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Kim S, Liu W, Daack-Hirsch S, Williams KN. Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation. West J Nurs Res 2024; 46:264-277. [PMID: 38400741 PMCID: PMC10955794 DOI: 10.1177/01939459241233360] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. OBJECTIVE This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. METHODS A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. RESULTS Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. CONCLUSIONS The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.
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Affiliation(s)
- Sohyun Kim
- College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX, USA
| | - Wen Liu
- The University of Iowa, Iowa City, IA, USA
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Shaw CA, Lee KR, Williams A, Shaw NA, Weeks D, Jackson L, Williams KN. Best practices for communication while wearing facemasks: A scoping review. J Nurs Scholarsh 2024; 56:227-238. [PMID: 37937861 PMCID: PMC10922106 DOI: 10.1111/jnu.12939] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Facemasks are an important piece of personal protective equipment (PPE) to mitigate the spread of respiratory illnesses, but they can impede communication between patients and healthcare providers. The purpose of this scoping review is to identify effective communication practices while wearing facemasks. DESIGN Scoping review using a systematic search of articles from the PubMed, CINAHL, and Embase databases. METHODS The PEO (population, exposure, outcome) methodology was selected for this systematic scoping review. The population of interest (P) includes humans of all ages (children, adults, and older adults); the exposure of interest (E) is PPE that covers the mouth (i.e., facemasks); and the outcome of interest (O) is successful or unsuccessful communication practices. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals appraisal guidelines were used to determine the level and quality of the research. RESULTS Thirty-nine articles met the inclusion criteria. Seventeen of these were high- or good-quality research studies, and the remaining 22 were non-research articles included with separate analysis as part of the scoping review. The 17 articles encompassed 2656 participants. The highest quality evidence indicated that standard surgical masks have the least impact on speech perception compared to other non-transparent mask types, and that recognizing emotions is less accurate with facemasks, necessitating compensatory actions (i.e., reducing extraneous noise, using a microphone to amplify voice, and employing clear speech). Evidence was contradictory regarding the use of transparent masks. Evidence was of limited quality for other non-verbal and verbal communication strategies. CONCLUSION Awareness of communication challenges is crucial when wearing facemasks. More high-quality studies are needed to evaluate communication techniques when speakers are wearing facemasks. Basic strategies such as selecting an appropriate mask type, reducing extraneous noise, using microphones, verbalizing emotions, and employing clear speech appear to be beneficial. CLINICAL RELEVANCE The findings of this scoping review highlight the importance of considering communication challenges while wearing facemasks in the healthcare settings. The review suggests that selecting an appropriate mask type, reducing extraneous noise, verbalizing emotions, and employing clear speech are some strategies that may be effective in mitigating the impact of facemasks on communication between patients and healthcare providers.
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Affiliation(s)
- Clarissa A. Shaw
- University of Iowa, College of Nursing, Division of Acute and Critical Care
| | | | | | - Nathan A. Shaw
- University of Iowa, Carver College of Medicine, Department of Family Medicine
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Williams KN, Coleman CK, Hu J. Determining Evidence for Family Caregiver Communication: Associating Communication Behaviors With Breakdown and Repair. Gerontologist 2023; 63:1395-1404. [PMID: 36574501 PMCID: PMC10474591 DOI: 10.1093/geront/gnac193] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Communication is fundamental for dementia care. The trouble source repair (TSR) framework can identify strategies that facilitate or impede communication in dyadic interactions. RESEARCH DESIGN AND METHODS A secondary analysis of videos (N = 221) from a clinical trial of a family caregiver telehealth intervention was analyzed using sequential behavioral coding of communication behaviors and breakdowns for 53 caregiver and person with dementia dyads. Coded data from 3,642 30-s observations were analyzed using penalized regression for feature selection followed by Bayesian mixed-effects modeling to identify communication strategies associated with communication breakdown and repair. RESULTS Breakdown (coded as 0) was associated with caregivers changing topic (median = -11.45, 95% credibility interval [CrI; -24.34, -4.37]), ignoring (median = -11.49, 95% CrI [-24.49, -4.72]), giving commands (median = -10.74, 95% CrI [-24.22, -3.38]), and taking over the task (median = -4.06, 95% CrI [-7.28, -1.77]). Successful repair of breakdown was associated with verbalizing understanding (median = 0.46, 95% CrI [0.09, 0.86]), tag questions, (median = 2.4, 95% CrI [0.33, 5.35]), and silence (median = 0.78, 95% CrI [0.42, 1.15]) and negatively associated with ignoring and changing topic (median = -3.63, 95% CrI [-4.81, -2.57] and -2.51 [-3.78, -1.33], respectively). DISCUSSION AND IMPLICATIONS The TSR was effective in identifying specific communication strategies to avoid (changing topic, ignoring, commands, and taking over the task) and to use to repair breakdown (verbalize understanding, tag questions, and silence). Future research is needed to test these strategies and explore the potential effects of dementia stage, diagnosis, and dyad characteristics in additional samples. Behavioral coding provides evidence of communication best practices as a basis for family caregiver communication training.
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Affiliation(s)
- Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
- Alzheimer’s Disease Research Center, University of Kansas, Fairway, Kansas, USA
| | - Carissa K Coleman
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jinxiang Hu
- School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Kim S, Liu W, Daack-Hirsch S, Williams KN. Development and psychometric testing of the dyadic communication observational coding scheme in DEmentia care (DCODE): family dyadic communication in dementia. Aging Ment Health 2023; 27:1770-1779. [PMID: 36178152 DOI: 10.1080/13607863.2022.2126819] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/16/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Understanding family dyadic communication in dementia is essential to promote the well-being of family caregivers and persons living with dementia. The Dyadic Communication Observational coding scheme in DEmentia care (DCODE) was developed and tested to assess family dyadic communication in dementia. METHODS The DCODE was developed from a review of literature, expert review, and pretesting. A secondary analysis of the 75 in-home care video observations from 19 family caregiver-care recipient dyads was conducted to test psychometric properties. RESULTS The DCODE consists of 43 caregiver items and 41 care recipient items. We observed internal consistency, intra-rater reliability, and inter-rater reliability as adequate. Content validity and convergent validity were moderate. Predictive validity was moderate in predicting caregiver burden. The overall psychometric properties demonstrated a moderate quality of the DCODE. CONCLUSIONS Findings provided the preliminary psychometric evidence of the DCODE as a promising instrument to assess family dyadic communication in dementia. Future testing for concurrent, divergent, and structural validity of the DCODE is needed.
