Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-06T12:58:02.280Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning

Published online by Cambridge University Press:  02 October 2017

Catharina Melander Open the ORCID record for Catharina Melander [Opens in a new window] ,
Stefan Sävenstedt ,
Malin Olsson  and
Britt-Marie Wälivaara
Catharina Melander*
Affiliation:
Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
Stefan Sävenstedt
Affiliation:
Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
Malin Olsson
Affiliation:
Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
Britt-Marie Wälivaara
Affiliation:
Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
*
Correspondence should be addressed to: Catharina Melander, Department of Health Sciences, Luleå University of Technology, 97187 Luleå, Sweden. Phone: +46-920-493469. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.

Method:

Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.

Results:

Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.

Conclusion:

The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

Keywords

behavioral and psychological symptoms of dementia (BPSD)clinical assessment, dementia, neuropsychiatric symptoms in dementia, nursing homes
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 581 - 589
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bergh, S., Engedal, K., Røen, I. and Selbæk, G. (2011). The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes. International Psychogeriatrics, 23, 1231–1239. doi: 10.1017/S1041610211001177Google Scholar
Cerejeira, C., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 1–21. doi: 10.3389/fneur.2012.00073Google Scholar
Conn, D. and Thorpe, L. (2007). Assessment of behavioural and psychological symptoms associated with dementia. The Canadian Journal of Neurological Sciences, 34, 67–71. doi: 10.1017/S0317167100005606Google Scholar
Cummings, J. L. (1997). The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology, 48, 10–16.Google Scholar
de Medeiros, K. et al. (2010). The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriatrics, 22, 984–994. doi: 10.1017/S1041610210000876Google Scholar
Dowding, D. et al. (2004). Using judgement to improve accuracy in decision-making. Nursing.Times, 100, 42–44.Google ScholarPubMed
Dowding, D. et al. (2016). Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings. International Journal of Nursing Studies, 53, 152–162. doi: 10.1016/j.ijnurstu.2015.08.009Google Scholar
Emilsson, L., Lindahl, B., Köster, M., Lambe, M. and Ludvigsson, J. F. (2015). Review of 103 Swedish healthcare quality registries. Journal of Internal Medicine, 277, 94–136. doi: 10.1111/joim.12303CrossRefGoogle ScholarPubMed
Eriksen, E. O. and Weigård, J. (2003). Understanding Habermas: Communicative action and deliberative democracy. London: Continuum.Google Scholar
Feast, A., Orrell, M., Russell, I., Charlesworth, G. and Moniz-Cook, E. (2017). The contribution of caregiver psychosocial factors to distress associated with behavioural and psychological symptoms in dementia. International Journal of Geriatric Psychiatry, 32, 76–85. doi: 10.1002/gps.4447CrossRefGoogle ScholarPubMed
Gill, R. (2000). Discourse analysis. In Bauer, M. W. and Gaskell, G. (eds.), Qualitative Researching with Text, Image and Sound (pp. 172–190). London: SAGE.Google Scholar
Gitlin, L. N., Marx, K. A., Stanley, I. H., Hansen, B. R. and Van Haitsma, K. S. (2014). Assessing neuropsychiatric symptoms in people with dementia: a systematic review of Measures. International Psychogeriatrics, 26, 1805–1848. doi: 10.1017/S1041610214001537CrossRefGoogle ScholarPubMed
Habermas, J. (1984). The Theory of Communicative Action. Vol. 1, Reason and the Rationalization of Society. Cambridge: Polity Press.Google Scholar
Herrmann, N. et al. (2006). The contribution of neuropsychiatric symptoms to the cost of dementia care. International Journal of Geriatric Psychiatry, 21, 972–976. doi: 10.1002/gps.1594Google Scholar
Hodges, B. D., Kuper, A. and Reeves, S. (2008). Discourse analysis. BMJ, 337, a879.CrossRefGoogle ScholarPubMed
