Document Type

Report

Publication Date

4-16-2019

Date of Final Presentation

3-7-2019

Committee Chair

Sara Ahten, DNP, RN, NC-BC

Committee Member

Leslie Falk, DNP, RN

Coordinator/ Chair of DNP Program

Pamela Gehrke, DNP

Abstract/ Executive Summary

Problem Description

Hospital clinical staff injuries can occur while caring for patients with dementia. Clinician injury is a concern because it can be career-ending for the clinician and costly to the hospital ($80,000) to replace a nurse. A reliable estimate of the numbers of staff injuries by patients does not exist in the academic literature. Occupational Safety and Health Administration (OSHA) now require hospitals to provide data on clinician injuries related to patient care. This project explored the use of dementia patient-centered care education to increase clinician self-efficacy to ultimately decrease clinician injury.

Intervention

This quality improvement project provided 20 minutes of education to clinicians on a hospital medical pilot unit during their monthly staff meeting. The dementia patient-centered care education addressed dementia pathology; the process and rationale to document behavioral events; importance of creating an individualized dementia care plan; communication techniques and interventions clinicians can use for the patient with dementia.

Results

Impact was measured three ways to demonstrate that education was adopted into practice. First method, a self-efficacy survey was administered immediately before and after the education program to measure clinician confidence in their dementia knowledge, communication with patients, recognition of patient triggers, and use of dementia interventions. Second and third methods, care plan utilization and behavioral event documentation were retrieved from the EMR one month prior, then one, two, and three months after the education.

The pre- and post-survey showed an increase in self-efficacy in these areas: dementia knowledge, recognition of patient triggers, communication, and use of music and food interventions. Self-efficacy decreased with interventions related to backing off and creating a calm environment. On the pilot unit, six care plans were created the first month after the education but none in the month prior nor two and three months after the education. Behavioral event documentation was inconclusive due to issues identified by the clinicians: workflow issues, challenges in identifying dementia patients, defining behavioral events, and inconsistencies in the information to be included in the behavioral event documentation.

Interpretation

The delivered education was shorter than the project design and was only delivered to 46 percent of the staff on the pilot unit. Overall clinician self-efficacy improved immediately after the education. The creation of six dementia care plans the first month after the education demonstrated the transition of education into practice, though this was not sustained in subsequent months. The ability to document patient behavioral events continues to be a struggle.

Conclusion

Education to the pilot unit demonstrated an increase in clinician self-efficacy but practice changes were unable to be sustained. The recommendation is to provide the education as designed (that is, to greater than 90 percent of staff and for 60 minutes) and to incorporate adult learning principles that allow for clinicians to practice communication techniques and identify interventions to enhance dementia care. Further analysis is needed to explore behavioral event documentation in the face of multiple barriers identified in the pilot project.

Comments

DNP Student Project Team Member:
Leslie Falk, DNP, RN

Hospital Project Team Members:
Teresa Stanfill, DNP, RN, NEA-BC, RNC-OB
Laura Tivis, PhD, CCRB

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