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Communication is fundamental for dementia care across long-term services and support (LTSS) settings. Education increasing nursing home (NH) staff awareness of person-centered communication has reduced staff elderspeak communication and reduced resistiveness to care of residents with dementia. The current study tested the Changing Talk Online (CHATO) education with adult day services (ADS) staff to identify strategies for adaptation for other LTSS settings. Three dementia-specific ADS sites participated in the CHATO education program. Participants completed knowledge assessment, communication ratings, and confidence ratings on providing care pre- and post-CHATO; a program evaluation; and rated their intention to use skills in practice. Findings were compared to an earlier study of CHATO in NHs. Focus groups evaluated feasibility, applicability, and directions for tailoring. Mean scores on the Changing Talk Scale knowledge test increased by 15 percentage points ( p < 0.001). Confidence in providing dementia care scores also increased ( p = 0.037). The mean Modified Diffusion of Innovation scale score was 2.2, similar to that in NHs, indicating intent to use skills; and program evaluation was positive. Focus group participants reported CHATO was valuable and recommended incorporating scenarios specific to ADS care. [ Research in Gerontological Nursing, 16 (2), 85–94.]

The purpose of this study was to conduct a comprehensive assessment of sleep and circadian rhythms in individuals with and without coronary artery disease (CAD).This was a cross-sectional study. Participants were 32 individuals; mean age = 70.9; female 46.9%; 19 with CAD; and 13 without CAD. We assessed sleep quality and 24-hour rest-activity rhythms for 14 days using wrist actigraphy and self-report measures, and circadian rhythm using dim light melatonin onset (DLMO).Melatonin levels prior to habitual bedtime were significantly lower in individuals with CAD than in those without CAD (median AUC = 12.88 vs. 26.33 pg/ml × h, p = .049). The median circadian timing measured by DLMO was the same for the two groups with 20:26 [hh:mm] for individuals with CAD and 19:53 for the control group (p = .64, r = 0.14). Compared to the control group, the CAD group had significantly lower amplitude (p = .03, r = -.48), and lower overall rhythmicity (pseudo-F-statistic p = .004, r = -.65) in their 24-hour rest-activity rhythms.This is one of the first study to comprehensively assess both sleep and circadian rhythm in individuals with CAD. Compared to non-CAD controls, individuals with CAD had lower levels of melatonin prior to habitual bedtime and a lower 24-hour rest-activity rhythm amplitude and overall rhythmicity. Future studies using larger sample sizes should further investigate the possibility of suppressed circadian rhythmicity in individuals with CAD.

Mealtime is a critical daily activity to ensure nutrition, hydration, function and socialisation. Interactions between staff and residents during mealtimes are complex and dynamic processes including verbal and/or nonverbal communication that can be positive/neutral or challenging. This study examined characteristics of and relationships between person-centred and task-centred care and positive/neutral and challenging mealtime behaviours in persons with dementia.This study was a secondary behavioural analyses of videotaped mealtime observations (n = 110) involving 42 unique staff-resident dyads (29 staff and 25 residents with dementia) in nine nursing homes. The refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme was used to code videos during 2019-2020. Dependent variables representing resident mealtime behaviours included positive verbal behaviours, positive/neutral nonverbal behaviours, functional impairments (nonverbal) and resistive behaviours (verbal and nonverbal). Independent variables were staff person-centred and task-centred approaches (verbal and nonverbal). Relationships between resident mealtime behaviours and staff approaches were examined using bivariate analysis and logistic regression.Staff person-centred verbal approaches were associated with resident positive verbal behaviours (OR = 1.38, 95% CI = 1.09-1.76), functional impairments (OR = 0.81, 95% CI = 0.66-1.00) and resistive behaviours (OR = 1.65, 95% CI = 1.18-2.31). Staff person-centred nonverbal approaches were associated with resident functional impairments (OR = 1.33, 95% CI = 1.02-1.74). Staff task-centred approaches were not associated with resident positive/neutral or challenging mealtime behaviours.This study characterised staff approaches and resident behaviours during mealtime care and provided preliminary support on associations between staff person-centred approaches and resident positive and challenging behaviours. Person-centred mealtime care practice is recommended by focusing on support of common, challenging behaviours and reinforcement of positive behaviours with adequate consideration of individual needs and preferences.

Assessment of knowledge gain from educational interventions is common in health care research. However, validity of tools developed to measure knowledge gains is often overlooked. For our current pragmatic clinical trial, we developed two 13-item parallel forms of the Changing Talk Scale (CHATS) to measure gains in knowledge of effective and person-centered communication due to the Changing Talk Online (CHATO) communication education for nursing home staff. This has been a multi-year, multi-study process of writing and editing test items in accordance with CHATO learning objectives and results of psychometric analyses of pilot data. Items were revised based on difficulty and discrimination. The tool has improved from an initial Cronbach’s alpha of .27 (pre-education) and .14 (post-education) to .63 (pre-education) and .64 (post-education). CHATS provides an exemplar of how measuring change in knowledge is a complex process that needs to be rigorously completed to accurately capture outcomes.

Background and Objectives Nursing home (NH) staff mealtime care approaches are associated with behaviors of residents with dementia, but their impact on food intake remains unexplored. This study examined the role of staff person-centered and task-centered approaches and resident positive, neutral, and challenging behaviors on food intake. Research Design and Methods Videotaped mealtime observations (N = 160) involving 36 staff and 27 residents (53 unique staff–resident dyads) in 9 NHs were coded using the refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme. The dependent variable was resident food intake. The independent variables were staff person-centered approaches that support resident abilities, staff–resident (dyadic) interactions, and dining environments, staff task-centered approaches, and resident positive, neutral, and challenging behaviors. Resident challenging behaviors included mealtime functional impairments and resistive behaviors. Linear mixed modeling was used. Moderating effects of staff approaches, food type, and length of dyadic mealtime interactions (ie, video duration) were examined. Results The relationship between food intake and resident mealtime functional impairments was moderated by food type (p < .001). The relationship between food intake and resident resistive behaviors was moderated by food type (p = .002) and staff person-centered verbal approaches (p = .001). The relationships between food intake and staff person-centered nonverbal approaches (p = .003) and resident positive/neutral nonverbal behaviors (p = .004) were moderated by the length of dyadic mealtime interactions. Discussion and Implications Food intake was associated with staff person-centered approaches and resident positive/neutral and challenging behaviors. Findings emphasize the importance of facilitating positive dyadic interactions using individualized, context-based, multifaceted, person-centered care. Future research on temporal and causal relationships is warranted in larger diverse samples.

