Reliability and Validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD Test.

BACKGROUND AND PURPOSE: The purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis. METHODS: This study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial. RESULTS: A total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions. CONCLUSIONS: Future use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

Health-related quality of life amongst primary caregivers of children with intellectual disability.

BACKGROUND: Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health-related quality of life (HRQoL) across co-morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population. METHODS: Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ-5D-5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties. RESULTS: Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ-5D-5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ-5D-5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age-equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co-morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL. CONCLUSIONS: This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost-effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers.

Parents' Consumer Preferences for Early Childhood Behavioral Intervention in Primary Care.

OBJECTIVE: Early childhood parenting interventions are increasingly delivered in primary care, but parental engagement with those interventions is often suboptimal. We sought to better understand parents' preferences for the content and delivery method of behavioral health guidance in pediatric primary care and to determine the relationship of those preferences with demographic characteristics, child behavior problems, and parenting style. METHODS: Participants were 396 parents of young children recruited from primary care offices. We collected measures of parental preferences (including behavioral topics, intervention strategies, and methods of delivery) for behavioral intervention in primary care, child behavior symptoms, parenting style, and demographic characteristics. Descriptive statistics were used to identify parents' most preferred behavioral topics and intervention delivery methods. We used a hierarchical regression approach to determine whether parenting style predicted parents' preferences beyond demographic and child-level factors. RESULTS: Nearly all parents (96%) endorsed a behavioral topic (e.g., aggression) as important. Most preferred to receive intervention during routine medical appointments. Child behavior problems correlated with parents' overall interest in behavioral guidance, but clinically significant symptoms did not differentiate interest in any single topic. Socioeconomic factors and negative parenting practices predicted some parental preferences. Notably, lax parenting generally predicted higher interest in behavioral intervention, whereas hostile and physically controlling parenting predicted lower interest. CONCLUSION: Most parents are interested in behavioral guidance as part of primary care, but their preferences for the content and delivery of that guidance vary by known socioeconomic, child, and parenting risk factors. Tailoring intervention to parents' preferences may increase engagement with available interventions.

Evaluating the Utility of a Structured Clinical Protocol for Reducing the Impact of Behavioural and Psychological Symptoms of Dementia in Progressive Neurological Diseases: A Pilot Study.

OBJECTIVES: Behavioural and psychological symptoms of dementia (BPSD) cause significant distress to both aged care residents and staff. Despite the high prevalence of BPSD in progressive neurological diseases (PNDs) such as multiple sclerosis, Huntington's disease, and Parkinson's disease, the utility of a structured clinical protocol for reducing BPSD has not been systematically evaluated in PND populations. METHOD: Staff (n = 51) and individuals with a diagnosis of PND (n = 13) were recruited into the study, which aimed to evaluate the efficacy of a PND-specific structured clinical protocol for reducing the impact of BPSD in residential aged care (RAC) and specialist disability accommodation (SDA) facilities. Staff were trained in the clinical protocol through face-to-face workshops, which were followed by 9 weeks of intensive clinical supervision to a subset of staff ("behaviour champions"). Staff and resident outcome measures were administered preintervention and immediately following the intervention. The primary outcome was frequency and severity of BPSD, measured using the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). The secondary outcome was staff coping assessed using the Strain in Dementia Care Scale (SDCS). RESULTS: In SDA, significant reductions in staff ratings of job-related stress were observed alongside a statistically significant decrease in BPSD from T1 to T2. In RAC, there was no significant time effect for BPSD or staff coping; however, a medium effect size was observed for staff job stress. CONCLUSIONS: Staff training and clinical support in the use of a structured clinical protocol for managing BPSD were linked to reductions in staff job stress, which may in turn increase staff capacity to identify indicators of resident distress and respond accordingly. Site variation in outcomes may relate to organisational and workforce-level barriers that may be unique to the RAC context and should be systematically addressed in future RCT studies of larger PND samples.

Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning.

ABSTRACTBackground:The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia. METHOD: Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication. RESULTS: Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues. CONCLUSION: The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

Managing behavioral disturbances in a patient with dementia.

A 92-year-old patient with Parkinson disease and dementia provides an opportunity for the advanced practice registered nurse to shift thinking about behavioral disturbances in dementia, away from controlling behavior with pharmacologic approaches, such as antipsychotics, toward understanding behavior by applying the nonpharmacologic Describe, Investigate, Create, and Evaluate method.

Positive Mental Health Outcomes in Individuals with Dementia: The Essential Role of Cultural Competence.

Over five million people in the United States are diagnosed with some form of dementia, and many more with cognitive impairment remain undiagnosed. In addition, most individuals with dementia experience one or more neuropsychiatric symptoms such as depression, anxiety, irritability, agitation, hallucinations, or delusions at some point during disease progression. The vast majority of individuals with dementia, including those with symptoms of serious mental illness, are cared for in home and community based settings by unpaid caregivers, often family members, who struggle with the daily challenges of providing care and services to someone with dementia. This article will briefly review selected aspects of the need for community care for individuals with dementia and cultural aspects related to dementia and mental health. A detailed case study will illustrate some of the challenges related to the mental health of individuals with dementia living in the community. We specifically discuss culturally competent care, using the example of a Nepalese refugee family caring for a family member with dementia and depression, as a critical aspect of the care plan. Finally, we provide implications for practice for organizations wishing to engage families in a comprehensive system of home-based dementia care.

