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offering choices about the care options, pro- and lower educational achievement (high
viding feedback to the resident about their school or less) are likely to disagree with eBP
participation in the task, engaging in social recommendations. These UAPs do not want U
conversation, and respectfully responding to care for demented or agitated residents
to the resident’s questions and concerns. The and, in fact, have a sense of helplessness
reliability and validity of the PcBI were not when trying to do their work and complete
reported nor were the statistical significance their assignments (Ayalon, Arean, Bornfeld,
of the findings. The guidelines to adminis- & Beard, 2009). Ayalon et al. (2009) examined
tering the PcBI, prepared by the researchers, three major beliefs about eBP with regard
can move forward further development and to Alzheimer’s disease and agitation: beliefs
testing of this instrument. about the use of isolation and intense super-
As has been reported by others, nH vision of residents with Alzheimer’s disease,
cnAs are subject to pejorative name-calling beliefs about the effectiveness of pharmaco-
by residents (Berdes & eckert, 2001; Ramirez, logical versus nonpharmacological/behav-
Teresi, & Holmes, 2006). In some cases, the ioral interventions, and beliefs about the
name-calling lacks specific racial references nature and intensity of family involvement.
(known as “anachronistic racism”); in other Significant differences between the UAPs
cases, it is targeted and meant to be offen- and health care professionals (i.e., admin-
sive (known as “malignant racism”; Berdes istrators, nurses, social workers, and thera-
& eckert. 2001). Support groups did not peutic recreation staff) were reported. More
improve the cnA’s feelings of worthlessness so than health care professionals, UAPs had
and demoralization. However, in-service great faith in the use of physical or chemical
education about confusion and dementia restraints to control agitation and dementia
behavior reduced the cnA’s perception of behavior, felt that the family’s role in manag-
racism and improved their attitudes towards ing the resident’s behavior was limited, and
such residents. believed that isolation and intense supervi-
As many as 65% of nH and ALc resi- sion were effective interventions. educational
dents have some kind of dementia in varying interventions have to start with preparing
stages and intensities. Interviews conducted for receptivity of eBPs and then move on
with 154 UAPs in nHs and ALcs revealed to actual findings and guidelines. nursing
that those with 1 to 2 years work experience assistants collect data and interpret what
had a higher stress level but more positive they see for use in rating scales, the mini-
attitude about Pcc in comparison with those mum data set, and in construction of the plan
who had been working longer (Zimmerman of care. Quality of life rating for persons with
et al., 2005). Patient-centered attitude was dementia by UAPs in nHs and ALcs seems
consistently associated with dementia-sensi- to be associated with their attitudes about
tivity, job satisfaction, and perceived compe- dementia, training, and their confidence in
tence in providing dementia care. identifying and attending to their residents’
Although education has been put forward care needs (Winzelberg, Williams, Preisser,
as the best way to help staff, especially direct Zimmerman, & Sloane, 2005).
care workers like UAPs, understand, man- An instrument developed in collabora-
age, and feel confident about care of persons tion with cnAs was able to identify change
with dementia, drawing on evidence-based in nH residents’ behaviors such that it pre-
practice (eBP) as the goldstone to guide prac- dicted the development of an acute illness
tice might not be appreciated or valued by within 7 days in comparison to residents
some health care workers. UAPs belonging to with no observed change (Boockvar, Brodie,
minority ethnic groups, with fewer years of & Lachs, 2000). Documentation of change
acculturation, english-language proficiency, on the “Illness Warning Instrument”