Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Instruments
2.3. Procedure
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- The person-centered approach (session I). Training based on the work of Tom Kitwood [22].
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- The behavior-oriented approach (sessions I and II). This approach is based on the importance of the environment and external reinforcements in learning. It is necessary that participants in the course understand that the environment must adapt to each person [35] as well as the relevance of the background and the consequences surrounding each behavior.
- —
- The communication approach (session III). This approach aims to raise awareness about how the way of communicating with people with cognitive impairment, including verbal and non-verbal language, has an influence.
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- The emotion-based approach and validation (session III). Training is based on Naomi Feil’s [36] work on validation and the idea of respect and consideration of the feelings of the people with whom one works through individualized attention plans.
2.4. Data Analysis
3. Results
3.1. Descriptives
3.2. Tests for Homogeneity
3.3. Effects of the Program on the Level of BPSD
3.4. Effects of the Program on the Use of Psychotropic Drugs
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Villalobos Dintrans, P.; Browne Salas, J.; Madero-Cabib, I. It’s not just mortality: A call from Chile for comprehensive COVID-19 policy responses among older people. J. Gerontol. 2020, 92, 1–6. [Google Scholar] [CrossRef]
- Fallon, A.; Dukelow, T.; Kennelly, S.P.; O’Neill, D. COVID-19 in nursing homes. QJM Int. J. Med. 2020, 113, 391–392. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lanctôt, K.L.; Amatniek, J.; Ancoli-Israel, S.; Arnold, S.E.; Ballard, C.; Cohen-Mansfield, J.; Osorio, R.S. Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms. Alzheimers Dement. 2017, 3, 440–449. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Morris, S.; Patel, N.; Baio, G.; Kelly, L.; Lewis-Holmes, E.; Omar, R.Z.; Katona, C.; Cooper, C.; Livingston, G. Monetary costs of agitation in older adults with Alzheimer’s disease in the UK: Prospective cohort study. BMJ Open 2015, 5, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Cummings, J.L.; Mega, M.; Gray, K.; Rosemberg, S.; Carusi, D.; Gornbein, J. The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994, 44, 2308. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Helvik, A.-S.; Selbæk, G.; Šaltytė Benth, J.; Røen, I.; Bergh, S. The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up. PLoS ONE 2018, 13, e0206147. [Google Scholar] [CrossRef] [Green Version]
- Losada, A.; Márquez, M.; Vara-García, C.; Gallego, L.; Romero, R.; Olazarán, J. Impacto psicológico de las demencias en las familias: Propuesta de un modelo integrador. Clin. Contemp. 2017, 8, 1–27. [Google Scholar] [CrossRef]
- Steppacher, I.; Kissler, J. A problem shared is a problem halved? Comparing burdens arising for family caregivers of patients with disorders of consciousness in institutionalized versus at home care. BMC Psychol. 2018, 6, 1–13. [Google Scholar] [CrossRef]
- Abraha, I.; Rimland, J.M.; Trotta, F.M.; Dell’Aquila, G.; Cruz-Jentoft, A.; Petrovic, M.; Cherubini, A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. BMJ Open 2017, 7, 1–28. [Google Scholar] [CrossRef] [Green Version]
- Smythe, A.; Jenkins, C.; Galant-Miecznikowska, M.; Bentham, P.; Oyebode, J. A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes. Nurse Educ. Today 2017, 50, 119–123. [Google Scholar] [CrossRef] [Green Version]
