Date of Award

Fall 12-22-2016

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Judith Lucas, Ed.D.

Committee Member

Mary Ellen Roberts, D.N.P.

Committee Member

Susan Zboray, APN

Abstract

Frequent use of antipsychotic medication (APM) for behavioral and psychological symptoms of dementia (BPSD) persists at high levels in long- term care (LTC) facilities despite extensive evidence of modest clinical benefits, serious adverse effects, public health advisories and a national initiative to improve dementia care. There is a gap between best-practice evidence and actual clinical practice related to pharmacological and nonpharmacological care for persons with dementia (PWD) and BPSD and/or neuropsychiatric symptoms (NPS) of dementia. The literature shows that clinicians often ignore FDA (Food and Drug Administration) warnings, CMS (the Centers for Medicare and Medicaid Services) initiatives and expert opinion regarding the use of APMs and other psychotropic medications. Surveyed nursing home staff believe pharmacological interventions are more effective than nonpharmacological interventions to manage challenging behaviors. Previous studies document that nonpharmacological interventions and patient/resident-centered education programs are effective in reducing the frequency and severity of BPSD. This project presents an evidence-based interdisciplinary education program developed and administered at a Long Term Care (LTC) facility in the northeast. This program was designed to help staff at long-term care facilities who work with persons with dementia (PWD). This educational intervention project teaches staff a resident-centered approach that enhances care-planning skills for behavior problems and emphasizes meaningful activities to improve the PWD's quality of life, reduce distressing symptoms and decrease the use of psychotropic drugs. This project uses Watson's Theory of Human Caring and integrates several effective patient-centered educational strategies including the STAR-VA program available in the public domain. The STAR-VA program has demonstrated that an intensive interdisciplinary staff education program and development of a behavioral support team can reduce the frequency and intensity of BPSD for PWD. The current project's specific educational program for nurses, nurse managers, certified nursing assistants, activity staff, unit secretaries, and social workers includes five 30-45 minutes sessions. The results demonstrate that an education project can be implemented in a LTC facility to heighten awareness and help staff consider the use of meaningful individualized activities to decrease BPSD. Recommendations include the continued testing of the modified STAR-VA program in long-term care facilities with dissemination to assist staff in working with PWD to reduce BPSD with a nonpharmacological approach.

Frequent use of antipsychotic medication (APM) for behavioral and psychological symptoms of dementia (BPSD) persists at high levels in long- term care (LTC) facilities despite extensive evidence of modest clinical benefits, serious adverse effects, public health advisories and a national initiative to improve dementia care. There is a gap between best-practice evidence and actual clinical practice related to pharmacological and nonpharmacological care for persons with dementia (PWD) and BPSD and/or neuropsychiatric symptoms (NPS) of dementia. The literature shows that clinicians often ignore FDA (Food and Drug Administration) warnings, CMS (the Centers for Medicare and Medicaid Services) initiatives and expert opinion regarding the use of APMs and other psychotropic medications. Surveyed nursing home staff believe pharmacological interventions are more effective than nonpharmacological interventions to manage challenging behaviors. Previous studies document that nonpharmacological interventions and patient/resident-centered education programs are effective in reducing the frequency and severity of BPSD. This project presents an evidence-based interdisciplinary education program developed and administered at a Long Term Care (LTC) facility in the northeast. This program was designed to help staff at long-term care facilities who work with persons with dementia (PWD). This educational intervention project teaches staff a resident-centered approach that enhances care-planning skills for behavior problems and emphasizes meaningful activities to improve the PWD's quality of life, reduce distressing symptoms and decrease the use of psychotropic drugs. This project uses Watson's Theory of Human Caring and integrates several effective patient-centered educational strategies including the STAR-VA program available in the public domain. The STAR-VA program has demonstrated that an intensive interdisciplinary staff education program and development of a behavioral support team can reduce the frequency and intensity of BPSD for PWD. The current project's specific educational program for nurses, nurse managers, certified nursing assistants, activity staff, unit secretaries, and social workers includes five 30-45 minutes sessions. The results demonstrate that an education project can be implemented in a LTC facility to heighten awareness and help staff consider the use of meaningful individualized activities to decrease BPSD. Recommendations include the continued testing of the modified STAR-VA program in long-term care facilities with dissemination to assist staff in working with PWD to reduce BPSD with a nonpharmacological approach.

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