Implementation of the 6-Week Educational Component in the Res-Care Intervention: Process and Outcomes
ABSTRACT A 6-week restorative care educational program (30 minutes weekly) was conducted for nursing assistants. A total of 523 nursing assistants from 12 nursing homes were recruited: 265 were at treatment sites and 258 were at control sites. The mean age of the participants was 38.1 years (SD = 12.0). The majority were female (486; 93%) and African American (466; 89%). The nursing assistants had an average of 14.7 (SD = 3.8) years of education and 11.5 (SD = 8.6) years of experience. Control sites had a single 30-minute in-service on managing behavioral problems commonly associated with dementia. A total of 33% of the nursing assistants who consented to participate at the treatment sites attended all six classes, and 53% of those who did not attend at least three classes received one-on-one review of the class content. Overall, 86% of the nursing assistants who consented to participate attended the 6-week educational program. At the control sites, 18% of the nursing assistants who consented to participate attended the in-service training. There was a significant increase in restorative care knowledge (SD = 2.7, F = 280.4, p < .05) in treatment group participants. The techniques used in this intervention were effective in helping to expose nursing assistants to educational sessions and increase their knowledge of nursing care practices.
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ABSTRACT: Rehabilitation treatments may be effective in improving the physical health of older people in long-term care. In 2010, 7.6% of the world's population were over 65 years old, and this is predicted to increase to 13% by 2035. It is expected that this will lead to a rise in demand for long-term residential care. This has increased interest in ways to prevent deterioration in health and activities of daily living, for example, walking and dressing, among care home residents. Physical rehabilitation (interventions based on exercising the body) may have a role, and this review examines the evidence available. This review included 67 trials, 36 of which were conducted in North America, 20 in Europe, and seven in Asia. In total, 6300 participants with an average age of 83 years were involved. Most interventions in some way addressed difficulties in activities of daily living. This review investigates the effects of physical rehabilitation on activities of daily living, strength, flexibility, balance, mood, cognition (memory and thinking), exercise tolerance, fear of falling, death, illness, and unwanted effects associated with the intervention, such as injuries. While variations between trials meant that we could not make specific recommendations, individual studies were often successful in demonstrating benefits to physical health from participating in different types of physical rehabilitation.Cochrane database of systematic reviews (Online) 02/2009; 2(1):CD004294. DOI:10.1002/14651858.CD004294.pub2 · 5.94 Impact Factor
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ABSTRACT: To test the effectiveness of a restorative care (Res-Care) intervention on function, muscle strength, contractures, and quality of life of nursing home residents, with secondary aims focused on strengthening self-efficacy and outcome expectations. A randomized controlled repeated-measure design was used, and generalized estimating equations were used to evaluate status at baseline and 4 and 12 months after initiation of the Res-Care intervention. Twelve nursing homes in Maryland. Four hundred eighty-seven residents consented and were eligible: 256 from treatment sites and 231 from control sites. The majority were female (389, 80.1%) and white (325, 66.8%); 85 (17.4%) were married and the remaining widowed, single, or divorced/separated. Mean age was 83.8 +/- 8.2, and mean Mini-Mental State Examination score was 20.4 +/- 5.3. Res-Care was a two-tiered self-efficacy-based intervention focused on motivating nursing assistants and residents to engage in functional and physical activities. Barthel Index, Tinetti Gait and Balance, grip strength, Dementia Quality-of-Life Scale, self-efficacy, and Outcome Expectations Scales for Function. Significant treatment-by-time interactions (P<.05) were found for the Tinetti Mobility Score and its gait and balance subscores and for walking, bathing, and stair climbing. The findings provide some evidence for the utility and safety of a Res-Care intervention in terms of improving function in NH residents.Journal of the American Geriatrics Society 08/2009; 57(7):1156-65. DOI:10.1111/j.1532-5415.2009.02327.x · 4.22 Impact Factor
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ABSTRACT: To develop and test the Function-Focused Care in Assisted Living (FFC-AL) intervention so as to alter the decline that older adults in AL experience. Cluster-randomized controlled trial using repeated measures to test the effect of FFC-AL. Four AL facilities with at least 100 beds. One hundred seventy-one residents and 96 direct care workers (DCWs) were recruited. Ninety-five of the DCWs were female (99%), and 59 were black (62%), with a mean age of 41.7 ± 13.8. The residents were mostly female (80%), white (93%), and widowed (80%), with a mean age of 87.7 ± 5.7. FFC-AL included four components implemented by a research-supported function focused-care nurse (FFCN) and a site-identified champion over a 12-month period. Control sites were exposed to FFC education only. Outcomes for residents included psychosocial domains (mood, resilience, self-efficacy, and outcome expectations for function and physical activity), function, gait and balance, and actigraphy. Outcomes for DCWs included knowledge, performance, and beliefs associated with FFC. DCWs in treatment sites provided more FFC by 12 months than those in control sites. Residents in treatment sites demonstrated less decline in function, a greater percentage returned to ambulatory status, and there were positive trends demonstrating more time in moderate-level physical activity at 4 months and more overall counts of activity at 12 months than for residents in control sites. Using a function-focused approach in AL may help prevent some of the functional decline commonly noted in these settings.Journal of the American Geriatrics Society 11/2011; 59(12):2233-40. DOI:10.1111/j.1532-5415.2011.03699.x · 4.22 Impact Factor