Nonpharmacological Management of Behavioral Problems in Persons with Dementia: The TREA Model

Alzheimer's care today 12/1999; 1(4).


: Several subtypes of problem behaviors are related differentially to personal and environmental characteristics. These subtypes are useful in guiding the formulation of an individualized treatment plan. This article presents the TREA-Treatment Routes for Exploring Agitation-approach for individualizing treatment plans for behavioral problems. Such a plan involves several stages: (a) hypothesize which need underlies the agitated behaviors; (b) characterize the way in which the behavior results from the need (eg, Does the behavioral attempt to accommodate the need? Does it express discomfort? Does it attempt to communicate the need?); and (c) provide an intervention that either provides for the unmet need, or, alternatively, when the behavior itself is alleviating the need, provide a method in which the behavior can be accommodated, When an intervention to provide for the unmet need is required, it needs to be matched to the person's sensory, mental, and physical abilities, as well as to the person's habits and preferences. The goal of the plan is to improve the quality of life for the patient, and to reduce the burden on caregivers. Case examples illustrate this approach.
(C)2000Aspen Publishers, Inc.

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    ABSTRACT: The aim of this study was to describe the development of a Nurse Cultural Competence Scale using Mokken scaling. The psychometrics of the present cultural competence assessment tools has been questioned. The levels of competence measured by existing tools are not capable of indicating individual differences. This study employed a cross-sectional design. A convenience sample of 172 on-the-job nursing students in a college of technology in Taiwan was recruited. Based on previous literature, the Nurse Cultural Competence Scale comprising 41 items was developed to measure the concept of cultural awareness, cultural knowledge, cultural sensitivity and cultural skill. Mokken scaling analysis was conducted to investigate the unidimensionality and hierarchical nature of the scale. From the 41 items entered into the Mokken scaling procedure, 20 form a strong Mokken scale. The 20 items form a reliable and statistically significant scale which is negatively skewed. The ordering of the items from lowest to highest difficulty shows a hierarchy. Nursing managers and educators may use this scale to assess the levels of cultural competence of their members or students and then provide the education according to individual needs.
    Journal of Clinical Nursing 01/2012; 21(11-12):1678-84. DOI:10.1111/j.1365-2702.2011.03933.x · 1.26 Impact Factor
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    • "Caring for people who demonstrate behavioural disturbance, such as Behavioural and Psychological Symptoms of Dementia (BPSD) has been characterised as a pendulum between a loss of power and capability, as well as rejection and acceptance (Graneheim et al., 2005): experiences which are painful both for the person with dementia and staff (Rodney, 2000; De Deyn et al., 2005; Verkaik et al., 2005). Healthcare providers are at times surrounded by chaos and situations that usually lead to restrictions for the person receiving care, including the loss of personal space, which could trigger aggressive behaviour (Cohen-Mansfield, 2000; Graneheim et al., 2001). Traditionally, threatening actions directed towards healthcare providers are described as 'aggressive' or 'problematic' and not as 'violent', even if research has shown that a majority of providers actually experience acts of violence (Gates et al., 1999, 2003). "
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    International Journal of Older People Nursing 06/2011; 6(2):153-62. DOI:10.1111/j.1748-3743.2010.00235.x
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