Background and Objectives Staff–resident communication is a critical part of nursing home (NH) care. Reducing elderspeak and increasing person-centered communication has been shown to reduce behavioral symptoms experienced by persons living with dementia. An online version of a successful classroom-based communication-training program that reduced staff elderspeak and resident behavioral symptoms was evaluated. The objective of this study was to establish feasibility and determine the preliminary effects of the online program in preparation for a national pragmatic clinical trial. Research Design and Methods Seven NHs were randomized to immediate intervention or wait-list control conditions. The NHs were provided with the web-based training program that staff individually accessed. Primary outcomes were knowledge scores and communication ratings of a video-recorded interaction, using pre- to posttraining comparisons. Results Knowledge increased from a mean pretest score of 61.9% (SD = 20.0) to a mean posttest score of 84.6% (SD = 13.5) for the combined group. Knowledge significantly improved between Time 1 and Time 2 for the immediate intervention participants (p < .001), but not for the wait-list control participants (p = .091), and this difference was statistically significant (p < .001). Ability to recognize ineffective, inappropriate, nonperson-centered, and elderspeak communication improved after training (p < .001). The magnitude of improvement in communication recognition was comparable to that of the original classroom format. Discussion and Implications The adapted communication intervention was feasible and improved knowledge and communication. Online instruction can improve access to quality education and is an effective means to improve dementia care by overcoming barriers to in-person training. Clinical Trials Registration Number: NCT03849937

To characterize dyadic mealtime verbal interactions and examine the associations with staff and resident characteristics.A secondary analysis of 110 videotaped mealtime observations collected from a dementia communication trial during 2011-2014.Videos involved 25 residents with dementia and 29 staff in nine nursing homes. Verbal behaviours (utterances) were coded during 2018-2019 using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing eight positive behaviours and four negative behaviours. Bivariate analyses and multivariate regression models were used.Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%); 85.1% of residents' utterances were positive and 14.9% negative. Staff positive utterances were correlated with their negative utterances and resident positive and negative utterances. Staff negative utterances were correlated with resident negative utterances. Resident positive and negative utterances were correlated. Resident positive utterances were significantly associated with staff care-giving length in the current nursing home (OR = 1.430, 95% CI = 1.008, 2.027). Resident negative utterances were significantly associated with resident gender (female versus male, OR = 11.892, 95% CI = 1.237, 114.289) and staff years worked as a caregiver (OR = 0.838, 95% CI = 0.710, 0.989). Staff positive and negative utterances were not associated significantly with any participant characteristics.Staff engage residents using primarily positive verbal strategies. Staff-resident mealtime verbal interactions were dynamic, interactive, and complex and related to multiple individual characteristics.Positive dyadic mealtime interactions are critical to engage residents in eating. Little work has characterized dyadic mealtime interactions, limiting the development of effective interventions. Findings showed staff-resident mealtime verbal interactions were primarily positive, inter-related, and associated with multiple individual characteristics. Findings inform directions to improve mealtime care practice and develop person-centred mealtime interventions targeting modifiable factors, including staff care-giving experiences.目的: 描述二元进餐时的言语互动, 并检查工作人员和养老院患者病症的相关性。 设计: 对2011-2014年痴呆症交流试验过程中收集的110个用餐时间录像观察进行二次分析。 方法: 视频涉及25名养老院痴呆患者和9家养老院的29名工作人员。2018-2019年间, 研究人员利用痴呆患者用餐时间视频编码方案中的线索利用和参与要求对言语行为(话语)进行编码, 共处理8种积极行为和4种消极行为。采用双变量分析和多元回归模型。 结果: 工作人员的说话频率 (76.5%) 是养老院患者(23.5%) 的三倍。几乎所有工作人员都积极谈话(99.2%) ; 85.1%的养老院患者积极谈话,而14.9%的养老院患者消极谈话。工作人员的话语积极性与其话语消极性、患者的话语积极性和患者的话语消极性相关。工作人员的话语消极性与养老院患者的话语消极性相关。养老院患者的话语积极性和消极性相关。养老院患者的话语积极性与目前疗养院工作人员的护理时间显著相关 (OR=1.430,95%CI=1.008,2.027) 。养老院患者的话语消极性与其性别 (女性对比男性, OR=11.892,95%CI=1.237114.289) 和护理人员工作年限 (OR=0.838,95%CI=0.710,0.989) 显著相关。工作人员的话语积极性和消极性与参与者特征无显著相关。 结论: 工作人员主要通过积极的语言策略来引起养老院患者注意。工作人员--养老院患者的进餐言语互动具有动态、互动、复杂的特点,得益于复杂的个人特征。 影响: 积极的二元进餐互动对养老院患者进餐至关重要。目前, 鲜有研究对进餐时的互动进行描述, 致使有效干预措施的采取受限。研究结果显示, 工作人员与养老院患者在进餐时的言语互动以积极、相互关联为主, 并且与复杂的个人特征相关。研究结果可为进餐护理实践的改进和以人为本的进餐干预措施的制定提供指导, 此类干预措施主要针对可改变的因素, 包括工作人员的护理经验。.

