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Computer-assisted behavioral observation data were collected from 66 nursing home residents while they received assistance during personal care routines from a certified nursing assistant (CNA). Data were collected both before and after a comprehensive behavior-management and communication-skills training program was delivered to the nursing staff. A total of 30 residents showed 6 or more episodes of disruptive vocalization or other forms of agitation during baseline observations, and timed-event sequential analysis methods were used to test whether certain CNA behaviors either elicited or prevented onsets of agitation in these 30 residents. Simple verbal prompts used by CNAs during personal care routines before staff training were found to elicit agitation onset (p = .03), whereas positive statements to the resident were found to reduce the likelihood of agitation onset (p = .02). In a previous analysis of the effects of staff training, we found that rates of resident agitation were significantly lower after training compared with baseline and that CNAs increased their rates of positive statements to residents. In the present study, timed-event sequential analyses indicated that the verbal prompts used by CNAs during personal care routines were no longer associated with an increased rate of resident agitation after staff training among the 20 residents who showed 6 or more episodes of agitation both before and after staff training. These findings suggest that the staff training program improved the quality of CNA verbal prompts. The sequential analysis of observational data provides an important method for studying interpersonal interactions, including those of nursing home residents and the nursing staff who care for them.

Purpose: To examine the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' (CNA) skill performance in the nursing home, to assess the effectiveness of a staff motivational system for maintaining newly acquired behavior management skills for a 6-month period, and to evaluate any resulting effects on resident agitation. Design and Methods: This study used a randomized clinical trial of 88 residents with behavior disturbances and 106 CNAs who cared for them in two urban nursing homes. After CNAs received 4 weeks of behavior management training, supervisory nursing staff implemented formal staff management (FSM), designed to maintain training effects over time. The supervisory staff used conventional staff management (CSM, usual supervisory routine) on control units. We completed behavioral observations and paper-and-pen assessments at baseline and repeated them during a 4-week post-intervention phase and at 3- and 6-month follow-ups. Results: During the immediate post-training phase, both the FSM and CSM groups improved five out of seven communication skills and the ability to delay physical assistance during care routines. Although CNAs showed a reduction in the use of ineffective behavior management strategies, they did not increase their use of effective behavioral strategies. Follow-up assessments suggested that the FSM system was more effective than CSM for maintaining and even improving communication skills over time. Resident agitation was reduced during care interactions and maintained at follow-up. Implications: The behavior management skills training program improved CNAs' ability to interact with behaviorally disturbed nursing home residents and produced sustained reductions in agitation. The FSM system was more effective for maintaining communication skills 6 months after training. Key Words: Behavior management, Nursing homes, Staff training and motivation, Agitation

This article describes a nursing staff training program in basic behavior management skills and a formal staff management system to encourage the application of these basic skills on the nursing unit. Behavioral skills training consists of a 5-hour in-service followed by three weeks of on-the-job training to ensure accurate application of behavior management skills. Following training, a staff management system is used to facilitate long-term use of the skills. Components of the staff management system include supervisory monitoring of the nursing assistants (NAs) by licensed practical nurses (LPNs), NA self-monitoring, verbal and written performance feedback, and incentives. Key Words: Behavior management, Staff training, Staff motivation, Quality of care

Nursing homes, of necessity, provide a number of mental health services for their residents. It is estimated that between 50 percent and 80 percent of nursing home residents suffer from mental illness, and studies assess the rate of mental illness among the institutionalized elderly as four times greater than among the elderly in the community. Despite these statistics, staffing in nursing homes does not generally include a large proportion of representatives from traditional mental health professions: 63 percent of the full-time employees are nursing assistants (aides), who are thought of as having poor training, high turnover, and low job satisfaction. The Penn State Mental Health Caregiving Questionnaire (MHQ) was developed as a tool to assess aides' levels of knowledge in various mental health areas. The final version of the questionnaire was completed by 191 aides and by 21 doctoral-level nursing home consultants. Of the 17 items on the questionnaire, aides answered, on average, 11 items correctly, and the consultants answered 15 items correctly (they were included as part of the evaluation of the MHQ's validity). The aides' performance represented a 65 percent rate of correct answers, indicating that despite their front-line duties in the care of institutionalized elderly, training of aides in the mental health needs of nursing home residents is insufficient. Mental health training program development and evaluation is needed and the MHQ can be a useful tool for assessing aides' current awareness of mental health issues. It is recommended that after administration of the questionnaire, an interactive discussion format be used for training staff. (Consumer Summary produced by Reliance Medical Information, Inc.)

Purpose: We examined the effects of communication skills training and the use of memory books by certified nursing assistants (CNAs) on verbal interactions between CNAs (n = 64) and nursing home residents (n = 67) during care routines. Design and Methods: CNAs were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities. A staff motivational system was used to encourage performance and maintenance of these skills. Formal measures of treatment implementation were included. Results: Results were compared with those for participants on no-treatment control units. Trained CNAs talked more, used positive statements more frequently, and tended to increase the number of specific instructions given to residents. Changes in staff behavior did not result in an increase in total time giving care to residents. Maintenance of CNA behavior change was found 2 months after research staff exited the facility. Although an increase was found in positive verbal interactions between CNAs and residents on intervention units, other changes in resident communication were absent. Implications: Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care. The methodological advantages of including measures to assess treatment implementation are discussed. Key Words: Long-term care, Staff training, Dementia

We need the right mix of teachers In the early days of our nursing training we all need a bit of mothering and brothering. We need someone who will nurture [...]

SOMETHING UNUSUAL is happening in the Greater Manchester area. In response to longterm staff shortages across professions, a new breed of worker is being created to plug the gaps. Assistant [...]

Jeanette McEachran (pictured above) always wanted to train as a nurse but somehow, as she says, life got in the way. After leaving school, she started work as a nursing [...]

A topic that should be high on the list of national priorities is the need to build a paraprofessional labor force that is trained to care for elderly and disabled persons in an effective and humane manner. While many older persons are cared for only by family members, there is also a large group of patients who do not have these resources and must have paid health workers provide for all their essential needs. The labor pool that supplies such workers as nurse's aides and home health aides, also provides child care workers; many such individuals are not adequately paid or appreciated, and are chronically overworked. Giving constant care to dependent clients, whether they are sick, elderly, or children, is emotionally draining and often physically strenuous. The labor force for home or institutional care is poorly trained and underpaid. To improve the quality of paid caregiving, many questions need to be answered. These include: what aspects of this work are satisfying; how much support and supervision of direct caregivers is needed to protect the patients and the workers; which situations warrant intervention by a case manager or family member; what characterizes a healthy and effective personal relationship between the worker and client; how much would improvements in caregiver training and supervision cost; and what is the nation willing to spend in this area. These issues must be addressed by an interdisciplinary team approach involving economists, employers, psychologists, and sociologists. Regardless of the method used to resolve these questions, the need for a well-trained and reliable paid work force to provide direct care for the elderly must not be ignored any longer. (Consumer Summary produced by Reliance Medical Information, Inc.)