Implementation of advanced practice nurse clinic for management of behavioral symptoms in dementia: a dyadic intervention (innovative practice).

Behavioral symptoms are common in all types of dementia and often result in significant caregiver stress and illness, institutionalization of the patient, and reduced quality of life for the patient and caregiver. Health care practitioners often lack the expertise or time to adequately assess behavioral symptoms or counsel caregivers about interventions. Our goal was to implement a specialty clinic managed by advanced practice nurses to assess and manage behavioral symptoms associated with dementia. The clinic evaluations consisted of an assessment of the patient by the Nurse Practitioner during the time that the family caregiver(s) was interviewed by the Clinical Nurse Specialist and focused on an assessment of the cognitive and functional abilities of the patient, identification of triggers for the problematic behaviors, and assessment of caregiver coping. We evaluated 66 dyads since implementation in February 2010. The patients were primarily female, Caucasian, 74.3 years of age with Alzheimer's disease. The majority of caregivers were spouses (n = 44) followed by adult children (n = 20) and then siblings (n = 2). Targeted interventions were developed and caregiver counseling, support, and education were an integral part of the consultation and included written information, video instruction, and internet resources. Evaluations indicated caregivers and referring providers found the appointment helpful in managing behavioral symptoms and caregiver stress.

The analysis of challenging relations: influences on interactive behaviour of staff towards clients with intellectual disabilities.

BACKGROUND: Relationships between support staff and clients with intellectual disability (ID) are important for quality of care, especially when dealing with challenging behaviour. Building upon an interpersonal model, this study investigates the influence of client challenging behaviour, staff attitude and staff emotional intelligence on interactive behaviour of one of these relationship partners, being support staff. METHOD: A total of 158 support staff members completed a questionnaire on staff interactive behaviour for 158 clients with ID and challenging behaviour, as well as two questionnaires on staff interpersonal attitude and emotional intelligence. RESULTS: Confronted with challenging behaviour as opposed to no challenging behaviour, staff reported less friendly, more assertive control and less support-seeking interpersonal behaviour. Also, staff used more proactive thinking and more self-reflection in dealing with challenging behaviour. Staff interpersonal attitude in general, mainly a harsh-dominant-resentful attitude, had a significant influence on most staff interactive behaviours towards an individual client with challenging behaviour. The influence of staff emotional intelligence, specifically intrapersonal abilities, on staff interactive behaviour towards an individual client with challenging behaviour was somewhat limited. CONCLUSIONS: This research supports the necessity for training staff in general interpersonal attitudes towards clients as well as training in intrapersonal emotional intelligence, when confronted with challenging behaviour. Future research should focus more on the bidirectional dynamics of staff and client interactions.

Mental health nurses' beliefs about smoking by mental health facility inpatients.

This study examined beliefs of mental health nurses about smoking by clients, nurses, and visitors in inpatient facilities and identified the influence of years of experience, smoke-free status, and workplace on these beliefs. Data were collected by a survey, distributed via a nursing newsletter with approximately 600 members. Descriptive statistics and cross-tabulations explored the data. A total of 104 responses were received. Smoke-free status made significant differences to nurses' beliefs relating to prohibition of smoking for clients, staff, and visitors; concern about the effects of passive smoking; the role of smoking in the development of therapeutic relationships; smoking as a source of patient pleasure; and the role of smoking in symptom management. That half of the nurses who responded believe that smoking is helpful in the creation of therapeutic relationships is of concern. The nurse plays an important role model in promoting smoke-free lifestyles amongst clients, and the effects of positive role modelling could be lost if nurses continue to smoke with clients. The negative impacts of smoking on the physical health of mental health inpatients is considerable and well documented, and the creation of smoke-free inpatient mental health services can help to address these.

Managing agitated behaviour in older people.

Older people diagnosed with dementia can have complex needs, especially when they exhibit agitated behaviour. Patients with agitated behaviour challenge the delivery of health care. Often the behaviour is a symptom of unmet needs in this population (Dewing 2010). It is important for nurses to understand the underlying causes and apply evidence-based interventions in their nursing practice to promote health, safety and the highest quality of life possible. This article defines and classifies agitated behaviours, discusses implications for their management and then presents evidence-based interventions nurses can use. The interventions are categorised according to each of the five senses.

Improving person-centred care in dementia.

Failings in dementia care in acute hospitals have been reported to the Scottish Public Services Ombudsman and other scrutiny bodies in Scotland and the UK. This article sets out key knowledge and resources to help nurses provide compassionate and person-centred care.

What is cyberbullying & how can psychiatric-mental health nurses recognize it?

