Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Meeks, Suzanne

Committee Co-Chair (if applicable)

Gopalraj, Rangaraj

Committee Member

Gopalraj, Rangaraj

Committee Member

Lewine, Richard

Committee Member

Mast, Benjamin

Committee Member

Stetson, Barbara

Author's Keywords

long term care; antipsychotics; psychosocial interventions


Purpose of the Study: This experimental study examined whether exposure to an injunctive norm against antipsychotic use and a sense of being evaluated influenced nurses’ intentions to initiate an antipsychotic or behavioral intervention with nursing home residents who have dementia-related behavioral difficulties, and examined the interrelationships of perceived time pressures, staffing, self-efficacy, and the nurses’ treatment intentions. Design and Methods: A total of 158 nurses from 28 long-term care facilities were randomized to one of four conditions within a two (injunctive norm: salient vs. not salient) x two (sense of evaluation: salient vs. not salient) between-participants design in this cross-sectional study. The nurses responded to a case study that depicted a resident with dementia-related behavioral difficulties and the dependent variables were their intent to initiate an antipsychotic or a behavioral intervention. The nurses completed self-report measures of their self-efficacy, time pressures, perceived staffing, descriptive norms, attitudes, and outcome expectancies. Multi-level modeling was utilized to examine the effect of the two conditions and explore the correlates of the nurses’ intentions. Results: The provision of a salient injunctive norm and/or a sense of evaluation were not associated with lower intentions to initiate an antipsychotic or higher intentions to initiate a behavioral intervention. Individuals working in facilities with higher rates of antipsychotic use had greater intentions to utilize an antipsychotic when presented with an injunctive norm than individuals working in facilities with lower rates of antipsychotic use. The nurses’ self-efficacy, attitudes, perceived descriptive norms, and outcome expectancies did not moderate the effect of an injunctive norm on their treatment intentions. Perceived staffing was related to intent to start an antipsychotic but not a behavioral intervention, and perceived time pressures were not related to the nurses’ intentions. Implications: Increasing the visibility of a message discouraging antipsychotic use may have limited utility in influencing nurses’ intentions to use an antipsychotic and may even be detrimental in facilities with higher rates of antipsychotic use. Further research examining the effect of a sense of evaluation, time pressures, staffing, and self-efficacy on nurses’ treatment intentions is needed.