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Enhancing CNA Skills for Effective Management of Behavioral Symptoms in Dementia Patients

The educational program aimed to improve the competency of Certified Nursing Assistants (CNAs) in recognizing, reporting, and responding to behavioral symptoms associated with dementia. With approximately 3.2 million nursing home residents in 2008, the majority suffering from cognitive impairments, effective training is critical. This case-based program included monthly interdisciplinary case conferences and resource materials to enhance staff communication and skills in non-pharmacologic interventions. Feedback indicates significant improvements in staff confidence and performance, fostering better person-centered care.

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Enhancing CNA Skills for Effective Management of Behavioral Symptoms in Dementia Patients

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  1. Development of an Educational Program to Improve the Skills of CNAs to Recognize, Report, and Respond to BPSD Shelley R McDonald

  2. Background • 3.2 million residents resided in a nursing home in 2008 – CMS NH data compendium • 68% had noted cognitive impairment • 10.4% was severe to very severe • 80-90 % of patients with dementia develop at least one distressing behavioral symptom over the course of illness

  3. Objectives • To improve the abilities of the front-line staff to: • Recognizeeach problem behavior • Reportproblem behaviors • Respond by using nonpharmacologic interventions (NPI)

  4. Case-based Educational Program • Secured dementia unit in a community- based NH • Monthly interdisciplinary case conference (behavior rounds) • Front-line staff chooses a resident to discuss • Systematic characterization of: • the behavior • possible antecedents

  5. Implementation • Feasibility • Attendance • Coverage • Efficiency • Communication • Education • Resource folders • Pocket Card • Behavior Team

  6. Pocket Card: Recognition

  7. Pocket Card: Responding & Reporting

  8. Residents with Behaviors Implementation Feasibility

  9. Documented Behaviors per Month *

  10. Perspectives • “it made you relate to how that person was acting and how you would want to be treated” • “now able to know what behavior they are having” • “can get more involved by taking them to see something they like” • “CNAs now run the floor” • “it is a great team” • “used to be the most difficult unit, now it is one of the best” • CNAs “ feel important”

  11. Conclusions • Engaging front-line staff is crucial for person-centered care • Behavior rounds held on a monthly basis has improved the ability of the front-line staff to recognize, report, and respond to difficult behaviors in persons with dementia • Ongoing training and reinforcement is needed • Have to have an in-facility champion

  12. Acknowledgements • The Pavilion at Croasdaile Village • Heidi White, MD, MHS, Med, CMD • Mitchell Heflin, MD • Sandro Pinheiro, PhD • Mugdha Thakur, MD • Billie Jean Best, RN • Iris Pleasants, RN • Rebecca Marion, LNA

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