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Affiliation(s)
- Sohyun Kim
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA, USA
| | - Wen Liu
- College of Nursing, University of Iowa, Iowa City, IA, USA
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Shaw CA, Ward C, Gordon J, Williams KN, Herr K. Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care. J Am Geriatr Soc 2022; 70:2258-2268. [PMID: 35642656 PMCID: PMC9378618 DOI: 10.1111/jgs.17910] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
Background Rejection of care (RoC) occurs when persons living with dementia (PLWD) withstand or oppose the efforts of their caregiver. Improvements in hospital dementia care are needed, and one way to address this need is by identifying factors that lead to RoC, particularly those that are modifiable. Elderspeak communication is an established antecedent to RoC among PLWD in nursing homes. The purpose of this study was to extend these results to acute care settings by determining the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. Methods Care encounters between nursing staff and PLWD were audio‐recorded, transcribed verbatim, and coded for semantic, pragmatic, and prosodic features of elderspeak. RoC behaviors was scored in real‐time using the Resistiveness to Care Scale. A Bayesian repeated‐measures hurdle model was used to evaluate the association between elderspeak and both the presence and severity of RoC. Results Eighty‐eight care encounters between 16 PLWD and 53 nursing staff were audio‐recorded for elderspeak and scored for RoC. Nearly all (96.6%) of the encounters included some form of elderspeak. Almost half of the care encounters (48.9%) included RoC behaviors. A 10% decrease in elderspeak was associated with a 77% decrease in odds of RoC (OR = 0.23, 95% CI = 0.03, 0.68) and a 16% decrease (eβ= 0.84, CI = 0.73, 0.96) in the severity of RoC. A one‐unit decrease in pain severity was associated with 73% reduced odds of RoC (OR = 0.27, CI = 0.12, 0.45) and a 28% decrease (eβ= 0.72, CI = 0.64, 0.80) in the severity of RoC. Conclusions Both elderspeak by nursing staff and RoC by PLWD are present and pervasive in acute care. Pain and elderspeak are two modifiable factors of RoC in hospitalized PLWD. Person‐centered interventions are needed that address communication practices and pain management for hospitalized PLWD.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Caitlin Ward
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA.,Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Jean Gordon
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, Iowa, USA
| | - Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Coleman CK, Hein M, Shaw CA, Beachy T, Perkhounkova Y, Berkley A, Williams KN. Developing and Testing Remote Implementation for the Changing Talk Online (CHATO) Communication Intervention for Nursing Home Staff: A Pilot Pragmatic Randomized Controlled Trial. Innov Aging 2022; 6:igac026. [PMID: 36161143 PMCID: PMC9495503 DOI: 10.1093/geroni/igac026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives The Changing Talk (CHAT) communication training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes (NHs). As part of the pilot pragmatic clinical trial testing Changing Talk: Online Training (CHATO), a new online version, a remote implementation design, and process evaluation were developed to capture contextual factors, ensure fidelity, and determine effective implementation strategies. Research Design and Methods The Expert Recommendation for Implementing Change compilation informed this 2-phase approach to develop and test remote implementation. An Advisory Board guided the developmental phase while pilot testing used a cluster-randomized design. Data were analyzed to evaluate NH characteristics; implementation strategies used; CHATO participation, completion, and passing rates; and leadership evaluation. Results Five out of 7 NHs were nonprofit with above average quality ratings (M = 4.3 of 5). Staff participants (N = 237) were mostly female (90%), non-Hispanic White (91%), and nursing assistants (46%). Implementation time ranged from 54 to 86 days (M = 70.3, standard deviation [SD] = 9.3), with planning phase ranging from 11 to 29 days (M = 20.1, SD = 6.7), and training phase ranging from 35 to 58 days (M = 50.0, SD = 7.6). A range from 3 to 11 implementation strategies were used by each NH. Assigning champions, including the social worker on the implementation team, utilizing multiple mediums for reminders, giving rewards or public recognition, supporting onsite discussions, and other tailoring strategies were associated with improved outcomes. Participation ranged from 20% to 76%. Over 63% of participants completed training (N = 150) and 87% passed the posttest (N = 130). Leadership evaluations noted staff used CHATO concepts in practice and improved communication culture. Discussion and Implications Leadership who took an active role, engaged multiple team members, and varied strategies had better outcomes. Effectiveness of the strategies will be evaluated in a national pragmatic clinical trial testing CHATO’s effects on reducing behavioral and psychological symptoms in dementia care.
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Affiliation(s)
- Carissa K Coleman
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maria Hein
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Tim Beachy
- College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Amy Berkley
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
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Coleman CK, Williams KN, Berkley A, Dunham A, Savundranayagam MY. Characterizing communication in dementia family caregiving: Identifying breakdown and repairs using the trouble source repair (TSR) framework via video observations. Alzheimers Dement 2021. [DOI: 10.1002/alz.054318] [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: 11/10/2022]
Affiliation(s)
| | | | - Amy Berkley
- University of Kansas School of Nursing Kansas City KS USA
| | - Ashlyn Dunham
- University of Kansas Department of Hearing and Speech Kansas City KS USA
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Liu W, Williams KN, Batchelor M, Perkhounkova Y, Hein M. Mealtime nonverbal communications among nursing home staff and residents with dementia: A secondary analysis of videotaped observations. Alzheimers Dement 2021. [DOI: 10.1002/alz.052415] [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: 11/06/2022]
Affiliation(s)
- Wen Liu
- University of Iowa Iowa City IA USA
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Williams KN, Coleman CK, Shaw CA, Perkhounkova Y, Hein M, Cramer E, Beachy T, Berkley A, Kantartjis M. Changing Talk Online: Protocol for a cluster pragmatic trial testing communication education to reduce behavioral and psychological symptoms of dementia in nursing home care. Contemp Clin Trials 2021; 109:106550. [PMID: 34478869 PMCID: PMC8556275 DOI: 10.1016/j.cct.2021.106550] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022]
Abstract
Nursing home (NH) care of persons living with dementia is often made challenging by behavioral and psychological symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur due to cognitive and communication changes. Staff frequently communicate to NH residents using "elderspeak" which is patronizing speech similar to baby talk. Residents respond to elderspeak with increased BPSD that prompts use of psychotropic medication to control symptoms. The Changing Talk (CHAT) training educates staff about effective, person-centered communication strategies and reduces elderspeak by staff and subsequent BPSD among residents. This study will test effects of an adapted online version (CHATO) increasing access and dissemination of education to busy staff across diverse care settings. Nursing homes (N = 128) will be stratified and then randomized to CHATO education (n = 64) or to the control group (n = 64). Data on behavioral symptoms (primary outcomes) and psychotropic medication use (secondary outcomes) will be extracted from the Center for Medicare and Medicaid Services Minimum Data Set before and after education and will be compared between the groups using generalized linear mixed modeling. It is hypothesized that after completing the CHATO education residents will have reduced behavioral symptoms and psychotropic medication use compared to residents in control NHs. Additionally, factors related to NH participation and cost of the intervention will be determined. The overall goal of this study is to prepare for large scale dissemination and implementation of the evidence-based nonpharmacological CHATO intervention to reduce BPSD in residents with dementia across long-term care settings.
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Affiliation(s)
- Kristine N Williams
- University of Kansas Medical Center School of Nursing, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Carissa K Coleman
- University of Kansas Medical Center School of Nursing, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Clarissa A Shaw
- University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Yelena Perkhounkova
- University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Maria Hein
- University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Emily Cramer
- University of Kansas Medical Center School of Nursing, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Tim Beachy
- University of Iowa College of Public Health, 200 Newton Rd, Iowa City, IA 52242, USA
| | - Amy Berkley
- University of Kansas Medical Center School of Nursing, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Michalis Kantartjis
- University of Iowa Interdisciplinary Graduate Program in Health Informatics, 201 Gilmore Hall, Iowa City, IA 52242, USA
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Williams KN, Shaw CA, Perkhounkova Y, Hein M, Coleman CK. Satisfaction, utilization, and feasibility of a telehealth intervention for in-home dementia care support: A mixed methods study. Dementia (London) 2021; 20:1565-1585. [PMID: 32902313 PMCID: PMC7940465 DOI: 10.1177/1471301220957905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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 Technology can enhance support for families caring for persons living with dementia but must be acceptable to be adopted. The FamTechCare clinical trial engaged caregivers in video recording care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports on caregiver satisfaction and utilization of the intervention and expert panel evaluation of the intervention. METHODS A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the FamTechCare intervention. In the multisite randomized controlled trial, caregiver-person living with dementia dyads were randomized to the FamTechCare video support or attention control telephone support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. Utilization was evaluated using the number and duration of videos submitted and calls received by caregivers. Relationships between participant characteristics and their satisfaction and utilization were evaluated. Feasibility of the intervention was assessed through content analysis of interviews with the expert panel. RESULTS The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p = 0.001) and effective (p = 0.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p = 0.050). Caregiver age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel described the FamTechCare intervention as useful and identified adaptations to enhance feasibility. CONCLUSION Regardless of age, gender, and relationship, caregivers found the intervention acceptable and easy to use and rated the expert feedback as effective in addressing care challenges. Further adaptation may be needed for FamTechCare to be readily implemented.
