The proposed study will evaluate the effects of behavior management skills for nursing home staff on care practices and resident behavior patterns, It builds directly on previous work involving the development of interventions with staff. The transfer of training effects is a salient issue in nursing home quality improvement given recently mandated training and certification of nursing assistants. The training program proposed in this project is focused on behavior-management strategies for nursing staff, reinforced by a complimentary supervisory training component. The conceptual model reflects the assumption that organizational factors are likely to moderate the effects of training on care practices and resident outcomes. Specifically, supervisory practices, administrative climate, and the design of the nursing assistant's job will interact with training in determining outcomes. Acquired knowledge, self-efficacy, and beliefs about outcomes are viewed as instrumental in changing resident care practices. Job design, operationalized as rotating vs stable assignment of staff to residents, is hypothesized to moderate both the effects of training on changes in care practices and the effect of those changes on resident behaviors. The study will be conducted in a group of 7 facilities in the Hartford/Springfield area of Southern New England. The nursing homes are owned and operated by Genesis Health Ventures, a proprietary chain of nursing homes. The facilities are located in close geographic proximity and are typical of the industry in terms of payor mix, staffing characteristics and resident mix. They are all jointly served by a regional training center, through which the training intervention will be delivered. Approximately 140 nursing assistants, 52 supervising nurses and 210 residents will participate as subjects, divided into intervention and control groups. Units within facilities will be randomly assigned a treatment condition, with both conditions represented in each facility. Four sites use rotating job assignments and 3 use stable assignment groups. A pre-post-follow-up design will be employed using surveys, stop-action video-response, and ratings of resident behavior as the data collection methods. Analysis will focus on the test of specific hypotheses using ANOVA and loglinear strategies and evaluation of the conceptual model of transfer of training effects using path analytic techniques.
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