Nurse aides' identification of onset and level of agitation in late stage dementia patients

Abstract

Nurse aides provide the majority of care to patients in nursing homes and thus are vital links in the early identification and treatment of agitation in dementia. Agitation increases in frequency as dementia progresses and unrecognized and untreated agitation may develop into a state of acute aggression (termed catastrophic reaction) in which demented patients become severely disturbed and may harm themselves or others. Nurse aides, however, are sometimes characterized as unable or unwilling to provide accurate observations of demented patients’ behavior, and thus are incapable of assisting with this important research. This study examined a process by which nurse aides were enlisted to identify and rate agitation in late stage dementia patients. Results indicate that nurse aides accurately identified agitation at a high level of agreement (r = >.90), on three occasions, with nurse experts. This high level of agreement was achieved along with a high level of nurse aide participation (75 percent), and with relatively little training time, i.e., approximately one hour per nurse aide. There were no significant differences in the demographic characteristics of aides participating versus those declining participation; likewise, participation rates in unionized versus non-unionized homes were not significantly different. The characteristics of the training program are described and the opinions of both nurse aides and administrators discussed as to why this program was successful.