Date on Master's Thesis/Doctoral Dissertation

12-2018

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Social Work

Degree Program

Social Work, PhD

Committee Chair

Faul, Anna

Committee Co-Chair (if applicable)

D'Ambrosio, Joseph G.

Committee Member

D'Ambrosio, Joseph G.

Committee Member

Yankeelov, Pamela A.

Committee Member

Singer, Terry L.

Committee Member

Jicha, Gregory A.

Author's Keywords

Alzheimer; nursing; compassionate care; disease

Abstract

The aim of this dissertation 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). More specifically, this dissertation used Kirkpatrick’s model of evaluation to assess the reactions, learning, and behavior change of the CNAs exposed to the curriculum, and ultimately the impact of the curriculum on the stress levels of residents with AD. To accomplish this, we had two studies that aligned with the Kirkpatrick model of evaluation. For Study #1, the evaluation of the compassionate care curriculum (Kirkpatrick Levels One, Two, and Three), the following hypotheses guided the study: Hypothesis 1: After completion of the compassionate care curriculum by the CNA experimental group, CNAs will show a significantly higher increase in knowledge, caregiving self-efficacy, caregiving satisfaction and a significantly higher reduction in feelings of affiliate stigma than the CNAs who completed the current standard curriculum (control group). For Study #2, Evaluation of the Compassionate Care Curriculum (Kirkpatrick Level Four), the following hypotheses were used to guide the study: Hypothesis 1a: Residents with AD from the experimental nursing facility will have a different 12-week agitation change trajectory from the residents with AD from the control nursing facility. Hypothesis 1b: Residents with AD from the experimental nursing facility will have a different 12-week salivary cortisol change trajectory from the residents with AD from the control nursing facility. Hypothesis 2a: Differences in change in CNAs knowledge, confidence, satisfaction and affiliate stigma will have a differential effect on the 12-week agitation trajectories of residents with AD in the experimental and control nursing facilities. Hypothesis 2b: Differences in change in CNAs knowledge, confidence, satisfaction and stigma and differences in residents with AD agitation will have a differential effect on the 12-week salivary cortisol trajectories of residents with AD in the experimental and control nursing facilities. Methods: The study included an experimental and control nursing facility. The sample of residents with AD from the two facilities, including a convenient sample of 25 residents from the experimental group and 27 from the control group. All the CNAs who took care of the residents with AD that took part in the study were also included in the study for a total of 99 CNAs, 48 in the experimental group and 51 in the control group. At baseline, prior to the implementation of the curriculum, data were collected on the 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, after the curriculum and care groups were implemented, data on AD knowledge, self-efficacy, caregiving satisfaction, and affiliate stigma were collected again for both groups. After equivalency between the two groups was tested, a two-way mixed method MANOVA was utilized to examine how scores changed for all of the dependent variables. For this study, the focus of the analysis was to examine whether there was a significant difference over time (within-subjects), whether there were differences between the control and experimental groups (between-subjects), and whether there was an interaction effect between time and group, indicating if the groups change differently over time. The second study examined the final element of the Kirkpatrick model, namely stress levels of residents with AD. 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, using levels 1, 2 and 3 of the Kirkpatrick Evaluation Model. 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 Kirkpatrick model, level 4 examined outcomes. This study focused on the stress outcomes of the residents with AD, specifically agitation and salivary cortisol levels. All models built showed that the experimental group performed better in reducing agitation and reducing 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, and CNA 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 AD can 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 AD in nursing facilities. Currently, CNAs are trained to only provide traditional basic nursing care focuses primarily on the basic needs of the person such as attending to activities of daily living. While traditional basic nursing care is important, it should be supplemented with compassionate care for persons with AD. Compassionate care (CC) emphasizes the bond between the caregiver (the CNA) and the care receiver (the person with AD) and their journey together. CC can also provide CNAs with skills to respond to the changes that the person with AD experiences as they decline.

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