NP led model of care

Borbasi and colleagues (2010) write about a new model of NP-led care for people with dementia who exhibit challenging behaviors.  The authors explain how the Dementia Outreach Service, or DEMOS, model can be a cost effective way to help reduce aggressive behaviors among people with dementia living in long-term care facilities.

In order to qualify for DEMOS care the resident must be diagnosed with cognitive impairment/dementia plus at least one of five criteria:

  1. successful or attempted elopement;
  2. high fall risk;
  3. aggression toward staff or other residents;
  4. physical or chemical restraint use; or
  5. possibility of having to be moved elsewhere (including ED admission) due to unmanageable behaviors.

The goal of the model is to improve the resident’s quality of life, improve the resident’s agitated behavior, avoid a possible ED transfer, and to help build staff members’ skills in managing and preventing difficult behavior.  Here's how it works:

  • First, the DEMOS NP is consulted and assesses the resident. The NP makes recommendations.
  • Next, the multidisciplinary DEMOS team follows up to ensure that the recommendations are being followed and to assist the staff in carrying out the recommendations.  The DEMOS follow-up team includes: (1)  several nurses, (2) a clinical facilitator, (3) a nursing assistant, (4) a social worker, and (5) an administrative assistant.  The team is able to devote up to 6 hours a day, 5 days a week, working with the resident receiving services and the staff.
  • They report back to the NP in a continuous cycle of improvement.

The authors discuss two cases in which the DEMOS model was utilized.

Case #1:  One resident was assessed to be having pain related to the chair he sat in during meals. 
His pain appeared to be causing the resident to behave aggressively toward the staff. The DEMOS team changed his seating arrangement to something more ergonomic and the resident’s behavior changed.

Case #2: Another resident was assessed to be having pain that was coinciding with the time staff would be assisting him with showering. The team implemented a plan for the resident to receive his pain medicine prior to showering. The follow-up team was able to work with staff in a collaborative manner to work with the resident; if the resident still seemed to be having pain at shower time, the plan included assisting him with a sponge bath instead of a shower. The resident’s aggressive behavior decreased.

As the NP leading the DEMOS model explained, the ultimate goal of DEMOS care is to use “minimal medication with maximal nursing interventions.”

Reference

Borbasi, S., Emmanuel, E., Farrelly, B., & Ashcroft, J. (2010). A nurse practitioner initiated model of service delivery in caring for people with dementia. Contemporary Nurse: A Journal for the Australian Nursing Profession. 36(1/2), p. 49-60.  doi:10.5172/conu.2010.36.1-2.049

http://web.ebscohost.com.proxy.lib.duke.edu/ehost/pdfviewer/pdfviewer?sid=2ffddb68-b805-4a6a-a3cb-fe8300d6c341%40sessionmgr4&vid=27&hid=20