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Affiliation(s)
| | - Clarissa A Shaw
- College of Nursing, 4083University of Iowa, Iowa City, IA, USA
| | | | - Maria Hein
- College of Nursing, 4083University of Iowa, Iowa City, IA, USA
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Shaw CA, Williams KN, Lee RH, Coleman CK. Cost-effectiveness of a telehealth intervention for in-home dementia care support: Findings from the FamTechCare clinical trial. Res Nurs Health 2021; 44:60-70. [PMID: 33075157 PMCID: PMC8459671 DOI: 10.1002/nur.22076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/06/2020] [Revised: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 01/28/2023]
Abstract
Determining the cost-effectiveness of technological interventions is a crucial aspect in assuring these interventions can be adopted. The FamTechCare intervention is an innovative telehealth support that links family caregivers of persons living with dementia to tailored feedback from dementia care experts based on caregiver-initiated video recordings of challenging care situations. The FamTechCare intervention has demonstrated significant reductions in caregiver depression and increases in caregiver competence when compared to standard telephone support. The purpose of this article is to report on the cost-effectiveness of the FamTechCare telehealth intervention. Process-based costing and a cost-effectiveness analysis using the incremental cost-effectiveness ratio (ICER) was completed with 68 caregiver and person living dementia with dyads. The cost of the 12-week FamTechCare telehealth intervention was found to be greater ($48.43 per dyad per week) due to the telehealth equipment, recording application, and expert panel time compared with the telephone support intervention ($6.96 per dyad per week). The ICER was $18.51 for caregiver depression and $36.31 for caregiver competence indicating that it cost no more than $36.38 per dyad per week over 12 weeks to achieve significant improvement in depression and competence in the FamTechCare caregivers compared to the telephone support caregivers. The FamTechCare intervention appears to be cost-effective when compared to the telephone support intervention and remains near the willingness-to-pay threshold for caregivers providing in-home dementia care support.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | - Robert H Lee
- Kansas Medical Center, University of Kansas, Kansas City, Kansas, USA
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Williams KN, Coleman CK, Perkhounkova Y, Beachy T, Hein M, Shaw CA, Berkley A. Moving Online: A Pilot Clinical Trial of the Changing Talk Online (CHATO) Communication Education for Nursing Home Staff. Gerontologist 2020; 61:1338-1345. [PMID: 33346349 DOI: 10.1093/geront/gnaa210] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Staff-resident communication is a critical part of nursing home (NH) care. Reducing elderspeak and increasing person-centered communication has been shown to reduce behavioral symptoms experienced by persons living with dementia. An online version of a successful classroom-based communication-training program that reduced staff elderspeak and resident behavioral symptoms was evaluated. The objective of this study was to establish feasibility and determine the preliminary effects of the online program in preparation for a national pragmatic clinical trial. RESEARCH DESIGN AND METHODS Seven NHs were randomized to immediate intervention or wait-list control conditions. The NHs were provided with the web-based training program that staff individually accessed. Primary outcomes were knowledge scores and communication ratings of a video-recorded interaction, using pre- to post-training comparisons. RESULTS Knowledge increased from a mean pretest score of 61.9% (SD=20.0) to a mean posttest score of 84.6% (SD=13.5) for the combined group. Knowledge significantly improved between Time 1 and Time 2 for the immediate intervention participants (p<.001), but not for the wait-list control participants (p=.091), and this difference was statistically significant (p<.001). Ability to recognize ineffective, inappropriate, non-person-centered, and elderspeak communication improved after training (p<.001). The magnitude of improvement in communication recognition was comparable to that of the original classroom format. DISCUSSION AND IMPLICATIONS The adapted communication intervention was feasible and improved knowledge and communication. Online instruction can improve access to quality education and is an effective means to improve dementia care by overcoming barriers to in-person training.
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Affiliation(s)
| | | | | | - Tim Beachy
- Institute for Public Health Practice, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Maria Hein
- University of Iowa College of Nursing, Iowa City, Iowa, USA
| | | | - Amy Berkley
- University of Kansas School of Nursing, Kansas City, Kansas, USA
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Coleman CK, Williams KN, Hein M, Perkhounkova Y, Beachy T, Berkley A, Shaw C. The Changing Talk: Online training (CHATO) — Developing and testing an implementation strategy for a national randomized control trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.047450] [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: 11/06/2022]
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Ptomey LT, Szabo-Reed AN, Vidoni ED, Washburn RA, Gorczyca AM, Little TD, Lee J, Helsel BC, Williams KN, Donnelly JE. A dyadic approach for a remote physical activity intervention in adults with Alzheimer's disease and their caregivers: Rationale and design for an 18-month randomized trial. Contemp Clin Trials 2020; 98:106158. [PMID: 32979515 PMCID: PMC7686020 DOI: 10.1016/j.cct.2020.106158] [Citation(s) in RCA: 2] [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] [Received: 05/07/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Adults with Alzheimer's disease and related dementia (ADRD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Options for increasing MPA in community dwelling adults with ADRD and their caregivers are limited. A home-based physical activity intervention delivered remotely via video conferencing to groups of adults with ADRD and their caregivers (RGV), represents a potentially effective approach for increasing MPA in this group. We will conduct an 18-month randomized trial (6 mos. Active intervention, 6 mos. Maintenance, 6 mos. no contact) to compare the effectiveness of the RGV approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with ADRD and their caregiver. The primary aim is to compare MPA (min/wk.), assessed by accelerometer, across the 6-mo. active intervention in adults with ADRD randomized to RGV or EUC. Secondarily, we will compare adults with ADRD and their caregivers randomized to RGV or ECU on the following outcomes across 18 mos.: MPA (min/wk.), sedentary time (min/wk.), percentage meeting 150 min/wk. MPA goal, functional fitness, activities of daily living, quality of life, residential transitions, cognitive function, and caregiver burden. Additionally, we will evaluate the influence of age, sex, BMI, attendance (exercise/support sessions), use of recorded sessions, self-monitoring, peer interactions during group sessions, caregiver support, type and quality of dyadic relationship, and number of caregivers on changes in MPA in adults with ADRD and their caregiver across 18 mos.
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Affiliation(s)
- Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Amanda N Szabo-Reed
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Eric D Vidoni
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Anna M Gorczyca
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Todd D Little
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA.
| | - Brian C Helsel
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Kristine N Williams
- School of Nursing, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
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Shaw CA, Williams KN, Perkhounkova Y, Hein M, Coleman CK. Effects of a Video-based Intervention on Caregiver Confidence for Managing Dementia Care Challenges: Findings from the FamTechCare Clinical Trial. Clin Gerontol 2020; 43:508-517. [PMID: 32072866 PMCID: PMC7434650 DOI: 10.1080/07317115.2020.1729917] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The Supporting Family Caregivers with Technology trial tested the FamTechCare video support intervention against telephone support. Dementia caregivers' video-recorded challenging care encounters and an interdisciplinary team provided tailored feedback. This paper reports on the effects of the intervention on caregiver confidence in managing priority challenges, a secondary outcome of this non-blinded parallel randomized controlled trial. METHODS Caregiver/person living with dementia dyads were randomized to the experimental FamTechCare video support (n = 43) or attention control telephone support (n = 41) groups. Caregivers providing in-home care to a person living with mild or more severe dementia were eligible. Caregivers identified three priority challenges using the Caregiver Target Problems Questionnaire and rated the frequency and severity of each challenge and their confidence managing the challenge at baseline and 3-months. Challenges were classified using the FamTechCare Technology-supported Dementia Care Typology. Effects on confidence were compared between groups using the Wilcoxon rank-sum test and within groups using the Wilcoxon signed-rank test. RESULTS Caregiver priority challenges included managing dementia behaviors, understanding disease expectations, and performing activity of daily living care. Improvements were observed across the three categories in both groups; however, not all changes were statistically significant. No significant differences were identified between groups. CONCLUSION Caregivers in the FamTechCare group reported benefit across all priority challenges including managing dementia behaviors, understanding disease expectations, and performing activity of daily living care. CLINICAL IMPLICATIONS Innovative technology provides new opportunities to support family caregivers in dementia home care. Video-recording can be used to enhance support for family caregivers facing care challenges.
