The association between patient engagement and quality of care interactions among acute care patients with dementia.
Rachel McPherson, Barbara Resnick, Marie Boltz and 4 others
PMID 38640645WHAT IT FOUND
Hospitalized patients with dementia were more likely to be actively engaged when staff care interactions were more positive.
Pain and poorer cognition also made active engagement less likely.
Key findings
01A 1-point higher total care interaction score was associated with an odds ratio of 1.65 for active engagement after controlling for age, cognition, pain, behavior, and function.
02Patients observed during positive social interactions were actively engaged 91% of the time (n = 202), while those observed during negative protective interactions were actively engaged 36% of the time (n = 6).
03Actively engaged patients had higher average SLUMS scores (8.60) and lower average PAINAD scores (0.66) than passively engaged patients (3.91 and 2.67).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational baseline analysis, so it shows association but does not prove that positive interactions caused active engagement. The sample came from ten hospitals in two states and was a convenience sample, so the results may not apply to other hospitals or regions. Of 365 parent-study patients, 286 had complete data, so some patients were missing information on the study variables. Interactions were observed for only about 30 minutes by a research evaluator, which may miss longer patterns and could have influenced staff behavior because staff knew they were being watched. The model did not account for hearing or vision loss, depression, learned helplessness, or patient-staff gender, race, and ethnic differences, which the authors note may affect engagement. The study did not test whether training staff to use more positive interactions improves engagement.
Declared interests
No conflicts of interest were declared. The paper lists NIH extramural research support.
The easy way to misread this
Do not read the odds ratio of 1.65 as proof that positive staff interactions caused active engagement. This was an observational baseline analysis, and staff may have interacted more positively with patients who were already able to engage.