as a reminder that this measure may be biased toward identification of symptoms of depression among White versus Black residents.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Organizational Systems and Adult Health, Baltimore, MD, USA.
| | | | - Ann Kolanowski
- Pennsylvania State University, School of Nursing, University Park, PA, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Organizational Systems and Adult Health, Baltimore, MD, USA
| | - Marie Boltz
- Pennsylvania State University, School of Nursing, University Park, PA, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Organizational Systems and Adult Health, Baltimore, MD, USA
| | - Liza Behrens
- Pennsylvania State University, School of Nursing, University Park, PA, USA
| | - Karen Eshraghi
- Pennsylvania State University, School of Nursing, University Park, PA, USA
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24
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Implementation of the Evidence Integration Triangle for behavioral and psychological symptoms of dementia (EIT-4-BPSD) in care communities. Nurs Outlook 2021; 69:1058-1071. [PMID: 34332762 PMCID: PMC8678150 DOI: 10.1016/j.outlook.2021.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Federal regulations stipulate that behavioral interventions be used for behavioral and psychological symptoms of distress in dementia (BPSD). Care community staff have difficulty implementing these approaches. PURPOSE This study tested an implementation strategy, the Evidence Integration Triangle for BPSD (EIT-4-BPSD), for assisting staff in the use of evidence-based behavioral approaches for BPSD. METHODS About 55 care communities were randomized to EIT-4-BPSD or usual care; 553 residents were enrolled. The implementation strategy was delivered by research facilitators, staff, stakeholders, and champions over 12 months. It involved four components: Environment and policy assessments; Staff education; Establishment of person-centered care plans; and Mentoring and motivating staff. The implementation strategy was evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance model. FINDINGS There was no evidence for resident or care community effectiveness. There was evidence of adoption and implementation. DISCUSSION EIT-4-BPSD was helpful as an implementation strategy and staff altered how care was provided.
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Affiliation(s)
| | | | | | | | - Marie Boltz
- Pennsylvania State University, University Park, PA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD
| | | | - Liza Behrens
- Pennsylvania State University, University Park, PA
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25
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Behrens L, Boltz M, Riley K, Eshraghi K, Resnick B, Galik E, Ellis J, Kolanowski A, Van Haitsma K. Process evaluation of an implementation study in dementia care (EIT-4-BPSD): stakeholder perspectives. BMC Health Serv Res 2021; 21:1006. [PMID: 34551782 PMCID: PMC8458006 DOI: 10.1186/s12913-021-07001-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders' perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. METHODS EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. CONCLUSION Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. TRIAL REGISTRATION The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov ( NCT03014570 ) January 9, 2017.
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Affiliation(s)
- Liza Behrens
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA.
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kiernan Riley
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Karen Eshraghi
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Ann Kolanowski
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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26
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Kolanowski A. Healthy Aging: Who is Responsible? The Gerontologist 2021. [DOI: 10.1093/geront/gnab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ann Kolanowski
- Ross and Carol Nese College of Nursing, The Pennsylvania State University , University Park, Pennsylvania , USA
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27
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Resnick B, Galik E, Paudel A, McPherson R, Van Haitsma K, Kolanowski A, Boltz M, Ellis J, Eshraghi K, Behrens L, Zhu S, Breman RB. Reliability and Validity Testing of the Quantified Quality of Interaction Schedule. J Nurs Meas 2021; 29:E95-E109. [PMID: 33863846 PMCID: PMC8324536 DOI: 10.1891/jnm-d-19-00101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the reliability and validity of the Quality of Interactions Schedule (QuIS) using a quantification scoring approach. METHODS Baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used. RESULTS A total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores. CONCLUSION This study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.