- Kales, H.C.; Gitlin, L.N.; Lyketsos, C.G. Assessment and management of behavioral and psychological symptoms of dementia. BMH 2015, 10, 350–369. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Muniz, R.; Pérez-Wehbe, A.I.; Couto, F.; Pérez, M.; Ramírez, N.; López, A.; Agüera-Ortiz, L. The “CHROME criteria”: Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia. Int. Psychogeriatr. 2020, 32, 315–324. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kolanowski, A.; Boltz, M.; Galik, E.; Gitlin, L.N.; Kales, H.C.; Resnick, B.; Liu, W. Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence. Nurs. Outlook 2017, 65, 515–529. [Google Scholar] [CrossRef] [PubMed]
- Dyer, S.M.; Harrison, S.L.; Laver, K.; Whitehead, C.; Crotty, M. An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioural and psychological symptoms of dementia. Int. Psychogeriatr. 2017, 30, 295–309. [Google Scholar] [CrossRef]
- Tan, Z.S.; Ramirez, K.; Soh, M.; Ercoli, L. The effects of an intensive dementia caregiver training curse on caregiver knowledge and perceived competence. Alzheimers Dement. J. Alzheimers Assoc. 2017, 13, 491–501. [Google Scholar] [CrossRef]
- Kong, E.H.; Choi, H.; Evans, L.K. Staff perceptions of barriers to physical restraint-reduction in long-term care: A meta-synthesis. J. Clin. Nurs. 2017, 26, 49–60. [Google Scholar] [CrossRef]
- Teri, L.; Huda, P.; Gibbons, L.; Young, H.; van Leynseele, J. STAR: A dementia- specific training program for staff in assisted living residences. Gerontologist 2005, 45, 686–693. [Google Scholar] [CrossRef] [Green Version]
- McCurry, S.M.; Logsdon, R.G.; Mead, J.; Pike, K.C.; La Fazia, D.M.; Stevens, L.; Teri, L. Adopting evidence-based caregiver training programs in the real world: Outcomes and lessons learned from the STAR-C Oregon translation study. J. Appl. Gerontol. 2017, 36, 519–536. [Google Scholar] [CrossRef]
- Lindauer, A.; La Fazia, D.M.; McKenzie, G.; McNeill, L.; Mincks, K.; Mattek, N.; Spooden, N.; Myers, M.; Teri, L. TELE-STAR for caregivers: Fidelity assessment methods and early findings. Alzheimers Dement. J. Alzheimers Assoc. 2018, 14, 1607–1608. [Google Scholar] [CrossRef]
- Legere, L.E.; McNeill, S.; Schindel Martin, L.; Acorn, M.; An, D. Nonpharmacological approaches for behavioural and psychological symptoms of dementia in older adults: A Systematic Review of Reviews. J. Clin. Nurs. 2018, 27, 1360–1376. [Google Scholar] [CrossRef]
- Cohen-Mansfield, J.; Dakheel-Ali, M.; Marx, M.S.; Thein, K.; Regier, N.G. Which unmet needs contribute to behaviour problems in persons with advanced dementia? Psychiatry Res. 2015, 228, 59–64. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kitwood, T. A new approach to the evaluation of dementia care. J. Adv. Health Nurs. Care 1992, 1, 40–48. [Google Scholar]
- Rodriguez, P. La Atención Integral y Centrada en la Persona; Fundación Pilares: Madrid, Spain, 2013. [Google Scholar]
- Barbosa, A.; Sousa, L.; Nolan, M.; Figueiredo, D. Effects of person-centered care approaches to dementia care on staff: A systematic review. Am. J. Alzheimers Dis. Other Dement. 2015, 30, 713–722. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Labra, C.; Millán-Calenti, J.C.; Buján, A.; Núñez-Naveira, L.; Jensen, A.M.; Peersen, M.C.; Mojs, E.; Samborski, W.; Maseda, A. Predictors of caregiving satisfaction in informal caregivers of people with dementia. Arch. Gerontol. Geriatr. 2015, 60, 380–388. [Google Scholar] [CrossRef] [Green Version]
- Anderson, K.; Blair, A. Why we need to care about the care: A longitudinal study linking the quality of residential dementia care to residents’ quality of life. Arch. Gerontol. Geriatr. 2020, 91, 104226. [Google Scholar] [CrossRef]
- Paudel, A.; Resnick, B.; Galik, E. The Quality of Interactions between Staff and Residents with Cognitive Impairment in Nursing Homes. Am. J. Alzheimers Dis. Other Dement. 2020, 35, 1–10. [Google Scholar] [CrossRef]
