Preparing care home staff to manage challenging behaviours among residents living with dementia: A mixed-methods evaluation.
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SUBMITTER: Campbell N
PROVIDER: S-EPMC8851137 | biostudies-literature | 2020 Jul-Dec
REPOSITORIES: biostudies-literature
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Preparing care home staff to manage challenging behaviours among residents living with dementia: A mixed-methods evaluation.
Campbell Niyah N Maidment Ian D ID Randle Emma E Shaw Rachel L RL
Health psychology open 20200703 2
We evaluated an intervention designed to manage challenging behaviours of people with dementia. Framework analysis of interviews (<i>n</i> = 21) showed the intervention modified practice and perceptions. The intervention (<i>n</i> = 58; power calculation proposed <i>n</i> = 160 for medium effect) had no significant effect on attitudes to dementia for time (<i>p</i> = .42) or care home (<i>p</i> = .15). The Maslach burnout scores did not change significantly for person-centredness for time (<i>p< ...[more]
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Project description:BackgroundQuality staff-resident communication is crucial to promote outcomes in nursing home residents with dementia requiring assistance during mealtimes. Better understanding of staff-resident language characteristics in mealtime interactions help promote effective communication, yet evidence is limited. This study aimed to examine factors associated with language characteristics in staff-resident mealtime interactions.MethodsThis was a secondary analysis of 160 mealtime videos involving 36 nursing staff and 27 residents with moderately severe to severe dementia in 9 nursing homes. Mixed-effects models was used to examine the relationships between factors and language characteristics in staff-resident mealtime interactions. The independent variables were speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities. The dependent variables were expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance). All models included staff, resident, and staff-resident dyad as random effects.ResultsStaff (utterance n = 2990, 99.1% positive, mean = 4.3 words per utterance) predominated conversations and had more positive, longer utterances than residents (utterance n = 890, 86.7% positive, mean = 2.6 words per utterance). As residents progressed from moderately severe to severe dementia, both residents and staff produced shorter utterances (z=-2.66, p = .009). Staff (18%) named residents more often than residents (2.0%; z = 8.14, p < .0001) and when assisting residents with more severe dementia (z = 2.65, p = .008).ConclusionsStaff-resident communication was primarily positive, staff-initiated, and resident-oriented. Utterance quality and dementia stage were associated with staff-resident language characteristics. Staff play a critical role in mealtime care communication and should continue to initiate resident-oriented interactions using simple, short expressions to accommodate resident declining language abilities, particularly those with severe dementia. Staff should practice addressing residents by their names more frequently to promote individualized, targeted, person-centered mealtime care. Future work may further examine staff-resident language characteristics at other levels of language using more diverse samples.
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Project description:IntroductionMealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia.MethodsThis study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression.ResultsStaff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours.ConclusionThis study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.
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Project description:IntroductionChallenging behavior and pain are common in nursing home residents with dementia. Challenging behavior and pain can be related and are stressful for residents, family caregivers and healthcare professionals. The STA OP! method provides a step-by-step protocol to manage challenging behavior and pain in nursing home residents with dementia. However, this method does not include a prominent and active role for family caregivers.MethodsThe STA OP! method was modified to include a role for family caregivers, in co-creation with family caregivers and healthcare professionals using elements of a realist approach. In separate meetings, two advisory groups comprised of family caregivers and professionals discussed ideas on how to involve family caregivers in STA OP!. Furthermore, barriers to involving family and possible solutions to overcome those barriers were discussed. Experts who had experience with the STA OP! method assessed the feasibility of the ideas in a nominal group technique meeting.ResultsThirty-eight ideas emerged in the advisory groups. The two ideas that generated the most discussion were Inviting family for a multidisciplinary meeting, and Assessment of pain in collaboration with family caregivers. Eventually, 21 ideas and suggestions to overcome possible barriers were included in a manual for the training of healthcare professionals in the adapted method, now called STA OP! with family.ConclusionHealthcare professionals and family caregivers collaborated well to shape the involvement of family caregivers in this method for managing challenging behavior and pain. The collected ideas supported by all involved resulted in a modified method: STA OP! with family and can now be tested in daily practice.
| S-EPMC11471609 | biostudies-literature