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Affiliation(s)
- Clarissa A Shaw
- College of Nursing, University of Iowa , Iowa City, Iowa, USA
| | | | | | - Maria Hein
- College of Nursing, University of Iowa , Iowa City, Iowa, USA
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16
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Manson A, Ciro C, Williams KN, Maliski SL. Identity and perceptions of quality of life in Alzheimer's disease. Appl Nurs Res 2020; 52:151225. [PMID: 31899042 DOI: 10.1016/j.apnr.2019.151225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/01/2019] [Revised: 09/03/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND With life expectancy on the rise and the baby boomer generation growing older, Alzheimer's disease (AD) will affect more individuals and families than ever before. Therefore, it is imperative that healthcare providers identify the objective and perceived factors which positively and negatively affect the experience of progressing through AD. AIM The goal of this exploratory qualitative research is to begin to develop an in-depth description of the perceptions related to life satisfaction in early-to mid-AD from the patient and caregiver perspectives. METHODS A convenience sample of four community-dwelling AD patients and caregivers were recruited from a local Alzheimer's Association support group. Semi-structured interviews were conducted together with participants and caregivers. RESULTS The major findings of this study uncovered a process by which 1) changes in activity occur in response to the diagnosis 2) dyads discover new ways in which to mutually adapt and cope and 3) the person with dementia remains meaningfully engaged in their lives with a generally positive perception of quality of life (QoL). CONCLUSIONS These preliminary findings are a promising line of research and have implications for Alzheimer's patients, their families, and person-centered care. By accounting for individual levels of baseline engagement and taking each patient's perspective into account, nurses have the ability to identify individual changes over time and positively impact the patient's QoL. Further studies with larger and more diverse samples are needed to expand upon this preliminary framework.
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Affiliation(s)
- Alana Manson
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States of America.
| | - Carrie Ciro
- Department of Rehabilitation Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, United States of America
| | - Kristine N Williams
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States of America
| | - Sally L Maliski
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States of America
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17
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Abstract
Abstract
Persons with dementia commonly experience mealtime challenging behaviors resulting in negative outcomes. Appropriate caregiver engagement is critical in engaging residents in eating. Current caregiver behavior measures are neither validated nor specific for mealtime care. A feasible and reliable measure to evaluate caregiver engagement during mealtimes is needed. Our team developed the Caregiver Mealtime Engagement Scale (CMES), a 29-item observational measure with good content validity (Content Validity Index = 1.00). The CMES includes 24 positive behaviors (e.g., position resident upright) and 5 negative behaviors (e.g., interrupt resident). Each item is scored by frequency on a 0 (never) – 3 (always) scale. Total score ranges from 0-87; higher score indicates better engagement. This study aimed to test the CMES’ reliability and validity through a secondary analysis of 87 mealtime video-recorded observations from a hand feeding trial (P30). The sample included 7 residents and 25 staff from 2 nursing homes. The CMES has good internal consistency (Cronbach’s α =.775). Inter-rater reliability was good (r = .861, p<.001) based on ratings of 20 videos by two independent trained coders. Intra-rater reliability was excellent (r = .905, p<.001) based on ratings of 20 videos by one trained coder at two times (2-3 weeks apart). The CMES demonstrated good convergent validity based on association with the Relational Behavior Scale (r = .822, p<.001) and Mealtime Relational Care Checklist (r = .324, p=.002). Findings support the CMES’ reliability and validity. Future research is needed to test CMES among a larger diverse sample of caregivers in different settings.
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Affiliation(s)
- Wen Liu
- The University of Iowa, Iowa City, Iowa, United States
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Jao YL, Williams KN, Berish D. ASSESSING APATHY IN LONG-TERM CARE RESIDENTS WITH DEMENTIA: COMPARING SELF-EVALUATION WITH PROXY RATINGS. Innov Aging 2019. [PMCID: PMC6845784 DOI: 10.1093/geroni/igz038.433] [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: 12/01/2022] Open
Abstract
Background: Apathy affects most individuals with dementia in long-term care. Apathy assessment is fundamental for appropriate treatment. Apathy involves subjective feelings thus individual’s self-evaluation may offer important perspectives for assessment. However, it is unclear whether self-evaluation is a valid assessment approach for this population. This study compared apathy ratings from resident self-evaluation to assessments from family, clinicians, and research staff. Methods: This pilot study enrolled 8 residents from two long-term care facilities in Pennsylvania. One family member, one certified nursing assistant (CNA), and one nurse or activity staff were also enrolled for each resident. Researchers interviewed each resident using the Apathy Evaluation Scale (AES) and rated their apathy levels. Family, CNAs, and nurses/activity staff independently rated the resident’s apathy level using the AES. Direct observations were conducted by researchers using the Person-Environment Apathy Rating (PEAR). Results: Correlation analysis revealed a discrepancy across raters in assessing apathy. While self-evaluation and family ratings where moderately positively correlated (r=0.48, p=.23), there was a moderate correlation in the opposite direction between self-evaluation and CNA ratings (r=-0.64, p=.09). Resident self-evaluation did not correlate with nurses/activity staff ratings (r=0.01, p=.99) or researcher observations (r=-0.08, p=.86). Discussion: These findings may reflect residents’ cognitive impairment and lack of insights, family and clinicians’ lack of understanding of apathy, or nurses’ and researchers’ lack of acquaintance with the resident. It remains undetermined whether self-evaluation provides valid information for apathy assessment for this population. Additional research is necessary to identify the most valid assessment approach for long-term care residents with dementia.
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Affiliation(s)
- Ying-Ling Jao
- Pennsylvania State University, University Park, Pennsylvania, United States
| | | | - Diane Berish
- Pennsylvania State University, University Park, Pennsylvania, United States
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Savundranayagam MY, Williams KN, Basque S, Orange JB, Kloseck M, Schmall V, Johnson K. IMPACT OF THE BE EPIC: A PERSON-CENTERED COMMUNICATION INTERVENTION FOR HOME CARE WORKERS. Innov Aging 2019. [PMCID: PMC6846370 DOI: 10.1093/geroni/igz038.2843] [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: 11/21/2022] Open
Abstract
The current study assessed the impact of Be EPIC, an innovative, evidence-informed and theoretically-grounded 6-week person-centered communication intervention for personal support workers (PSWs) caring for persons with dementia. Be EPIC focuses on [E]nvironment contexts for using [P]erson-centered communication, while considering client relationships ([I] matter too), and [C]lients’ abilities, life history and preferences during routine care. A pre- post-Be EPIC comparative design included an intervention (n=13) and a 6-week waitlist control group (n=10) who completed the same communication-related questionnaire. A Two-Way Mixed ANOVA showed a significant group by time interaction for perceived communication skill (F(1, 21) = 4.67, p = .042, ηp2= .18). Simple main effects analysis showed that participants who completed Be EPIC reported feeling more confident in communicating with persons with dementia (Mpre = 13.46; SD = .76; Mpost = 16.31, SD = .85). There was no significant change in the control group. Similarly, there was a significant group by time interaction for perceived helpfulness of communication strategies (F(1, 21) = 6.23, p = .021, ηp2 = .23). Simple main effects analysis showed that participants who completed Be EPIC reported significant increases in the helpfulness of effective communication strategies (Mpre = 36.92; SD = 3.42; Mpost = 43.15, SD = 3.21), with no significant change among controls. Findings indicate that Be EPIC enhanced PSWs’ confidence in communicating with persons with dementia and enhanced their perception of the helpfulness of effective communication strategies.