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Affiliation(s)
| | | | - Anju Paudel
- University of Maryland School of Nursing, Baltimore, MD
| | | | | | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, PA
| | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, PA
| | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, PA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD
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28
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Wagner LM, Van Haitsma K, Kolanowski A, Spetz J. Recommendations to Deliver Person-Centered Long-Term Care for Persons Living With Dementia. J Am Med Dir Assoc 2021; 22:1366-1370. [PMID: 34044010 PMCID: PMC8996758 DOI: 10.1016/j.jamda.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/24/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022]
Abstract
Person-centered care (PCC) is the standard for the delivery of long-term services and supports (LTSS). In this article, we summarize the state of the science on meaningful outcomes and workforce development and discuss what is needed to ensure that person-centered LTSS becomes a universal reality. These 2 themes are intimately related: the dementia care workforce’s capacity cannot be improved until care processes and outcomes that are significant to PCC are explicated. The LTSS workforce needs training in PCC as well as pragmatic measures to assess the quality of the care they provide. We conclude with several recommendations for future policy and practice-oriented workforce research.
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Affiliation(s)
- Laura M Wagner
- Philip R. Lee Institute for Health Policy Studies and the UCSF Health Workforce Research Center on Long-Term Care, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Ann Kolanowski
- College of Nursing, The Pennsylvania State University, State College, PA, USA
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies and the UCSF Health Workforce Research Center on Long-Term Care, University of California, San Francisco, San Francisco, CA, USA
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29
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McPherson R, Resnick B, Galik E, Kolanowski A, Boltz M, Van Haitsma K. Differences in Staff-Resident Interactions Between Male and Female Residents in Nursing Homes. J Gerontol Nurs 2021; 47:19-25. [PMID: 34039090 DOI: 10.3928/00989134-20210407-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to describe gender differences in the quality of interactions between nursing home residents with behavioral and psychological symptoms of dementia and staff. Data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study were used for the current study. A total of 535 residents (72% female and 28% male) from 55 settings were included in the analyses. The highest percentage of interactions occurred in dining rooms (38.4%) and with nursing staff (68%). There were no significant differences in the quality of staff interactions with male or female residents. Most interactions were positive social (n = 360, 71% males, 66% females), positive care (n = 312, 60% males, 58% females), or neutral (n = 123, 25% males, 22% females). There were 31 (7% males, 6% females) negative protective and 23 (3% male, 5% female) negative restrictive interactions. Future work should focus on eliminating neutral and negative interactions across both genders and address whether the gender of staff is related to the quality of staff-resident interaction. [Journal of Gerontological Nursing, 47(5), 19-25.].
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Kolanowski A, Colling KB, Beattie E. In Memory of a Gerontological Nursing Leader: Ann F. Whall, PhD, RN, FAAN, FGSA. J Gerontol Nurs 2021; 47:7-8. [PMID: 34039097 DOI: 10.3928/00989134-20210407-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ann Kolanowski
- College of Nursing, Pennsylvania State University University Park, Pennsylvania
| | | | - Elizabeth Beattie
- Aged and Dementia Care, School of Nursing, Queensland University of Technology Brisbane, QLD, Australia
