An intervention to improve therapeutic communication during nursing home care among certified nursing aides

Certified nursing aides (CNAs) receive minimal training in how to communicate with persons with dementia. The purpose of this paper is to present preliminary results from an intervention to improve CNAs' therapeutic communication. Eighteen CNAs and residents (RES) with some dementia from two long-term care facilities were video- and audio-taped during lunch-time interactions. The intervention and evaluation focused on five therapeutic communication techniques including 1) greeting, 2) eye gaze, 3) sitting in front, 4) direct/redirect, and 5) wait for a response. A master's level person taught the intervention in four 1-hour sessions over four weeks. Pre- and post-video and audio taping occurred a total of four times during the two weeks before and two weeks after the intervention for each CNA-RES dyad. Coders used the videos to code the five communication behaviors at 30-second or one-minute intervals. Inter-rater reliability (Cohen's kappa) varied by therapeutic communication technique and averaged .64 with a range of .23 to 1. The kappa for all behaviors combined was .81 (N=119-a subset of the total time intervals). At the first site (four dyads), all behaviors combined and each CNA behavior declined from pre- to post-observations. At the second site (14 dyads), all behaviors combined and two individual ones improved from pre- to post-test: eye gaze and wait (p<.05 using the Wilcoxon Signed Rank Test). These results suggest that the level of CNAs' therapeutic communication can be measured and improved. The clinical significance of these findings and expected challenges in improving CNAs' communication will be discussed.