PURPOSE To assess the association between depression symptoms and pain characteristics, including pain intensity, location, and effectiveness of pain management strategies, among women in their third trimester of pregnancy. DESIGN Descriptive, exploratory cross-sectional study. SETTING Mobile health pregnancy application (app). PARTICIPANTS A convenience sample of women in their third trimester of pregnancy from across the United States. METHODS Women completed demographic questionnaires, the Brief Pain Inventory, and Edinburgh Postnatal Depression Scale (EPDS) through an online Web site. RESULTS N = 132 women participated. The sample was demographically diverse. . Women ranged in age from 18 to 39 years (M 28.1 ± SD 5.2). Most women were Caucasian (68%), with smaller percentages of Hispanic (12%) and African American (11%) women. Most had commercial insurance (59%) and a partner (85%). Of the 132 women, 79.6% reported moderate-to-severe pain. Approximately 93% experienced back and pelvic pain, whereas 27% experienced moderate-to-severe depression symptoms. Bivariate and linear regression analyses revealed that higher EPDS depression scores were associated with higher levels of pain (p < .01). Other variables significantly associated with higher EPDS scores were White race (p = .04), marital status (p = .05), and headache (p < .01). CLINICAL IMPLICATIONS In the third trimester of pregnancy, pain affects more than two-thirds of women and may occur with and without depression symptoms. Although the value of universal depression screening during pregnancy is widely recognized, our findings suggest clinical outcomes for pregnant women would improve with a standardized, multidimensional screen for both pain and depression symptoms. Nurses are ideally positioned to assess and advocate for the combined treatment of pain and depression.

Background Technology can enhance support for families caring for persons living with dementia but must be acceptable to be adopted. The FamTechCare clinical trial engaged caregivers in video recording care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports on caregiver satisfaction and utilization of the intervention and expert panel evaluation of the intervention. Methods A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the FamTechCare intervention. In the multisite randomized controlled trial, caregiver-person living with dementia dyads were randomized to the FamTechCare video support or attention control telephone support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. Utilization was evaluated using the number and duration of videos submitted and calls received by caregivers. Relationships between participant characteristics and their satisfaction and utilization were evaluated. Feasibility of the intervention was assessed through content analysis of interviews with the expert panel. Results The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful ( p = 0.001) and effective ( p = 0.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy ( p = 0.050). Caregiver age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel described the FamTechCare intervention as useful and identified adaptations to enhance feasibility. Conclusion Regardless of age, gender, and relationship, caregivers found the intervention acceptable and easy to use and rated the expert feedback as effective in addressing care challenges. Further adaptation may be needed for FamTechCare to be readily implemented.

Medication near-misses occur at higher rates than medication errors and are usually underreported. Reporting a medication near-miss is crucial, as it highlights areas of human and system failures. Identifying these incidents is particularly important in nursing home (NH) settings to help managers plan and initiate proactive measures to contain the errors. However, scarce evidence exists about predictors of nurses' willingness to report near-misses. Therefore, the purpose of this study was to test a proposed model for NH nurses' willingness to report medication near-misses. Data for this cross-sectional study were collected using a random sample of RNs working in NHs across one Midwestern state. The proposed model predicted a 19% variance in nurses' willingness to report medication near-misses, with the strongest predicators being non-punitive responses to errors ( β = 0.33, p < 0.001). According to the study results, system and social factors are needed to improve nurses' voluntary reporting of medication near-misses. [ Journal of Gerontological Nursing, 46 (4), 21–30.]

Background and Objectives The Changing Talk (CHAT) communication training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes (NHs). As part of the pilot pragmatic clinical trial testing Changing Talk: Online Training (CHATO), a new online version, a remote implementation design, and process evaluation were developed to capture contextual factors, ensure fidelity, and determine effective implementation strategies. Research Design and Methods The Expert Recommendation for Implementing Change compilation informed this 2-phase approach to develop and test remote implementation. An Advisory Board guided the developmental phase while pilot testing used a cluster-randomized design. Data were analyzed to evaluate NH characteristics; implementation strategies used; CHATO participation, completion, and passing rates; and leadership evaluation. Results Five out of 7 NHs were nonprofit with above average quality ratings (M = 4.3 of 5). Staff participants (N = 237) were mostly female (90%), non-Hispanic White (91%), and nursing assistants (46%). Implementation time ranged from 54 to 86 days (M = 70.3, standard deviation [SD] = 9.3), with planning phase ranging from 11 to 29 days (M = 20.1, SD = 6.7), and training phase ranging from 35 to 58 days (M = 50.0, SD = 7.6). A range from 3 to 11 implementation strategies were used by each NH. Assigning champions, including the social worker on the implementation team, utilizing multiple mediums for reminders, giving rewards or public recognition, supporting onsite discussions, and other tailoring strategies were associated with improved outcomes. Participation ranged from 20% to 76%. Over 63% of participants completed training (N = 150) and 87% passed the posttest (N = 130). Leadership evaluations noted staff used CHATO concepts in practice and improved communication culture. Discussion and Implications Leadership who took an active role, engaged multiple team members, and varied strategies had better outcomes. Effectiveness of the strategies will be evaluated in a national pragmatic clinical trial testing CHATO’s effects on reducing behavioral and psychological symptoms in dementia care.

This study characterized mealtime nonverbal behaviors of nursing home staff and residents with dementia and examined the relationships between individual characteristics and nonverbal behaviors. Videotaped observations (N=110) involving 25 residents and 29 staff (42 unique staff-resident dyads) in 9 nursing homes were coded using the refined Cue Utilization and Engagement in Dementia Mealtime Video-Coding Scheme. Wilcoxon rank-sum test or Kruskal-Wallis test were used for continuous characteristics, and Fisher’s exact test for categorical characteristics. Residents primarily exhibited challenging behaviors including resistive behaviors (35.7%), chewing/swallowing difficulties (33.5%), and functional impairments (9.9%), followed by positive/neutral behaviors (20.9%). Staff primarily used person-centered behavioral strategies, including modifications of: 1) resident abilities (41.9%), 2) care approaches (35.1%), and 3) dining environment (13.6%), followed by task-centered behaviors (9.3%). Residents challenging behaviors were correlated with staff person-centered behavioral strategies. Dyadic nonverbal behaviors were correlated with multiple individual characteristics. Understanding dyadic nonverbal interactions facilitates use of person-centered, multilevel, behavioral strategies to optimize mealtime outcomes.

