Supporting Persons With Dementia: Perspectives From Certified Nurse’s Assistants

Abstract

Background and Objectives Many persons with Alzheimer’s disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). While CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about attitudes of CNAs towards providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods We conducted a thematic analysis of semi-structured interviews with 11 CNAs (91% female, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, non-verbal communication, and internal beliefs and attitudes towards persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.

“I′m not a risk taker”

“…The general rule should be that every resident retains decision-making capacity until proven otherwise 22 . A qualitative study with certified nursing assistants (CNAs) supporting persons with ADRD in care communities suggests CNAs value creating meaningful and personalized social interactions with residents using both verbal and nonverbal communication techniques 23 . One CNA described offering choices to promote residents’ autonomy despite cognitive impairments stating “…you’re supposed to help them feel safe and happy.…”

“…One CNA described offering choices to promote residents’ autonomy despite cognitive impairments stating “…you’re supposed to help them feel safe and happy. And when you succeed at that…it’s very rewarding.” 23 Licensed Nurses can also support residents living with ADRD at various stages of decision-making capacity by: 1) recognizing the resident’s preferences through communication and practicing person-centered care; 24 2) leveraging teamwork and interdisciplinary support to prioritize residents’ needs and wishes through care planning; 24 3) securing organizational support through education of colleagues and others on the importance of supporting resident autonomy; 24 and 4) conducting capacity assessments 19 . It is important to note that currently published capacity assessment tools alone cannot effectively collect all information needed for difficult health care decisions, therefore should be considered support for decision-making and not replace experienced clinical judgement 19 .…”

2024 Alzheimer's disease facts and figures

“…With training in active listening, empathic response and other relevant skills, direct care workers can reduce social isolation, provide emotional support and, with additional training, help administer nonpharmacological treatments -such as music and pet therapy and personcentered bathing -to prevent or reduce distress associated with dementia. [764][765][766][767] Direct care workers also support quality outcomes and cost savings. Direct care workers providing in-home care enable individuals to continue living at home and help prevent or delay nursing home placement.…”

“…With training in active listening, empathic response and other relevant skills, direct care workers can reduce social isolation, provide emotional support and, with additional training, help administer nonpharmacological treatments — such as music and pet therapy and person‐centered bathing — to prevent or reduce distress associated with dementia. 764 , 765 , 766 , 767 …”