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What factors affect caregiver communication in psychogeriatric care?

Weert, J.C.M. van, Dulmen, A.M. van, Bensing, J.M. What factors affect caregiver communication in psychogeriatric care? In: A.M. Visser. Alzheimer's disease: new research. New York: Nova Science Publishers, 2008. p. 87-117.
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Background: Dementia among nursing home residents is often accompanied by high care dependency and behavioral disturbances, possibly resulting in increased workload, increased stress reactions and decreased job satisfaction. This might result in negative caregiver behaviour. Until now, little is known about the relationship between caregivers’ perceived ‘quality of working life’ (i.e. workload, job satisfaction and stress reactions) and the quality of nurse communication in psychogeriatric care. The aim of this study is to investigate the relationship between perceived quality of working life and observed Certified Nursing Assistants’ (CNAs) behaviour during morning care of demented nursing home residents and to find out what other factors affect caregiver behaviour in psychogeriatric care. Methods: 228 videotapes were recorded during morning care in twelve psychogeriatric wards and analysed by independent observers. The video-recordings were assessed using a measurement scale that measures the overall quality of nurse communication in psychogeriatric care, based on Kitwood’s Dialectical Framework. The scale distinguishes both positive CNA communication (‘Positive Person Work’) and negative CNA communication (‘Malignant Social Psychology’). In addition, three rapport-building nonverbal affective communication behaviours were selected to be observed: eye-contact, affective touch and smiling. Inter-observer reliability was good. The quality of working life was assessed by measuring perceived workload (time pressure), stress reactions and job satisfaction. First , bivariate analyses were done to explore the relationship between the ‘quality of working life’ and the quality of nurse communication. Next, the influence of intervening factors, i.e. resident and CNA characteristics and the care model used by participating CNAs, was established by multivariate regression analysis. Results: A high workload, high levels of stress reactions and dissatisfaction with work are related to less positive communicative behaviour towards demented nursing home residents. Regarding nonverbal communication, results are similar. Perceived workload is associated with less eye-contact, less smiling and less affective touch. However, these effects disappear when the care model used on the ward is taken into account. There is a positive relationship between the use of an integrated snoezelen care model and the quality of overall CNA communication and CNA nonverbal communication. CNA communication is also influenced by the care dependency of the resident, the residents’ age and the age of the CAN. Conclusion: There is a relationship between the quality of working life and CNA communicative behaviour, but the care model used by the nursing home seems to be an important, intervening factor. This implicates that management investments in patient-centred care models such as integrated snoezelen will result in high quality of caregiver behaviour and, finally, better quality of care. (aut. ref.)