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Affiliation(s)
| | | | | | - J B Orange
- Western University, London, Ontario, Canada
| | | | | | - Karen Johnson
- McCormick Dementia Services, London, Ontario, Canada
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20
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Williams KN, Shaw C, Coleman CK. CHALLENGES FOR IMPLEMENTING PRAGMATIC COMMUNICATION INTERVENTIONS IN NURSING HOME SETTINGS. Innov Aging 2019. [PMCID: PMC6840812 DOI: 10.1093/geroni/igz038.1327] [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
Interventions to improve nursing home care have been developed and tested. However readily disseminated interventions are lacking. Barriers include low staffing levels contributing to limited time for education and high turnover of direct care and administrative staff. Educational interventions must be accessible to accommodate busy staff. Meaningful outcome measures are needed and interventions must fit varied nursing home sizes, ownership, resident population, and regions. Changing Talk Online (CHATO) was adapted from the effective, yet time-intensive, Changing Talk program addressing nursing home staff communication. The original classroom-based program significantly improved staff communication with residents and resulted in subsequent reductions in resident behavioral and psychological symptoms of dementia. Strategies for marketing and recruiting nursing homes and to engage administrators and staff will be discussed as implemented in the Changing Talk Online (CHATO) R61 trial. Approaches addressing unique nursing home challenges to implementation are essential for successful dissemination to improve care.
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Affiliation(s)
| | - Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, Iowa, United States
| | - Carissa K Coleman
- University of Kansas School of Nursing, Kansas City, Kansas, United States
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21
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Williams KN, Shaw C. NOT READY FOR PRIME TIME: A FAILED STUDY TESTING A TECHNOLOGICAL INTERVENTION IN NURSING HOME CARE. Innov Aging 2019. [PMCID: PMC6845744 DOI: 10.1093/geroni/igz038.2834] [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
This pilot-study tested an adaptation of a successful family caregiver telehealth support intervention in nursing home settings. The goal was to support staff in managing challenging behaviors of residents with dementia. Nursing homes were provided with an iPad mini equipped with a special application to video record staff-resident challenging care situations. Videos were uploaded to a secure site for review by dementia care experts who provided feedback to improve care. Despite efforts to engage staff, only four videos were submitted. Factors including privacy, workload, and fear of documenting abuse contributed to implementation failure. The same intervention was successfully implemented in the home setting; differences in engagement and utilization will be discussed. Understanding the unique environments of nursing home dementia care is needed to successfully implement technology-based interventions to improve care. Evaluation of factors predicting the failure of this intervention may inform future research.
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Affiliation(s)
| | - Clarissa Shaw
- University of Iowa, College of Nursing, Iowa City, Iowa, United States
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22
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Shaw C, Williams KN, Hein M, Coleman C, Perkhounkova Y. RELATIONSHIP BETWEEN CARE CHALLENGE TYPE AND PSYCHOSOCIAL OUTCOMES IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA. Innov Aging 2019. [PMCID: PMC6845820 DOI: 10.1093/geroni/igz038.3340] [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: 11/23/2022] Open
Abstract
Enhancing dementia care is a public health priority and supporting family caregivers of persons living with dementia (PLWD) is a critical need. This poster reports the relationships between the types of care challenges reported by family caregivers and their scores on psychosocial measures. Family caregivers (N=83) participating in the FamTechCare clinical trial identified three top priority care challenges and completed a series of measures (i.e., burden, depression, sleep quality, and reaction to dementia behaviors) at baseline. Priority care challenges were classified using the 10-category Technology-supported Dementia Care Typology. Three of the categories (i.e., behavioral and psychological symptoms of dementia [BPSD], activities of daily living [ADL], and disease expectations [DE]) were reported by an adequate number of caregivers in order to test relationships with psychosocial measures using the Kruskal-Wallis Test. Caregivers reporting 2 or 3 BPSD challenges had higher burden (p=.007), more depression (p=.022) and worse sleep quality (p=.020) compared to those reporting 0 or 1 care challenges related to BPSD. In comparison, caregivers with 2 or 3 challenges related to DE (e.g., PLWD memory loss) had less burden (p=.008), less depression (p=.030), and better sleep quality (p=.042), compared to those reporting 0 or 1 challenge related to DE. Caregivers identifying 2 or 3 care challenges related to ADLs also reported higher levels of depression (p=.036). Dementia caregivers face vast caregiving responsibilities. Caregivers facing BPSD challenges report greater burden and depression. These results reinforce the need for tailored interventions to assist family caregivers in the managing varied care challenges.
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Affiliation(s)
- Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, Iowa, United States
| | | | - Maria Hein
- The University of Iowa, Iowa City, Iowa, United States
| | - Carissa Coleman
- University of Kansas Medical Center, Kansas City, Kansas, United States
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23
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Williams KN, Perkhounkova Y, Shaw CA, Hein M, Vidoni ED, Coleman CK. Supporting Family Caregivers With Technology for Dementia Home Care: A Randomized Controlled Trial. Innov Aging 2019; 3:igz037. [PMID: 31660443 PMCID: PMC6794215 DOI: 10.1093/geroni/igz037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The number of persons living with dementia (PLWD) in the United States will reach 16 million by 2050. Behavioral and psychological symptoms of dementia challenge family caregivers and contribute to negative caregiver outcomes such as burden and depression. Available technology can support the delivery of effective interventions to families providing dementia care at home. The Supporting Family Caregivers with Technology for Dementia Home Care (FamTechCare) randomized controlled trial evaluated the effects of a telehealth intervention on caregiver outcomes. RESEARCH DESIGN AND METHODS The FamTechCare intervention provides tailored dementia-care strategies to in-home caregivers based on video recordings caregivers submit of challenging care situations. An expert team reviews the videos and provides individualized interventions weekly for the experimental group. In the telephone-support attention control group, caregivers receive feedback from an interventionist via the telephone based on caregiver retrospective recall of care challenges. Effects of the intervention on caregiver outcomes, including burden, depression, sleep disturbance, competence, desire to institutionalize the PLWD, and caregiver reaction to behavioral symptoms were evaluated by fitting linear mixed regression models to changes in the outcomes measured at 1 and 3 months. RESULTS FamTechCare caregivers (n = 42) had greater reductions in depression (p = .012) and gains in competence (p = .033) after 3 months compared to the attention control group (n = 41). Living in rural areas was associated with a reduction in depression for FamTechCare caregivers (p = .002). Higher level of education was associated with greater improvements or lesser declines in burden, competence, and reaction to behavioral symptoms for both the FamTechCare and attention control caregivers. DISCUSSION AND IMPLICATIONS This research demonstrated benefits of using available technology to link families to dementia care experts using video-recording technology. It provides a foundation for future research testing telehealth interventions, tailored based on rich contextual data to support families, including those in rural or remote locations.
