Friday, September 27, 2002: 1:15 PM-2:45 PM

Improving Care For Persons With Alzheimer's Disease: Preventing Injury In The Home, Mamagement Of Resistiveness To Care, And Pain Assessment - Methods, Outcomes, Qritique And Application To Practice

The purposes of this symposium are to share 3 specific studies in a program of interdisciplinary research led by nursing principal investigators to improve care of persons with Alzheimer's disease (AD) and raise/discuss issues about design and methods and incorporation of results into practice and policy. About four million Americans suffer from AD. They, their families, and healthcare providers, struggle with a relentless and irreversible neurological syndrome that can last from 2-20 years. AD causes both cognitive and functional impairments that predispose the patient to behavioral symptoms, destroy intellectual capacity and personality, and erase the ability to communicate one's wishes for care. In the early stage, there is a need to balance safety with autonomy and to address issues of not driving or being home alone, and of living in a protective physical environment. Potential tension can occur between providers’ views of a home environment made safer to accommodate a cognitively impaired elder (similar to making a toddler’s home safe) and the caregiver’s need to maintain stability in the physical features of the home (as the care recipient deteriorates, the home may be the one stable refuge). Study one is qualitative and results include a home safety protocol as an outcome measure and a rich repository of descriptive data to be used for a follow-up instrument development project. Study two deals with the issue of the challenging behavior, resistiveness to care (RTC), which is common during the middle to late stages of dementia and occurs during interactions among care-recipient, caregiver, and their environment. RTC stresses both patients and caregivers, and unmanaged, is a major reason for institutionalization, prompting the use of psychotropic medications and restraints. The RTC study design was the randomized controlled clinical trial and results have been rapidly translated into clinical practice for professionals and will be examined for use with lay and family caregivers. Re-analysis of the data using a single subject design methodology provided more powerful “proof” of the value of the interventions. Study three, assessing pain in persons with advanced AD, is applicable to all caregiving sites and through the severe/terminal stage of AD. When clinical staff wanted to do a quality improvement project they found that reliable and valid tools developed for research projects were too complex in terms of training and administration for clinical use and partnered with researchers to develop and test the PAINAD. As a result, use of the PAINAD was written into policy and promotes compliance with the Joint Commission on Accreditation of Health Care Organizations pain standards. Multiple themes are woven into this symposium during research presentations and discussions of issues. One theme is successfully managing potential tensions between:  Family caregivers in their homes on their own turf with their longstanding values and beliefs v. the professional visitor with a mindset of safety standards  Research funders whose portfolios tend to the randomized clinical trial with cost benefit analysis v. nurses who see individual differences in all patients and responses to interventions yet fear those differences leading to different responses to interventions will be lost in a MANOVA  Tools needed for quality improvement projects that will help today’s patients tomorrow v. scales needed for research projects that will benefit many others at a later time. Other themes are:  Many “right” methods and designs, eg. single subject v. randomized clinical trial  Questions about clinical knowledge of expert practitioners v. quantification of level of evidence, eg. what is needed before recommending a local practice change or national health policy change?  The nurse/patient relationship in clinical practice and research settings, eg. what to do in the context of a research project if a community residing care-recipient with AD is left alone? Supported by the Center for Excellence in Nursing Practice, Brigham and Women's Hospital, Boston, MA; Department of Veterans Affairs (NRI-97030 and NRI-96023; School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA; Boston College School of Nursing, Chestnut Hill, MA; and Boston University Alzheimer Disease Center (NIH - P30AG13846)
Organizer:Ann C. Hurley, DNSc, RN, FAAN, Executive Director, Ce
Evidence For Practice: Essential Or Not Admissible?
Bonnie Mowinski Jennings, DNSc, RN, FAAN, Deputy Director, Health Program Analysis and Evaluation
Promoting A Safer Home Environment: "My Home Is My Castle" Or A Standardized Protective Physical Environment For Persons With Dementia
Kathy J. Horvath, PhD, RN, Associate Director, Ann C. Hurley, DNSc, RN, FAAN, Executive Director, Ce, Mary Anne Gauthier, EdD, RN, Associate Professor, Rose Harvey, DNSc, RN, Education Core Leader, Mary E. Duffy, PhD, FAAN, Professor, Scott A. Tudeau, MA, OLR/L, Director of Therapies, P. Ben Cipolloni, MD, Director, Outpatient
Quality Improvement -> Instrument Development Research Project -> Quality Improvement: Assessment Of Pain In Advanced Dementia
Victoria Warden, RN, Nursing Research Health Scientist, Ann Hurley, DNSc, FAAN, Ladislav Volicer, PhD, MD, FAAN
The "Power Of One" Versus "One Size Fits All": Reducing Uncomfortable Behaviors When Bathing Persons With Alzheimer's Disease
Ellen Mahoney, DNS, RN, CS, Associate Professor, Ann C. Hurley, DNSc, RN, FAAN, Executive Director, Ladislav Volicer, PhD, MD, FAAN, Susan Ruka, RN, MS, PhD(C), Kristen Sethares, RN, MS, PhD(C)

The Advancing Nursing Practice Excellence: State of the Science