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Kolanowski A, Cortes TA, Mueller C, Bowers B, Boltz M, Bakerjian D, Harrington C, Popejoy L, Vogelsmeier A, Wallhagen M, Fick D, Batchelor M, Harris M, Palan-Lopez R, Dellefield M, Mayo A, Woods DL, Horgas A, Cacchione PZ, Carter D, Tabloski P, Gerdner L. A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes. Am J Nurs 2021; 121:24-27. [PMID: 33625007 DOI: 10.1097/01.naj.0000737292.96068.18] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
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Affiliation(s)
- Ann Kolanowski
- The authors of this article are: Ann Kolanowski, PhD, RN, FAAN; Tara A. Cortes, PhD, RN, FAAN; Christine Mueller, PhD, RN, FGSA, FAAN; Barbara Bowers, PhD, RN, FAAN; Marie Boltz, PhD, GNP-BC, FAAN; Deb Bakerjian, PhD, APRN, FAAN, FAANP, FGSA; Charlene Harrington, PhD, RN, FAAN; Lori Popejoy, PhD, RN, FAAN; Amy Vogelsmeier, PhD, RN, FAAN; Margaret Wallhagen, PhD, GNP-BC, AGSF, FGSA, FAAN; Donna Fick, PhD, RN, FAAN; Melissa Batchelor, PhD, RN-BC, FNP-BC, FGSA, FAAN; Melodee Harris, PhD, RN, FAAN; Ruth Palan-Lopez, PhD, GNP-BC, FAAN; Mary Dellefield, PhD, RN, FAAN, Ann Mayo, DNS, RN, FAAN; Diana Lynn Woods, PhD, APRN-BC, FGSA, FAAN; Ann Horgas, PhD, RN, FAAN; Pamela Z. Cacchione, PhD, CRNP, GNP, BC, FGSA, FAAN; Diane Carter, MSN, RN, CS, FAAN; Patricia Tabloski, PhD, GNP-BC, FAAN; and Linda Gerdner, PhD, RN, FAAN . For author affiliations, please see http://links.lww.com/AJN/A205 . Contact author: Ann Kolanowski, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Madrigal C, Kolanowski A, Berish D, VanHaitsma K. Feasible and Appropriate Strategies for Implementing Evidence-Based Practices in Nursing Homes. J Am Med Dir Assoc 2021; 22:717-720. [PMID: 33421370 DOI: 10.1016/j.jamda.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline Madrigal
- Center of Innovation in Long-Term Services and Supports, Providence, RI, USA
| | - Ann Kolanowski
- College of Nursing, Penn State University, University Park, PA, USA
| | - Diane Berish
- College of Nursing, Penn State University, University Park, PA, USA
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Colancecco E, Kolanowski A, Chinchilli V. Gender Differences in Predictive Factors of Older Adults’ IADL Recovery Following Hip Fracture. Innov Aging 2020. [PMCID: PMC7740319 DOI: 10.1093/geroni/igaa057.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
After hip fracture, older adults experience poor functional outcomes including a lack of IADL recovery. Gender differences exist in risk, incidence, mortality, and complication rates; yet, analyses of predictive factors of IADL especially by gender are often not conducted. The purpose of this study was to investigate gender differences in predictive factors of IADL recovery for older adults at two and six months following hip fracture. This secondary analysis used data (n=326 with IADL of n=399) the Baltimore Hip Studies (BHS-7 cohort). Participants were >65 years of age and community-dwelling. Men were sequentially enrolled; women were frequency-matched. Data analysis required building a shared parameter model was built that incorporated an ordinal logistic regression within a generalized linear mixed-effects model, in conjunction with a time-to-event hazards regression model for the time to death or withdrawal. Predictive factors included: age, race, marital status, and comorbidities; physical function; cognitive status (3MS); and psychosocial function (depression [CES-D], resilience, fear of falling, social participation, and perceived health status. Results indicated that higher age (OR 1.1 95% CI 1.05, 1.15, p< .01), greater comorbidity burden (OR 1.31 95% CI 1.08, 1.6, p < .01), poorer baseline Lower Physical ADL ( OR 1.8 95% CI 1.54, 2.15, p< .01), better cognitive function (OR 0.95 95% CI 0.9, 1; p= 0.047) and poorer LPADL recovery (OR 1.27 95% CI 1.07, 1.5, p< .05) significantly impacted IADL recovery. The stratified (by gender) model was not as strong as the full model, but did indicate some gender differences may exist.
