the impact of life history on nurse empathy and aggressive behaviours of individuals with dementia

187 Pages·2014·1.45 MB·English

LIFE HISTORY, NURSE EMPATHY, AND AGGRESSIVE BEHAVIOURS IN
INDIVIDUALS WITH DEMENTIA

A Thesis
Submitted to the Faculty of Graduate Studies and Research
In Partial Fulfillment of the Requirements
For the Degree of

Doctor of Philosophy
in
Clinical Psychology
University of Regina

by
Heather Sharlene Eritz
Regina, Saskatchewan
November 2014

Copyright 2014: Heather Eritz
UNIVERSITY OF REGINA

FACULTY OF GRADUATE STUDIES AND RESEARCH

SUPERVISORY AND EXAMINING COMMITTEE

Heather Sharlene Eritz, candidate for the degree of Doctor of Philosophy in Clinical
Psychology, has presented a thesis titled, Life History, Nurse Empathy, and Aggressive
Behaviours in Individuals with Dementia, in an oral examination held on November 19,
2014. The following committee members have found the thesis acceptable in form and
content, and that the candidate demonstrated satisfactory knowledge of the subject material.

External Examiner: *Dr. Sandra Hirst, University of Calgary

Supervisor: Dr. Thomas Hadjistavropoulos, Department of Psychology

Committee Member: Dr. Mary Hampton, Department of Psychology

Committee Member: Dr. Kristi Wright, Department of Psychology

Committee Member: Dr. R. Nicholas Carleton, Department of Psychology

Committee Member: Dr. Rebecca Genoe, Faculty of Kinesiology & Health Studies

Chair of Defense: Dr. Kenneth Montgomery, Faculty of Education

*via Teleconference
Abstract
Dementia is common among long term care (LTC) residents and has many
implications for their quality of life. Individuals with dementia often present with
behavioural disturbances such as aggression (e.g., destructive actions toward persons,
objects, or the self) that negatively affect their quality of life and may result from unmet
needs (Whall et al., 2008). Egan et al. (2007), using a very small patient sample (N = 4;
no control group), successfully piloted an intervention intended to influence professional
caregivers’ behaviour toward residents, and thus decrease aggressive behaviours by
presenting staff members with life histories of the residents. The goal of these life
histories was to increase staff perceptions of patient personhood with the outcome of
improving person-centered care. The current study was designed to replicate the
intervention designed by Egan et al. (2007) with a larger number of participants and a
control group. Within a framework of the Functional Analytic (FA) model (Fisher,
Drossel, Ferguson, Cherup, & Sylvester, 2008), it was expected that changes in nurse
behaviour toward the residents would lead to changes in behavioural disturbance and
specifically decreases in aggressive behaviour and increases in quality of life for the
residents. It was also expected that these changes in nurse behaviour would stem from
increases in empathy and personhood perception. As such, perceptions of empathy and
personhood would serve as mediators for the expected changes in aggressive behaviours
and quality of life. Significant differences between the experimental and control groups
were found following the intervention. These changes were reflected in aggressive
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behaviours, personhood perception, and quality of life. Mediation analyses found a
significant mediated effect, with personhood perception serving as a mediator for quality
of life. Additional analyses revealed a significant negative relationship between patient
cognitive impairment and staff personhood perception prior to the intervention, at
intervention, and at follow-up. Finally, qualitative analyses explored the attitudes staff
members have toward residents and their perceptions of resident personhood. The
implications of these findings are discussed.

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Acknowledgements
I am grateful for the expertise of my dissertation supervisor, Dr. Thomas
Hadjistavropoulos. His knowledge and commitment to research inspired me to do my
best work. His ability to find solutions for every problem was greatly appreciated. I
would also like to thank my committee members for reviewing the document and
providing helpful suggestions to improve the final product.
Thank you to the Alzheimer’s Society of Canada and the Saskatchewan Health
Research Foundation for providing funding for this project. The Research and
Community Alliance for Quality of Life Team provided valuable feedback throughout all
stages of this project.
I am grateful that I had the opportunity to consult with other professionals while
completing this project. Dr. Lisa Lix and Kristine Einarson have been fantastic resources
for statistics questions. Likewise, Dr. Jaime Williams provided support and guidance
throughout the analysis of the open-ended data.
This project was an ambitious undertaking that could not have been completed
without the help of several research assistants (Ashley, Kirstie, Sarah, Kerry). Special
thanks go to Eleni Gardikiotis, whose exceptional writing skills and organization were
relied upon heavily during the busiest parts of data collection.

