Changing Talk to Reduce Resistiveness to Dementia Care

改变言论以减少对痴呆症护理的抵触情绪

基本信息

批准号：
7983070
负责人：
KRISTINE N. WILLIAMS
金额：
$ 42.76万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-28 至 2014-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7983070
关键词：
Address Adult Aggressive behavior Behavior Behavioral Behavioral Symptoms Care given by nurses Caring Characteristics Clinical Trials Clinical Trials Design Code Communication Control Groups Cost Effectiveness Analysis Crossover Design Data Dementia Discipline of Nursing Educational Intervention Emotional Family Frequencies Fright Goals Home Nursing Care Hour Impaired cognition Intervention Job Satisfaction Link Long-Term Care Nursing Measurable Methods Modeling Monitor Nursing Homes Nursing Staff Outcome Persons Problem behavior Psycholinguistics Quality of life Randomized Randomized Clinical Trials Recruitment Activity Reporting Research Speech Statistical Models Stress Surveys Symptoms Testing Time Training Training Support Video Recording Videotape Withdrawal base burnout care episode cost cost effectiveness group intervention improved innovation nursing care quality nursing intervention post intervention public health relevance research study satisfaction skills success

项目摘要

DESCRIPTION (provided by applicant): The purpose of this clinical trial is to test the effects of the Changing Talk (CHAT) communication training intervention for nursing staff on decreasing resistive behaviors of nursing home (NH) residents with dementia. Resistiveness to care (RTC) includes aggression, withdrawal, vocal outbursts, and other "problem behaviors" that occur in 75-90% of persons with dementia. These behaviors disrupt and lengthen daily care, adding to staff stress, burnout, and turnover, increasing the costs of care by 25-30%. RTC can occur due to unmet needs of persons with dementia and has been empirically linked to communication style. The PI's recent research found that NH residents with dementia were twice as likely to resist care when nursing staff used elderspeak communication; a common and measurable speech style similar to baby talk, compared to normal adult communication. CHAT reduced elderspeak use by staff in quasi-experimental NH studies. However, the effect of CHAT on staff elderspeak use and on subsequent resident RTC has never been empirically tested. The proposed randomized clinical trial study aims to establish causal evidence of CHAT's reduction in staff elderspeak use and subsequent lessening of RTC in residents with dementia. The primary specific aim of the proposed clinical trial is to test CHAT's effect on decreasing RTC of nursing home residents with dementia. The 3-hour CHAT intervention will be provided to nursing staff in NHs (N=16) randomly assigned to INTERVENTION or CONTROL groups. Costs for CHAT will be tabulated in ratio to hypothesized effects on the proportion of RTC behavior, time required for resident morning care, staff charting of RTC, staff satisfaction and efficacy, and quarterly NH turnover rates. Staff-resident dyads (N=80) will be video recorded during morning care before, immediately after, and 3- months post-intervention. As in past studies, each video taped care episode (N=720) will be coded for the frequency and duration of resident RTC using established behavioral coding analyses. Linear mixed modeling will compare between group differences in RTC, coded from video recordings of morning care immediately and 3 months after CHAT. Video episodes also will be used to verify staff enactment of CHAT skills using behavioral, emotional tone, and psycholinguistic coding of elderspeak. And as in prior studies, sequential time relationships between staff elderspeak and RTC will be tested. Costs to provide CHAT will be tabulated in ratio to between group differences in time required to complete resident morning care, RTC in staff charting, staff job satisfaction, and turnover rates. Facility, resident, and staff factors that influence effects of CHAT will be analyzed in multi-level statistical models. This clinical trial, based on the Need-Based Dementia-Compromised Behavior model, will use a unique combination of research strategies and sophisticated analyses to test an intervention with potential to reduce resident RTC. The long term goal of this research is to improve the quality of nursing care for persons with dementia while reducing costs. PUBLIC HEALTH RELEVANCE: This study tests the effects of the Changing Talk (CHAT) communication training intervention for nursing home staff on the common and problematic resistiveness to care behaviors of nursing home residents with dementia. CHAT reduces nursing staff use of patronizing elderspeak communication, that was found to double the likelihood of resident resistiveness to care. Determination of CHATs effect on resident resistiveness to care will contribute evidence for nursing interventions to manage behavioral symptoms of dementia, to improve dementia care.

描述（由申请人提供）：这项临床试验的目的是测试不断变化的谈话（CHAT）对护理人员的沟通培训干预措施对减少患有痴呆症的疗养院（NH）居民的抵抗行为的影响。对护理的抵抗力（RTC）包括侵略性，戒断，声音爆发以及75-90％患有痴呆症患者的其他“问题行为”。这些行为破坏并加长了日常护理，增加了员工的压力，倦怠和营业额，使护理成本增加了25-30％。 RTC可能是由于痴呆症患者的需求未满足的，并且与沟通风格有关。 PI最近的研究发现，NH患有痴呆症的NH居民在护理人员使用Elderspeak沟通时抵制护理的可能性是两倍。与正常的成人交流相比，一种与婴儿谈话相似的常见且可衡量的语音风格。聊天减少了员工在准实验性NH研究中的使用。但是，聊天对员工Elderspeak使用以及随后的RTC的影响从未经过经验测试。拟议的随机临床试验研究旨在建立聊天减少的因果证据，以减少痴呆症居民的RTC的人员使用，随后减少RTC。拟议的临床试验的主要特定目的是测试聊天对减少患有痴呆症疗养院居民RTC的影响。 3小时的聊天干预措施将提供给NHS的护理人员（n = 16），随机分配给干预或对照组。聊天的成本将以比较对RTC行为比例的影响，居民晨保健所需的时间，RTC的员工图表，员工满意度和功效以及季度NH周转率的比例。居民二元组（n = 80）将在干预后的早晨，立即和3个月的早晨护理中记录。与过去的研究一样，使用既定的行为编码分析的居民RTC的频率和持续时间将编码每个视频录像带（n = 720）。线性混合建模将比较RTC中的组差异，这是根据晨接受的视频记录和聊天后的3个月进行编码。视频情节还将用于使用行为，情感语调和Elderspeak的心理语言编码来验证员工颁布聊天技能。与先前的研究一样，将测试员工Elderspeak和RTC之间的顺序时间关系。提供聊天的费用将以列表与群体差异之间的比例列表，以完成居民晨保健，RTC在员工图表，员工工作满意度和周转率中所需的时间。在多级统计模型中将分析影响聊天影响的设施，居民和员工因素。这项基于基于需求的痴呆症受损行为模型的临床试验将使用研究策略和复杂分析的独特组合来测试具有减少居民RTC的潜力的干预措施。这项研究的长期目标是提高痴呆症患者的护理质量，同时降低成本。公共卫生相关性：这项研究测试了不断变化的谈话（CHAT）疗养院工作人员的沟通培训干预措施对养老院养老院居民的护理行为的共同和有问题的抵抗力。聊天减少了护理人员对光顾Elderspeak通讯的利用，这被发现是居民对护理的抵抗力的可能性的一倍。确定聊天对居民对护理的抵抗力的影响将有助于护理干预措施管理痴呆症的行为症状，以改善痴呆症护理。