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Affiliation(s)
| | - Ann Kolanowski
- Penn State University, University Park, Pennsylvania, United States
| | - Vernon Chinchilli
- Penn State College of Medicine, Hershey, Pennsylvania, United States
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Behrens L, Van Haitsma K, Kolanowski A, Boltz M, Sciegaj M, Abbott K, Madrigal C. Risky Preferences: Nursing Staff Perceptions of Risks May Impede Delivery of Person-Centered Care. Innov Aging 2020. [PMCID: PMC7743791 DOI: 10.1093/geroni/igaa057.3065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Participants (N=27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs experiencing 6-12 health citations. Content analysis of 12 focus groups indicated nursing staff perceptions of risks may impede delivery of PCC. This is supported by the overarching theme: pervasive risk avoidance; and sub-themes of: staff values, supports for risk-taking, and challenges to honoring preferences. Findings will be discussed considering a newly modified risk engagement framework meant to understand and inform the clinical management of older adult preferences perceived to carry risks. Opportunities for future research will be discussed (e.g. measurement development). Part of a symposium sponsored by the Research in Quality of Care Interest Group.
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Affiliation(s)
- Liza Behrens
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | | | | | - Marie Boltz
- Penn State University, University Park, Pennsylvania, United States
| | - Mark Sciegaj
- Penn State University, University Park, Pennsylvania, United States
| | | | - Caroline Madrigal
- Providence VA Medical Center, Providence, Rhode Island, United States
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Kolanowski A. Advancing the Science of Person-Centered Care: Commentary on Kales et al Paper. Am J Geriatr Psychiatry 2020; 28:1270-1271. [PMID: 32950364 DOI: 10.1016/j.jagp.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ann Kolanowski
- Professor Emerita, College of Nursing, Penn State, University Park, PA, 16802.
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Behrens LL, Boltz M, Kolanowski A, Sciegaj M, Madrigal C, Abbott K, Van Haitsma K. Pervasive Risk Avoidance: Nursing Staff Perceptions of Risk in Person-Centered Care Delivery. Gerontologist 2020; 60:1424-1435. [PMID: 32756959 PMCID: PMC7759749 DOI: 10.1093/geront/gnaa099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH) staff perceptions of risks to residents' health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' preferences for everyday living and care activities. RESEARCH DESIGN AND METHODS Qualitative, descriptive design using sequential focus group (FG) methodology. RESULTS Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6-12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences. DISCUSSION AND IMPLICATIONS Development of a multidimensional framework with specific risk engagement measures that account for the unique risk perspectives of nursing staff will contribute significantly to the clinical management of older adult preferences and research on the effectiveness of preference-based PCC delivery in the NH setting.
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Affiliation(s)
- Liza L Behrens
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, State College
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, State College
| | - Mark Sciegaj
- College of Health and Human Development, Pennsylvania State University, State College
| | - Caroline Madrigal
- Center for Innovations in Long-term Services and Supports, Providence Veterans Affairs Medical Center, Rhode Island
| | - Katherine Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio
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Sefcik JS, Madrigal C, Heid AR, Molony SL, Van Haitsma K, Best I, Resnick B, Galik E, Boltz M, Kolanowski A. Person-Centered Care Plans for Nursing Home Residents With Behavioral and Psychological Symptoms of Dementia. J Gerontol Nurs 2020; 46:17-27. [PMID: 33095889 PMCID: PMC8274316 DOI: 10.3928/00989134-20201012-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
Abstract
Little literature exists examining the development and implementation of person-centered care (PCC) plans focused on behavioral and psychological symptoms of dementia (BPSD). The current study aimed to describe BPSD documented in nursing home (NH) residents' care plans, the types of approaches staff document in addressing those symptoms, and whether resident and/or facility characteristics are associated with documentation of PCC approaches. The sample included 553 residents from 55 NHs in two East Coast states. Resistiveness to care (44.9%), agitation (42.2%), and aggression (42%) were most frequently documented in care plans. PCC approaches were documented in care plans in 21.3% to 62.7% of cases depending on BPSD type. Resident (e.g., younger age, lower functional ability, lower cognitive ability, longer length of stay, male gender) and facility (e.g., less certified nursing assistant staffing hours, greater percentage of residents taking antipsychotic medications, non-profit status) characteristics were associated with increased odds of PCC approaches being documented. Optimal PCC planning is discussed, and a sample PCC plan is provided. [Journal of Gerontological Nursing, 46(11), 17-27.].