- Sarre, S.; Maben, J.; Aldus, C.; Schneider, J.; Wharrad, H.; Nicholson, C.; Arthur, A. The challenges of training, support and assessment of healthcare support workers: A qualitative study of experiences in three English acute hospitals. Int. J. Nurs. Stud. 2018, 79, 145–153. [Google Scholar] [CrossRef]
- Van Der Linde, R.; Stephan, B.; Savva, G.; Dening, T.; Brayne, C. Systematic reviews on behavioural and psychological symptoms in the older or demented population. Alzheimers Res. Ther. 2012, 4, 28. [Google Scholar] [CrossRef] [Green Version]
- Ismail, Z.; Smith, E.E.; Geda, Y.; Sultzer, D.; Brodaty, H.; Smith, G.; Agüera-Ortiz, L.; Sweet, R.; Miller, D.; Lyketsos, C.G. Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016, 12, 195–202. [Google Scholar] [CrossRef]
- Lobo, A.; Saz, P.; Marcos, G. Adaptación del Examen Cognoscitivo Mini-Mental. In Adaptation of the Mini-Mental State Examination; Tea Ediciones: Madrid, Spain, 2002. [Google Scholar]
- López-Trigo, J.A.; Ramos, P.; Gutiérrez, J.; Rexach, L.; Artaza, I.; Moreno, M.; González, T.; Martínez, A.; Nevado, M.; García, C.; et al. Documento de Consenso Sobre Sujeciones Mecánicas y Farmacológicas; Sociedad Española de Geriatría y Gerontología: Madrid, Spain, 2014. [Google Scholar]
- Muñiz, R.; Gómez, S.; Curto, D.; Hernandez, R.; Marco, B.; García, P.; Tomás, J.; Olazarán, J. Reducing Physical Restraints in Nursing Homes: A Report from Maria Wolff and Sanitas. J. Am. Med. Dir. Assoc. 2016, 17, 633–639. [Google Scholar] [CrossRef] [Green Version]
- Spector, A.; Orrell, M.; Goyder, J. A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res. Rev. 2013, 12, 354–364. [Google Scholar] [CrossRef]
- Lawton, M.P. Aging and performance of home tasks. Hum. Factors 1990, 32, 527–536. [Google Scholar] [CrossRef] [PubMed]
- Feil, N. Validación: Un Método para Ayudar a las Personas Mayores Desorientadas; Herder: Barcelona, Spain, 2002. [Google Scholar]
- McCabe, M.P.; Davison, T.E.; George, K. Effectiveness of staff training programs for behavioural problems among older people with dementia. Aging Ment. Health 2007, 11, 505–519. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bravo-Benítez, J.; Navarro-González, E. Problemas de conducta en personas con demencia: Eficacia de un programa de formación de cuidadores. Psicol. Conduct. 2018, 26, 159–175. [Google Scholar]
- Burgio, L.D.; Stevens, A.; Burgio, K.L.; Roth, D.L.; Paul, P.; Gerstle, J. Teaching and managing behavior management skills in the nursing home. Gerontogist 2002, 42, 487–496. [Google Scholar] [CrossRef] [Green Version]
- Ikeda, Y.; Han, G.; Maruta, M.; Hotta, M.; Ueno, E.; Tabira, T. Association between Daily Activities and Behavioral and Psychological Symptoms of Dementia in Community-Dwelling Older Adults with Memory Complaints by Their Families. International. Int. J. Environ. Res. Public Health 2020, 17, 6831. [Google Scholar] [CrossRef] [PubMed]
- Vega, M.; Miralles, J.M.; Mangas, D.; Castrillejo, A.I.; Rivas, M.; Gil, A.; López, E.; Arrieta, J.E.; Lozano, M.; Fragua, M. Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias. Neurology 2018, 3, 491–498. [Google Scholar] [CrossRef]
- Weiner, M.F.; Tractenberg, R.E.; Sano, M.; Logsdon, R.; Teri, L.; Galasko, D.; Gamst, A.; Thomas, R.; Thal, L.J. No long-term effect of behavioral treatment on psychotropic drug use for agitation in Alzheimer’s Disease patients. J. Geriatr. Psychiatry Neurol. 2002, 15, 95–98. [Google Scholar] [CrossRef]
- Janus, S.I.; Van Manen, J.G.; IJzerman, M.J.; Zuidema, S.U. Psychotropic drug prescriptions in Western European nursing homes. Int. Psychogeriatr. 2016, 28, 1775–1790. [Google Scholar] [CrossRef]
- Gómez-Aguirre, N.; Caudevilla, A.; Bellostas, L.; Crespo, M.; Velilla, J.; Díez-Manglano, J. Pluripatología, polifarmacia, complejidad terapéutica y uso adecuado de la medicación. Rev. Clin. Esp. 2017, 217, 289–295. [Google Scholar] [CrossRef]