Communication education has been effective in reducing elderspeak use for nursing home staff and subsequently reduces resistiveness to care and inappropriate antipsychotic medication use in residents living with dementia. Communication is fundamental for dementia care and educating staff in other long-term service and support settings such as Adult Day Care (ADC) is needed. Tailoring education to the specific setting is indicated to optimize acceptability and effectiveness. ADC staff (N=22) from 3 ADC centers participated in the Changing Talk: Online Training (CHATO). Results for the 19 staff who completed the education program were analyzed. A focus group was conducted with a subset of participants to evaluate feasibility, applicability, and directions for tailoring for ADC settings. Knowledge gain was demonstrated by score increases 15.0 percentage points (p

Person-centered mealtime care is highly recommended in dementia care. While current research examined associative relationships between person- and task-centered care and resident mealtime behaviors, few studies evaluated their temporal associations. Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were coded. Staff person-centered and task-centered approaches were conceptualized as antecedents of resident positive behaviors, functional impairments, and resistive behaviors using 5-, 10-, and 15-second time windows. Immediately after staff person-centered approaches, resident positive and resistive behaviors were more likely (p range=

Retained surgical items (eg, sponges, instruments) remain the most frequently reported sentinel events. The primary strategy for preventing retained sponges is the sponge count. Reconciling sponge counts is time consuming and can extend the duration of operative and other invasive procedures. The primary objective of this observational study was to evaluate the effect of a radiofrequency (RF) surgical-sponge detection system on time spent searching for surgical sponges. The study included 27,637 procedures during nine months before and after implementing an RF surgical-sponge detection system. After implementation of the system, time spent searching for sponges was reduced by 79.58%, the percentage of unreconciled counts was reduced by 71.28%, and time spent using radiography to rule out a retained sponge was reduced by 46.31%. This resulted in a reduction of costs. These findings should be used as part of a comprehensive cost analysis of alternative methods when evaluating RF sponge detection technology.

To describe development and pilot testing of the Test of Adolescent Sexual Knowledge (TASK) developed by the researcher using content recommendations of the National Sexuality Education Standards. ...

Nursing home (NH) care of persons living with dementia is often made challenging by behavioral and psychological symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur due to cognitive and communication changes. Staff frequently communicate to NH residents using “elderspeak” which is patronizing speech similar to baby talk. Residents respond to elderspeak with increased BPSD that prompts use of psychotropic medication to control symptoms. The Cha nging T alk (CHAT) training educates staff about effective, person-centered communication strategies and reduces elderspeak by staff and subsequent BPSD among residents. This study will test effects of an adapted online version (CHATO) increasing access and dissemination of education to busy staff across diverse care settings. Nursing homes (N = 128) will be stratified and then randomized to CHATO education (n = 64) or to the control group (n = 64). Data on behavioral symptoms (primary outcomes) and psychotropic medication use (secondary outcomes) will be extracted from the Center for Medicare and Medicaid Services Minimum Data Set before and after education and will be compared between the groups using generalized linear mixed modeling. It is hypothesized that after completing the CHATO education residents will have reduced behavioral symptoms and psychotropic medication use compared to residents in control NHs. Additionally, factors related to NH participation and cost of the intervention will be determined. The overall goal of this study is to prepare for large scale dissemination and implementation of the evidence-based nonpharmacological CHATO intervention to reduce BPSD in residents with dementia across long-term care settings.

Mealtime is an important daily activity to ensure intake. Person-centered and task-centered care may influence individual positive, neutral, and challenging mealtime behaviors. Yet, little work has fully examined their relationships. This study aimed to examine the association between person-centered and task-centered care approaches and individuals’ positive, neutral, and challenging mealtime behaviors. This secondary analysis of 110 videotaped mealtime observations involved 29 staff and 25 residents with dementia (42 unique staff-resident dyads) in 9 nursing homes. Videos were coded using the refined Cue Utilization and Engagement in Dementia mealtime video-coding scheme. Logistic regression models were fit to four dependent variables representing resident mealtime behaviors: 1) positive/neutral behaviors (nonverbal), 2) positive utterances (verbal), 3) functional impairments (nonverbal), and 4) resistive behaviors (verbal and nonverbal). Independent variables were staff person-centered care modifications (nonverbal), person-centered utterances (verbal), and task-centered behaviors (verbal and nonverbal). Covariates included resident age, gender, eating function, and video duration. Resident positive utterances were associated with staff person-centered care utterances (OR =1.38, 95% CI = 1.09,1.76). Resident functional impairments were associated with staff person-centered care modifications (OR=1.33, 95% CI=1.02, 1.74) and fewer staff person-centered utterances (OR=0.81, 95% CI=0.66, 1.00). Resident resistive behaviors were associated with more staff person-centered utterances (OR=1.65, 95% CI=1.18, 2.31). Findings provided preliminary information supporting the role of staff person-centered care on resident positive and challenging mealtime behaviors. Findings inform use of verbal and nonverbal person-centered care strategies to improve positive communication and reduce challenging behaviors during mealtime in people with dementia.

BACKGROUND People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters. OBJECTIVE To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL). METHODS Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ2 test. Longitudinal changes in outcomes were examined graphically. RESULTS The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy. CONCLUSION A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes. IMPLICATIONS FOR PRACTICE Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.

Aims and objectives To understand how pain affects physical and mental health-related quality of life during the third trimester of pregnancy. Background Poor health-related quality of life during pregnancy is associated with adverse maternal foetal health outcomes such as increased risk of low-birth-weight neonates. Poor health-related quality of life is linked to pain, pain interference and anxiety in the general adult population. However, we do not know how pain, pain interference (i.e., interference of pain with patient function), and anxiety are interrelated during the third trimester of pregnancy. Methods This exploratory cross-sectional study followed STROBE guidelines. A mobile educational and tracking pregnancy application was used to obtain a racially/ethnically diverse convenience sample of 141 third trimester pregnant women from the U. S. In this sample, 58.2% of women had commercial health insurance, 68.8% were Caucasian, 86.5% were younger than 35 years, and 85.1% had a partner. Women completed demographics, Edinburgh Postnatal Depression Scale and the Brief Pain Inventory on REDCap. Path analysis was used to investigate a model for the relationships among pain intensity, pain interference, anxiety and physical and mental health-related quality of life. Results Pain intensity affected health-related quality of life indirectly by increasing pain interference, which in turn, decreased both physical and mental health-related quality of life. In addition, pain interference also increased anxiety, which in turn worsened mental health-related quality of life, but not physical health-related quality of life. Conclusions Treating perinatal pain may improve health-related quality of life by decreasing pain interference and anxiety. Relevance to clinical practice Nurses should assess for pain interference and anxiety in women experiencing moderate to severe pain during the third trimester of pregnancy. With this knowledge, nurses may advocate for women in receiving effective treatment for their conditions and improvements in their physical and mental health-related quality of life.

