An Innovative Simulator-Enhanced Training Program to Improve Dressing Assistance in Nursing Homes

Purpose: Dementia is highly prevalent in the elderly population. When elders with dementia lose some of their ability to perform activities of daily living (ADLs), caregivers tend to offer assistance. However, ADL skills deteriorate more quickly when caregivers do not allow or encourage elders to perform to their full extent of ability. In addition, this leads to lower self-esteem and reduced control over self and personal space. Therefore, providing appropriate assistance is important to ensure that elders with dementia do not lose their ADL abilities. Therefore, we proposed a simulator-enhanced training program, levels of assistance (LoA) trainer, that taught caregivers to use the appropriate LoA strategy when helping an elder with dementia to perform ADLs. We chose dressing assistance as the initial target for improvement because dressing is the way we present who we are to others. As elders with dementia transition to nursing home, the percentage of residents who are dependent on others for dressing rises substantially. However, studies have shown that 75% of residents dressed by staff were able to dress more independently when staff used appropriate LoA strategies. This study, therefore, reported the initial effect of this training program on caregivers’ LoA in dressing assistance and nursing home residents’ dressing performance.

Methods: Nine dyads, assigned to either the experimental (LoA trainer + traditional face to face education module) or control arms (traditional face to face education module), completed the study.  The experimental arm received the LoA trainer using a newly developed video simulator on a tablet computer that enabled Certified Nursing Assistants (CNAs) to practice their LoA skills. Major outcomes [CNAs’ LoA usage and residents’ dressing performance measured by the Beck Dressing Performance Scale (BDPS)]—were measured before the intervention and 6 weeks after the intervention.  

Results: The results showed that the two arms were not significantly different in either LoA usage or BDPS (p=.25-.36). Detailed analysis showed that a lack of effort to assist and low statistical powers might explain the insignificant finding. The observed effect sizes of the experimental intervention in LoA usage and BDPS were .51 and .89, respectively. There was a strong correlation between CNAs’ LoA usage and the dressing performance of elders with dementia. In order to enable an elder to reach approximately 90% of their dressing potential, LoA must be used at least 66% of the time when providing dressing assistance.

Conclusion: Future studies should verify CNAs achieve a specific skill level and knowledge after training, and consider incorporating a strategy to improve CNAs’ intention to change behavior. In addition, the training program should consider the timing of training to achieve maximum effect.