- Ballard, C.; Corbett, A.; Orrell, M.; Williams, G.; Moniz-Cook, E.; Romeo, R.; Woods, B.; Garrod, L.; Testad, I.; Woodward-Carlton, B.; et al. Impact of person-centered care training and person-centered activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. PLoS Med. 2018, 15, 1–18. [Google Scholar] [CrossRef] [PubMed]
- Sheikh, A.; Dhingra-Kumar, N.; Kelley, E.; Kieny, M.P.; Donaldson, L. El Tercer reto Mundial por la Seguridad del Paciente: Reducir los Daños Causados por los Medicamentos. Boletín de la Organzación Mundial de la Salud 2017, 95, 546. [Google Scholar] [CrossRef]
- O’Mahony, D.; O’Sullivan, D.; Byrne, S.; O’Connor, M.N.; Ryan, C.; Gallagher, P. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing 2015, 44, 213–218. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fariña-López, E.; Estévez-Guerra, G.J.; González, E.N.; Hernández, D.D.; Crego, M.G. Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores. Rev. Esp. Geriatr. Gerontol. 2013, 48, 209–215. [Google Scholar] [CrossRef] [PubMed]
- Eskandari, F.; Abdullah, K.L.; Zainal, N.Z.; Wong, L.P. The effect of educational intervention on nurses’ knowledge, attitude, intention, practice and incidence rate of physical restraint use. Nurse Educ. Pract. 2018, 32, 52–57. [Google Scholar] [CrossRef] [PubMed]
- Wimo, A.; Guerchet, M.; Ali, G.C.; Wu, Y.T.; Prina, A.M.; Winblad, B.; Prince, M. The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimers Dement. 2017, 13, 1–7. [Google Scholar] [CrossRef]
Sessions | Contents |
---|---|
Session I | Aging, dementia, and cognitive impairment |
Behavioral and psychological symptoms of dementia and biopsychosocial repercussions | |
Person-centered care in residential caring | |
Biopsychosocial model and importance of the environment | |
Introduction to the risks of physical and chemical restraints | |
Session II | Conceptualization of each behavioral and psychological symptoms of dementia |
Possible precipitants | |
Management and case studies | |
Session III | Importance of communication |
Guidelines to facilitate verbal communication | |
Non-verbal communication | |
Aspects to avoid when dealing with people with dementia | |
Infantilization, ageism, and ostracism | |
Validation method and its benefits | |
Conclusions |
Time | Experimental Group Mean (SD) | Control Group Mean (SD) | F * | p-Value | η2 ** |
---|---|---|---|---|---|
T1 | 10.13 (11.67) | 5.18 (5.99) | 9.01 | 0.003 | 0.061 |
T2 | 9.68 (9.99) | 7.65 (7.93) | 1.69 | 0.195 | 0.012 |
T3 | 9.81 (11.27) | 7.28 (7.99) | 2.19 | 0.141 | 0.016 |
T4 | 9.10 (9.82) | 8.08 (8.93) | 0.39 | 0.530 | 0.003 |
T5 | 6.36 (7.45) | 10.10 (10.37) | 5.90 | 0.016 | 0.041 |
Time | Experimental Group Mean (SD) | Control Group Mean (SD) | F * | p-Value | η2 ** |
---|---|---|---|---|---|
T1 | 1.65 (1.30) | 1.60 (1.26) | 0.06 | 0.798 | 0.000 |
T2 | 1.52(1.21) | 1.85 (1.57) | 2.05 | 0.154 | 0.014 |
T3 | 1.47 (1.19) | 2.01 (1.57) | 5.51 | 0.020 | 0.037 |
T4 | 1.43 (1.16) | 2.07 (1.60) | 7.71 | 0.006 | 0.051 |
T5 | 1.35 (1.22) | 2.27 (1.65) | 14.68 | 0.000 | 0.093 |
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Pinazo-Clapés, C.; Pinazo-Hernandis, S.; Sales, A. Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study. Int. J. Environ. Res. Public Health 2020, 17, 8845. https://doi.org/10.3390/ijerph17238845
Pinazo-Clapés C, Pinazo-Hernandis S, Sales A. Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study. International Journal of Environmental Research and Public Health. 2020; 17(23):8845. https://doi.org/10.3390/ijerph17238845
Chicago/Turabian StylePinazo-Clapés, Carolina, Sacramento Pinazo-Hernandis, and Alicia Sales. 2020. "Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study" International Journal of Environmental Research and Public Health 17, no. 23: 8845. https://doi.org/10.3390/ijerph17238845