Frequency Of Disruptive Behaviors Research Articles

Network Analysis of Comorbid Depressive and Anxious Symptoms in Family Caregivers of People with Dementia

ABSTRACT Objectives The aim of this study is an in-depth approach to depressive-anxious comorbidity in caregivers according to stress reactivity to disruptive behaviors using network analysis. Methods The sample was composed of 317 primary family caregivers recruited through Day Care Centers and Neurology Services. The sample was split into low and high stress reactivity groups, based on their reports of reaction to disruptive behaviors. Depressive and anxious symptoms, daily hours dedicated to caregiving, time of caring, frequency of disruptive behaviors, co-residence, and kinship were also cross-sectionally measured. Results The sample had a mean age of 62.38 years (SD = 12.97) and 68.5% were women. Regarding the network analysis, while the low reactivity group presents a sparse network, with no connection between anxious and depressive symptoms, the high reactivity group shows a high connection of intra and intercategory symptoms, with apathy, sadness, feeling depressed, and tension being the bridge symptoms between disorders. Conclusions Caregivers’ stress reaction to disruptive behaviors might be a key factor for understanding comorbidity between depressive and anxious symptoms. Clinical implications Tension, apathy, sadness, and feeling depressed should be clinical targets in the interventions, as they act as bridge symptoms between anxious and depressive symptomatology.

Developing ward social climate and sense of community within a high security forensic psychiatric service: Evaluating a sense of community and social climate intervention

ABSTRACT Inpatient ward social climate and sense of community can influence the recovery and care experiences of forensic mental health patients. This research evaluated an intervention designed to improve social climate and sense of community within a high-secure psychiatric hospital in the UK. The intervention was offered across six wards: two wards received the full intervention, two received the partial intervention, and two received no intervention (control). Social climate and sense of community were measured prior to the start of the intervention 6 and 18 months into the intervention, using the Essen Climate Evaluation Schema and the Sense of Community Index-2. Changes in frequency of disruptive behaviour were also monitored across time points. Results revealed that the full and the partial intervention groups reported greater feelings of social climate than the control group. This effect was also observed across time points, with higher social climate scores in the full and partial intervention groups compared to control group at 6 and 18 months. Furthermore, social climate scorespredicted a significant reduction in frequency of incidents across time in the full intervention. These findings provide longitudinal evidence of the importance of developing ward social climate and sense of community within forensic inpatient settings.

Validation of a Brief Screen to Identify Persons With Dementia at Risk for Behavioral Problems

Clinical assessment of persons with dementia should include potential causes of behavioral problems, including pain, depression, and caregiver-patient relationship quality. Many validated assessment tools are available; however, a brief screening tool is needed, as administering a battery of instruments is impractical in most clinical settings. We evaluated (a) the construct validity of brief screens for pain, depression, and relationship strain by examining their associations with validated measures and medication use and (b) the predictive validity of each screen and the screens as a set by examining their associations with frequency of disruptive behaviors. Patient-caregiver dyads (n = 228) in Aggression Prevention Training for Caregivers were examined. There was evidence of good construct validity for each screen. The relationship screen and total number of screens endorsed were significantly associated with frequency of disruptive behaviors. The brief screens show potential for use in clinical practice.

Responding to disruptive behaviors in nursing: One-year follow-up of quasi-experimental research measuring links to turnover, intent to leave, and patient care quality

Background and objectives: Disruptive behaviors among nurses are a prevalent problem in health care, contributing to nursing staff turnover and compromising patient care. Newly licensed nurses may be unprepared to respond to disruptive behaviors effectively, negatively impacting them, patients, and organizations. Cognitive rehearsal can increase self-efficacy to respond effectively to disruptive behaviors. The purpose of this study was to determine the longitudinal impact of a cognitive rehearsal intervention delivered to nursing students during the final semester of their pre-licensure program on self-efficacy to respond to disruptive behaviors, turnover and intent to stay in a job, frequency of disruptive behaviors, and perceived impact on patient care.Methods: Design: This study was the second phase in a quasi-experimental, longitudinal project. Participants and Setting: In Phase 1, 129 participants were recruited from three pre-licensure nursing programs in the Midwestern United States. All participants received the intervention. In Phase 2, one year after graduating, 95 remained enrolled. Methods: An electronic survey was used to collect data. Paired t-tests were used to detect changes in self-efficacy; bi-variate correlations were utilized to determine relationships between outcome variables.Results: Multiple measures of self-efficacy to respond remained statistically significantly increased one year after graduating (p < .05). Experiencing (r = .489; p < .000) and witnessing (r = .432; p < .000) disruptive behaviors was significantly linked to patient care.Conclusions: Cognitive rehearsal had a sustained, positive impact on self-efficacy to respond to disruptive behaviors and should be included in pre-licensure curricula.

