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Testing the Feasibility and Impact of the Res-Care-CI

AMDA 30th Annual Symposium March 29 – April 1, 2007 Hollywood, Florida. Testing the Feasibility and Impact of the Res-Care-CI. Elizabeth Galik, MSN, CRNP University of Maryland School of Nursing. Faculty Disclosures:.

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Testing the Feasibility and Impact of the Res-Care-CI

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  1. AMDA 30th Annual Symposium March 29 – April 1, 2007 Hollywood, Florida Testing the Feasibility and Impact of the Res-Care-CI Elizabeth Galik, MSN, CRNP University of Maryland School of Nursing

  2. Faculty Disclosures: Ms. Galik has disclosed that she has no relevant financial relationship(s).

  3. What is Restorative Care? • Focuses on the restoration and/or maintenance of physical function • Helps older adults to compensate for functional impairments so that the highest level of function is obtained (Resnick, 2004)

  4. Res-Care-CI Intervention • 2 tiered self-efficacy based intervention • Focuses on motivating NAs and teaching them the skills to motivate nursing home residents with moderate-severe cognitive impairment to engage in restorative care activities • Modification of the basic Res-Care Model (Grant No. R01 HS/MH 13372-01)

  5. Primary Aim: Nursing Assistants • To test the feasibility and impact of the Res-Care-CI Intervention on nursing assistants’ (NAs) beliefs, knowledge and performance of restorative care, their job satisfaction and their job retention.

  6. NA Related Hypotheses • NAs will experience an increase in: • Self-efficacy for restorative care • Outcome expectations for restorative care • Restorative care knowledge • Performance of restorative care activities at 2 and 4 months following exposure to the Res-Care-CI. • Job Satisfaction

  7. Secondary Aim: Residents • To test the feasibility and impact of the Res-Care CI Intervention on the physical function, physical activity, mood, and behavior of nursing home residents with moderate-severe cognitive impairment.

  8. Resident Related Hypotheses • Residents with moderate to severe cognitive impairment will maintain or improve: • functional performance (ADLs) • time in physical activity at 2 and 4 months after implementing the Res-Care-CI.

  9. Resident Related Hypotheses (continued) • Residents with moderate to severe cognitive impairment will demonstrate a decrease in • symptoms of depression • Behavioral disturbance at 2 and 4 months after implementing the Res-Care-CI.

  10. Design of the Res-Care-CI Pilot Study • Single group time series design, with measurements at 2 month intervals over a period of 6 months • Implementation of Res-Care-CI Intervention immediately following the completion of the 2nd baseline measure

  11. Inclusion Criteria for Nursing Assistants • Work day or evening shift at least 20 hours a week • Able to read and write English

  12. Inclusion Criteria for Residents • Age 55 years old or older • Anticipated length of stay > 6 months • MMSE of 15 or less

  13. Sample: Nursing AssistantsN = 20

  14. Sample: ResidentsN = 46

  15. Procedure: The Res-Care-CI Intervention • Oversight by a Restorative Care Nurse to serve as “Champion”, teacher and coach for NAs (20 hours/week) • 4 week restorative care in-service program • Ongoing encouragement & support of NAs through standardized protocol • Development and monthly evaluation of resident restorative goals and care plan • Weekly monitoring of restorative care documentation

  16. Nursing Assistant Training Classes“Moving Beyond Behavior” • Open to all staff of the facility, but focused on needs of the NAs • Four 30 minute classes over 4 weeks • 1:1 make-up classes for NAs who do not attend the original classes

  17. Nursing Assistant Training Classes “Moving Beyond Behavior” • Philosophy of restorative care • Motivation of the cognitively impaired to engage in functional activities • Specific restorative care interventions for the cognitively impaired • Coordination and documentation of restorative care

  18. Restorative Care Outcomes • Nursing Assistants • Self-efficacy (The NA Self-efficacy for Restorative Care Activities) • Outcome Expectations (The NA Outcome Expectations for Restorative Care Activities • Knowledge of Restorative Care Activities (The NA Theoretical Testing of Restorative Care Activities) • The Restorative Care Behavior Checklist • Job Satisfaction (The Job Attitude Scale) • Job Retention

  19. Restorative Care Outcomes • Residents • Physical function (The Barthel Index) • Physical activity (Physical Activity Survey in Long Term Care; ActiGraph) • Mood (Cornell Scale for Depression in Dementia) • Behavior (The Cohen-Mansfield Agitation Inventory, Short Form)

  20. Means of NA Outcome Variables (N=18)

  21. Change in NA Self Efficacy for Restorative Care (NASERCA) Intervention

  22. Change in NA Outcome Expectations for Restorative Care (NAOERCA)*** Intervention

  23. Change in NA Restorative Care Knowledge (NA-TTRCA)*** Intervention

  24. Change in Performance of Observed Restorative Care (Restorative Care Behavior Checklist) Intervention

  25. Change in Job Satisfaction (Job Attitude Scale) Intervention

  26. NA Job Retention • 100% for the 6 month study • 2 NAs were out for an extended medical leave and each missed 1 measurement point and were excluded from the final data analysis

  27. Means of Resident Outcome Variables N=41

  28. Change in Physical Function (Barthel Index) Intervention

  29. Change in Physical Activity (PAS-LTC Survey) Intervention

  30. Change in Physical Activity (ActiGraph) N=35 ** Intervention

  31. Change in Depressive Symptoms (Cornell Scale for Depression in Dementia)* Intervention

  32. Change in Agitated Behaviors (The Cohen-Mansfield Agitation Inventory)* Intervention

  33. Treatment Fidelity • Delivery: NAs completion of all 4 restorative care in-service trainings • Receipt: Paper and pencil test on knowledge of restorative care, goal development and log completion • Enactment: Weekly monitoring of restorative care logs

  34. Treatment Fidelity Results • Delivery: 100% of NA participants attended all 4 classes or participated in one on one class instruction with RCN • Receipt: Statistically significant improvement in NA knowledge of restorative care; 100% of recruited NAs participated in resident goal development • Enactment:

  35. Strengths & Limitations • Important first step in implementing interventions to improve resident quality of life, and change knowledge and beliefs about how care is provided to cognitively impaired nursing home residents • Treatment fidelity data was collected • Small sample size • Inclusion of only a single facility • Lack of a control group

  36. Areas for Future Research • Randomized controlled trial to test a more comprehensive Res-Care-CI Intervention focused on changing the behavior of care providers and cognitively impaired nursing home residents so that functional performance and physical activity is optimized

  37. Moving Beyond Behavior!

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