The goal of this preliminary longitudinal study is to increase the knowledge of nursing processes used in the nonpharmacologic management of secondary symptoms exhibited by ADRD/cognitively impaired residents in nursing homes. These processes include Encouragement and Control procedures identified in our ongoing NIA study of nursing home residents in the State of Delaware. Operational Measures of these concepts will be expanded and internally validated to include independent observational confirmation of self-reported measures. Their presence as management strategies will be assessed at three time points and estimates will be made of how variations in these processes are related to the use of other interventions (e.g. psychoactive medications and physical restraints) and to changes in mood and behavioral status. We will also study whether purposeful and planned manipulation of these processes within the care planning process results in positive outcomes - altered staff behavior toward residents (e.g. more consistent patterns of encouragement and control processes) and improved resident status (e.g. improved mood or behavioral status, greater independence in physical functioning, and greater involvement in activities). To complete the primary longitudinal analyses of these nursing management processes and their behavioral change correlates, residents in 12 randomly designated homes (six of which will be assigned to be Experimental Demonstration sites) will be followed over time. The sample will consist of 480 residents, 40 from each home - half from Experimental and half from Comparison homes. Selected residents will be assessed at baseline, 6 months, and 11 months. Residents in the randomly designated Comparison homes will be used to evaluate longitudinal changes under existing conditions. To ensure accurate estimates of outcomes from the Experimental Demonstration homes, we will introduce a variety of control procedures in these evaluations - facility randomization, covariate adjustment, and multiple repeated measures MANCOVA profile comparisons. Our methods will incorporate standardized techniques that will minimize inter-observer variability, and increase process reliability. These steps will allow us to generate consistently reliable data which are not compromised by threats of selection bias or of internal validity. Not only will this study add to knowledge regarding relationships between nursing management strategies and secondary symptoms (exhibited by ADRD/cognitively impaired nursing home residents), but, these findings have the potential for widespread practical applications. In particular, should the Encouragement/Control program be found to have its intended effects, a low cost but effective nursing intervention will have been developed that, with the support materials resulting from this effort, can be easily replicated elsewhere.
| Ooi, W L; Sherwood, S; Murphy, K et al. (1996) Development, testing, and validation of two scales measuring nursing home management of subjects with mental disorder. J Clin Epidemiol 49:1381-8 |
