Changing Talk to Reduce Resistiveness to Dementia Care

描述(申请人提供)：这项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)居民痴呆症患者抵抗行为的效果。耐受关爱(RTC)包括攻击性、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，增加了员工的压力、倦怠和流失率，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居民抵制护理的可能性是前者的两倍；与正常的成年人交流相比，这是一种类似于婴儿交谈的常见且可衡量的语言风格。在准实验性NH研究中，Chat减少了工作人员使用老年人的语言。然而，聊天对工作人员长话的使用以及随后的驻地驻地培训中心的影响从未得到过经验检验。拟议的随机临床试验研究旨在建立CHAT减少工作人员老年语言使用以及随后在患有痴呆症的居民中减少RTC的因果证据。这项拟议的临床试验的主要具体目的是测试ChAT对降低痴呆症疗养院居民RTC的效果。3小时的聊天干预将提供给NHS(N=16)中的护理人员，随机分配到干预组或对照组。聊天成本将与RTC行为比例、住院晨间护理所需时间、RTC工作人员图表、工作人员满意度和效率以及季度NH流动率的假设影响的比率列表。工作人员-居民二人组(N=80)将在干预前、干预后立即和干预后3个月的晨间护理期间进行录像。与过去的研究一样，每个录像护理插曲(N=720)将使用已建立的行为编码分析针对住院RTC的频率和持续时间进行编码。线性混合建模将比较即时和聊天后3个月的晨间护理视频记录的RTC的组差异。还将使用视频片段来验证工作人员使用行为、情感语调和老年人语言的心理语言编码来执行聊天技能。与以前的研究一样，将测试工作人员长话权和驻地协调员之间的顺序时间关系。提供聊天的成本将按完成住院早间护理所需时间、工作人员图表中的RTC、工作人员工作满意度和离职率之间的组间差异比例列出。影响聊天效果的设施、居民和工作人员因素将在多水平统计模型中进行分析。这项基于需求的痴呆症折衷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降低居民RTC的潜力的干预措施。这项研究的长期目标是在降低成本的同时提高痴呆症患者的护理质量。 公共卫生相关性：本研究测试了对养老院工作人员进行的改变谈话(Chat)沟通培训干预对养老院痴呆症患者常见的和有问题的护理行为抵抗力的影响。聊天减少了护理人员使用居高临下的老年语言交流，这被发现使居民抵抗护理的可能性增加了一倍。确定聊天对居民护理抵抗力的影响，将为护理干预管理痴呆的行为症状，改善痴呆护理提供依据。

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.