Positive Care Interactions Research Articles

Reliability and Validity Testing of the Modified Quality of Interaction Scale.

Background and Purpose: Limited care interaction measurements capture important interaction characteristics that occur during staff-resident care interactions. The purpose of this study was to test the reliability and validity of Modified Quality of Interaction Scale (MQuIS). Methods: Data from an observational study in four assisted living facilities was used. Results: A total of 152 staff-resident care interactions were observed. There was some evidence of reliability based on the Rasch analysis (item reliability of .98). There was some support for validity based on the item fit and hypothesis testing as active resident engagement was significantly associated with positive social and positive care interactions. Conclusions: This study provides some support for the use of the MQuIS to evaluate the quality of care interactions in assisted living settings.

The association between patient engagement and quality of care interactions among acute care patients with dementia

Effective staff-patient communication is critical in acute care settings, particularly for patients with dementia. Limited work has examined the impact of quality of staff-patient care interactions on patient engagement. The purpose of this study was to determine whether the quality of staff-patient care interactions were associated with active patient engagement during the interaction after controlling for relevant covariates. The study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care intervention study, with a total sample of 286 patients. Descriptive statistics and a generalized linear mixed model were used. The findings indicated that there was a significant relationship between the quality of care interactions and patient engagement such that receiving positive care interactions resulted in higher odds of active patient engagement. These findings can inform future interventions and training for acute care staff to improve quality of care interactions and patient engagement.

THE ASSOCIATION BETWEEN RESIDENT ENGAGEMENT AND QUALITY OF CARE INTERACTION AMONG ACUTE CARE PATIENTS WITH DEMENTIA

Abstract Care interactions are essential to patients with dementia. The purpose of the study was to describe the quality of staff-patient care interactions among acute care (AC) patients with dementia and to test whether the quality of staff-patient care interactions varied by resident level of engagement in the interaction. Specifically, it was hypothesized that controlling for age, cognition, pain, behavior, and function, actively engaged patients would have more positive care interactions with staff compared with passively engaged patients. This secondary data analysis used baseline data from the Function Focused Care for Acute Care (FFC-AC- EIT), an ongoing intervention study. The sample included 286 patients. Descriptive statistics and a multiple linear regression were conducted. The majority of interactions that occurred were positive care (n = 225, 79%). Actively engaged patients had significantly more positive interactions compared to passively engaged patients (b = 1.49, p < .001). Patients with more pain (b = -0.26, p < .001) and behavioral symptoms (b = -0.12, p < .05) had significantly poorer care interactions. Passively engaged patients or patients with pain and behavioral symptoms may be at risk to receive poor quality care interactions. Findings from this study will inform future interventions and training for AC staff to promote positive care interactions among patients with dementia. Managing pain, managing behavior, and supporting resident engagement in care will likely help increase the frequency of positive care interactions in future work.

QUALITY OF CARE INTERACTIONS IN ACUTE CARE

Abstract Care interactions are verbal or nonverbal exchanges between staff and patients and promote quality of care and optimize outcomes for hospitalized patients living with dementia. Care interactions vary regarding quality and are differentiated between positive interactions (e.g., interactions that provide beneficial companionship or appropriate care communication for residents), neutral interactions (e.g., brief, indifferent interactions), or negative interactions (e.g., interactions that restrict residents due to safety concerns or interactions that are restrictive for no justified reason). Patients exposed to negative care interactions, particularly those that are living with dementia, are at risk for negative outcomes such as increased resistiveness to care, anxiety, depression, and apathy. The Quality of Care Interactions Survey (QuIS) is an observation measure used to evaluate interactions between staff and patients based on definitions of positive social, positive care, neutral, negative protective, or negative restrictive interaction. Scores range from 0 to 7, with higher scores indicating more positive care interactions between staff and residents. Nursing interactions with the first 365 patients in the FFC-AC-EIT study indicated that on admission the majority of the care interactions were positive (82%), half were neutral (50%), and a small percentage were negative protective (7%) and negative restrictive (6%). By discharge, there was a decrease in neutral interactions to 47%, negative protective to 6% and negative restrictive to 5%. Ongoing oversight and education is needed to decrease neutral and negative interactions between staff and patients using techniques provided in our function focused care intervention.

Model Testing of the Factors that are Associated with Care Interactions among Nursing Home Residents with Dementia.

The purpose of this study was to test a model of the resident and community factors that are associated with quality of care interactions among nursing home (NH) residents living with dementia and test for invariance between model fit when tested with the Black versus White residents and female versus male residents. It was hypothesized that resident age, gender, race, pain, comorbidities, quality of life, resistiveness to care, function, cognition, community profit status, overall community star rating, community size, and staffing star rating would be directly and/or indirectly associated with quality of care interactions. It was also hypothesized that the model fit would be invariant by resident race and gender. This was a secondary data analysis using baseline, cross-sectional data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) intervention study. The study included 528 residents from 55 NH facilities. Descriptive statistics and structural equation modeling was used to test the proposed model. The results showed that the final model with significant paths only had a poor fit to the data (χ2/df= 10.79, comparative fit index= 0.57, Tucker-Lewis index= 0.15, normed fit index= 0.57, root mean square error of approximation= 0.13). However, the findings indicated that comorbidities, pain, profit status, and overall community star rating were significantly associated with quality of care interactions. There was no difference in model fit between Black residents versus White residents, and between male versus female residents. This study suggests factors that may influence quality of care interactions. Managing comorbidities, managing pain, and supporting higher quality of care in NH communities will likely help increase the frequency of positive care interactions. These findings can inform future interventions and training curricula for NH care staff to promote positive care interactions.

