Fostering Compassionate Care for Persons with Alzheimer's Disease

Background

The aim of this study was to examine the impact of the implementation of a new Compassionate Care (CC) curriculum on the quality of care provided by Certified Nursing Assistants (CNAs) to residents with Alzheimer’s disease (AD). This study used Kirkpatrick’s model of evaluation to assess the reactions, learning, and behavior change of the CNAs exposed to the curriculum, and the impact of the curriculum on the stress levels of residents with AD.

Methods

The study included an experimental and control nursing facility. The sample of residents with ADfrom the two facilities, including a convenient sample of 25 residents from the experimental group and 27 from the control group. The CNA sample included 48 in the experimental group and 51 in the control group. Demographics of the CNAs along with their pre-test on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma for both the experimental and control groups. At the 12-week period, data on AD knowledge, self-efficacy, caregiving satisfaction, andaffiliate stigma were collected again for both groups. A two-way mixed method MANOVA was utilized to examine how scores changed for all of the dependent variables to determine whether there were differences between the control and experimental groups and the interaction effect between time and group. The final element of the Kirkpatrick model examined stress levels of residents withAD. This study was conducted by testing a hybrid multilevel growth model.

Results

CNAs changes in terms of their knowledge of AD, self-efficacy, caregiving satisfaction and affiliate stigma were analyzed to understand the impact the compassionate care curriculum had on the CNAs. For AD knowledge, we saw a significant increase in scores from baseline to 12 weeks for the experimental group while the control group remained the same over the 12-week period. Self-efficacy for the experimental group improved between baseline and 12-weeks but deteriorated slightly for the control group. Caregiver satisfaction showed a slight improvement at 12-weeks for both groups, yet the experimental group showed a trend of greater improvement than the control group. For the experimental group, feelings of affiliate stigma declined between baseline and 12- weeks, while the control group remained similar at the 12-week period.  From the Kirkpatrickmodel, level 4 examined outcomes and focused on the stress outcomes of the residents with AD, specifically agitation and salivary cortisol levels. The final models were able to show how the changes in the CNAs specifically affected these positive outcomes. CNA knowledge and self-efficacy had the most impact on changing agitation levels, andCNA knowledge and agitation levels had the most impact on salivary cortisol levels.

Conclusions

The results of this study showed that integrating a compassionate care curriculum into the work that CNAs perform with persons with ADcan lead to positive outcomes on CNAs knowledge, self-efficacy, caregiving satisfaction, affiliate stigma and a reduction of agitation and cortisol levels in persons with AD. This has implications for the way we conceptualize the type of care that is provided by CNAs to persons with ADin nursing facilities.