The use of vignettes in research and education is well documented. Documentation of how vignettes are developed and content validity is established, however, are rare. The purpose of this paper is to describe a method for development and establishing content validity of vignettes that can be used to assess student performance and research participant outcomes. This three-phase method was designed to validate seven vignettes for a future research project. Content validity index survey and expert panel interviews were used to inform improvements in validity. Findings showed that clinical vignettes were improved with respect to content relevance (from 0.93 to 0.96) and importance (from 0.68 to 0.93). Developing validated vignettes is essential when used to measure outcomes in education and in research. This three-phase method of vignette development and validation is feasible and effective in improving content validity of vignettes and can be used in other education and research projects.

Access to emergency medications is a growing concern, particularly regarding the availability, safety, and use of these medications in schools. The purpose of this article is to report results not previously published from a national survey, specifically regarding the emergency use of epinephrine, albuterol inhalers, and glucagon. A nonexperimental, cross-sectional design was utilized for this descriptive study. An online survey was distributed to school nurses in 2015, and data from 6,298 school nurse respondents are presented in the analysis. Findings related to stock and student-specific emergency medication use and storage, epinephrine usage data, and delegation of emergency medication administration to unlicensed assistive personnel are presented in this article. Further development of policies and procedures regarding emergency medication administration in schools is needed. School nurses are a valuable resource for obtaining knowledge in this area and keeping students safe at school.

Nurses function at the point of care and assume a significant role in intercepting errors. They work in a mentally and physically demanding profession that is comprised of shift-work, subjecting nurses to considerable fatigue. Yet, few studies constructed a comprehensive model that integrates personal and occupational factors to explore their relationship with various types of fatigue (acute, chronic, physical, mental, and total). Here, we examine this type of comprehensive fatigue-model, in a report that represents one aim of a larger, mixed-methods study. The study sample comprised of 1137 registered nurses working in eight hospitals in a Midwestern state. Nurses reported higher levels of acute and total fatigue than chronic and physical fatigue. Staffing and resource adequacy, exercise, and sleep were among the strongest predictors. Since fatigue is a multi-faceted construct, a comprehensive fatigue-management strategy that targets both day and night-shift nurses is the optimal way to manage nurse fatigue.

Background It is critical to understand but difficult to study nursing behavior in response to safety interventions. Methods A common nursing scenario, evidence based on appropriate nursing actions in response to patient safety risks, and a corresponding measure of nursing behavior, the Safety Action Performance Scale, were developed. These tools were content validated and tested for feasibility. Results The scenario was low-cost, realistic, and successfully used in a mixed-method pilot study. The Safety Action Performance Scale was easy to use and revise for greater interrater reliability. Conclusion Simulation provides a feasible means for testing safety interventions to improve safety-oriented behavior and subsequent patient outcomes.

Background: The Changing Talk intervention improves nursing home staff communication by reducing elderspeak. To facilitate dissemination, interactive online modules were created, maintaining the original content. This article reports on the process of transitioning and the results of pilot testing the modules. Method: Interactive online modules were developed, pilot tested, and the evaluated in comparison to outcomes from the classroom format training. Results: Online participants ( N = 9) demonstrated pre to posttest knowledge gain (scores improved from M = 82.4% to M = 91.2%). Rating of a staff–resident interaction showed improved recognition of elderspeak and person-centered communication after training. Online and original participants reported similar intentions to use learned skills and rated the program highly. Conclusion: Evidence-based interventions can be translated from traditional classroom to online format maintaining effects on increasing staff knowledge and intentions to use learned skills in practice. However, the modules should be tested in a larger and more representative sample. J Contin Educ Nurs. 2017;48(7):320–328.

Introduction Medication errors are one of the most frequently occurring errors in health care settings. The complexity of the ED work environment places patients at risk for medication errors. Most hospitals rely on nurses' voluntary medication error reporting, but these errors are under-reported. The purpose of this study was to examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors. Methods A cross-sectional descriptive design using a questionnaire with a convenience sample of emergency nurses was used. Data were analyzed using descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. Results A total of 71 emergency nurses were included in the study. Emergency nurses' willingness to report errors decreased as the nurses' years of experience increased ( r = –0.25, P = .03). Their willingness to report errors increased when they received more feedback about errors ( r = 0.25, P = .03) and when their managers used a transactional leadership style ( r = 0.28, P = .01). Discussion ED nurse managers can modify their leadership style to encourage error reporting. Timely feedback after an error report is particularly important. Engaging experienced nurses to understand error root causes could increase voluntary error reporting.

Background/Significance People with cancer can experience co-occurring related symptoms, labeled symptom clusters. Gastrointestinal (GI) symptoms are common side effects of chemotherapy, but little research has investigated GI symptom clusters. A further gap in symptom cluster research is the lack of studies reporting symptom clusters based on symptom distress ratings. Purpose To identify distress-based GI symptom clusters and to investigate their relationship to symptom interference with daily life and quality of life (QoL). Subjects About 105 adults with hematologic malignancy receiving chemotherapy. Methods On Day 1 of a cycle of chemotherapy, participants completed a modified version of the Memorial Symptom Assessment Scale assessing 30 clinically relevant symptoms, the M.D. Anderson Symptom Inventory Symptom Interference with Daily Life subscale, and the Fox Simple Quality of Life Scale. Exploratory factor analysis was used to identify distress-based symptom clusters. Symptom clusters with ≥50% GI symptoms were labeled GI symptom clusters. Linear mixed modeling explored relationships between GI symptom clusters and symptom interference with daily life and QoL. Results Of the six distress-based symptom clusters found, the bloating cluster and appetite cluster were identified as GI symptom clusters. Both the bloating cluster and the appetite cluster were significantly related to symptom interference with daily life, but only the appetite cluster was significantly related to QoL. Conclusions This research demonstrates the existence of distress-based GI symptom clusters and their relationship to symptom interference and QoL. Future work should explore predictors of distress-based symptom clusters and interventions to manage them.