The Association Between Engagement in Activities of Daily Living and Care Interactions for Residents Living With Dementia.

Care interactions are essential to residents with dementia. The purpose of the study was to describe the characteristics and quality of staff-resident care interactions among nursing home residents living with dementia and to test whether the quality of staff-resident care interactions varied by resident level of engagement in the interaction. Specifically, it was hypothesized that controlling for age, gender, comorbidities, cognition, and function, actively engaged residents would have more positive care interactions with staff compared with passively engaged residents. This was a secondary data analysis using baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia intervention study. A total of 532 residents were included. Actively engaged residents had significantly more positive interactions compared to passively engaged residents. Passively engaged residents may be at risk to receive poor quality care interactions. Strategies and interventions to optimize care interactions for these individuals are needed.

Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living.

The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].

Pilot Testing of the Promoting Positive Care Interactions (PPCI) in Assisted Living Study During a Pandemic

The purpose of this study was to test the feasibility and preliminary efficacy of Promoting Positive Care Interactions (PPCI)—a four step intervention designed to establish positive care interactions between staff and residents with cognitive impairment or dementia in Assisted Living (AL). Initially designed as a traditional on-site intervention, PPCI was later transformed to be conducted remotely through webinar and virtual meetings due to challenges related to onsite engagement in AL during the COVID-19 pandemic. Additionally, the study adopted shorter timeline, a single group pretest-posttest design, and limited recruitment to staff only; 17 care staff were recruited, and data was collected via online surveys and interviews. PPCI was successfully implemented as intended with considerable stakeholder engagement. Findings demonstrated feasibility and promising staff adoption of PPCI. Continued research is needed to optimize the quality of care interactions in AL and evaluate whether online approach to staff training can change staff behavior.

Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living

Care interactions are essential to understand and respond to resident needs in assisted living (AL). The factors that influence care interactions in AL have not been directly examined. In this study, we explored the factors associated with the quality of care interactions in AL. It was hypothesized that resident functional status, agitation, depression, and resistiveness to care as well as facility size and ownership would be significantly associated with the quality of care interactions in AL after controlling for resident demographics (age, gender, marital status), comorbidities, and cognition. To test the hypothesis, we utilized baseline data including 379 residents from the second and third cohorts recruited in a randomized trial titled ‘Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle’. Regression analysis was performed using a stepwise method. The care interactions were mostly positive (mean=6.3; range = 0-7). Resident agitation and facility ownership were significantly associated with care interactions and accounted for 8.2% of the variance. Increased resident agitation was associated with negative or neutral interaction while for-profit ownership was associated with positive interactions. To promote positive care interactions, staff should be educated about strategies to minimize resident agitation (e.g., calm posture and respectful listening) and encouraged to engage with residents using resident-centered care and communication approach. Findings also suggest the need to work towards optimizing care interactions in nonprofit stings. Future research could further explore the impact of facility-level factors (e.g., staffing ratios, staff longevity, and job satisfaction) on care interactions.

Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living.

Care interactions are verbal or nonverbal interactions between staff and residents during social or physical care activities. The quality of care interactions could be positive, negative, or neutral. The purpose of this study was to examine the resident- and facility-level factors associated with the care interactions in assisted living (AL). Regression analysis was performed using a stepwise method utilizing baseline data of 379 residents from 59 AL facilities recruited in a randomized trial. Accounting for 8.2% of variance, increased resident agitation was associated with negative or neutral quality interactions while for-profit ownership was associated with positive quality interactions. To promote positive care interactions, findings suggest the need to educate staff about strategies to minimize resident agitation (eg, calm posture and respectful listening) and work toward optimizing care interactions in nonprofit settings. Future research could further explore the influence of staff-level factors on care interactions.

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial.

BackgroundAgitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost.Methods and findingsThis was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory–Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen’s D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI −7.39, −1.15; Cohen’s D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI −7.07,−2.02; Cohen’s D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen’s D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group.ConclusionsThese findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting.Trial registrationISRCTN Registry ISRCTN62237498

Quality of Staff Service User Interaction in Two Day Centres for Adults with Learning Disabilities

This study involves quality of interaction between Day Centre staff and Service-Users with Learning Disabilities in two Day Centres (Dc1 n=50, Dc2 n=247). The Quality of Interactions Schedule (QUIS) was applied within an eight month prospective design, involving 32 visits which constructed a ‘typical day’ composed of 20-30 minute observational sessions within each Day Centre. The largest proportions of interactions were of a positive nature (87%) across both Day Centres. More positive care interactions were seen in Dc1 and significantly higher rates of positive interactions in Dc1. The greatest use of Verbal and Non-verbal interaction was observed in Dc1. Service users initiated more of the interactions in Dc2. Lengthier verbal interactions were seen in Dc1 and conversely greater amounts of short verbal interactions were seen in Dc2. Within both centres time-tables that were inspected indicated similar proportions spent in: Work, Leisure, Education, Community and Social skills sessions. In comparison to previous studies a relatively low proportion of activities were community based and social skills orientated. Results are framed within comparable observational studies in Day Centres; differences in measurement characteristics employed (Cummins, 2000, 2002) and service evaluation of quality of life in Day centres for adults with Learning Disabilities. Reliability and validity of results were also examined.