Local Problem
Antianxiety and hypnotic medications are used commonly in the elderly population and have risks related to safety issues and the mortality of patients. The problem identified was that the percentage of nursing home patients taking antianxiety and/or hypnotic medications is 40 – 50% in three nursing homes in rural West Tennessee. These percentages are twice the national average. Research has shown that reminiscence therapy is an effective non-pharmacological intervention to decrease anxiety in the nursing home population. Although the three nursing homes in West Tennessee use nonpharmacological interventions to address anxiety, no evidence was found that reminiscence therapy was being used. A gap in the literature was also identified based on barriers to the use of reminiscence therapy within the nursing home setting.
Project Purpose
The purpose of this study is to identify if barriers to the use of reminiscence therapy exist within the nursing home setting and to develop recommendations to address any identified barriers.
Methodology
The Evidence Based Practice Model was used as the framework for this project. Step 1 included the identification of the problem. The problem was identified through researching nursing home data and discussions with nursing home administration. Step 2 included evidence gathered through a literature review and analyzed. Step 3 included identifying a gap in the literature and administration of a survey to identify barriers to the use of reminiscence therapy perceived by the nursing home staff within the 3 nursing homes in rural West Tennessee. Step 4 included the development of recommendations that were presented to the three nursing homes to address the identified barriers. The plan for steps 5 and 6 were addressed with the nursing home administration and staff for finalization of change.
Results
The survey results identified three themes. Findings indicate that perceived barriers related to staff knowledge, facility resources, and time are present. Meetings with the nursing home administrators, directors of nursing, and staff allowed for dissemination of the project information and identified areas of improvement of anxiety treatment for nursing home residents by using the nonpharmacological intervention of reminiscence therapy.
Implications for Practice
The information gathered from the study was used to develop plans for clinical change within each nursing home. The findings from this project provided an opportunity to develop interventions to increase the use of RT and provided a nonpharmacological intervention option to decrease anxiety in nursing home patients. Further benefit could be the decreased need for antianxiety medications within the nursing home settings. Short term evaluation of the DNP project was determined to be successful because barriers were identified and plans for clinical change were made. Long term evaluation will be performed by comparing CMS data of antianxiety and hypnotic use of the nursing homes over the next year. Continued training and evaluation of the recommended plan will also occur.