Wisdom From the Front Lines: Clinicians’ Descriptions of Treating Agitation in the Nursing Home, A Pilot Study

Cohen‐Mansfield, Jiska; Lipson, Stephen J.; Patel, Dinesh Kumar; Tomsko-Nay, Patricia; Álvarez, Consuelo Vélez; Wilks, Gary; Compton, Gregory; Doyle, Damien; Smith, Margaret M.

doi:10.1016/j.jamda.2005.05.005

Cited by 25 publications

(36 citation statements)

References 10 publications

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“…Perceived time pressures are commonly reported as a rationale for why providers elect to initiate antipsychotics instead of behavioral interventions (Cohen-Mansfield et al, 2005;Cornegé-Blokland et al, 2012;Wood-Mitchell et al, 2008). Resources, such as staffing, can influence whether people will utilize their skills (Ajzen, 1991).…”

Section: Discussionmentioning

confidence: 99%

“…Resources, such as staffing, can influence whether people will utilize their skills (Ajzen, 1991). Although objective measures of staffing have been inconsistently associated with antipsychotic use (Garrard et al, 1995;Hughes et al, 2000;Shorr et al, 1994;Sonntag et al, 2006;Stevenson et al, 2010;Zuidema et al, 2011), qualitative research indicates that providers believe low staffing levels prevent them from using behavioral interventions (Cohen-Mansfield et al, 2005;Cornegé-Blokland et al, 2012;Wood-Mitchell et al, 2008). In light of these findings, self-efficacy, time pressures, and resources are expected to influence providers' intentions to use an antipsychotic or a behavioral intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Several interventions provided information to improve staffing patterns (CMS, 2014;Fossey et al, 2006;Meador et al, 1997;Ray et al, 1993), but did not report relevant process outcomes. Providers report low staffing levels prevent them from using behavioral treatments (Cohen-Mansfield et al, 2005;Cornegé-Blokland et al, 2012;Wood-Mitchell et al, 2008). However, while some empirical studies have reported higher staffing levels are inversely associated with antipsychotic use (Hughes, Lapane, and Mor, 2000;Shorr et al, 1994), others have not found a relationship (Garrard et al, 1995;Sonntag et al, 2006;Stevenson et al, 2010;Zuidema et al, 2011).The independent influence of staffing levels on antipsychotic misuse remains unclear.…”

Section: Staffing and Timementioning

confidence: 99%

“…Time pressures are a related but distinct factor that providers cite as to why they choose antipsychotics over behavioral interventions (Cohen-Mansfield et al, 2005;Cornegé-Blokland et al, 2012;Wood-Mitchell et al, 2008), which likely reflects the extra time required to implement a behavioral intervention (Cohen-Mansfield & Jensen, 2008). No empirical studies have tested the relationship of time pressures and antipsychotic use, and none of the reviewed interventions discussed time pressures.…”

Section: Staffing and Timementioning

confidence: 99%

“…Perceived time pressures are commonly reported as a reason why providers choose antipsychotics over behavioral interventions (Cohen-Mansfield et al, 2005;Cornegé-Blokland et al, 2012;Wood-Mitchell et al, 2008), but their association with antipsychotic use has not been empirically examined. This study operationalized time pressures as providers' perceived workload, which was measured using the Quantitative Workload Inventory (QWI) 1 (Spector & Jex, 1998).…”

Section: Sense Of Evaluationmentioning

confidence: 99%

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Nurses' intentions to initiate an antipsychotic or behavioral intervention with nursing home residents : the role of norms, being evaluated, self-efficacy, time pressures, and staffing.

Ludwin¹

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Design and Methods:A total of 158 nurses from 28 long-term care facilities were randomized to one of four conditions within a two (injunctive norm: salient vs. not salient) x two (sense of evaluation: salient vs. not salient) between-participants design in this cross-sectional study. The nurses responded to a case study that depicted a resident with dementia-related behavioral difficulties and the dependent variables were their intent to initiate an antipsychotic or a behavioral intervention. The nurses completed self-report measures of their self-efficacy, time pressures, perceived staffing, descriptive norms, v attitudes, and outcome expectancies. Multi-level modeling was utilized to examine the effect of the two conditions and explore the correlates of the nurses' intentions. Results:The provision of a salient injunctive norm and/or a sense of evaluation were not associated with lower intentions to initiate an antipsychotic or higher intentions to initiate a behavioral intervention. Individuals working in facilities with higher rates of antipsychotic use had greater intentions to utilize an antipsychotic when presented with an injunctive norm than individuals working in facilities with lower rates of antipsychotic use. The nurses' self-efficacy, attitudes, perceived descriptive norms, and outcome expectancies did not moderate the effect of an injunctive norm on their treatment intentions. Perceived staffing was related to intent to start an antipsychotic but not a behavioral intervention, and perceived time pressures were not related to the nurses' intentions.

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