A descriptive study of nursing interventions for disruptive behaviors in elderly subacute care patients

Abstract

Disruptive behaviors are a prevalent problem among hospitalized elderly patients and a challenge for today's policy-makers. This problem had not been studied in the two subacute care models: hospital and nursing home-based. This study reviewed the responses of 101 licensed nurses working in 8 JCAHO accredited subacute care programs, 5 hospital-based and 3 nursing home-based. A new scale was developed that provided a comprehensive inventory of interventions for the management of disruptive behaviors. The inventory utilized the following categories of management strategies: behavioral, functional, psychological, environmental, and medical (Beck et al., 1993; Taft et al., 1997). Nurses were asked to rate videotapes of the 4 most commonly occurring types of disruptive behaviors, physical aggression, verbal aggression, agitation, and wandering with respect to (a) the effort involved in behavior management; (b) tolerance toward the occurrence of the behavior; (c) frequency of occurrence and (d) the types of primary interventions (actual and ideal) most likely to be instituted in caring for elderly patients in their particular subacute care setting. Analysis of variance indicated no significant differences between the four types of behaviors with respect to perceived effort, although organizational tolerance for agitation-type behavior was significantly higher than for the other three types. Nursing home-based subacute nurses witnessed a greater frequency of physical aggression, verbal aggression, and agitation-related disruptive behaviors, but fewer occurrences of wandering than hospital-based subacute nurses. No significant differences were found between nurses' intervention selections by facility type nor actual and ideal determined by chi square analyses. Stepwise regression analyses were not statistically significant for demographic and professional characteristics of nurses nor type of facility to explain perceived effort, but did reveal there was a significant (R 2 = 0.049; p = 0.026) positive relationship between organizational tolerance and perceived effort for agitation. An important study finding consistent with the Omnibus Reconciliation Act of 1987 was that nurses in both hospital and nursing home-based subacute settings did not select physical or chemical restraints as a primary intervention for managing disruptive behaviors.