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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）：本临床试验的目的是测试针对护理人员的改变谈话（CHAT）沟通培训干预对减少养老院（NH）痴呆患者抵抗行为的影响。护理抵抗（RTC）包括攻击，退缩，声音爆发和其他“问题行为”，发生在75-90%的痴呆症患者中。这些行为扰乱和延长了日常护理，增加了工作人员的压力，倦怠和营业额，增加了25- 30%的护理成本。RTC可能是由于痴呆症患者的需求未得到满足而发生的，并且已经在经验上与沟通方式有关。PI最近的研究发现，当护理人员使用老年人语言沟通时，患有痴呆症的NH居民抵制护理的可能性是正常成人沟通的两倍;与婴儿谈话相比，这是一种常见的可测量的言语风格。在准实验性NH研究中，CHAT减少了工作人员使用老年人语言。然而，CHAT对工作人员使用老年人语言和随后的居民RTC的影响从未进行过实证检验。拟议的随机临床试验研究旨在建立CHAT减少工作人员使用老年人语言和随后减少痴呆症居民RTC的因果关系证据。拟议的临床试验的主要具体目的是测试CHAT对降低老年痴呆症疗养院居民RTC的影响。将为随机分配到干预组或对照组的NH（N=16）的护理人员提供3小时CHAT干预。CHAT的成本将按照对RTC行为比例、居民晨间护理所需时间、RTC工作人员图表、工作人员满意度和有效性以及季度NH周转率的假设影响的比例制成表格。将在干预前、干预后即刻和干预后3个月的晨间护理期间对工作人员-住院医师配对（N=80）进行视频记录。与过去的研究一样，将使用已建立的行为编码分析对每个录像护理事件（N=720）的住院RTC频率和持续时间进行编码。线性混合模型将比较RTC的组间差异，编码自CHAT后即刻和3个月的晨间护理视频记录。视频片段也将被用来验证工作人员制定聊天技能使用行为，情绪的语气，和心理语言编码的老年人说话。和以前的研究一样，将测试工作人员老年人语言和RTC之间的顺序时间关系。提供CHAT的成本将按照完成住院医师晨间护理所需时间、员工图表中的RTC、员工工作满意度和流动率的组间差异的比例制成表格。将在多层次统计模型中分析影响CHAT效果的设施、居民和工作人员因素。这项临床试验基于基于需求的痴呆症损害行为模型，将使用独特的研究策略和复杂的分析组合来测试有可能减少居民RTC的干预措施。这项研究的长期目标是提高老年痴呆症患者的护理质量，同时降低成本。公共卫生相关性：本研究旨在探讨针对老人院员工的沟通训练干预对老人院失智症患者照护行为的影响。CHAT减少了护理人员使用居高临下的老年人语言交流，这被发现是居民照顾的可能性增加了一倍。探讨CHAT对居民照护意愿的影响，将为护理干预提供依据，以管理痴呆的行为症状，提高痴呆的照护水平。