Behavioral and Team Functioning to Meet Resident Needs

描述：（由申请人提供）本修订后的申请是1993年最初资助的行为技能员工管理系统（R01NR03497； L. Burgio, PhD [PI]； A. Stevens, PhD； P. Paul， DNS； K. Burgio, PhD [co -PI]）的竞争延续。原始研究的结果表明：1)持证护理助理（CNAs）可以在护理过程中学习行为管理技能（行为技术和沟通技巧），2)正式的员工激励系统可以增强CNA对沟通技巧的长期使用，3)员工治疗技能的变化与住院医生躁动的适度下降有关。然而，最初的疗效研究包括大量研究人员的参与，这限制了研究结果的外部有效性。此外，养老院目前在培训和维持CNA工作人员方面面临相当大的困难。因此，对原始项目的两项方法改进定义了本提案：1)通过将土著员工纳入项目的各个方面，研究的重点已转移到有效性试验上；2)修改了我们成功的培训协议，以减少CNA培训需求。当前应用的主要干预目标（A. Stevens, PhD）， [PI]；L. Burgio博士；L. Davis， RN， PhD [co - pi]是：1)通过使用与原始研究类似的行为管理技能来提高干预的效果，但在基于需求驱动的痴呆-损害行为（NDB）模型（Algase等，1996）的更广泛模型中概念化；2)通过改善团队功能和工作环境的整体社会氛围来丰富原始项目中使用的员工激励系统。本研究的第一个目的是评估行为规划和团队功能（BPTF）干预与最小治疗（MinTx）控制条件对CNAs行为策略表现的相对影响，这些策略是由土著养老院护理计划协调员使用我们的BPTF网页开发的个性化的、以问题为中心的行为计划所规定的。第二个目的是比较两种情况下居民ndb（问题行为）的变化。第三个目的是检验BPTF对养老院工作环境的影响。广泛的治疗实施程序将用于记录工作人员对BPTF干预方案的遵守情况。必要时，将使用多层次数据分析策略来解决我们设计中固有的嵌套问题。

DESCRIPTION: (provided by applicant) This revised application is the competing continuation for Staff Management System for Behavioral Skills (R01NR03497; L. Burgio, PhD [PI]; A. Stevens, PhD; P. Paul, DNS; K. Burgio, PhD [Co-PIs]) originally funded in 1993. Findings from the original study suggest that: 1) certified nursing assistants (CNAs) could be taught to perform behavior management skills (behavioral techniques and communication skills) during care routines with residents, 2) a formal staff motivational system enhanced CNA's long-term use of communication skills, and 3) changes in staff therapeutic skills were associate with modest declines in resident agitation. The original efficacy study, however, included substantial research staff involvement, which limits the external validity of the findings. Moreover, nursing homes currently face considerable difficulty training and maintaining a CNA workforce. Accordingly, two methodological refinements to the original project define this proposal: 1) focus of the study has been shifted towards an effectiveness trial by incorporating indigenous staff into all aspects of the program, and 2) our successful training protocols were modified to reduce CNA training demands. The main intervention goals of the current application (A. Stevens, PhD), [PI]; L. Burgio, PhD; L. Davis, RN, PhD [Co-PIs] are: 1) to improve the efficacy of the intervention by using behavior management skills similar to the original study, but conceptualized within a broader model based on the need-driven dementia-compromised behavior (NDB) model (Algase et al., 1996), and 2) enrich the staff motivational system used in the original project by improving team functioning and the overall social climate of the work environment. The first aim of the study is to evaluate the relative effects of a Behavioral Programming and Team Functioning (BPTF) intervention as compared to a minimal treatment (MinTx) control condition on CNAs performance of behavioral strategies prescribed by individualized, problem-focused behavioral programs that will be developed by the indigenous nursing home care plan coordinator using our BPTF web page. The second aim is to compare changes in resident NDBs (problematic behaviors) across the two conditions. The third aim is to examine the effects of BPTF on the work milieu of the nursing home. Extensive treatment implementation procedures will be used to document staff's adherence to the BPTF intervention protocol. Multi-level data analytic strategies will be used, when necessary, to address nesting issues that are inherent in our design.