Holst, G. and Hallberg, I. R. (2003). Exploring the meaning of everyday life, for those suffering from dementia. American Journal of Alzheimer's Disease and Other Dementias, 18, 359–365. doi: 10.1177/153331750301800605CrossRefGoogle ScholarPubMed
Hutchinson, A. (2005). Analysing audio-recorded data: using computer software applications. Nurse Researcher, 12, 20–31. doi: 10.7748/nr2005.01.12.3.20.c5945CrossRefGoogle ScholarPubMed
Jeon, Y.-H. et al. (2011). Recommended measures for the assessment of behavioral disturbances associated with dementia. The American Journal of Geriatric Psychiatry, 19, 403–415. doi: 10.1097/JGP.0b013e3181ef7a0dCrossRefGoogle ScholarPubMed
Johansen, M. L. and O'Brien, J. L. (2016). Decision making in nursing practice: a concept analysis. Nursing Forum, 51, 40–48. doi: 10.1111/nuf.12119CrossRefGoogle ScholarPubMed
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482. doi: 10.1002/gps.2550CrossRefGoogle ScholarPubMed
Krysinska, K., Sachdev, P., Breitner, J., Kivipelto, M., Kukull, W. and Brodaty, H. (2017). Dementia registries around the globe and their applications: a systematic review. Alzheimer's & Dementia, 1–17. doi: 10.1016/j.jalz.2017.04.005Google ScholarPubMed
Mayer, S., Granvik, E., Minthon, L. and Nägga, K. (2014). Improved quality of life by active intervention with the Swedish BPSD registry. Alzheimer's & Dementia, 10, 139–40. doi: 10.1016/j.jalz.2014.04.088Google Scholar
Mishler, E. G. (1984). The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, N.J.: Ablex.Google Scholar
O'Neill, E. (1996). An exploratory study of clinical decision making in home healthcare nursing. Home Healthcare Nurse, 14, 362–368.Google Scholar
Peters, K. R. et al. (2006). Characterizing neuropsychiatric symptoms in subjects referred to dementia clinics. Neurology, 66, 523–528. doi: 10.1212/01.wnl.0000198255.84842.06CrossRefGoogle ScholarPubMed
Stella, F. et al. (2015). Caregiver report versus clinician impression: disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients. International Journal of Geriatric Psychiatry, 30, 1230–1237. doi: 10.1002/gps.4278Google Scholar
Tame, S. L. (2009). Continuing professional education: the experiences and perceptions of nurses working in perioperative patient care (Doctoral dissertation). University of Hull.Google Scholar
Tan, K. T., Adzhahar, F. B., Lim, I., Chan, M. and Lim, W. S. (2014). Transactive memory system as a measure of collaborative practice in a geriatrics team: implications for continuing interprofessional education. Journal of Interprofessional Care, 28, 239–245. doi: 10.3109/13561820.2014.901938Google Scholar
Taylor, H. (2005). Assessing the Nursing and Care needs of Older Adults: A Patient-Centred Approach. Abingdon: Radcliffe.Google Scholar
Wainwright, M. and Russell, A. (2010). Using NVivo audio-coding: practical, sensorial and epistemological considerations. Social Research Update, 60, 1–4.Google Scholar
Wetherell, M. and Potter, J. (1988). Discourse analysis and interpretative repertoires. In Antaki, C. (eds.), Analysing Everyday Explanation (pp. 168–184). London: SAGE.Google Scholar
Wetzels, R. B., Zuidema, S. U., de Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2011). Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics, 23, 1249–1259. doi: 10.1017/S1041610211000755CrossRefGoogle ScholarPubMed
Woods, D. L., Yefimova, M. and Brecht, M.-L. (2014). A method for measuring person-centered interventions: detecting and characterizing complex behavioral symptoms of persons with dementia. Clinical Gerontologist, 37, 139–150. doi: 10.1080/07317115.2013.868850CrossRefGoogle Scholar
Zamawe, F. C. (2015). The implication of using NVivo software in qualitative data analysis: evidence-based reflections. Malawi Medical Journal, 27, 13–15. doi: 10.4314/mmj.v27i1.4Google Scholar
Zwijsen, S. A. et al. (2014). Nurses in distress? An explorative study into the relation between distress and individual neuropsychiatric symptoms of people with dementia in nursing homes. International Journal of Geriatric Psychiatry, 29, 384–391. doi: 10.1002/gps.4014Google Scholar