Objectives-Evaluate Internet training to help Nurse Aides decrease resident aggression.Design-Randomized treatment and control design; pre-post assessment.Setting-The study was conducted entirely on the Internet. Participants-Nurse Aides; N=62Intervention-Internet based interactive training using video modeling and mastery learning instructional design.Measurements-Video situations testing and assessment of psycho-social constructs associated with behavior change; follow-up interviews with a sample of treatment participants.Results-MANCOVA analysis showed positive results (p=.001) for knowledge, attitudes, self efficacy, and behavioral intention, with large effect sizes; it was well received by the users.Conclusions-Interactive training is an effective approach to shaping appropriate staff reactions to aggressive resident behaviors. The training can effectively be delivered on the Internet. In this research, it was both valued and well received by study participants.Keywords resident aggression; training; Internet; Nurse Aides; long term care; interactive Violence and assaults by residents against staff or other residents in the long-term care system are a major public health concern 1-5 . Direct care workers in long-term care facilities (LTCs) are the workers at highest risk to suffer from workplace violence 6 (e.g., grabs, chokes, hair pulls, kicks, hits, bites, etc,) and injury due to interactions with residents. Aggressive behavior in the form of threats, harassment, and assaults by residents often occurs daily in LTCs and is widely accepted as part of the job by Nurse Aides (NAs) 4,7-10 . Aggressive resident behaviors can take a physical and emotional toll on both NAs and residents 8,11 , impacting the quality of care provided 4 , and potentially making workers more prone to aggressive responses towards residents 12,13 . The frequency of assaults has been poorly documented, but in a recent study, 138 NAs reported an average of 4.69 assaults during 80 hours of work with a range of 0-67 assaults 14 . Morgan, Stewart, D'Arcy, Forbes, and Lawson 15 reported that 73.4% of NAs in Conflict of interest: None of the authors has a conflict of interest related to this research.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An interactive multimedia (IMM) training approach that links video presentations with the interactive capabilities of computers has the potential to solve many of these problems 42,43 . IMM programs potentially can blend video modeling vignettes and testimonials, graphics and text, and test questions into a criterion-referenced mastery learning ins...

Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach Nurse Aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved two weekly visits to the on-line training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. HLM models show significant group differences at T2 in knowledge and the levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were non-significant at T2, but decreased significantly from T1 to T3 with a very large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

Internet training is a viable approach to shape appropriate NA reactions to aggressive resident behaviors. This format has future potential because it offers fidelity of presentation and automated documentation, with minimal supervision.

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Objectives Mental illness is prevalent among nursing home residents, but staff are not well trained to deal with it. This research evaluated an Internet mental illness training program designed for certified direct care workers i.e., Nurse Aides (NAs). Pilot research was also conducted to explore effects and acceptance of the same program with a sample of Licensed Health Professionals (LHPs). Design Trial 1: Pre-post randomized treatment and control design for NAs; Trial 2: Quasi-experimental pre-post within-subjects design for LHPs. Setting Both studies were conducted on the Internet. Participants Trial 1: N=62 NAs; Trial 2: N=16 LHPs Intervention Internet-based behavioral skills training and knowledge building, using video modeling with mastery learning instructional design. Measurements Video situations testing and assessment of psycho-social constructs associated with behavior change; follow-up interviews with a sample of treatment NAs. Results Trial 1: MANCOVA analysis showed positive results (p=.003) for knowledge, attitudes, self efficacy, and behavioral intention, with medium-large effect sizes. The training was well received by the users. Trial 2: Paired t-tests showed significant effects on five of six outcome measures, with medium-large effect sizes, and it was well received by the LHP sample. Conclusions Internet training can be an effective approach to help staff work with residents with mental illness. In this research, it showed significant positive effects and was well received by NAs and by LHPs.

Internet training courses for Nurse Aides (NA) in long term care facilities (LTCs) have been shown to be effective., Little is known, however, about Internet training effects on NAs in a non-research context, or about continued utilization of an available training program. In this research, a replication study was conducted with the Internet training program Caring Skills: Working with Mental Illness. Three LTCs provided the training to all NAs, each within a one-month interval scheduled during consecutive months. Supervisors were interviewed subsequently about their experiences organizing and supervising the training. Participants in all three LTCs showed positive pre-posttests effects with large effect sizes on situational knowledge and self-efficacy, and knowledge about mental illness. Users rated the program highly, and they indicated that it would improve quality of their resident care. Supervisors praised the training, and they said NAs were using recommended training behaviors. Although available to all staff, nursing and other staff made little use of the training in subsequent months. Training for NAs on the internet thus appears feasible, and it is perceived to be beneficial for resident care. Plans for continued utilization and dissemination of best practices to other staff, however, should be integrated when planning for staff training on the Internet.