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Affiliation(s)
| | | | | | - Maria Hein
- University of Iowa, College of Nursing, Iowa City
| | - Eric D Vidoni
- University of Kansas, Alzheimer’s Disease Center, Fairway
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Abstract
Identifying the needs of dementia caregivers is critical for supporting dementia home care. This study identified a typology of expert interventions delivered to dementia caregivers during an innovative telehealth trial that used in-home video recordings to directly observe care challenges. Qualitative content analysis was used to analyze narrative notes describing interventions that were developed based on video data submitted by 33 caregiver-care recipient dyads. Two major themes emerged: education and skills for dementia care and caregiver support. Ten subthemes included education and skills related to: behavioral and psychological symptoms of dementia, disease expectations, safety, activities of daily living, medical care optimization, and medication utilization and caregiver support related to: respite, positive reinforcement, social and financial support, and self-care. Families providing in-home dementia care experience a wide range of care challenges. By using video data, dementia care experts were able to witness and evaluate challenging care situations and provide individualized feedback.
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Affiliation(s)
- Sohyun Kim
- University of Iowa College of Nursing, Iowa City, IA, USA
| | - Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, IA, USA
| | | | - Maria Hein
- University of Iowa College of Nursing, Iowa City, IA, USA
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Williams KN, Perkhounkova Y, Jao YL, Bossen A, Hein M, Chung S, Starykowicz A, Turk M. Person-Centered Communication for Nursing Home Residents With Dementia: Four Communication Analysis Methods. West J Nurs Res 2018; 40:1012-1031. [PMID: 28335698 PMCID: PMC5581294 DOI: 10.1177/0193945917697226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/16/2022]
Abstract
Person-centered communication recognizes the individual as a person and responds to the individual's feelings, preferences, and needs. This secondary analysis tested four interdisciplinary strategies to measure changes in person-centered communication used by nursing home staff following an intervention. Thirty-nine nursing assistants were recruited from 11 nursing homes and participated in the three-session Changing Talk communication training. Video recordings were collected at baseline, immediately postintervention, and at 3-month follow-up. Staff communication was analyzed using behavioral, psycholinguistic, and emotional tone coding of elderspeak communication and content analysis of communication topics. Sign rank test was used to compare postintervention changes for each measure of communication. Postintervention improvements in communication occurred for each measure; however, the changes were statistically significant only for behavioral and psycholinguistic measures. Methods and results for each communication measure were compared. Implications for future research and use of measures of person-centered communication as a tool to improve care are discussed.
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Affiliation(s)
| | | | - Ying-Ling Jao
- 3 Pennsylvania State University, University Park, PA, USA
| | - Ann Bossen
- 2 The University of Iowa, Iowa City, IA, USA
| | - Maria Hein
- 2 The University of Iowa, Iowa City, IA, USA
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Williams KN, Perkhounkova Y, Herman R, Bossen A. A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial. Gerontologist 2017; 57:707-718. [PMID: 27048705 PMCID: PMC5881770 DOI: 10.1093/geront/gnw047] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 09/02/2015] [Accepted: 12/03/2015] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study Nursing home (NH) residents with dementia exhibit challenging behaviors or resistiveness to care (RTC) that increase staff time, stress, and NH costs. RTC is linked to elderspeak communication. Communication training (Changing Talk [CHAT]) was provided to staff to reduce their use of elderspeak. We hypothesized that CHAT would improve staff communication and subsequently reduce RTC. Methods Thirteen NHs were randomized to intervention and control groups. Dyads (n = 42) including 29 staff and 27 persons with dementia were videorecorded during care before and/or after the intervention and at a 3-month follow-up. Videos were behaviorally coded for (a) staff communication (normal, elderspeak, or silence) and (b) resident behaviors (cooperative or RTC). Linear mixed modeling was used to evaluate training effects. Results On average, elderspeak declined from 34.6% (SD = 18.7) at baseline by 13.6% points (SD = 20.00) post intervention and 12.2% points (SD = 22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3% points (SD = 32.4) post intervention and 13.4% points (SD = 33.7) at 3 months. Linear mixed modeling determined that change in elderspeak was predicted by the intervention (b = -12.20, p = .028) and baseline elderspeak (b = -0.65, p < .001), whereas RTC change was predicted by elderspeak change (b = 0.43, p < .001); baseline RTC (b = -0.58, p < .001); and covariates. Implications A brief intervention can improve communication and reduce RTC, providing an effective nonpharmacological intervention to manage behavior and improve the quality of dementia care. No adverse events occurred.
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Affiliation(s)
| | | | - Ruth Herman
- Center for Public Partnerships and Research, University of Kansas, Lawrence
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Williams KN, Ayyagari P, Perkhounkova Y, Bott MJ, Herman R, Bossen A. Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care. J Nurs Home Res Sci 2017; 3:22-27. [PMID: 28503675 PMCID: PMC5425099 DOI: 10.14283/jnhrs.2017.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CONTEXT Persons with Alzheimer's disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC). OBJECTIVE This analysis evaluates the cost-effectiveness of the CHAT intervention to reduce elderspeak communication by staff and RTC behaviors of NH residents with dementia. DESIGN Costs to provide the intervention were determined in eleven NHs that participated in the CHAT study during 2011-2013 using process-based costing. Each NH provided data on staff wages for the quarter before and for two quarters after the CHAT intervention. An incremental cost-effectiveness analysis was completed. ANALYSIS An average cost per participant was calculated based on the number and type of staff attending the CHAT training, plus materials and interventionist time. Regression estimates from the parent study then were applied to determine costs per unit reduction in staff elderspeak communication and resident RTC. RESULTS A one percentage point reduction in elderspeak costs $6.75 per staff member with average baseline elderspeak usage. Assuming that each staff cares for 2 residents with RTC, a one percentage point reduction in RTC costs $4.31 per resident using average baseline RTC. CONCLUSIONS Costs to reduce elderspeak and RTC depend on baseline levels of elderspeak and RTC, as well as the number of staff participating in CHAT training and numbers of residents with dementia-related behaviors. Overall, the 3-session CHAT training program is a cost-effective intervention for reducing RTC behaviors in dementia care.
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Affiliation(s)
| | | | | | | | - Ruth Herman
- University of Kansas Center for Public Partnerships and Research, Lawrence, KS
| | - Ann Bossen
- University of Iowa College of Nursing, Iowa City, IA
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Williams KN, Perkhounkova Y, Bossen A, Hein M. Nursing Home Staff Intentions for Learned Communication Skills: Knowledge to Practice. J Gerontol Nurs 2016; 42:26-34. [PMID: 26934971 PMCID: PMC4841447 DOI: 10.3928/00989134-20160212-06] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 11/04/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022]
Abstract
Staff education is critical to improving nursing home dementia care practice. However, a lag in translation to practice is a barrier to improving care. As part of a clinical trial testing effects of a communication intervention on behaviors of residents with dementia, participant-reported likelihood of using learned skills in practice was evaluated in relation to organizational and individual factors in 10 nursing homes. The authors hypothesized that organizational and individual factors would influence staff intention to use new skills in practice. Pre-and post-training comparisons confirmed that staff gained knowledge about communication effectiveness. Staff reported high likelihood for using skills in practice based on modified Duke Diffusion of Innovation (DOI) Scale scores. Care organization was correlated with total DOI scores (r = 0.82, p < 0.01). DOI subscales correlations to organizational and individual attitudes are reported. Evaluating quality improvement interventions in relation to translation to practice is essential in today's nursing home environment.
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Coleman CK, Fanning K, Williams KN. Comparing Person-Centered Communication Education in Long-Term Care Using Onsite and Online Formats. J Gerontol Nurs 2015; 41:22-8. [PMID: 26046364 DOI: 10.3928/00989134-20150515-88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 05/07/2015] [Indexed: 11/20/2022]
Abstract
Educating nursing home (NH) staff to provide person-centered care is complicated by scheduling, costs, and other feasibility issues. The current study compared outcomes for an in-service program focused on person-centered communication provided in onsite and online formats. The Changing Talk program was provided onsite in seven NHs (n = 327 staff). The online program included eight NHs (n = 211 staff). Analysis of variance revealed an interaction between format type and pre-/post-test scores with improved recognition of person-centered communication in the onsite group only. Group program evaluations based on the modified Diffusion of Innovation in Long-Term Care Battery indicated no significant differences between training formats. Staff perception of the program was similar. Although statistically significant gains were noted in posttest scores indicating awareness of person-centered communication for the onsite group, gains were of limited clinical significance. Feasibility and effectiveness are important considerations for in-service education supporting NH culture change.
