Variables related to caregiver behaviors with cognitively impaired elders in institutional settings

Mealtime interactions between nursing home staff and residents with dementia: a behavioral analysis of Language characteristics

BACKGROUND

Quality 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.

METHODS

This 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.

RESULTS

Staff (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).

CONCLUSIONS

Staff-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.

Mealtime Interactions between Nursing Home Staff and Residents with Dementia: A Behavioral Analysis of Language Characteristics

Background. Quality 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. Methods. This was a secondary analysis of 160 mealtime videos involving 36 staff and 27 residents with dementia (53 unique staff-resident dyads) in 9 nursing homes. We examined the associations of speaker (resident vs. staff), utterance quality (negative vs. positive), intervention (pre- vs. post-communication intervention), and resident dementia stage and comorbidities with expression length (number of words in each utterance) and addressing partner by name (whether staff or resident named their partner in each utterance), respectively. Results. Staff (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). Conclusions. Staff-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 word and other levels using more diverse samples.

A communication model for nursing staff working in dementia care: Results of a scoping review

BACKGROUND

Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking.

OBJECTIVES

To identify and visualize factors associated with communication between nursing staff and people with dementia.

DESIGN

A scoping review of scientific literature.

DATA SOURCES

Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO.

REVIEW METHODS

The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model.

RESULTS

The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed.

CONCLUSIONS

The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.

The relationship between care providers' relational behaviors and residents mood and behavior in long-term care settings

BACKGROUND

Care providers' interactions with residents are an important element in long-term care settings. This study aimed at examining the association between care providers' relational behaviors and affect and mood of residents with dementia over different caregiving situations and with different residents.

METHODS

This study utilized a repeated-measures design. Thirty-eight residents with a diagnosis of dementia and 35 care providers from three nursing homes in Ontario, Canada, participated in the study. Care providers' relational behaviors and residents' mood and affect were assessed using direct observation methods and self-rating scales.

RESULTS

The care providers' relational behavior varied according to the caregiving situation, with the most effective relational behaviors observed during interpersonal interactions and the least effective during mealtimes. Less effective relational behaviors were observed between care providers and residents that were perceived as more resistive to care. In addition, effective relational behaviors were associated with positive mood and affect of the residents.

CONCLUSION

These findings emphasize the importance of acknowledging and enhancing care providers' relational behaviors when caring for persons with dementia living in long-term care settings.

Assault of long-term care personnel

The purpose of this study was to explore contributing factors, consequences, and solutions to assault of long-term care personnel. The study sample consisted of three focus groups composed of certified nursing assistants and administrators employed in long-term care facilities within a large Midwestern city. Using content analysis methodology, multiple themes emerged: worker attitude, vulnerability, work culture, job tasks, training, working short-staffed, financial concerns, changes in social values and health care, community crime, substance abuse, accepting assaults, coworker threats, issues of retaliation, professional withdrawal, and inability to share experiences. Preventive measures suggested by the participants are consistent with those recommended by the Occupational Safety and Health Administration. Implications for staff and administrators include both personal and workplace strategies. Recommendations include implementing more comprehensive violence prevention programs that includes conflict management and training tailored to the type of residents.

Factors related to nurse communication with elderly people

This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients a study was made of nurse-patient communication. In addition, relevant data related to patients, nurses and situation were gathered by questionnaires and were combined with the results of observations of videotaped nurse-patient interactions. It was found that the educational level of nurses was related most strongly to the way nurses communicate with their elderly patients. Patient characteristics such as age, gender and subjective state of health appeared to play a minor role in the way nurses communicate.

Factors influencing the proportion of food consumed by nursing home residents with dementia

BACKGROUND

Assessment of and interventions for promoting eating in persons with late-stage dementia have primarily focused on facilitation of safe feeding and methods to promote ingestion of nutrients via several routes. Using Social Exchange Theory, this study examined how the quality of the interaction between care giver and care receiver influenced the proportion of food consumed by persons with late-stage dementia.

METHODS

Fifty-three dyads composed of nursing home residents with late-stage dementia and Certified Nursing Assistants (CNAs) were observed during the breakfast meal. The proportion of food consumed by the residents was measured by weight. The study included measures of the quality of interaction between the resident and the CNA (Interaction Behavior Measure-Modified (IBM-M) and the IBM), CNA empathy (Interpersonal Reactivity Index), and CNA power (Control subscale of the FIRO-B).

RESULTS

Specific resident behaviors and the CNA's ability to allow another person to control a relationship were most predictive of the variance in the proportion of food consumed (R2 = .41; F(3,49) = 12.54; P < .001). The quality of the resident-CNA interaction accounted for 32% of the variance in the proportion of food consumed. One aspect of power was correlated significantly to the proportion of food consumed whereas CNA empathy was not.

CONCLUSIONS

Because eating is the most social of all ADLs and is culturally bound, clinicians need to examine the interactional components of meals within the caregiving dyad when a person with late-stage dementia fails to ingest adequate nutrients.

Meaning-making for family carers in nursing homes

This ontological hermeneutic study highlights the importance of understanding the human experience of family caring. In contrast to much family caregiving research which focuses upon the home care situation, this study involved in-depth audiotaped conversational interviews and observations with 14 family carers who continue to care within a nursing home context. Thematic analysis of the transcribed interviews/field notes uncovered a number of common themes of meaning which highlight the nature of family caring experience in nursing homes. Discussion of such findings will challenge practitioners to reconceptualise the nurse resident-family carer relationship, appreciate the many ways in which a family member's involvement in care provides meaning and significance in their lives, and understand family carers through a process of human relating which fosters families' meaningful involvement in caring within a nursing home context.

Psychiatric nursing outcome research: the state of the science

A review of the nursing literature from 1989 to 1994 indicates that few psychiatric nursing studies are published in the major nursing research journals. The psychiatric specialization literature includes a large number of studies that are classified as either outcome studies or could serve as building blocks for future outcome studies. Few studies build on prior research, resulting in a weak scientific basis for evaluating the outcomes of psychiatric nursing care. Strategies for increasing the quantity and quality of psychiatric nursing outcome research are presented.