Prospective measurement of behavioral disturbances in nursing homes

To determine the reliability and validity of a behavior measurement scale (BMS) that rates behavioral disturbances (BD) prospectively in four categories.

A prospective observational study.

A total of 70 long-term care residents from two nursing homes.

Registered nurses (RNs), licensed practical nurses (LPNs), and certified nurses' assistants (CNAs) performed behavior ratings concurrently and independently on 30 residents for a period of 2 weeks. One RN performed ratings on the additional 40 residents. Each category of behavior was rated either present (occurred at least once) or absent (never occurred) at the end of each nursing shift. The Kappa (k) statistic and Cronbach's alpha were used to measure the BMS interrater reliability and internal consistency, respectively. Spearman's coefficient was used to measure correlation between total BMS scores and the level of functional impairment (construct validity).

Interrater reliability was marginal to good for RN-LPN paired ratings (weighted k = 0.30-0.53) and good to excellent for LPN-CNA paired ratings (weighted k = 0.68-0.90). The internal consistency reliability of the BMS was 0.75. Total BMS scores correlated with the level of functional impairment (P = 0.021). CNAs reported significantly more behavior episodes than RNs and LPNs. Nonaggressive verbal agitation was the most frequently encountered behavior in both nursing homes. There were no missing observations during the 2-week rating period.

The BMS is a simple and reliable tool that a variety of nursing staff members can use consistently for behavior measurement at the bedside. CNAs, who have more direct contact with nursing home residents, reported more BD than RNs and LPNs. Standardized behavior measurements can be used to monitor the frequency of BD and to evaluate the efficacy of interventions targeted either to individuals or to nursing homes. A simple and reliable tool such as the BMS may increase the likelihood that consistent reporting of BD is routinely available in nursing homes.