A. Blair Irvine, MS, MAPE, PhD, Molly B. Billow, BA, Donna M. Gates, EdD, MSPH, MSN, RN, FAAN, Evelyn L. Fitzwater, DSN, RN, John R. Seeley, PhD and Michelle Bourgeois, PhD, CCC/SLP
The Gerontologist , October 2011

Abstract

Purpose: This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver. Design and Methods: A randomized treatment and control design was implemented, with baseline, 1-, and 2-month assessments for 158 NAs. The training involved 2 weekly visits. The Internet intervention was a behaviorally focused and video-based training that included content on skills for safely dealing with physical aggression. Measures included video situation testing and assessment of psychosocial constructs associated with behavior change. Results: Analysis of covariance showed positive results for knowledge, attitudes, self-efficacy, and empathy, with medium–large effect sizes maintained after 2 months. The training was well received by participants. Implications: 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.

© The Author 2011. Published by Oxford University Press on behalf of The Gerontological Society of America.

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Author’s Notes:

The literature is clear that care giving staff in long term care facilities (LTCs) receive inadequate training to react to symptoms of dementia, which is often comorbid with other mental illnesses. Such a training deficit can cause a diminished quality of life for the resident, and stressful, even dangerous, working conditions for the caregiver.

The abstract above is from one of a suite of 7 publications over 10 years result

ing from 3 NIH grants to develop Internet training for LTC workers. The trainings were video-based and behaviorally focused, with a simple user interface. Three of the program evaluations were conducted with a national sample recruited via the Internet, and three of the studies, including the one above, were conducted in a real world LTC environment. The research goals were to develop on-line trainings to help professional caregivers:

(a) to prevent if possible, or if necessary to react appropriately to aggressive resident behaviors (above research),

(b) to communicate and react appropriately with residents showing symptoms of dementia and other mental illnesses.

While designed for Nurse Aides in LTCs, the training also showed significant positive effects on licensed professional staff (e.g., RNs, OTs, PTs), as well as non-health care staff working in a LTC.

In addition to the results cited in the abstract above, results from the suite of research projects showed that trainees:

• had improved response scores to videos and photos of problematic caregiving scenarios;

• had improved self confidence to carry out their caregiving duties;

• had improved knowledge and attitudes about caregiving;

• gave the training and the training interface high satisfaction and usability scores;

• felt the training would improve their caregiving;

Material developed across the grants is combined into 14 hours of on-line training now available for Continuing Education credits or for licensing. Contact ORCAS at for more information, or browse the Caring Skills course catalog at http://e-learning.orcasinc.com/catalog/?id=4052.