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Bossen AL, Kim H, Williams KN, Steinhoff AE, Strieker M. Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technol Telehealth 2015; 3:49-57. [PMID: 26636049 PMCID: PMC4666316 DOI: 10.2147/shtt.s59500] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [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] [Indexed: 12/27/2022] Open
Abstract
Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one’s progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored.
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Affiliation(s)
- Ann L Bossen
- University of Iowa College of Nursing, Iowa City, IA, USA
| | - Heejung Kim
- University of Kansas School of Nursing, Kansas City, KS, USA ; Yonsei University College of Nursing, Seoul, Republic of Korea
| | | | | | - Molly Strieker
- University of Iowa College of Nursing, Iowa City, IA, USA
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Abstract
Psychometric analysis of the Emotional Tone Rating Scale (ETRS) was completed using ratings of naïve listeners who evaluated staff-resident communication in three nursing homes. Interrater consistency was high with ICC (2, 1) for agreement = 0.95 and consistency = 0.95. Factor analysis revealed two factors-person-centered communication and controlling communication-that explained 84.8% of the variance. Person-centered communication included seven descriptors (items) with loadings ranging from 0.84 to 0.98 and a coefficient alpha of 0.98. Controlling communication included five items that loaded from -0.63 to .99 with a coefficient alpha of 0.94. These factors were negatively correlated p = -.64 and demonstrated good ranges, standard deviations, and high item-total correlations. Person-centered communication correlated with higher resident engagement in conversation in contrast to controlling communication. The ETRS provides a measure of person-centered communication that can be used to evaluate interactions between nursing staff and older adults who reside in long term care settings.
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Affiliation(s)
- Kristine N Williams
- University of Kansas Medical Center School of Nursing, Kansas City, Kansas, USA
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Abstract
This pilot study tested an intervention designed to improve memory for assisted-living (AL) residents. Seven residents in one Midwestern AL facility participated in a six-session memory program based on qualitative research that identified typical memory challenges of residents (e.g., remembering names, schedules, and appointments). Scores on memory self-efficacy (the Memory Complaint in Age-Associated Impairment) and performance (Rivermead Behavioral Memory Test) measures were compared before and after the intervention. Self-efficacy improved significantly after the program (z = 2.37, p = .018) for remembering names, phone numbers, lists of items, and facts. Increases in actual memory performance were not statistically significant. However, three out of seven participants (43%) improved in recalling first and last names. Ongoing testing on larger samples with a control group design is needed to verify effects and determine any effects on daily functioning. This study suggests that cognitive interventions targeting frail elder populations are feasible to provide to older adults in AL.
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Abstract
Memory loss often signifies loss of independence, which is a growing concern for residents in assisted living (AL) facilities. The purpose of this exploratory study was to characterize the memory experiences and concerns of AL residents. Six residents voluntarily participated in 1-hour recorded interviews focusing on memory and guided by eight open-ended questions. Interviews were transcribed and analyzed using qualitative content analysis. Subjects reported varying degrees of memory loss they found frightening and frustrating, but also accepted the loss as a natural part of the aging process. Concerns focused primarily on inability to recall staff and resident names and activities, schedules, and appointments. Understanding memory experiences and concerns is important for nursing staff members who care for AL residents. Memory challenges identified by these residents were used to develop a memory intervention for older adults residents of this and other AL facilities. Improving cognitive skills may help AL residents maintain their functional abilities, enabling them to "age in place" in AL.
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Williams KN, Herman RE. Linking resident behavior to dementia care communication: effects of emotional tone. Behav Ther 2011; 42:42-6. [PMID: 21292050 PMCID: PMC3485306 DOI: 10.1016/j.beth.2010.03.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 02/16/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
Abstract
Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior. Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r=.49, p<.05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.
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Abstract
As the population ages, risks for cognitive decline threaten independence and quality of life for older adults and present challenges to the health care system. Nurses are in a unique position to advise older adults about cognitive health promotion and to develop interventions that optimize cognition in older adults. A literature review was conducted to provide nurses in mental health and geriatric care with an overview of research related to the promotion of successful cognitive aging for older adults. Research evaluating cognitively stimulating lifestyles and the effects on cognitive function in older adults of interventions targeting cognitive training, physical activity, social engagement, and nutrition were reviewed. Overall research findings support positive effects of cognitive and physical activity, social engagement, and therapeutic nutrition in optimizing cognitive aging. However, the strength of the evidence is limited by research designs. Applications for health promotion to optimize cognitive aging and future directions for research are discussed.
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Affiliation(s)
- Kristine N Williams
- Kansas University Medical Center, School of Nursing, Kansas City, KS 66160-7502, USA.
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Abstract
Resistiveness to care (RTC) in older adults with dementia commonly disrupts nursing care. Research has found that elderspeak (infantilizing communication) use by nursing home (NH) staff increases the probability of RTC in older adults with dementia. The current analysis used general sequential querier (GSEQ) software to analyze behavior sequences of specific behavioral events. We found that older adults with dementia most frequently reacted to elderspeak communication by negative vocalizations (screaming or yelling, negative verbalizations, crying). Because negative vocalizations disrupt nursing care, reduction in elderspeak use by staff may reduce these behaviors thereby increasing the quality of care to these residents. The results clearly demonstrate that sequential analysis of behavioral events is a useful tool in examining complex communicative interactions and targeting specific problem behaviors.
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Affiliation(s)
- Ruth E Herman
- University of Kansas School of Nursing, Kansas City, Kansas 66160, USA
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Abstract
Assisted living (AL) is a caregiving option between independent living and nursing home placement. This study explores women residents' experience of AL in four Midwestern facilities, using interview and field research methods. We found that most residents wanted to stay in AL rather than move to a nursing home; they looked backward nostalgically toward home, and complied with staff rules and directives in order to remain in place. In contrast to nursing homes, AL allows residents to experience continuities with self and home: a private room, some of their own belongings, and access to relationships and activities associated with self and home. Given the expanded lifespan and growing popularity of AL, it is becoming a new stage in the trajectory of women's aging.
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Affiliation(s)
- Kristine N Williams
- University of Kansas School of Nursing, 3901 Rainbow Blvd., Kansas City, KS 66160-7502, USA.
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Abstract
Assisted living facility residents are at risk of cognitive decline that can precipitate nursing home placement. Cognitive training protects cognition and leads to maintained self-care for community dwelling elders. This pilot study tested an intervention designed to improve reasoning and everyday problem solving for assisted living residents. Volunteers (N = 4) completed six Reasoning Exercises in Assisted Living (REAL) training sessions provided over one month. Pre-intervention, immediate post-intervention, and three-month follow-up assessments of problem solving were compared. Participants' scores on Everyday Problems for Cognitively Challenged Elderly (EPCCE) increased 20% from pre-(M = 11.00, SD = 8.83) to post-intervention (M = 19.5, SD = 8.35, t = -312, p = .05). After three months, participants showed sustained EPCCE score improvement (M = 21.75, SD = 4.57, t = -3.95, p = .03).
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Affiliation(s)
- Kristine N Williams
- School of Nursing, University of Kansas, Kansas City, Kansas 66160-7502, USA.
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Williams KN. P2‐471: Training assisted‐living residents in reasoning and everyday problem solving skills. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1550] [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: 11/26/2022]
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Williams KN, Herman RE, Gajewski B, Wilson K. O3‐07–04: Linking communication with resistance to nursing care in persons with dementia. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.462] [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: 11/30/2022]
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Abstract
Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.