Background: Stress from multiple sources is inherent in law enforcement. However, it is possible to modify responses to stress with resilience training that includes teaching techniques to modify emotional and physical responses to stress, interface with mental health professionals, and practice sessions to improve self-regulation of responses to stress including coherence, a measure of heart rate variability. A gap exists in the research, however, regarding evaluation of the duration of effects after the initial resilience training. Method: Subjects included ( N = 34) recruits enrolled in summer 2015 at the Milwaukee Police Academy. An experimental design was used to compare recruits who received resilience training to recruits in the control group. Results: No statistically significant differences between the groups were found for self-reported measures of stress and resilience. For the treatment group ( n = 17), change in coherence was significant ( p < .001) and improvement in the Personal Organizational Quality Assessment Emotional Buoyancy subscale correlated significantly with the number of practice sessions ( r = .63, p = .01) and marginally with change in coherence ( r = .47, p = .07). Conclusion: Results confirm several significant effects of resilience training with recruits.

Mealtime difficulties are common in residents with dementia, leading to negative outcomes. Interaction with staff are critical to engage residents in eating. This study characterized dyadic verbal interactions (descriptive statistics), and relationships among verbal behaviors and between verbal behaviors and individual characteristics (bivariate analyses). This secondary analysis of 110 videotaped mealtime observations involved 25 residents and 29 staff (42 unique dyads) in 9 nursing homes (NH). Verbal behaviors (utterances) were coded using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing 8 positive behaviors and 4 negative behaviors. Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%). 85.1% of residents’ utterances were positive and 14.9% negative. Staff positive utterances were associated with staff negative utterances (p=.02), and resident positive (p

OBJECTIVES: The Supporting Family Caregivers with Technology trial tested the FamTechCare video support intervention against telephone support. Dementia caregivers’ video-recorded challenging care encounters and an interdisciplinary team provided tailored feedback. This paper reports on the effects of the intervention on caregiver confidence in managing priority challenges, a secondary outcome of this non-blinded parallel randomized controlled trial. METHODS: Caregiver/person living with dementia dyads were randomized to the experimental FamTechCare video support (n=43) or attention control telephone support (n=41) groups. Caregivers providing in-home care to a person living with mild or more severe dementia were eligible. Caregivers identified three priority challenges using the Caregiver Target Problems Questionnaire and rated the frequency and severity of each challenge and their confidence managing the challenge at baseline and 3-months. Challenges were classified using the FamTechCare Technology-supported Dementia Care Typology. Effects on confidence were compared between groups using the Wilcoxon rank-sum test and within groups using the Wilcoxon signed-rank test. RESULTS: Caregiver priority challenges included managing dementia behaviors, understanding disease expectations, and performing activity of daily living care. Improvements were observed across the three categories in both groups; however, not all changes were statistically significant. No significant differences were identified between groups. CONCLUSION: Caregivers in the FamTechCare group reported benefit across all priority challenges including managing dementia behaviors, understanding disease expectations, and performing activity of daily living care. CLINICAL IMPLICATIONS: Innovative technology provides new opportunities to support family caregivers in dementia home care. Video-recording can be used to enhance support for family caregivers facing care challenges.

Purpose To describe neonatal nurses' growth measurement practices, attitudes, knowledge, bases of practice knowledge, and barriers and facilitators for changing practice; and to identify differences in practices and knowledge by nursing organization, unit type, education, and experience. Design and methods A cross-sectional online survey of U.S. neonatal nurses was distributed through two neonatal nursing organizations. Results The survey was completed by 301 nurses. Some evidence-based practices (EBPs) were infrequently reported including recording frontal-occipital head circumference (FOC) and length using 0.1 cm increments (17.9% and 17.6%, respectively); measuring FOC, weight, and length more than once before recording (61.9%, 27.2%, and 39.6%, respectively); and for length, using a length board instead of tape measure (19.4%), with a second person assisting (25.1%), with Frankfort plane head positioning (3.3%), and measuring from crown to heels of both feet (19.1%). Most nurses perceived their measurements as accurate or highly accurate (96.7% for FOC, 99.3% for weight, and 87.1% for length). The mean percentage correct on knowledge items was 68.1%. NICU nurses scored slightly better than well-newborn nurses (mean 69.3% correct vs. 65.1% correct, p = .04). Most based measurement practices on clinical practice guidelines (86.6%) and unit policies and procedures (85.9%). Team culture (33.3%) and insufficient resources (32.6%) were the most common barriers to EBP. The support of nurse managers (70.0%) and unit educators (68.5%) were common facilitators. Conclusions and implications Knowledge gaps and practice improvement areas were identified. Results can inform interventions to improve the accuracy and reliability of neonatal growth measurement practices.

Most surgical patients receiving regional or general anesthesia experience perioperative hypothermia unless effective preventive measures are used. Patient positioning poses a challenge for clinicians using existing technology. The purpose of this study is to describe outcomes of hypothermia after a combination of preoperative and intraoperative conductive skin warming (CSW). This retrospective observational study included 972 adult surgical patients receiving general or neuraxial anesthesia. Clinicians were provided an alternative for perioperative warming, an underbody conductive warming mattress using resistive ink technology (VitaHEAT UB3, VitaHEAT Medical), or the option to use current practice, forced air warming (FAW). The primary study endpoint was temperature on arrival in the postanesthesia care unit. Active warming was provided preoperatively with CSW (81.5%) or FAW (0.6%) and intraoperatively with CSW (61.1%), FAW (21.8%), or both (12.1%). Hypothermia occurred in 3.5% of patients overall and in 16.7% of patients when active warming was not used. When CSW was used preoperatively and intraoperatively, 4.1% of patients became hypothermic. When CSW was used preoperatively and FAW was used intraoperatively, 2.3% of patients became hypothermic. When clinicians used active warming methods based on individual patient needs, nearly all patients (96.5%) remained normothermic.

