Burgio Louis D, Stevens Alan, Burgio Kathryn L, Roth David L, Paul Penelope, Gerstle John
Applied Gerontology Program, University of Alabama, Tuscaloosa 35487-0315, USA.
Gerontologist. 2002 Aug;42(4):487-96. doi: 10.1093/geront/42.4.487.
To examine the efficacy of a comprehensive behavior management skills training program for improving certified nursing assistants' (CNA) skill performance in the nursing home, to assess the effectiveness of a staff motivational system for maintaining newly acquired behavior management skills for a 6-month period, and to evaluate any resulting effects on resident agitation.
This study used a randomized clinical trial of 88 residents with behavior disturbances and 106 CNAs who cared for them in two urban nursing homes. After CNAs received 4 weeks of behavior management training, supervisory nursing staff implemented formal staff management (FSM), designed to maintain training effects over time. The supervisory staff used conventional staff management (CSM, usual supervisory routine) on control units. We completed behavioral observations and paper-and-pen assessments at baseline and repeated them during a 4-week post-intervention phase and at 3- and 6-month follow-ups.
During the immediate post-training phase, both the FSM and CSM groups improved five out of seven communication skills and the ability to delay physical assistance during care routines. Although CNAs showed a reduction in the use of ineffective behavior management strategies, they did not increase their use of effective behavioral strategies. Follow-up assessments suggested that the FSM system was more effective than CSM for maintaining and even improving communication skills over time. Resident agitation was reduced during care interactions and maintained at follow-up.
The behavior management skills training program improved CNAs' ability to interact with behaviorally disturbed nursing home residents and produced sustained reductions in agitation. The FSM system was more effective for maintaining communication skills 6 months after training.
检验一项全面行为管理技能培训计划在提高养老院认证护理助理（CNA）技能表现方面的效果，评估一种员工激励系统在为期6个月的时间里维持新习得的行为管理技能的有效性，并评估其对居民躁动的任何影响。
本研究采用随机临床试验，涉及88名有行为障碍的居民以及在两家城市养老院照顾他们的106名CNA。在CNA接受4周的行为管理培训后，督导护理人员实施了旨在长期维持培训效果的正式员工管理（FSM）。督导人员在对照单元采用传统员工管理（CSM，常规督导程序）。我们在基线时完成了行为观察和纸笔评估，并在干预后4周阶段以及3个月和6个月随访时重复进行。
在培训后立即进行的阶段，FSM组和CSM组在七项沟通技能中的五项以及护理常规中延迟身体协助的能力方面均有改善。尽管CNA减少了无效行为管理策略的使用，但他们并未增加有效行为策略的使用。随访评估表明，随着时间推移，FSM系统在维持甚至提高沟通技能方面比CSM更有效。在护理互动期间居民躁动减少，并在随访时得以维持。
行为管理技能培训计划提高了CNA与行为障碍养老院居民互动的能力，并持续减少了躁动。FSM系统在培训6个月后对维持沟通技能更有效。