Implementation of Token Economic Techniques in Modifying the Disruptive Behavior of Hearing Impairment Students

Economic token behavior modification techniques are often used to change unwanted children's behavior. The purpose of this study was to look at the use of economic token techniques to reduce the disruptive behavior of a ten-year-old special education student. In the context of this study the behavior that you want to change is talking / gesturing with a friend without the permission of the teacher, frequently vomiting without mouthing, frequent sneezing, not paying attention to joking, biting nails, constantly moving in the seat, blindfolding and playing with tools write. This study uses a single case study method with design A-B-A Where A represents the baseline phase, B represents the intervention phase and A is the second phase of the intervention phase with the withdrawal of the intervention without the use of economic tokens. Data is collected through observations in the classroom. This study was conducted for 4 weeks involving 3 phases namely 1 week for the baseline phase, 2 weeks for the intervention phase and 1 week for the second baseline phase after withdrawal of the intervention. The data obtained are expressed in the form of frequency tables and linear graphs to see the effectiveness of the intervention. The findings indicate that there is a reduction in the frequency of disruptive behaviors after intervention and that this reduction persists even after withdrawal of the intervention. This shows that the economic token technique used to modify disruptive behavior has successfully reduced such disruptive behavior.

VALIDATION OF A BRIEF SCREEN TO IDENTIFY PERSONS WITH DEMENTIA AT RISK FOR BEHAVIORAL DISTURBANCE

Per current guidelines, clinical assessment of persons with dementia (PWD) should include potential causes of behavioral and psychiatric problems including pain, depression, and caregiver-patient relationship quality. Many validated assessment tools are available; however, administering a battery of instruments is not practical in most clinical settings. Objectives of this secondary analysis are to 1) evaluate the construct validity of brief screens (1-3 questions each) for pain, depression, and relationship strain by examining their associations with validated measures (Geriatric Depression Scale, Modified Philadelphia Pain Scale, Zarit Burden Interview, Mutuality Scale) and medication use and 2) evaluate the predictive validity of each individual screen and the screens as a set (number positive) by examining their associations with frequency of disruptive behaviors on the Revised Memory and Behavior Problem Checklist. PWDs (n=228) were included in the original trial if the PWD or the caregiver endorsed one or more of the three screens. There was evidence of good convergent and discriminate validity for each individual screen (p’s < 0.01). Although only the relationship screen was individually associated with frequency of disruptive behaviors (p < 0.00010), the total number of screens endorsed was positively associated with this frequency (F (2,225) = 5.50, p = 0.005). In this sample, the brief screening questions showed good construct and predictive validity. Further studies are needed to determine if they can be used to identify patients with depression, pain, and/or caregiver-patient relationship problems in the clinical setting.

Stress and Blood Pressure in Dementia Caregivers: The Moderator Role of Mindfulness

ABSTRACTObjective: Dementia caregiving has been described as a chronically stressful situation with adverse cardiovascular effects. Psychological resources such as mindfulness may reduce the impact of stress on caregivers’ cardiovascular health. The objective of this study was to analyze the moderating effect of trait mindfulness on the relationship between frequency of disruptive behaviors of the care recipient and blood pressure (BP) in dementia caregivers.Method: Participants were 110 dementia family caregivers. Two hierarchical regressions (for systolic and diastolic BP) were conducted to analyze whether mindfulness moderates the relationship between disruptive behaviors and BP after controlling for known predictors of cardiovascular outcomes.Results: A significant moderator effect of mindfulness was found between the frequency of disruptive behaviors and diastolic BP (β = −.195, p < .05). Among those caregivers reporting low levels of mindfulness, the relationship between frequency of disruptive behaviors and diastolic BP was relatively stronger than among those reporting high mindfulness levels.Conclusions: The results suggest that a high level of trait mindfulness may have protective effect on BP when caregivers face high levels of stress.Clinical Implications: Mindfulness seems to be an important variable with potential for buffering the effects of caregiving stressors on caregivers’ blood pressure.

Using the Good Behavior Game with High School Special Education Students: Comparing Student- and Teacher-Selected Reinforcers

The authors investigated the implementation of the Good Behavior Game (GBG) on disruptive behaviors of high school special education students. Additionally, the study compared the effect of student-selected rewards versus teacher-selected rewards. A multielement withdrawal (A/[B + C]/A/[B + C]) design was used in the classroom to monitor behavior and compare the reward topography. Results suggested that the GBG decreased the frequency of disruptive behavior in both teams; however, there were no notable differences across reward type for either team. Effect sizes were reported using nonoverlap of all pairs. Nonoverlap of all pairs scores indicated moderate-to-large effects for the GBG, but small effects for reward topographies. Limitations and future directions are also discussed.