Background and Objectives The number of persons living with dementia (PLWD) in the United States will reach 16 million by 2050. Behavioral and psychological symptoms of dementia challenge family caregivers and contribute to negative caregiver outcomes such as burden and depression. Available technology can support the delivery of effective interventions to families providing dementia care at home. The Supporting Family Caregivers with Technology for Dementia Home Care (FamTechCare) randomized controlled trial evaluated the effects of a telehealth intervention on caregiver outcomes. Research Design and Methods The FamTechCare intervention provides tailored dementia-care strategies to in-home caregivers based on video recordings caregivers submit of challenging care situations. An expert team reviews the videos and provides individualized interventions weekly for the experimental group. In the telephone-support attention control group, caregivers receive feedback from an interventionist via the telephone based on caregiver retrospective recall of care challenges. Effects of the intervention on caregiver outcomes, including burden, depression, sleep disturbance, competence, desire to institutionalize the PLWD, and caregiver reaction to behavioral symptoms were evaluated by fitting linear mixed regression models to changes in the outcomes measured at 1 and 3 months. Results FamTechCare caregivers (n = 42) had greater reductions in depression (p = .012) and gains in competence (p = .033) after 3 months compared to the attention control group (n = 41). Living in rural areas was associated with a reduction in depression for FamTechCare caregivers (p = .002). Higher level of education was associated with greater improvements or lesser declines in burden, competence, and reaction to behavioral symptoms for both the FamTechCare and attention control caregivers. Discussion and Implications This research demonstrated benefits of using available technology to link families to dementia care experts using video-recording technology. It provides a foundation for future research testing telehealth interventions, tailored based on rich contextual data to support families, including those in rural or remote locations.

BACKGROUND Pain management in critically ill children is complex. Epidemiological research is needed to identify how often patients in pediatric intensive care units experience pain and the practices being used to lessen pain. OBJECTIVES To describe pain assessment and intervention practices in pediatric intensive care units, determine the prevalence of pain and painful procedures, and identify characteristics of children with moderate to severe pain. METHODS A 24-hour observational cohort study was conducted in 15 units. Nurses completed surveys regarding patients' communicative ability. Patients' records were reviewed for pain assessments, painful procedures, and pharmacologic and nonpharmacologic interventions. RESULTS For the 220 patients in this study, pain was assessed a median (interquartile range) of 10 (7-13) times, usually with behavioral pain scales. Sixty-eight percent of patients received pharmacologic interventions and 44% received nonpharmacologic interventions. Fentanyl was the most common analgesic provided. Repositioning was the most common nonpharmacologic intervention. Forty-five percent of patients had pain and 24% had moderate to severe pain. Patients experienced a median (interquartile range) of 7 (2-15) painful procedures in 24 hours. More frequent pain assessments and pharmacologic interventions and the ability to communicate were associated with moderate to severe pain. No patient in the moderate to severe pain category received neuromuscular blockers. CONCLUSIONS Critically ill children experience pain and multiple painful procedures daily. Assessment and intervention practices vary considerably. Research is needed to establish best practices for pain assessment in patients with limited communicative ability and to determine which pain management strategies improve patients' outcomes.

Objectives To evaluate the feasibility of using a biobehavioral approach to examine symptom burden in rural residents with advanced cancer. Sample & setting 21 patients with advanced lung, colorectal, or pancreatic cancer were enrolled at the University of Iowa in Iowa City. Methods & variables Using Cleeland's cytokine-immunologic model of symptom expression, symptom burden (i.e., severity, count, and interference) and inflammatory cytokines were measured for 24 weeks. Potential predictors included demographics, clinical characteristics, optimism, social support, and cancer-related stress. Descriptive statistics, Wilcoxon rank-sum, and Fisher's exact test were used for analysis. Results Recruitment and retention rates were similar for rural and nonrural patients. Demographics, optimism, and social support were no different between groups. The cancer-related stress total score for rural patients was nearly half of the score of nonrural patients, with rural patients reporting significantly less avoidance. Symptom severity for the five worst symptoms remained moderate during the 24 weeks, whereas nonrural residents reported steady declines in severity of their five worst symptoms. Significant differences in inflammatory cytokines between groups were only found at one time point. Implications for nursing Rural residents who seek care at a cancer center may be clinically and demographically more similar to their nonrural counterparts than to rural residents seeking local care.

Identifying those at risk of poor outcomes after hospital discharge is a central focus of health care systems. Our purpose was to better understand whether and how patient- and nurse-assessed readiness for discharge (Pt- and RN-RHDS) is related to patient experiences after discharge. We conducted a prospective survey of 70 Veterans and their assigned nurses on the day of, and again with Veterans 2 weeks after, hospital discharge. The predictive model for post-discharge coping difficulty included educational level ( p = .05) and an interaction between Pt-RHDS ratings and Pt-RN RHDS discordance ( p = .01). The predictive model for patient-reported quality of hospital to home transition experience included Pt-RN RHDS discordance and an interaction between Pt-RHDS and the number of people living with the patient ( p = .05). Our findings demonstrate that agreement between Pt- and RN-RHDS may be an important measure in work aiming to improve patient outcomes post-hospitalization.

OBJECTIVE The aim of this study is to examine a resilience training intervention that impacts autonomic responses to stress and improves cardiovascular risk, psychological, and physiological outcomes in police. METHODS Officers [(n = 38) 22 to 54 years] modified emotional and physical responses to stress using self-regulation. Measurements include psychological and physiological measures [eg, heart rate variability (HRV), blood pressure, C-reactive protein)] obtained at three time intervals. RESULTS Age was significantly (P

Background and Purpose: This study evaluated the psychometric properties of the Perception of Risk Factors for Type 2 Diabetes (PRF-T2DM), an instrument designed to measure awareness and vulnerability to diabetes and diabetes risk factors. Methods: 248 individuals at increased risk for diabetes because of a positive family history completed the PRF-T2DM. The factor-structure, internal consistency reliability, and construct validity of the PRF-T2DM were examined. Results: The 2-factor structure of the PRFT2DM was a good fit to our data. Overall Cronbach's alpha was .68. Pearson correlation between PRF-T2DM score and overall risk perception was significant (r = .26, p < .001). Replies to individual items supported the validity of the PRF-T2DM. Conclusion: The PRF-T2DM performed modestly in this population. Refinement in scoring and score interpretation may improve reliability and validity of the instrument.