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Dedication
The participation of the staff and residents of the long term care facilities in the
Regina Qu’Appelle Health Region, along with their family members, was crucial for the
completion of this project. I dedicate this work to them and thank them for their warm
welcomes, positive attitudes, and kind offers of coffee as I spent many long days in their
facilities.
This dissertation could not have been completed without the patience and support
of all of my friends and family. Despite the challenges of completing my research, they
provided ongoing encouragement that one day I would be able to add the letters Ph.D.
behind my name.
Thank you to my parents, Terry and Sharlene Eritz, and the rest of my family who
constantly encouraged me to keep going and who did not object when I brought my
laptop to Christmas dinner. And to my husband, Matt, who has never known me to not be
working on my dissertation.

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Table of Contents
Page
Abstract…………………………………………………………………………….. i
Acknowledgements………………………………………………………………... iii
Dedication………………………………………………………………………….. iv
Table of Contents…………………………………………………………………... v
List of Tables…………………………………………………………………….… ix
List of Figures……………………………………………………………………… x
List of Appendices………………………………………………………………… xii
Overview…………………………………………………………………...……… 1
Dementia and Long Term Care………………………………….………… 2
Behavioural Disturbance and Dementia…………………………..……….. 3
Dementia and Aggressive Behaviour……………………………..……….. 9
Interventions for aggressive behaviours…………………..……….. 15
Antipsychotic Medications………………………………………..……….. 17
Functional Analytic Model……………………………………...…………. 21
Quality of Life in Long Term Care……………………………..…………. 25
Nurse Empathy…………………………………………………………… 30
Personhood………………………………………………………..……….. 35
Person-Centred Care……………………………………………..………… 39
Life History as Intervention……………………………………..…………. 41
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Purpose…………………………………………………………..………… 44
Hypotheses……………………………………………………..………….. 45
Method……………………………………………………………………………. 46
Participants……………………………………………………………….. 46
Resident characteristics…………………………………………... 49
Staff characteristics………………………………………………. 49
Procedure…………………………………………………………………. 52
Measures…………………………………………………………………... 57
Chart review………………………………………………………. 57
Aggressive incident report………………………………………... 57
Cognitive Performance Scale (CPS)……………………………… 57
The Medication Quantification Scale Version III (MQS III)……… 58
The Jefferson Scale of Physician Empathy – Health Professional
Version (JSPE-HP)………………………….……………………... 59
The Personhood in Dementia Questionnaire (PDQ)……………… 61
Aggression Behaviour Scale (ABS)………………………………. 62
Cohen-Mansfield Agitation Inventory (CMAI)………………….. 63
Alzheimer’s Disease-Related Quality of Life (ADRQL)…………. 64
Staff Member Questionnaire……………………………………… 65
Quantitative Analysis……………………………………………………………... 65
Data Cleaning……………………………………………………………... 65
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Hypothesis Testing………………………………………………………... 66
Hypothesis I…………………………………………….…………. 66
ABS……………………………………………..…………. 74
CMAI………………………………..……………………... 78
Hypothesis II……………………………………………………… 79
JSPE-HP…………….………………………………….. 91
PDQ…………………………………………………….. 94
Hypothesis III…………………………………………………... 95
PRN medication………………………………………… 100
Hypothesis IV……………………………………………………... 102
ADRQL…………………………………………………… 102
Hypothesis V……………………………………………………… 110
Additional Correlations…………………………………………………… 117
Analysis of Open-Ended Data……………………………………………………. 120
Analysis Broken Down by Staff Members………………………………… 122
Analysis by Resident……………………………………………………… 126
Results…………………………………………………………… 127
Discussion…………………………………………………………………………. 132
Aggression and Agitated Behaviours……………………………………... 133
Empathy and Personhood Perception……………………………………... 134
Quality of Life……………………………….………………………….. 136
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Antipsychotic Medication………………………………………………… 138
Personhood Perception as Mediator…………………………………… 138
Cognitive Impairment, Empathy, Personhood Perception, and Quality of
Life……………………………………………………………………… 140
The Culture of Long Term Care…………………………………………... 142
Specific Recommendations for LTC Facilities……………………………………. 144
Limitations and Future Directions………………………………………………… 144
Conclusions…………………………...…………………………………………… 149
References……………………………………………………………………… 150

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