Mystery Motivator: A Tier 1 classroom behavioral intervention.

This study is an examination of the effectiveness of the Mystery Motivator-an interdependent group contingency, variable-ratio, classwide intervention-as a tool for reducing disruptive classroom behavior in eight diverse general-education elementary school classrooms across seven different schools. The study was conducted using an ABAB, changing criterion design, and the effectiveness of the intervention was assessed for an 8-week period. The frequency of disruptive behavior in all classrooms decreased. Teacher intervention acceptability data indicated seven of eight teachers found the intervention to be acceptable. Overall, data indicated the Mystery Motivator intervention was a powerful intervention for reducing disruptive behaviors in elementary classrooms.

Analysis of inter-provider conflicts among healthcare providers

Background:Patient safety is a top priority of healthcare organizations. The Joint Commission (TJC) is now requiring that healthcare organizations promulgate polices to investigate and resolve disruptive behavior among employees.Methods:Our aims in this investigation utilizing the Provider Conflict Questionnaire (PCQ: Appendix A) included; determining what conflicts exist among a large sample of healthcare providers, how to assess the extent and frequency of disruptive behaviors, and what types of consequences result from these conflicts. The PCQ was distributed utilizing electronic postings, and predetermined e-mail lists to nurses and physicians across the US.Results:The convenience sample included 617 respondents to the questionnaire. All incomplete responses (failure to answer all 17 items on the questionnaire) were excluded from data analysis. Our major finding was that disruptive behavior was the greatest problem observed in 82% of organizations; 74% personally witnessed these behaviors, while 5% personally experienced these behaviors. Friedman analysis of variance (ANOVA) analyses demonstrated that the difference between these three estimates were significant (χ2 = 207.8 df = 2, P < 0.0001).Conclusion:Healthcare organizations in the US are bound by TJC regulations to develop leadership standards that address disruptive behavior. These organizations can no longer stand by and ignore behaviors that threaten not only the bottom line of the institution, but also most critically, patient safety. As more attention is being paid to recommendations and mandates from the TJC and the Institute of Medicine (IOM), we will need more data, like those provided from this study, to better document how to address, resolve, and prevent future “misbehaviors”.

Variables modulating depression in dementia caregivers: a longitudinal study

Dementia caregiving has been linked to negative consequences for mental health in caregivers. Although depression seems to be an enduring psychological consequence associated with caregiving, little is known about the longitudinal effects that modulating variables related to coping strategies have on caregiver's changes in depression over time. This study is aimed at investigating whether, in a one-year longitudinal study with 130 dementia caregivers, caregivers' depression scores co-vary with modulating variables such as self-efficacy for controlling upsetting thoughts, frequency of leisure activities, and cognitive reappraisal, after controlling for gender and caregivers' stressors (frequency of disruptive behaviors). Linear mixed models analysis was used to analyze the associations between time-varying values for caregivers' stressors and modulating variables in predicting caregivers' depression. It was found that increases in caregivers' self-efficacy, frequency of leisure activities, and cognitive reappraisal significantly predicted decreases in caregivers' depression over time, even after controlling for gender and frequency of disruptive behaviors. In addition, increases in stressors were significantly related to increases in depression over time. The inclusion of modulating variables significantly contributed to the explanation of the variance in caregivers' depression, adding explanatory power to the variables usually included in the stress and coping model (gender and stressors).

An Analysis of Training, Generalization, and Maintenance Effects of Primary Care Triple P for Parents of Preschool-Aged Children with Disruptive Behavior

A brief primary care intervention for parents of preschool-aged children with disruptive behavior was assessed using a multiple probe design. Primary Care Triple P, a four session behavioral intervention was sequentially introduced within a multiple probe format to each of 9 families to a total of 10 children aged between 3 and 7 years (males = 4, females = 6). Independent observations of parent-child interaction in the home revealed that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent report data also confirmed there were significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the Parent Experience Survey, and high levels of consumer satisfaction. All short-term intervention effects were maintained at four-month follow-up. Implications for the delivery of brief interventions to prevent conduct problems are discussed.

Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia

To assess the effect of an interdisciplinary educational program in reducing the use of antipsychotics in nursing home residents with dementia. We conducted a longitudinal pilot study to test the implementation of a 7-month interdisciplinary educational program in a fixed cohort of residents with dementia receiving antipsychotics. The program included consciousness-raising, educational sessions, and clinical follow-up. Administrators, physicians, pharmacists, nursing staff, and personal care attendants were involved. The effect of the program was assessed over a 6-month period, in terms of the proportion of discontinuations and dose reductions of antipsychotics. Repeated measures for use of other psychotropics and restraints, frequency of disruptive behaviors, and stressful events experienced by nursing staff and personal care attendants were simultaneously assessed. Among the 81 residents still present at the end of the program, there were 40 (49.4%) discontinuations and 11 (13.6%) dose reductions. No significant changes were found in the use of other psychotropics, the use of restraints, or in the number of stressful events experienced by nursing staff and personal care attendants. The frequency of disruptive behaviors decreased significantly over the 6-month period (p<0.001). Our interdisciplinary educational program led to a substantial reduction in the number of residents receiving antipsychotics and to a decrease in the frequency of disruptive behaviors. Our findings suggest that implementation of recognized practice guidelines could be an effective way to target residents who might not benefit from antipsychotics or who may tolerate a dose reduction.

Older Husbands as Caregivers

The purpose of this study, based on Pearlin et al.'s model, was to determine the factors associated with the health of older husband caregivers and with their intention to end home caregiving for their wives. The results showed subjective stressors to be associated with outcomes. Role overload was linked to psychological distress and to lower self-perceived health, whereas role captivity was associated with psychological distress and the intention to end home caregiving. The likelihood of ceasing home caregiving increased when caregivers reported high relational deprivation. A high percentage of the variance in psychological distress was explained (51%). The quality of prior husband-wife relationships, the frequency of disruptive behaviors, family conflicts, and self-efficacy were associated with this variable. Selfefficacy had a mediating effect between subjective stressors and psychological distress, whereas the number of services received had a moderating effect on the intention to end home caregiving among husbands with high role captivity. This study provides avenues for interventions sensitive to male caregivers.

Efficacy of Recreational and Occupational Activities Associated to Psychologic Support in Mild to Moderate Alzheimer Disease

We evaluated the efficacy of a stimulation program mainly based on recreational and occupational activities, associated with a brief cycle of support psychotherapy for patients and caregivers, in mild to moderate Alzheimer Disease (AD) associated or not with cerebrovascular lesions. Sixty-seven patients and 31 controls from 2 Italian towns entered the study. The control group was comprised of AD subjects who voluntarily declined to participate in the program for practical reasons. Patients were divided in groups of 4 subjects: treatment was delivered for 6 weeks. Multidimensional efficacy assessment of functional, behavioral, and neuropsychologic aspects was performed. When comparing baseline with posttraining condition, patients displayed a substantial reduction in disruptive behavior, and a tendency to a general reduction of behavioral symptoms compared with controls (Revised Memory and Behavior Problems Checklist--RMBPC--symptoms frequency-total P=0.07; frequency of disruptive behavior P=0.008). This reduction was mirrored by a significant reduction of caregiver reaction to behavioral disturbances (RMBPC caregiver reaction-total P=0.035; reaction to disruptive behavior, P=0.011). At 3 months follow-up, the reduction of caregiver reaction to behavioral symptoms results was confirmed (RMBPC caregiver reaction-total P=0.014, caregiver reaction to disruptive behavior P=0.028). No other significant difference was detected. These results partially confirm findings of previous studies, showing that AD patients treated with similar techniques demonstrated an improvement in behavioral disturbances.

Identifying patterns of disruptive behavior in long-term care residents.

To determine the frequency, timing, and pattern of 45 operationalized disruptive behaviors (DB) in older people in long-term care units. Nursing staff collected prospective descriptive data over 21 consecutive shifts for each patient to document prevalence, frequency, and co-occurrences of DBs. All of the eight long-term care units and one acute/admission unit of a large Veterans Administration Medical Center (VAMC). Each 40-bed unit had patients with varying levels of cognitive impairment and skilled nursing needs. The sample consisted of 240 hospitalized VA patients with a mean age of 72.8 (SD = 8.6) years and mean length of stay of 4.02 (SD = 8.6) years. Residents had dementia, a psychiatric diagnosis, or mixed dementia and psychiatric diagnoses. The Disruptive Behavior Scale (DBS), an instrument designed for collecting patient-level data on 45 separate DBs. In a 24-hour period, the average frequency was 3.6 DBs per subject. We found that 41.2% of DB occurred during the day shift, 39.2% during the evening shift, and 19.6% during the night shift. In 32% of observed occurrences, only one DB occurred within the hour. In the remaining 68% of observations, two or more DBs occurred within the same hour. We found two behaviors, Does Not Follow Directions and Excessive Motor Activity, to occur with multiple behaviors in multiple categories. Several characteristic patterns were noted; e.g., physically aggressive behaviors rarely co-occurred with verbal DBs. Physically nonaggressive behaviors seemed to occur most frequently with other physically nonaggressive behaviors and, to a lesser extent, with verbal DBs. These findings lend support to the existence of patterns of DBs in long-term care patients, a useful step toward targeting interventions early in the behavioral sequence.