Learning Objective #1: Describe four nurse responses to behaviors exhibited by people with advanced dementia

Learning Objective #2: Explain the relationship of different nurse responses to recurrence of behaviors exhibited by people with dementia

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People with advanced dementia frequently exhibit behaviors that have been described as “challenging,” “disruptive,” or “problematic”. The purpose of this study was to describe patterns of nurse response to behaviors of people with advanced dementia and predict recurrence of resident behavioral symptoms based on type of nurse response. A total of 54 nurses and 112 residents with advanced dementia participated in this mixed method study. For each subject, nurses recorded on a daily log for 20 days four observations: 1) behaviors of subjects that initiated care; 2) assessments done in response to the behavior; 3) treatments given in response to behaviors or as a result of assessment findings; and 4) the degree to which the behavioral symptom returned to baseline following assessments or treatments. Content analysis revealed that nurses responded to behaviors in four ways: dismissive (the nurse does no assessment or intervention); static (the nurse continues to utilize the same 1 or 2 assessment and/or intervention technique(s) over multiple days, even though ineffective); reactive (the nurse uses one or more treatments, but intervenes before completing a thorough assessment); and comprehensive (assessment of 3 or more domains plus one or more treatments). Dismissive responses had the lowest effectiveness rating (M = 17.91, SD = 36.79). Static responses had an effectiveness rating of 45.89 (SD = 35.19), Reactive responses were the most frequent response, with an effectiveness rating of 62.66 (SD = 31.20). Comprehensive responses were used for 55 subjects with an effectiveness rating of 74.75 (SD = 29.57).Hierarchical regression analysis revealed that reactive responses, after controlling for functional status and pretest behavior symptom profile significantly predicted recurrence of behavior. The model shows that 20.1% of the variance in behavioral symptom days is uniquely accounted for by the use of static responses (p < .001).