Health behaviors, including physical activity (PA), of registered nurses (RNs) and medical assistants (MAs) are suboptimal but may improve with worksite programs. Using a repeated-measures crossover design, the authors explored if integrating a 6-month worksite non-exercise activity thermogenesis (NEAT) intervention, with and without personalized health coaching via text messaging into workflow could positively affect sedentary time, PA, and body composition of nursing staff without jeopardizing work productivity. Two ambulatory clinics were randomly assigned to an environmental NEAT intervention plus a mobile text message coaching for either the first 3 months (early texting group, n = 27) or the last 3 months (delayed texting group, n = 13), with baseline 3-month and 6-month measurements. Sedentary and PA levels, fat mass, and weight improved for both groups, significantly only for the early text group. Productivity did not decline for either group. This worksite intervention is feasible and may benefit nursing staff.

Objective: The present study established severity cut-off scores for the Edinburgh Postnatal Depression Scale (EPDS) based on a widely used depression symptom severity measure, the Beck Depression Inventory (BDI).Background: The EPDS is a widely used screening tool to identify clinically significant levels of depression in postpartum women. Traditionally, an EPDS cut-off score is used to identify probable depression. This dichotomisation of postpartum women into depressed vs. non-depressed groups fails to account for valuable information regarding the variability in symptom severity among those in the depressed group. The identification of depression severity ranges (e.g. mild, moderate or severe) for the EPDS would provide incremental information regarding level of depression, which in turn, could inform treatment referrals.Methods: A sample of 1516 postpartum women completed the EPDS and the BDI. Equipercentile linking was used to develop concordance between EPDS and BDI scores, and severity ran...

The Changing Talk (CHAT) training effectively reduces elderspeak and subsequent behavioral challenges in residents with dementia in nursing homes. The Changing Talk: Online (CHATO) training was developed to increase staff access to education using a new online format. A pilot test was conducted to confirm the feasibility and effects of CHATO on training outcomes. In the initial nursing home, twenty-three direct care staff members in a small Midwestern nursing home enrolled in the course including 12 CNAs, 4 RNs, 2 LPNs, 2 CMAs, 1 Dietary Aide, 1 Social Worker, and 1 in Transportation. Two forms of a 13-item scenario-based test to measure knowledge gain were developed and tested. Of the 23 staff, 18 (78%) completed the post-test and 83% of completers achieved a post-test score of 70% or greater. Scores on the test improved from M=69% correct (SD=11.7) at pretest to 86% correct (SD=10.6) on posttest demonstrating knowledge gain (p=.024). Participants improved their recognition of elderspeak (21%) and person-centered communication (24%) in a video vignette and 86% self-reported improvement in their abilities to recognize ineffective communication and to apply more effective communication strategies in practice. A randomized control trial enrolled staff (N=187) in eight additional nursing homes. Preliminary results confirm improvements in test scores from M=70.6% correct (SD=15.8) at pretest to 77.2% correct (SD=14.1) on posttest and increased elderspeak recognition (p=.004). Relationships between nursing home characteristics, implementation strategies, and culture change measured by the Artifacts of Culture Change Tool and their relationship to communication outcomes will be presented.

Technology can enhance support for families caring for persons with dementia but must be acceptable to be adopted. In the FamTechCare trial, caregivers used an app to videorecord care encounters that were reviewed by an expert panel who provided tailored feedback. The intervention reduced caregiver depression and improved caregiver competence. This mixed methods study reports caregiver satisfaction and utilization of the intervention and evaluation of the intervention by the expert panel. A convergent parallel mixed methods design was used to evaluate the satisfaction, usability, and feasibility of the intervention. Caregiver-person with dementia dyads were randomized to the FamTechCare video support or telephone attention control support groups. Caregivers completed a satisfaction survey at the completion of the 3-month trial. The number and duration of videos submitted and calls received by caregivers were used to evaluate utilization. Relationships between participant characteristics and satisfaction and utilization were evaluated. Feasibility and future directions for the intervention were assessed through interviews with the expert panel. The majority of caregivers in both groups reported benefits from participation. More FamTechCare caregivers found the interventionist support to be helpful (p=.001) and effective (p=.020) compared to attention control caregivers. FamTechCare caregivers of persons with more severe dementia were more likely to report that video recording intruded on their privacy (p=.050). Age, gender, education, dyad relationship, rural status, and type and severity of dementia were not associated with ratings of acceptability, ease of use, or intervention utilization. The expert panel rated FamTechCare as useful and identified adaptations to enhance feasibility.

Objectives An educational program to enhance communication in nursing home dementia care increased person-centered communication by staff and resulted in reduced resident behavioral symptoms measured as resistiveness to care. The purpose of this analysis was to evaluate effects on resident antipsychotic medication use in participating nursing homes. The National Partnership to Improve Dementia Care set a goal of reducing antipsychotic medications in nursing homes by 15% during the study period. Design A post hoc analysis of Nursing Home Compare data was used to evaluate change in antipsychotic medication rates in nursing homes receiving the communication education versus the corresponding statewide average change. Setting and Participants Eleven nursing homes participated in a cluster-randomized controlled trial from 2011 to 2013 in one Midwestern state. Measures Antipsychotic medication rates were abstracted from Nursing Home Compare data sets. Antipsychotic medication rates were compared for each participating nursing home for the 2 quarters before and the 2 quarters after the communication intervention. To control for other factors supporting reduction in antipsychotic use, changes in the participating nursing homes were compared to the state average change for the corresponding quarters using a 1-sample t test. Results Antipsychotic medication use decreased on average by 4.88 percentage points (22.9%) in participating nursing homes compared to the state average decrease of 0.68 percentage points (2.7%) during the same period (P = .06). Conclusions A clinically meaningful reduction in antipsychotic medication usage occurred in the nursing homes that received communication education. Measurable changes in communication and behavioral symptoms were reflected in reductions in antipsychotic medication usage. Improving staff communication has the potential to reduce inappropriate antipsychotic medication use in long-term care.