Fostering compassionate care for persons with Alzheimer's disease in nursing facilities.

Abstract

The aim of this dissertation study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). More specifically, this dissertation used Kirkpatrick’s model of evaluation to assess the reactions, learning, and behavior change of the CNAs exposed to the curriculum, and ultimately the impact of the curriculum on the stress levels of residents with AD. To accomplish this, we had two studies that aligned with the Kirkpatrick model of evaluation. For Study1, the evaluation of the compassionate care curriculum (Kirkpatrick Levels One, Two, and Three), the following hypotheses guided the study: Hypothesis 1: After completion of the compassionate care curriculum by the CNA experimental group, CNAs will show a significantly higher increase in knowledge, caregiving self-efficacy, caregiving satisfaction and a significantly higher reduction in feelings of affiliate stigma than the CNAs who completed the current standard curriculum (control group). For Study #2, Evaluation of the Compassionate Care Curriculum (Kirkpatrick Level Four), the following hypotheses were used to guide the study: Hypothesis 1a: Residents with AD from the experimental nursing facility will have a different 12-week agitation change trajectory from the residents with AD from the control nursing facility. Hypothesis 1b: Residents with AD from the experimental nursing facility will have a different 12-week salivary cortisol change trajectory from the residents with AD from the control nursing facility. Hypothesis 2a: Differences in change in CNAs knowledge, confidence, satisfaction and affiliate stigma will have a differential effect on the 12-week agitation trajectories of residents with AD in the experimental and control nursing facilities. Hypothesis 2b: Differences in change in CNAs knowledge, confidence, satisfaction and stigma and differences in residents with AD agitation will have a differential effect on the 12-week salivary cortisol trajectories of residents with AD in the experimental and control nursing facilities. Methods: The study included an experimental and control nursing facility. The sample of residents with AD from the two facilities, including a convenient sample of 25 residents from the experimental group and 27 from the control group. All the CNAs who took care of the residents with AD that took part in the study were also included in the study for a total of 99 CNAs, 48 in the experimental group and 51 in the control group. At baseline, prior to the implementation of the curriculum, data were collected on the demographics of the CNAs along with their pre-test on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma for both the experimental and control groups. At the 12-week period, after the curriculum and care groups were implemented, data on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma were collected again for both groups. After…