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This study describes the development of the Disruptive Behavior Impact Assessment (DBIA) designed to measure three aspects of severity of 44 disruptive behaviors: (1) the resources used to address DBs (e.g. increased patient care time), (2) the physical impact of DBs (e.g. injury to the patient or others), and (3) the psychological impact of DBs on staff. Data were collected prospectively for 21 consecutive shifts on each of 240 institutionalized subjects diagnosed with cognitive impairment, psychiatric, and mixed diagnoses. The contexts and impacts of 894 episodes of disruptive behavior are described. Although 25% of all disruptive behaviors required no intervention, those receiving intervention required 24 minutes to manage the 'average' disruption, the majority of which was spent on direct care. Physical impact included injuries to others (0.8%) and physical damage to the environment (0.9%). The average caregiver reported minimal emotional adverse affect from DBs. [ABSTRACT FROM AUTHOR]

The present study developed and tested an instrument to assess the severity of disruptive behavior in geropsychiatric patients. A qualitative analysis of existing instruments and literature was used to develop the 45 items of the Disruptive Behavior Scale (DBS). Disruptive behaviors were weighted using a Q-sort performed by experts in geropsychiatric nursing. Weighted scores were used to predict perceived patient disruptiveness. Nurses providing care served as data collectors. They completed the DBS for each shift across a one-week period for each of the older adults, indicating the frequency of occurrence of each of the 45 behaviors for each hour. Weighting improved the ability to predict perceived patient disruptiveness over other schemes to score disruptive behavior. The DBS provides a measure of patient disruptiveness that takes into account the frequency and impact of individual behaviors. Some items of the DBS were found to be more reliable than others. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of nasal congestion alone relative to a full set of allergic rhinitis (AR) symptoms on sleep, fatigue, daytime somnolence, and work and school productivity in a 15-day prospective, naturalistic study.Research Design and Methods: Patients (N = 404) received a clinical exam to confirm congestion and assess its possible causes, including confirmed allergic rhinitis. They completed a battery of patient-reported outcomes (PROs) that assess the impact of nasal congestion and morning AR symptoms on patients' reports of sleep, daytime sleepiness, fatigue, and work, school, and activity impairment. Data were analyzed using multiple regression. Each PRO was regressed separately on congestion and morning AR symptoms, controlling for patient demographics.Results: Nasal congestion has a significant (p < 0.05), negative impact on patients' lives. Nasal congestion alone had only a slightly smaller negative impact on sleep adequacy relative to AR symptoms more broadly (congestion: beta = 0.137-0.534; AR: beta = 0.123-0.642). Congestion increases the likelihood of sleep problems, fatigue, shortness of breath, headache, and daytime somnolence.Conclusions: A single congestion item by itself is a statistically and substantively significant predictor of patient-relevant outcomes. Although the sample was not randomly drawn from clinics or physician offices, the consistency and strength of the findings suggest the salience of this single symptom for patients' experiences. [ABSTRACT FROM AUTHOR]