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Viviano N, Madrigal C. Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test. J Nurs Meas 2020; 28:472-488. [PMID: 33067367 DOI: 10.1891/jnm-d-19-00016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. METHODS This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. RESULTS A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. CONCLUSIONS Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.
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Affiliation(s)
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, PA
| | | | | | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, PA
| | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, PA
| | | | - Caroline Madrigal
- Pennsylvania State University College of Nursing, University Park, PA
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Gawrysiak MJ, Baime M, King TS, Watach AJ, McPhillips MV, Kolanowski A, Schutte-Rodin S, Sawyer AM. Intervention Design and Trial Protocol: Mindfulness-based Exposure for PAP-associated Claustrophobia. West J Nurs Res 2020; 43:261-272. [PMID: 32443950 DOI: 10.1177/0193945920924608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive airway pressure (PAP) associated claustrophobia is common among obstructive sleep apnea patients and plays a prominent role in low adherence and treatment failure. As there are no evidence-based interventions for PAP-associated claustrophobia, the objective of the present research is to pilot test Mindfulness-based Exposure for PAP-associated Claustrophobia, in sleep apnea adults that present with treatment non-adherence and claustrophobia. This approach combines Mindfulness-based Stress Reduction with exposure-based treatment components to target this treatment-associated claustrophobia. The present article outlines the mindfulness exposure intervention design and methods and reports the pilot trial study protocol. Trial findings are intended to: (a) develop a preliminary effect size of the intervention on PAP-associated claustrophobia; (b) explore differences in treatment adherence by group (intervention vs control); and (c) establish feasibility for expanded protocol implementation, delivery, and participant acceptability of the intervention to support subsequent design of a fully powered randomized controlled trial.
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Affiliation(s)
- Michael J Gawrysiak
- Department of Psychology, West Chester University of Pennsylvania, West Chester, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Baime
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tonya S King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alexa J Watach
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda V McPhillips
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann Kolanowski
- College of Nursing, Penn State University, University Park, PA, USA
| | | | - Amy M Sawyer
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia
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Resnick B, Galik E, Kolanowski A, VanHaitsma K, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K. Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia. J Women Aging 2020; 33:635-652. [PMID: 32142386 DOI: 10.1080/08952841.2020.1735925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly VanHaitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Liza Behrens
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Eshraghi
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
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41
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. J Aging Environ 2020; 34:310-331. [PMID: 34378006 PMCID: PMC8351619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study was to test the reliability and validity of the Assessment of the Environment for Person-Centered Management of BPSD and the Assessment of Policies for Person-Centered Management of BPSD. The sample included 35 long term care facilities. There was evidence of reliability based on internal consistency and test-retest reliability of both measures. There was some evidence of validity based on Rasch model testing and INFIT and OUTFIT statistics. Across both measures there were six items with that were endorsed as present by all facilities. The INFIT and OUTFIT statistics were all within the expected range of .5 to 1.5 with the exception of four high OUTFIT statistics for the Assessment of the Environment for Person-Centered Management of BPSD. For the Assessment of Policies for Person-Centered Management of BPSD there were two items that had high INFIT statistics and six with low OUTFIT statistics and one with high OUTFIT statistics. Measure revisions are suggested including removal of some poor fitting items, items with no variance, and adding items to differentiate those very high in evidence of environments and policies that manage BPSD.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
| | | | | | - Elizabeth Galik
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
| | | | - Shijun Zhu
- University of Maryland School of Nursing
| | - Jeanette Ellis
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
| | | | | | - Nicole Viviano
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore MD 21218
