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Biomedical subjects

Christine R Kovach

Publications and source records attributed to Christine R Kovach.

12 recordsLinked to original sources
PubMed2006

Deconstruction of a complex tailored intervention to assess and treat discomfort of people with advanced dementia.

AIM: This paper describes the use of components of the Serial Trial Intervention (STI), which is designed to address problems of physical and affective discomfort in people with late-stage dementia. BACKGROUND: Nursing intervention studies frequently test the efficacy of tailored interventions that contain multidimensional assessment and diverse treatment components. Describing differences in the intervention as planned in the research design and as delivered under study conditions increases understanding of what really contributed to outcomes achievement, Type III error and improves the validity of conclusions regarding intervention effectiveness. METHOD: Data from 57 participants in the treatment arm of a randomized experiment testing the intervention are used to describe the assessments and treatments actually delivered, to evaluate the effectiveness of specific components, and to compare differences between those receiving and not receiving the intervention. DISCUSSION: While targeted treatment in response to positive physical assessment was effective for 86% of those receiving treatment, 70% of participants with a positive assessment finding did not receive treatment during this step of the STI. Trials of non-pharmacological treatments were effective for 62% and trials of analgesics were effective for 75% of participants. Those treated at the not-for-profit facilities received a higher dose of the intervention and had statistically significant less discomfort after treatment than those at for-profit facilities (effect size of 0.963). CONCLUSION: Components of the STI were effective for many participants and this supports the use of a multidimensional approach to resolve the unmet needs of people with dementia who no longer communicate their needs through spoken language. Treating the intervention as both a categorical and continuous variable in experimental studies allows the effect of group assignment as well as dosage delivered to be examined.

Aged, 80 and over↗
PubMed2006

The Serial Trial Intervention: an innovative approach to meeting needs of individuals with dementia.

Individuals with dementia often use behaviors rather than specific verbal complaints to express the presence of a symptom or need. The Serial Trial Intervention uses systematic serial assessments and sequential trials of treatments to identify and treat unmet needs that may be the underlying cause of these behaviors. Because chronic pain is common and often under-treated in this population, a trial of analgesics is used when other approaches, including nonpharmacological treatments, have not been effective. A systematic approach to nursing assessment and treatment is needed to identify and treat discomfort and other unmet needs of individuals with dementia.

Activities of Daily Living↗
PubMed2006

Positive gain: rethinking the outcomes of dependency.

While independent behavior by older adults is routinely encouraged, some individuals can benefit from engaging in dependent behavior. In traditional views of dependency, dependent behaviors are considered maladaptive and dysfunctional. The purpose of this article is to consider the interactions between health professionals and older patients, the ways that dependent behaviors can lead to both positive outcomes for older adults, as well as serve as barriers to self-care and examine the role of nurses and institutions in interactions with older adults. An improved understanding of dependency and its relevance to nursing practice will contribute to a heightened awareness of the control dynamics occurring in everyday nursing care activities. An understanding of potential gains attained through dependency can add another dimension to assessment of a patient's progress and capability for present and future self-care.

Activities of Daily Living↗
PubMed2006

Behaviors of nursing home residents with dementia: examining nurse responses.

It is challenging for nurses to understand and respond to behaviors expressed by individuals with dementia. Nurses in this study responded to behaviors in 4 discrete ways--with no treatment, treatment without assessment, repetitive use of ineffective treatments, and with comprehensive assessment followed by treatment. Using ineffective treatments and treating without assessing were associated with recurrence of behaviors. This study suggests there is a need for more assessment and critical thinking when addressing behavior change in individuals with dementia.

Aged↗
PubMed2005

A model of consequences of need-driven, dementia-compromised behavior.

PURPOSE: To extend the original need-driven, dementia-compromised behavior (NDB) model by explaining the consequences of behavioral symptoms for the person with dementia. ORGANIZING CONSTRUCT AND METHODS: Literature is reviewed and the consequences of expressing needs through need-driven, dementia-compromised behaviors are posited. The consequences of need-driven, dementia-compromised behavior (C-NDB) theory is proposed as a framework to improve understanding of the person with dementia and the consequences of behavioral symptoms and unmet needs. FINDINGS: Instead of normative verbal communication, people with significant dementia commonly communicate need via non-normative behaviors, making it difficult for caregivers to know that the person has a need and the extent of such need. Not meeting needs of people with dementia affects the person with dementia, care factors, and contextual factors. Cascading effects occur in which not meeting the original need results in new needs and behavioral symptoms. CONCLUSIONS: This framework indicates the consequences of expressing need behaviorally rather than verbally and shows that caregiver actions might moderate the events that lead to many needs being unresolved. Suggestions are made regarding future research questions deduced from the model.

Attitude of Health Personnel↗
PubMed2004

Effect of the BACE intervention on agitation of people with dementia.

PURPOSE: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. DESIGN AND METHODS: A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person's high-arousal and low-arousal states. The outcome measure was observed agitation. RESULTS: When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group x Time interaction, F(1, 69) = 4.26, p =.043, with a partial eta(2) =.06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of.7. IMPLICATIONS: The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.

Aged↗
PubMed2002

The assessment of discomfort in dementia protocol.

Many people with dementia are unable to clearly or consistently verbalize pain symptoms. The Assessment of Discomfort in Dementia (ADD) Protocol is a systematic tool that can be used by nurses to make a differential assessment and treatment plan for both physical pain and affective discomfort experienced by people with dementia. This ADD Protocol is based on the assumption that behaviors associated with dementia are symptoms of unmet physiologic and/or nonphysiologic needs. Steps of the process include a physical assessment, a review of the patient's history, an assessment of affective needs including environmental stress and sensoristasis, and the administration of analgesics. The ADD Protocol is unique in that it uses "as needed" analgesics as a part of the assessment process. The dualistic perspective, in which physical and affective needs are considered in tandem, is an essential and innovative feature of the ADD Protocol.

Clinical Protocols↗
PubMedDate not supplied

Effects of the Serial Trial Intervention on discomfort and behavior of nursing home residents with dementia.

This study tested the effectiveness of the Serial Trial Intervention (STI), an innovative clinical protocol for assessment and management of unmet needs in people with late-stage dementia. A double-blinded randomized experiment was conducted in 14 nursing homes with 114 subjects. The treatment group had significantly less discomfort than the control group at posttesting and more frequently had behavioral symptoms return to baseline. The group of nurses using the STI also showed more persistence in assessing and intervening than control group nurses did. There was a statistically significant difference between the groups in the use of pharmacological, but not nonpharmacological, comfort treatments. Results suggest that the STI is effective and that effective treatment of discomfort is possible for people with late-stage dementia.

Aged, 80 and over↗