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Affiliation(s)
- Kristine N Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
Resistiveness to care (RTC) by persons with dementia significantly adds to subjective and objective burden for caregivers and may be triggered by environmental factors, including communication. This case study evaluated behavioral responses of a nursing home resident with dementia to nursing staff use of elderspeak communication (infantilizing speech). Four videotaped staff-resident interactions that were previously recorded were coded for staff elderspeak communication and resident RTC. Total elderspeak scores (M= 29.5,SD= 25.74) and RTC scores (M= 8.75,SD= 13.79) were correlatedr= 0.93,p= .03. This preliminary single-subject observational study suggests a relationship between staff elderspeak communication and RTC in a nursing home resident with dementia that warrants further investigation. Limitations include the use of a convenient case study sample with inability to control time of day, medications, different care activities, staff characteristics, and other factors. Knowledge about communication in dementia care may inform nursing care practices to overcome behavioral symptoms such as RTC and improve quality of life for individuals with dementia and working conditions for nursing staff.
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Williams KN, Nowak J, Scobee RL. Fostering student interest in geriatric nursing: impact of senior long-term care experiences. Nurs Educ Perspect 2006; 27:190-3. [PMID: 16921803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Preparing nurses to meet the care needs of an expanding aging population is a challenge for nursing. Student experience in long-term care is typically limited to initial practicums. Students are rarely able to appreciate the complexity, challenge, and rewards of geriatric nursing. Few students seek geriatric nursing roles upon graduation, and care facilities report an inability to fill current vacancies. This article describes the integration of long-term care experiences into senior year community health practicums and reports on a qualitative analysis to evaluate the project's impact on student attitudes and intentions toward geriatric nursing roles.
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Abstract
As the primary caregivers for the millions afflicted with Alzheimer's disease, family members have been the focus of research for the past two decades. Differences in care patterns and deleterious effects of care provision have been clearly established. However, similar demands and hardships associated with care-giving result in different consequences for different families. A greater understanding of the care-giving context and its determinants will enhance knowledge of the differential impacts of care-giving. The most critical determinant of care-giving context is the role relationship between the caregiver and the care recipient. Future research must address role relationship as the primary determinant of what care is provided by whom, and in what manner. This will enhance the understanding of specific caregiver outcomes and lead to optimal targeting of interventions. Future research must also focus on the interface between the family and other social institutions. Evidence calls into question the equity, quality, and capacity of the current system of care, which assumes that family care is best. It will be important for future studies to explore alternate options for long-term care policy. Families and patients will also benefit from studies that assess strategies to ensure an adequate labor pool of qualified formal caregivers.
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Hoke GP, Stone BA, Klein L, Williams KN. The influence of gender on incidence and outcome of patients with bladder cancer in Harlem. J Natl Med Assoc 1999; 91:144-8. [PMID: 10203916 PMCID: PMC2608460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Although African Americans have a lower incidence of bladder cancer, overall survival is worse compared with American whites. This phenomenon has been attributed to the higher incidence of advanced disease at diagnosis and poor follow-up. Fifty-nine cases of bladder cancer were identified through the Tumor Registry at Harlem Hospital and reviewed retrospectively. Complete data were obtained for 42 patients. The primary independent variables of interest were primary care utilization, comorbid conditions, social variables, and gender. The outcome variables of interest were stage of disease at presentation and death. The median age at diagnosis in this group was 73 years compared with 68 for bladder cancer patients in the United States. There was no statistically significant correlation between primary care utilization or severity of comorbidities, and clinical stage at presentation. Similarly, these variables did not influence the occurrence of death as an outcome. For women, the mean age at diagnosis was 74.2 years compared with 67.3 in men (P = .112). The ratio of male-to-female cases in this group was 1.3 to 1 compared with 2.7 to 1 for the general US population. Women had lower odds of being diagnosed with superficial disease (OR = 0.24, 95% CI, 0.06-0.94) and a higher incidence of a cancer-specific death (OR = 2.7, 95% CI). The poor outcome and high incidence of bladder cancer cases among women in Harlem is intriguing. Overall, primary care utilization, comorbidities, and other social factors did not seem to influence stage or death as an outcome. The significantly elevated prevalence of smoking among women in this community, increased age at diagnosis, and possible environmental influences may play a role.
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Affiliation(s)
- G P Hoke
- Department of Surgery, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Posner NA, Unterman RR, Williams KN, Williams GH. Screening for postpartum depression. An antepartum questionnaire. J Reprod Med 1997; 42:207-15. [PMID: 9131493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To develop and evaluate a questionnaire used antepartum to screen for postpartum depression. STUDY DESIGN Demographic and clinical data, based on previously identified variables, were obtained from 106 second-trimester gravidas (sample I) by interview, self-administered questionnaire and medical record review. The Beck Depression Inventory (BDI) was administered at 1, 6 and 12 weeks postpartum (PP). Statistical analysis, including stepwise linear regression with maximum r-squared improvement, identified a subset of the 24 most predictive variables. This antepartum questionnaire (APQ) was validated retrospectively in the original sample and prospectively in a second group of 99 women (sample II). RESULTS In both sample populations the APQ had acceptable sensitivity (80-82%) and specificity (78-82%). The incidence of postpartum depressive symptoms (PPDS) rose from 10% to 17% by six weeks without an appreciable decline at 12 weeks (15%). The percentage of women showing more than mild depressive symptoms increased with PP time from 30% at 1 week to 47% at 12. CONCLUSION The APQ is now available for screening and evaluating early therapeutic intervention in PPDS.
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Affiliation(s)
- N A Posner
- Department of Obstetrics and Gynecology, Albany Medical College, NY 12208, USA
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Shartava A, Miranda P, Williams KN, Shah A, Monteiro CA, Goodman SR. High density sickle cell erythrocyte core membrane skeletons demonstrate slow temperature dependent dissociation. Am J Hematol 1996; 51:214-9. [PMID: 8619402 DOI: 10.1002/(sici)1096-8652(199603)51:3<214::aid-ajh6>3.0.co;2-#] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have previously demonstrated that slow dissociation of HDSS membrane skeletons in high ionic strength Triton X-100 buffer was related to a posttranslational modification in beta-actin, in which a disulfide bridge was formed between cysteine 284 and cysteine 373[Shartava et al: J Cell Bio 128:805, 1995]. These previous dissociation assays were limited to two homozygous (SS) sickle cell patients and a single temperature (37 degrees C). In the current work, we have expanded the SS subjects to 9 and have carried out dissociation assays at 0, 24, 30, 34, and 37 degrees C. At 0 degrees C there was limited dissociation of spectrin and actin from normal(AA), low density sickle cell(LDSS), and high density sickle cell (HDSS) core skeleton up to 24 hr. The first order rate constants for dissociation of spectrin, at 0 degrees C, was 0.030-0.035 x 10-4 sec-1 for AA,LDSS, and HDSS core skeletons. However at 24, 30, 34, and 37 degrees C the rate of dissociation of spectrin from HDSS core skeletons was significantly slower than the rate of dissociation from AA core skeletons. Having determined the first order rate constants for spectrin dissociation at these specified temperatures, we then asked whether dithiothreitol (DTT) would hasten the dissociation of core skeletons. The presence of DTT caused the rate of dissociation of the HDSS membrane skeleton to become statistically indistinguishable from the rate of dissociation of AA membrane skeletons. This is consistent with the suggestion that reversible thiol oxidation is responsible for the slow dissociation of the HDSS membrane skeleton.
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Affiliation(s)
- A Shartava
- Department of Structural and Cellular Biology, Univeristy of South Alabama College of Medicine, Mobile 36688, USA
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