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Zhu S, Ellis J, Behrens L, Eshraghi K, Viviano N, Jao YL. Reliability and Validity Testing of the Assessment of the Environment for Person-Centered Management of BPSD and Assessment of Policies for Person-Centered Management of BPSD Measures. Journal of Aging and Environment 2020. [DOI: 10.1080/02763893.2019.1683670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, PA, USA
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marie Boltz
- School of Nursing, Pennsylvania State University, PA, USA
| | - Shijun Zhu
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Jeanette Ellis
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Liza Behrens
- School of Nursing, Pennsylvania State University, PA, USA
| | - Karen Eshraghi
- School of Nursing, Pennsylvania State University, PA, USA
| | - Nicole Viviano
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Ying-Ling Jao
- School of Nursing, Pennsylvania State University, PA, USA
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Kolanowski A, Behrens L, Lehman E, Oravecz Z, Resnick B, Boltz M, Van Haitsma K, Galik E, Ellis J, Eshraghi K. Living Well With Dementia: Factors Associated With Nursing Home Residents' Affect Balance. Res Gerontol Nurs 2020; 13:21-30. [PMID: 31454406 PMCID: PMC6980972 DOI: 10.3928/19404921-20190823-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 11/20/2022]
Abstract
Well-being is an important outcome for people with dementia. The current study is a secondary analysis of baseline data from an ongoing pragmatic trial. Affect balance, the ratio of positive to negative affect, was used as a measure of well-being, and factors related to it were examined in a sample of 325 nursing home residents. Measures of staff interaction during caregiving, staff knowledge of person-centered approaches for dementia care, staff hours of care, the physical environment, person-centered policies, resident function, and quality of life were obtained using direct observation, staff interview, and medical chart review. The results of the quantile multivariable regression analysis indicated that positive staff interaction and higher resident function were significantly associated with higher affect balance after controlling for other variables. The findings have heuristic value for the development of conceptual frameworks that focus on meaningful outcomes for residents with dementia and future research. [Research in Gerontological Nursing, 13(1), 21-30.].
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Galik E, Boltz M, Resnick B, Kolanowski A, Haitsma KV. BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: DOES GENDER MATTER? Innov Aging 2019. [PMCID: PMC6841493 DOI: 10.1093/geroni/igz038.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Regardless of presenting symptoms, there are concerns that BPSD is more often identified in males versus females and males are more likely to be treated with pharmacologic and non-pharmacologic interventions than females. In part this is due to the behaviors in men, specifically aggression, being more distressing for staff and more difficult to manage. The purpose of this study was to test for gender differences in identification and management of BPSD. This was a secondary data analysis using data from the EIT-4-BPSD study including 357 residents, 114 males and 243 females. Men had more aggressive behavior (p=.03) and women more refusal of care (p=.05) and repetitive verbal behavior (p=.03). Men received more mood stabilizers (p=.02) than women. Ongoing research is needed to evaluate if aggression in females may not be recognized or treated as aggressive women are less distressing for staff than these same behaviors in males.
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Affiliation(s)
- Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, United States
| | - Marie Boltz
- Pennsylvania State University, State College, Pennsylvania, United States
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, United States
| | - Ann Kolanowski
- Pennsylvania State University, State College, Pennsylvania, United States
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Massimo L, Kales HC, Kolanowski A. State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia. J Am Geriatr Soc 2019; 66 Suppl 1:S4-S12. [PMID: 29659001 DOI: 10.1111/jgs.15343] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/01/2022]
Abstract
Apathy is one of the most common and pervasive of the behavioral and psychological symptoms of dementia (BPSDs). Apathy has profound consequences for morbidity, mortality, and caregiver burden. Treatment of apathy has been hindered because of poor understanding of the mechanisms underlying this heterogeneous syndrome. Research has demonstrated that apathy is associated with disruption of the frontal-striatal system in individuals with neurodegenerative disease. As with other BPSDs, these neural mechanisms alone do not completely account for the syndrome; individual, caregiver, and environmental factors also contribute to apathy. In this article, we modify a current conceptual model of the factors contributing to BPSDs to examine determinants of apathy. This integrative model provides a more complete and theoretically informed understanding of apathy, allowing for greater insight into potential targets for research, intervention, and care. We end by proposing an agenda for moving the science of BPSDs in general, and apathy in particular, forward.
