Testing the Feasibility and Impact of the ResCareCI - PowerPoint PPT Presentation

Title: Testing the Feasibility and Impact of the ResCareCI


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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

• Elizabeth Galik, MSN, CRNP
• University of Maryland School of Nursing

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Faculty Disclosures

• Ms. Galik has disclosed that she has no relevant
  financial relationship(s).

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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)

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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)

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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.

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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

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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.

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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.

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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.

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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

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Inclusion Criteria for Nursing Assistants

• Work day or evening shift at least 20 hours a
  week
• Able to read and write English

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Inclusion Criteria for Residents

• Age 55 years old or older
• Anticipated length of stay gt 6 months
• MMSE of 15 or less

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Sample Nursing AssistantsN 20
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Sample ResidentsN 46
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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

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Nursing Assistant Training ClassesMoving Beyond
Behavior

• Open to all staff of the facility, but focused on
  needs of the NAs
• Four 30 minute classes over 4 weeks
• 11 make-up classes for NAs who do not attend the
  original classes

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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

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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

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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)

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(No Transcript)
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Means of NA Outcome Variables (N18)
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Change in NA Self Efficacy for Restorative Care
(NASERCA)
Intervention
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Change in NA Outcome Expectations for Restorative
Care (NAOERCA)
Intervention
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Change in NA Restorative Care Knowledge
(NA-TTRCA)
Intervention
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Change in Performance of Observed Restorative
Care (Restorative Care Behavior Checklist)
Intervention
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Change in Job Satisfaction (Job Attitude Scale)
Intervention
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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

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Means of Resident Outcome Variables N41
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Change in Physical Function (Barthel Index)
Intervention
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Change in Physical Activity (PAS-LTC Survey)
Intervention
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Change in Physical Activity (ActiGraph) N35
Intervention
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Change in Depressive Symptoms (Cornell Scale for
Depression in Dementia)
Intervention
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Change in Agitated Behaviors (The Cohen-Mansfield
Agitation Inventory)
Intervention
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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

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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

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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

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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

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Moving Beyond Behavior!