Training for Care Staff of Residents with Aggressiveness Caused by Dementia - Literature review Example

Nursing Research Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Course Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecture Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Description of Research Area During my clinical practices I encountered many patients who are aggressive and sometimes abusive to nursing staff. In the residential care home for mentally ill individual’s nurses encounter both verbal and physical aggression. Aggression against nurses causes them great mental distress and in some cases has led to serious physical injuries. However, most nurses do not report patient aggression as they regard it as part of the job. During my practice I found one of my colleagues crying hysterically after a patient had verbally abused her, within a month she quit her job. This research paper attempts to provide effective interventions to reduce future incidents of patient aggression against nurses. Relationship between Knowledge; Research and Practice Research into patient aggression and how to prevent it has influenced nursing practice and hospital management for many years. Researchers have developed various models to analyze and prevent patient aggression against their carers. Through research findings based on the external model of aggression Ward reorganization and structures have been made to make sure the environment is not a contributing (Kynoch, Wu and Chang 2009). Research has also linked substance abuse and mental illness to the increased likelihood of patients becoming aggressive towards their nurses (Relan 2013). On the other hand the interactional model views negative relationship with staff and patients as the main causes of aggressive behavior against nurses. Therefore, it has been recommended that staff maintain cordial relationship with patients when they are on nursing duty. According to Hobday et al (2010), patients controlling methods are ineffective in combating patient aggression although they remain common in most health settings. In the residential home where I worked seclusion, restraints and medication were the most common intervention to manage patient aggression. In the home there was a zero tolerance policy for patient aggression and thus controlling measures took precedent over other more effective intervention. Description of Potential Research Problem Aggression towards nurses is a huge challenge and is now viewed as a cause of anger, sadness and hurt among staff. Colleagues who had been victims of patient aggression were prone to become angry and resentful and had strong feelings of being violated. According to Irvine et al (2012), most interventions used to prevent aggressiveness among patients have been poorly researched and little is known about their effectiveness. Access to subjects for research has been one of the major obstacles in determining which intervention is most effective in preventing aggression. Most aggression interventions cannot be studied separately therefore making its hard to study how each intervention separately affect patient aggression. With the rate of patient aggressiveness increasing their need to be effective evidence based interventions that can be used by care providers in preventing aggressive behavior. Attempt to address this problem have been made in Kynoch, Wu and Chang (2009) which compares the effectiveness of various interventions in preventing patient aggressiveness. However, there have been few studies that empirically compare the effectiveness of various interventions on preventing patient aggressiveness. This study examines how staff training, chemical restraint, physical restraint and de-escalation compare in their effectiveness in preventing patient aggressiveness. Critical appraisal of research Nau et al (2009) is a study that focuses on how aggression management training can reduce the intensity of patient aggression against nurses. This research used the pretest-posttest study design and cross-sectional investigation was taken to record student’s performance in managing patient aggression prior to the aggression management training. The participants of the study were 107 students between the 10th and 28th month of a three year nursing program selected through a convenient sample at a German nursing educational institution. Ethical approval was granted by the university ethics committee. Data was collected through Videotaping of students handling aggressive patients prior and after aggressive management training. The performance of participants was measured using the De-escalating Aggressive Behaviour Scale (DABS). DABS uses a 7-item scale of desired behaviour and inopportune behaviour and 5-point Likert scale ranging from strongly agree to strongly disagree. The video tapes were studied by performance raters and their evaluation converted to mean rates. The study found out that once nurses underwent aggressive patient management training they performed better than their untrained colleagues in de-escalating patient aggression. This study implies that nursing education should involve programs to train nurses in effectively handling aggressive patients. Irvine et al (2011) is study to evaluate the effectiveness of individualized internet training of Nurses aids as an intervention for managing or preventing patient aggression. The study used a randomized treatment and control assessment. Test of the 158 participating Nurse aids were taken at baseline, 1-motnth and 2-months. The study was entirely set on the internet. The participants in the treatment group were trained twice every week on skills for successfully managing physical aggression in the care setting. The protocol used for the research had the approval of the Institutional Review Board and an informational website was set up to recruit participants. Data was collected through video situation testing and psychosocial constructs assessment. The measures used to access the effectiveness of the treatment intervention included Video situation testing (VST) reaction, VST self-efficacy, VST knowledge, self efficacy in applying skills learnt in the program, Attitudes towards patients, Empathy and user acceptance of the training. The study found out that the internet based program resulted in improved knowledge, empathy, attitude, self-efficacy among nurse aids while handling aggressive patients. The study found out that an internet based training program on patients aggression can be a viable approach in reducing and de-escalating situations of patient violence. Relan (2013) is a study into the effectiveness of individualized interventions in reducing aggressive behaviour among patients suffering from Alzheimer’s disease. The research design was quasi experimental involving both qualitative and quantitative elements set in an Alzheimer’s care centre. The participants of the study included an 89 year old Caucasian female and one Licensed Practical nurse and the two Certefied Nursing assistants (CNAs) stationed at the home. IRB approval was obtained from the university and informed consent was obtained from the carers and responsible parties in the case of the patient. Baseline data was collected pre-intervention and post intervention. The individualized intervention was developed on based on the ranking of the patient on the Hierarchic Dementia Scale tool. Data collection for the patient’s response was collected by the Nursing assistants and the Principal Investigator through an aggressive behavior checklist, with number of instance of combative behavior occurred recorded every 12-hour