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The Gerontologist Advance Access originally published online on June 11, 2009
The Gerontologist 2009 49(4):570-576; doi:10.1093/geront/gnp069
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Moving Forward: Evaluating a Curriculum for Managing Responsive Behaviors in a Geriatric Psychiatry Inpatient Population

Jennifer Speziale, RN, MPH2, Ed Black, PhD1,3, Robin Coatsworth-Puspoky, RN, MScN4, Tom Ross, BA3 and Tony O'Regan, RN, BSc, MSc, Cert Ed3

2 Centre for Diabetes Endocrinology, Diabetes Education Centre, St. Joseph's Health Care London, London, Ontario, Canada
3 Geriatric Psychiatry Program, Regional Mental Health Care London, St. Joseph's Health Care London, London, Ontario, Canada
4 School of Nursing, Lambton College, Sarnia, Ontario, Canada

1 Address correspondence to Ed Black, PhD, Geriatric Psychiatry Program, Regional Mental Health Care London, St. Joseph's Health Care London, 850 Highbury Avenue, London, Ontario, Canada N6A 4H1. E-mail: ed.black{at}sjhc.london.on.ca


  Abstract

Purpose: The Gentle Persuasive Approaches (GPA) curriculum was developed as an adjunct to other educational initiatives that were part of Ontario, Canada's Alzheimer Strategy. GPA emphasizes that an individual's unique personal history has a direct application to the interpretation of and response to their behavior. It incorporates strategies into geriatric patient care to assist staff to respond effectively to verbal and physical expressions of need. Design and Methods: A pre- and postintervention approach was used to evaluate the effectiveness of GPA: (a) Staff Satisfaction Surveys immediately after GPA training and after 3 months, (b) risk event profiling to monitor aggressive behavior rates, (c) occupational health and safety records pre- and post-GPA training, and (d) Residential Assessment Instrument–Mental Health indicators pre- and post-GPA training. Results: Surveys revealed that GPA training significantly improved staff's response to challenging behaviors, understanding of how brain changes impact behavior, and learning strategies to respond to challenging behaviors. Specific body containment techniques were less employed on geriatric patients who experience responsive behaviors. Pre- and postphysical aggression rates declined over the 6-month period following GPA training. The training did not appear to impact occupational injury rates. Implications: GPA appears to be a useful and positive approach for providing care to an inpatient geriatric psychiatry population. Specific body containment techniques may be less useful when employed with patients who have responsive behaviors. The program evaluation suggests that application of the GPA curriculum may be extended to patients with diagnoses other than dementia.

Keywords: Geriatric psychiatry, Challenging behaviors, Responsive behaviors, Gentle persuasive approaches, Dementia care

Received October 20, 2008; Accepted March 16, 2009

Decision Editor: Kathleen Walsh Piercy, PhD


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