Come talk with me: improving communication between nursing assistants and nursing home residents during care routines.

PURPOSE We examined the effects of communication skills training and the use of memory books by certified nursing assistants (CNAs) on verbal interactions between CNAs (n = 64) and nursing home residents (n = 67) during care routines. DESIGN AND METHODS CNAs were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities. A staff motivational system was used to encourage performance and maintenance of these skills. Formal measures of treatment implementation were included. RESULTS Results were compared with those for participants on no-treatment control units. Trained CNAs talked more, used positive statements more frequently, and tended to increase the number of specific instructions given to residents. Changes in staff behavior did not result in an increase in total time giving care to residents. Maintenance of CNA behavior change was found 2 months after research staff exited the facility. Although an increase was found in positive verbal interactions between CNAs and residents on intervention units, other changes in resident communication were absent. IMPLICATIONS Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care. The methodological advantages of including measures to assess treatment implementation are discussed.

[1]  M. Powell Lawton,et al.  Annual Review of Gerontology and Geriatrics , 1988, Springer Berlin Heidelberg.

[2]  L. Burgio,et al.  Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. , 1994, Journal of gerontology.

[3]  M. Bourgeois.  Enhancing conversation skills in patients with Alzheimer's disease using a prosthetic memory aid. , 1990, Journal of applied behavior analysis.

[4]  J. Schnelle,et al.  Total Quality Management: Administrative and Clinical Applications in Nursing Homes , 1993, Journal of the American Geriatrics Society.

[5]  L. Burgio,et al.  Effective behavioral interventions for decreasing dementia‐related challenging behavior in nursing homes , 1999, International journal of geriatric psychiatry.

[6]  J. Rader,et al.  REDUCING AGGRESSIVE BEHAVIOR: During Bathing Cognitively Nursing Home Residents , 1997 .

[7]  L. Burgio,et al.  A descriptive analysis of nursing staff behaviors in a teaching nursing home: differences among NAs, LPNs, and RNs. , 1990, The Gerontologist.

[8]  L. Burgio,et al.  Temporal patterns of disruptive vocalization in elderly nursing home residents , 2001, International journal of geriatric psychiatry.

[9]  L. Burgio,et al.  Teaching and maintaining behavior management skills with nursing assistants in a nursing home. , 1998, The Gerontologist.

[10]  William L. Hays,et al.  Statistics, 5th ed. , 1994 .

[11]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[12]  R. Toseland,et al.  An Evaluation of a Family Visit Education Program , 1999, Journal of the American Geriatrics Society.

[13]  L. Burgio,et al.  Direct Observation of Behavioral Disturbances of Dementia and Their Environmental Context , 1997, International Psychogeriatrics.

[14]  Michelle S. Bourgeois,et al.  MEMORY WALLET INTERVENTION IN AN ADULT DAY-CARE SETTING , 1996 .

[15]  Chuanchieh Hsu,et al.  Improving Morning Care Routines of Nursing Home Residents with Dementia , 1999, Journal of the American Geriatrics Society.

[16]  L. Burgio,et al.  Environmental "white noise": an intervention for verbally agitated nursing home residents. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[17]  L. Burgio,et al.  Increasing Communication Among Nursing Home Residents , 2001 .

[18]  J. Schnelle,et al.  Costs of Promoting Independence , 1999, Journal of the American Geriatrics Society.

[19]  T. Cook,et al.  Quasi-experimentation: Design & analysis issues for field settings , 1979 .

[20]  L. Burgio,et al.  Modifying repetitive verbalizations of community-dwelling patients with AD. , 1997, The Gerontologist.

[21]  J. Schnelle,et al.  Management of patient continence in long-term care nursing facilities. , 1990, The Gerontologist.

[22]  R. Prinz,et al.  Treatment fidelity in outcome studies , 1991 .

[23]  D. N. Ripich,et al.  Alzheimer's disease caregivers: The FOCUSED program , 1995 .

[24]  Alan C. Repp,et al.  A Computer-Based System for Collecting and Analyzing Observational Data , 1989 .

[25]  M. Bourgeois,et al.  Evaluating memory wallets in conversations with persons with dementia. , 1992, Journal of speech and hearing research.

[26]  A. Norberg,et al.  A comparison between the care of vocally disruptive patients and that of other residents at psychogeriatric wards. , 1990, Journal of advanced nursing.

[27]  E. Pfeiffer.  A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients † , 1975, Journal of the American Geriatrics Society.

[28]  M. Bourgeois,et al.  Effects of memory aids on conversations between nursing home residents with dementia and nursing assistants , 2001 .

[29]  R. Toseland,et al.  Educating nursing assistants to communicate more effectively with nursing home residents with dementia. , 1999, The Gerontologist.

[30]  A. Whall,et al.  Behavioral analysis and nursing interventions for reducing disruptive behaviors of patients with dementia. , 1995, Applied nursing research : ANR.

[31]  K. Lichstein,et al.  Fair tests of clinical trials: A treatment implementation model , 1994 .

[32]  M. Bourgeois,et al.  Effects of memory aids on the dyadic conversations of individuals with dementia. , 1993, Journal of applied behavior analysis.

[33]  C. Kovner,et al.  Experts recommend minimum nurse staffing standards for nursing facilities in the United States. , 2000, The Gerontologist.

[34]  William R. Shadish,et al.  Evaluation studies : review annual , 1976 .

[35]  B. J. Winer.  Statistical Principles in Experimental Design , 1992 .

[36]  J. Cohen-Mansfield,et al.  Screaming in Nursing Home Residents , 1990, Journal of the American Geriatrics Society.

[37]  M P Lawton,et al.  Observed affect in nursing home residents with Alzheimer's disease. , 1996, The journals of gerontology. Series B, Psychological sciences and social sciences.

[38]  Jacob Cohen,et al.  Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. , 1968 .

[39]  A. Petruckevitch,et al.  The Functional Independence Measure: a comparative validity and reliability study. , 1995, Disability and rehabilitation.

[40]  L. Burgio,et al.  Institutional Staff Training and Management: A Review of the Literature and a Model for Geriatric, Long-Term-Care Facilities , 1990, International journal of aging & human development.

[41]  L. Burgio,et al.  Judging outcomes in psychosocial interventions for dementia caregivers: the problem of treatment implementation. , 2001, The Gerontologist.

[42]  C. Granger,et al.  Interrater reliability of the 7-level functional independence measure (FIM) , 1994, Scandinavian journal of rehabilitation medicine.

[43]  L. Burgio,et al.  Teaching and maintaining behavior management skills in the nursing home. , 2002, The Gerontologist.

[44]  L. Burgio,et al.  Caregiver Performance in the Nursing Home: The Use of Staff Training and Management Procedures , 1994 .