period. The interventions were tailored to each patient by the LPN and the PI based on the weaksnesses/strengths of the patient, his/her past experience, clinical experience and personal history. At baseline the patient showed aggression 7 out of 10 days she was under observation, however post-intervention results showed that aggression was only observed in 5 out of 10 days under observation representing a 26 per cent decline in observed aggression per day. This decline in aggression implies that individualized intervention tailored to each patient can be an effective way of reducing their aggression towards nursing staff. Nau et al (2008) is longitudinal pre-test post-test study to establish the effect of the training program targeted at bolstering student’s confidence in tackling patient aggression. The participants of the study were 63 nursing students. Ethical approval was obtained from the Ethical Commission of the Charite ´ Universita ¨tsmedizin. The intervention for the study was a three-day training program on managing aggressive patients. Data was collected using questionnaires completed by the students. They questionnaires were posted to the students after completing the training program and joining a practice environment. Qualitative content analysis was used to analyze the data collected. Student confidence in dealing with incidents of patient’s aggressiveness increased significantly after the training. This implies that medical institutions should regularly retrain their staff on handling aggression from their patients. Hobday et al (2010) investigates the effectiveness of an internet based training program in improving the practice of nurse’s faced with patient aggression. The study administered pre-test and post-test questionnaires to the 40 certified Nursing Assistant recruited for the study. The intervention was a module named CARES (connect with the resident, assess behavior, respond appropriately, evaluate what works, share with the team. The results of the research show that nursing students that undergo CARES training are more competent and knowledgeable in handling aggressive Dementia patients. This study imply that internet based training programmes are an effective way of arming nurses with the knowledge to combat and prevent aggression in their care environment. Discussion of Interventions and Findings In the five research articles analyzed for this study training programs for nurses were the most commonly mentioned intervention for preventing or managing patient aggression in care settings. In Nau et al (2009) the nurse training program is referred to as aggression management training. The training consisted of 24 session delivered over a period of one week aimed at certain objectives that enhance the students competency in dealing with aggressive patients. The educational aims of the intervention were divided into: preventive objectives, occurrence assessment, dealing with patient and coping strategies. Similarly in Nau et al (2008) a three day training program was the primary intervention. In Irvine et al (2011) and Hobday et al (2010) the training program was conducted over the internet a significant difference with Nau et al (2009). Irvine et al (2011) concentrated on physical intervention meant to de-escalate violence and ensure the nurse stays safe. The program involved an aggression intervention technique referred to as A.I.D which stands for (Asses, Investigate, Do Something). Assessing the situation is done from arms reach, while investigating the situation the nurse should approach calmly and break the violent behavior by a calm greeting while being attentive to know the causes of the behavior. Finally, Do something requires the nurse to respond to the situation. Irvine et al (2011) training intervention is also aimed at imparting nurse with physical skills to enable them apply more coercive physical interventions. The most significantly different intervention was in Relan (2013) which employed an intervention individually tailored to the patient to investigate patient aggression. Except in Relan (2013) all the four articles agree that equipping nurses with the right skills to deal and manage patient aggression is the most effective way of dealing with patient aggression. However, they differ about the delivery of the program with two studies preferring an internet based delivery and the other group going for physical delivery of the programs. The studies agree that further studies need to be undertaken to come up with an effective training program to impart the skills necessary to impart nurses with the skills to deal with patient aggression. Critical Analysis of the Research Problem and Developing a Research Question From the critical analysis a multi-variable examination of the effectiveness of various interventions in preventing patient aggression is an entailing undertaking. Since staff training has been shown as an effective way of managing and preventing patient aggression, this paper will focus on examining the effectiveness of staff training in preventing and dealing with patient aggression. The study will focus on the long term effects of aggression management training on the occurrence of aggression in care settings. The articles reviewed focuses on the short –term effects of training in preventing and managing patient intervention and there is a gap in knowledge concerning how the staff training intervention affects patient aggression in the long-term. This research will seek to answer the question; is staff training a more effective intervention than Pharmacological intervention in preventing and managing patient aggression? Additionally the research will be interested in knowing whether the length and content of a training program has any significant effect on the efficacy of the intervention. The study will also have one group taken through an internet based training program while the second group will study in a classroom setting. This approach of splitting the training group into an internet based training and the ordinary classroom setting is aimed at comparing the effectiveness of the two learning methods in imparting skills to handle patient aggression. Furthermore, the patient cohort will be separated into a mentally ill group and patients who have no signs of mental illness. References Hobday, JV, Savik, K, Smith, S, & Gaugler, JE 2010, ‘Feasibility of Internet Training for Care Staff of Residents with Dementia: The CARES® Program’ Journal of gerontological nursing, vol. 36 , no. 4, p.13. Irvine, B, Billow, MB, Gates, DM, Fitzwater, EL, Seeley, JR, & Bourgeois, M 2012, ‘An Internet Training to Reduce Assaults in Long-Term Care’, Geriatric Nursing, vo. 33, no.1, p. 28-40 Kynoch, K, Wu, C. JJJ, & Chang, AM 2009, ‘The effectiveness of interventions in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting: a systematic review’, The JBI Database of Systematic Reviews and Implementation Reports, vol. 7, no. 6,pp. 175-223. Nau, J, Dassen, T, Needham, I, & Halfens, R 2009, ‘The development and testing of a training course in aggression for nursing students: a pre-and post-test study’, Nurse Education Today, vol. 29, no. 2, p. 196. Nau, J, Halfens, R, Needham, I, & Dassen, T 2010, ‘Student nurses’ de-escalation of patient aggression: A pretest–posttest intervention study’ International journal of nursing studies, vol 47, issue 6, p. 699. Relan, NE 2013, ‘EFFECTIVENESS OF INDIVIDUALIZING INTERVENTIONS INFORMED BY THE HIERARCHICDEMENTIA SCALE (HDS), USED BY NURSING STAFF, TO REDUCE AGGRESSIVE BEHAVIORS IN AN INDIVIDUAL WITH ALZHEIMER’S DISEASE’, Honors Theses, Paper 121. Read More