The Quality of Interactions Between Staff and Residents With Cognitive Impairment in Nursing Homes

Abstract

Background: Positive and effective staff–resident interactions are imperative to adequately assess and meet the needs of cognitively impaired residents in nursing homes and optimize their quality of life. Aim: The purpose of this study was to quantify, describe, and analyze the interaction between staff and cognitively impaired residents in nursing homes, using the Quality of Interaction Schedule (QuIS). Method: This descriptive analysis utilized baseline data from the first 2 cohorts in a randomized clinical trial including 341 residents from 35 nursing homes. Results: Five hundred fifty-six staff–resident interactions were evaluated; majority were positive (n = 466, 83.8%) and the remaining were either neutral (n = 60, 10.8%) or negative (n = 30, 5.4%). The quality of interactions varied by interaction location, interpersonal distance, and resident participation. Conclusion: Future research should focus on decreasing the negative/neutral interactions and explore staff characteristics (eg, gender, level of experience) and facility factors (eg, size, ownership) that might influence the quality of interactions.

Mealtime verbal interactions among nursing home staff and residents with dementia: A secondary behavioural analysis of videotaped observations

“…In this study, resident age and dementia stage were not associated with staff–resident positive and negative utterances. Such findings were consistent with a recent study that showed resident age and cognitive status were not associated with positive and negative/neutral dyadic interactions during care‐related activities other than mealtime (Paudel et al., 2019). This study is the first that examined the role of resident eating function on mealtime interaction and found resident eating function was not associated with dyadic positive and negative verbal interaction.…”

“…This study showed that female residents were more likely to make negative utterances than male residents. Such difference was not identified in prior research (Paudel et al., 2019). In this study, resident age and dementia stage were not associated with staff–resident positive and negative utterances.…”

“…Prior research on other NH care‐related (not mealtime) dyadic interactions reported similar findings in that staff behaviours were primarily positive and neutral (versus distracting and negative). One study reported 83.8% of dyadic interactions were positive with the rest being neutral (10.8%) or negative (5.4%) among staff and cognitively impaired residents (Paudel et al., 2019). Another study reported that 32.1% of staff verbal behaviours were neutral, 18.7% positive, 5.4% distraction, 4.7% negative, and 39.1% of the interaction duration showed absence of behaviours or other behaviours impossible to rate in hygienic care routines (Belzil & Vézina, 2015).…”

“…Prior studies have examined temporal associations of staff behaviours with resident agitation (Gilmore‐Bykovskyi et al., 2015) and aspiration (Gilmore‐Bykovskyi & Rogus‐Pulia, 2018) during mealtime and temporal associations of staff behaviours with resident agitation (Roth et al., 2002) and resistiveness to care (Belzil & Vézina, 2015) during hygienic care routines. Another study shows that both positive and negative/neutral interactions during care‐related activities (not mealtime specific) are associated with interaction location and resident participation level and suggests more research on the role of resident and staff characteristics on quality of dyadic interactions in dementia care (Paudel et al., 2019). Overall, little research has quantitatively characterized patterns and distributions of mealtime‐specific dyadic interactions or examined the role of staff and resident characteristics.…”

A Description of Staff-resident Interactions in Assisted Living

“…Positive social interactions involve good constructive conversation and companionship that is more than necessary to complete the task; positive care interactions involve limited interactions necessary to complete the task and or to keep residents safe and prevent from danger; negative protective interactions are those interactions that lack reassurance, comfort, and appropriate regard to the resident; negative restrictive interactions are those that oppose residents freedom of choice or action without a valid reason; and neutral interactions are brief interactions that lack verbal or non-verbal contact with residents (Dean et al, 1993). A detailed description of the QUIS with the definition of each type of interaction has been previously published (Paudel et al, 2019). The QuIS was quantified in the current study and scoring was done such that "positive social" was a 2 if present, "positive care" was a 1 if present, "neutral" was 1 if not present, "negative protective" was a 1 if not present, and "negative restrictive" was a 2 if not present (Resnick et al, 2019).…”