Cyberbullying is an emerging issue within our society, particularly among adolescents. The phenomenon is similar to traditional bullying in that it is hurtful, repetitive behavior involving a power imbalance, often causing psychosocial issues. With the availability of cell phones, Internet, and video gaming systems, adolescents are constantly plugged into technology and therefore at risk of being a victim or a perpetrator of cyberbullying. Both physical and mental health problems can result from cyberbullying, which, in turn, can affect an adolescent's performance in school and other crucial areas of life. Legal action is an option, but many times the law is not clear. Psychiatric-mental health nurses are in a position to help educate children about resources to prevent or cope with cyberbullying in a way that will help not only the patients themselves but also parents, teachers, school administrators, and the community.

Two sides of the coin: the bully and the bullied.

Bullying has become a worldwide phenomenon that produces serious individual and societal consequences when it is ignored. There are two sides of the coin that require consideration when psychiatric-mental health (PMH) nurses conduct assessments of situations that involve bullying behaviors. Both the bully and the bullied can incur serious, negative, and debilitating psychological effects. In some cases, physical injury and/or death occurs as a result of bullying. Deciphering the biopsychosocial mental health issues associated with bullying is challenging. PMH nurses have the clinical expertise to develop coping interventions and strategies that stop bullying, as well as enhance the mental health and wellness of both those who bully and who are bullied. This article presents PMH nursing biopsychosocial strategies for both sides of the bullying coin. Exemplars are provided to aid implementation of the strategies.

[Nursing care for the aged with dementia and with behavioral symptoms]. / Cuidados de enfermagem ao idoso com Demência que apresenta sintomas comportamentais.

In the course of dementia, behavioral disorders are highly prevalent and are frequently associated with the stress of caregivers. This study aims to identify in scientific literature the types of dementia associated with behavioral and psychological symptoms (BPSD); describe the non-pharmacological management of these alterations, and describe the nursing interventions in this context. The literature in the field of geriatrics and nursing was searched. It became evident that the nursing care provided to the demented elderly goes farther beyond the basic care and depends on the active participation of the family. The identification of strategies to minimize and manage the behavioral symptoms is an important contribution that nursing can give to geriatrics.

Cuidados de enfermagem ao idoso com Demência que apresenta sintomas comportamentais / La atención de enfermería a los ancianos con Demencia y con síntomas comportamentales / Nursing care for the aged with Dementia and with behavioral symptoms

No curso das demências, os transtornos comportamentais são altamente prevalentes e estão freqüentemente associados ao stress dos cuidadores. Este estudo tem como objetivo identificar na literatura os tipos de demências que apresentam sintomas comportamentais e psicológicos associados; descrever o manejo não farmacológico destes distúrbios e descrever a atuação da enfermagem neste contexto. Foi pesquisada a literatura nas áreas de geriatria e enfermagem. Tornou-se evidente que a assistência de enfermagem prestada ao idoso demenciado vai muito além dos cuidados básicos e depende da participação ativa da família. A identificação de estratégias para minimizar e manejar os sintomas comportamentais é uma importante contribuição que a enfermagem pode dar para a geriatria.

In the course of dementia, behavioral disorders are highly prevalent and are frequently associated with the stress of caregivers. This study aims to identify in scientific literature the types of dementia associated with behavioral and psychological symptoms (BPSD); describe the non-pharmacological management of these alterations, and describe the nursing interventions in this context. The literature in the field of geriatrics and nursing was searched. It became evident that the nursing care provided to the demented elderly goes farther beyond the basic care and depends on the active participation of the family. The identification of strategies to minimize and manage the behavioral symptoms is an important contribution that nursing can give to geriatrics.

En el curso de la demencia, los trastornos de comportamiento son muy prevalentes y se asocian frecuentemente con el estrés de los cuidadores. Este estudio tiene como objetivo identificar en la literatura científica los tipos de demencias asociadas a los trastornos de comportamiento y síntomas psicológicos, describir el manejo no-farmacológico de estas alteraciones y describir las intervenciones de enfermería en este contexto. La Literatura en los campos de la geriatría y de enfermería fue investigada. Se hizo evidente que los cuidados de enfermería prestados a las personas mayores con demencia va más allá de la atención básica y depende de la participación activa de la familia. La identificación de estrategias para minimizar y manejar los síntomas de comportamiento es una importante contribución que la enfermería puede ofrecer a la geriatría.

An educative support group for female family caregivers: impact on caregivers psychological distress and patient's neuropsychiatry symptoms.

BACKGROUND: In developing world most patients with dementia live in the community. And female family caregivers are the primary source to delivering care to patients. Educating and supporting the careers may reduce psychological distress and the challenging behavior as well. METHODS: We run a non pharmacological intervention focusing on education regarding dementia, behavioral problems and interactive self support group. Twenty nine female family caregivers were assigned and divided in two groups of 15 and 14. Two hours weekly sessions were conducted for 8 weeks. Baseline and outcome measures were assessed using neuropsychiatry Inventory (NPI), general health questionnaire and perceived stress scale (PSS). RESULTS: Initial co relational analysis demonstrated a significant correlation between GHQ and total NPI scores but not for PSS. Paired sample test revealed significant change from baseline and at the end in both GHQ score and neuropsychiatry symptoms. CONCLUSION: This study supports the use of a non-pharmacologic intervention focusing on education in a feasible and cost benefit setting for dementia caregivers.