Changing Talk to Reduce Resistiveness to Dementia Care

描述（由申请人提供）：本临床试验的目的是测试护理人员改变谈话（CHAT）沟通训练干预对减少养老院（NH）痴呆症患者抵抗行为的效果。抗护理性（RTC）包括攻击性、退缩、声音爆发和其他“问题行为”，这些行为发生在75-90%的痴呆症患者身上。这些行为扰乱和延长了日常护理，增加了员工的压力、倦怠和人员流动，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得到满足而发生的，并且根据经验与沟通方式有关。PI最近的研究发现，当护理人员使用老年人语言交流时，患有痴呆症的NH居民拒绝护理的可能性增加了一倍；一种常见的、可测量的语言风格，与正常的成人交流相比，类似于婴儿语。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对工作人员长者语使用和随后住院人员RTC的影响从未经过实证检验。提出的随机临床试验研究旨在建立因果证据，证明CHAT减少了痴呆症患者的工作人员老年语使用，并随后减少了RTC。本临床试验的主要目的是测试CHAT对降低老年痴呆患者的RTC的效果。对NHs护理人员（N=16）进行3小时CHAT干预，随机分为干预组和对照组。CHAT的成本将按RTC行为比例、住院医师早晨护理所需时间、RTC员工图表、员工满意度和有效性以及季度NH流失率的假设影响比例制成表格。在干预前、干预后和干预后3个月的晨间护理期间，将对住院工作人员夫妇（N=80）进行录像。与过去的研究一样，每个录像护理事件（N=720）将使用已建立的行为编码分析对住院RTC的频率和持续时间进行编码。线性混合建模将比较各组RTC的差异，这些RTC是根据CHAT后立即和3个月的晨间护理视频记录编码的。视频片段还将用于验证员工使用老年人语言的行为、情感语调和心理语言编码来制定CHAT技能。与之前的研究一样，我们将测试员工长者话语与RTC之间的顺序时间关系。提供CHAT的成本将按完成住院医师晨间护理所需时间、员工图表中的RTC、员工工作满意度和离职率等组间差异的比例制成表格。影响CHAT效果的设施、居民和工作人员因素将在多层次统计模型中进行分析。该临床试验基于基于需求的痴呆-妥协行为模型，将使用独特的研究策略和复杂的分析相结合，以测试有可能减少住院患者RTC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。

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.