Interventions for disruptive behaviors. Use and success

Health care providers deal with disruptions from geriatric patients routinely. Despite the negative impact on provider efficiency, provider-patient relations, and patient well-being, there have been no systematic clinical studies of the impact of disruptive behaviors on geriatric inpatient care. This article presents a taxonomy for these behaviors, applying them to a study of disruptive behaviors and concomitant nursing interventions on a geriatric evaluation and management (GEM) unit. The sample, consisting of 23 nursing staff (16 RNs, 4 LPNs, and 3 nurse aides), was followed over 8 weeks (five shifts per week, distributed randomly over day, evening, and night shifts). An experienced pair of RN observers logged all disruptive behaviors and the associated interventions employed by the nursing providers. The taxonomy was validated on 97 disruptive events (113 disruptive behaviors) initiated by 87 patients. The major findings of the study were: (a) disruptive behaviors are common on a GEM unit; (b) behaviors that disrupt care are recognized only 50% of the time by nursing staff; (c) interventions, when used singly, were found successful 45% of the time; (d) multiple simultaneous interventions may be more successful than single interventions but were used in only 16% of cases; and (e) selection of interventions may be associated with staff education level.