Resistiveness in dementia: Nurse communication in acute care
Clarissa Shaw, MSN, RN, PhD Candidate
- Sigma Affiliation
- Contributor Affiliation(s)
- The University of Iowa, Iowa City, Iowa, USA
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Persons living with dementia (PLWD) are twice as likely to be hospitalized compared to cognitively intact older adults and while hospitalized PWD often exhibit behavioral symptoms of dementia such as aggression. Challenging behaviors that disrupt nursing care are termed resistiveness to care (RTC) and leave patients at risk for neglect and nurses at risk for strain. Effective communication by nursing staff is critically important in preventing RTC. The purpose of this cross-sectional study was to identify and characterize elderspeak communication by hospital nursing staff to PLWD and determine the association between elderspeak communication and RTC by PLWD. Nursing staff were audio-recorded and observed during care encounters with hospitalized PLWD. Behavioral observations were performed to evaluate RTC by PLWD using the valid and reliable RTC Scale. Recordings were coded for elderspeak using an evidence-based elderspeak coding scheme. A mixed-effects model was used to evaluate the relationship between elderspeak and RTC. Eighty-eight observations between 16 PLWD and 53 nursing staff were collected. Twenty-eight percent of communication by hospital nursing staff to PLWD contained elderspeak. A 15% in reduction in elderspeak by nursing staff decreased the odds of RTC by 62% in PLWD (p=.002) while controlling for pain, length of stay, and PLWD gender. Elderspeak is a pervasive problem in acute care and leads to negative outcomes for hospitalized PLWD. Future research is needed on interventions to reduce elderspeak in the hospital setting.
Detailed funding information: National Institute of Nursing Research (Award Number F31NR018580); Midwest Nursing Research Society Joseph and Jean Buckwalter Dissertation Grant; Barbara and Richard Csomay Gerontology Research Award for PhD Students and Postdoctoral Fellows; Dr. Shaw is a 2018-2019 recipient of a Sigma small grant.
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The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the Sigma grant. No further peer-review has taken place upon the completion of the Sigma grant final report and its appearance in this repository.
|Report||Self-submission||None: Sigma Grant Recipient Report||Text-based Document|
|Level of Evidence||Research Approach||Keywords|
Resistiveness to Care;