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Affiliation(s)
- Lauren Massimo
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania.,Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen C Kales
- Program for Positive Aging, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania
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Steensma E, Zhou W, Ngo L, Gallagher J, Inouye S, Leslie D, Boltz M, Kolanowski A, Mion L, Marcantonio ER, Fick D. Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia. J Am Med Dir Assoc 2019; 20:1391-1396.e1. [PMID: 31279670 DOI: 10.1016/j.jamda.2019.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/10/2019] [Accepted: 05/11/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Delirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD. DESIGN/SETTING/PARTICIPANTS Older hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee). MEASURES The reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen. RESULTS Overall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was "What day of the week is it?" with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was "list the days of the week backwards" and "What day of the week is it?" with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was "list the days of the week backwards," "What type of place is this? [hospital]" and "Does the patient appear sleepy?" with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48). CONCLUSIONS/IMPLICATIONS We identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.
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Affiliation(s)
| | - Wenxiao Zhou
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Sharon Inouye
- Harvard Medical School, Boston, MA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Douglas Leslie
- College of Medicine, Pennsylvania State University, Hershey, PA
| | - Marie Boltz
- College of Nursing, College of Medicine, Penn State University, University Park, PA
| | - Ann Kolanowski
- College of Nursing, College of Medicine, Penn State University, University Park, PA
| | - Lorraine Mion
- College of Nursing, Ohio State University, Columbus, OH
| | - Edward R Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Donna Fick
- College of Nursing, College of Medicine, Penn State University, University Park, PA
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MacAndrew M, Kolanowski A, Fielding E, Kerr G, McMaster M, Wyles K, Beattie E. "Would you like to join me for a walk?" The feasibility of a supervised walking programme for people with dementia who wander. Int J Older People Nurs 2019; 14:e12244. [PMID: 31125189 DOI: 10.1111/opn.12244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/12/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES Five of the eight focus areas of Bowen's Feasibility Framework were utilised to assess the feasibility of implementing the Safe Walking Program (SWP) with people with severe dementia who wander in long-term care (LTC). BACKGROUND Dementia-related wandering in LTC is associated with adverse outcomes related to intensity (malnutrition, exhaustion and pain, injury) and type of walking (sleep deprivation, resident violence and elopement, death). There is little evidence guiding best practice for managing wandering in LTC. DESIGN The SWP involved a three-week trial of taking residents (n = 7) for a 30-min supervised walk, 30 min before individual peak walking activity periods (PWAP), outside the care facility. Quantitative (real-time observation and 24/7 Actigraph™ data: not reported here) and qualitative data were collected pre-, during and postintervention. METHODS Feasibility to implement the SWP protocol was evaluated using a protocol fidelity checklist completed at the end of each scheduled intervention. Acceptability and sustainability of the programme were evaluated through staff interviews. RESULTS Eighty per cent of scheduled walks commenced and were completed, with 91% of walks lasting the full 30 min. Care staff reported benefits for participants and care staff. The perceived sustainability of the SWP in the LTC setting was impacted by the strict timing of the walk to coincide with participant's individual PWAP. The use of care staff to lead some scheduled walks was seen as interfering with care routines. CONCLUSIONS To enhance the acceptability/sustainability of the SWP in LTC, further testing of the importance of dose and timing is required. Consideration needs to be given to suggested modifications to the protocol. IMPLICATIONS FOR PRACTICE The SWP is an acceptable and enjoyable activity for people with severe dementia who wander. Utilising walking tracks around the neighbourhood was perceived as being an important element of the programme.
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Affiliation(s)
- Margaret MacAndrew
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Ann Kolanowski
- School of Nursing, Pennsylvania State University, University Park, Pennsylvania
| | - Elaine Fielding
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Graham Kerr
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation and School of Exercise & Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mitchell McMaster
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Katy Wyles
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Elizabeth Beattie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Sawyer AM, Gawrysiak M, King TS, Watach AJ, McPhillips MV, Kolanowski A, Schutte-Rodin SM, Baime M. 0532 Mindfulness-based Stress Reduction For Claustrophobia Associated With Positive Airway Pressure In Obstructive Sleep Apnea. Sleep 2019. [DOI: 10.1093/sleep/zsz067.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amy M Sawyer
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine Center for Sleep & Circadian Neurobiology, Philadelphia, PA, USA
| | - Michael Gawrysiak
- West Chester University of Pennsylvania, West Chester, PA, USA
- Penn Program for Mindfulness at University of Pennsylvania, Philadelphia, PA, USA
| | - Tonya S King
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - Alexa J Watach
- University of Pennsylvania Perelman School of Medicine Center for Sleep & Circadian Neurobiology, Philadelphia, PA, USA
| | - Miranda Varrasse McPhillips
- University of Pennsylvania Perelman School of Medicine Center for Sleep & Circadian Neurobiology, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, State College, PA, USA
| | - Sharon M Schutte-Rodin
- University of Pennsylvania Perelman School of Medicine Center for Sleep & Circadian Neurobiology, Philadelphia, PA, USA
| | - Michael Baime
- Penn Program for Mindfulness at University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Zhu S. Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment. Clin Nurs Res 2019; 30:59-69. [PMID: 30943786 DOI: 10.1177/1054773819838678] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cognition, pain, comorbidities, facility factors, and state. Overall 63% (n = 211) received at least one psychotropic medication, 16% (n = 52) an anti-seizure medication, 23% (n = 77) an anxiolytic, 30% (n = 99) an antidepressant, 2% (n = 8) a sedative hypnotic, 28% (n = 93) an antipsychotic medication, and 9% (n = 29) an opioid. Testing of models explained 9% to 15% of psychotropic medication use. There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore the impact of deprescribing, person-centered behavioral interventions, and beliefs of providers on psychotropic medication use.
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Affiliation(s)
| | - Ann Kolanowski
- Pennsylvania State University College of Nursing, University Park, USA
| | | | | | - Marie Boltz
- Pennsylvania State University College of Nursing, University Park, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, USA
| | - Liza Behrens
- Pennsylvania State University College of Nursing, University Park, USA
| | - Karen Eshraghi
- Pennsylvania State University College of Nursing, University Park, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, USA
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Gilmore-Bykovskyi AL, Block L, Hovanes M, Mirr J, Kolanowski A. Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities. Res Gerontol Nurs 2019; 12:61-69. [PMID: 30703217 DOI: 10.3928/19404921-20190122-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023]
Abstract
Gaps in pain management, including discontinuity in analgesic medication prescribing, frequently complicate transitions from hospital to skilled nursing facilities (SNFs) for patients with dementia. The objective of the current study was to examine analgesic medication use and prescribing patterns in the last 48 hours of hospitalization and upon discharge to SNF among stroke and hip fracture patients with dementia. Of 318 patients who received an analgesic medication within the last 48 hours of hospitalization, 23% experienced potentially abrupt discontinuations upon discharge. These rates varied by medication, with acetaminophen with codeine (27%), hydromorphone (19%), and acetaminophen with hydrocodone (19%) having the highest rates of potentially abrupt discontinuations. Conversely, 38% of patients experienced potentially abrupt additions of an analgesic medication upon discharge. Findings suggest that changes to analgesic regimens prior to and upon discharge may be common practice, potentially hindering care continuity and pain control during transitions. [Res Gerontol Nurs. 2019; 12(2):61-69.].
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