Nurses’ Intentions to Initiate an Antipsychotic or Behavioral Intervention with Nursing Home Residents: The Role of Norms and Being Evaluated

ABSTRACT

Objectives: To examine whether exposure to a message to avoid antipsychotic medications and a salient sense of managerial oversight influenced nurses’ treatment intentions.

Methods: 158 nurses from 28 long-term care facilities were randomized to one of four conditions within a 2 × 2 between-participants design. The nurses responded to a case study depicting a resident with dementia-related behavioral problems with their intent to initiate an antipsychotic or a psychosocial intervention. Self-efficacy, descriptive norms, and attitudes were measured via self-report.

Results: Perceived local antipsychotic prevalence was related to the nurses’ treatment intentions. There were no main or interactive effects of the avoid antipsychotic or manager oversight conditions on the nurses’ treatment intentions. However, there was a significant interaction of actual facility antipsychotic prevalence and the avoid antipsychotics message on intentions to initiate an antipsychotic.

Conclusions: Nurses’ perceptions of local antipsychotic prevalence were positively associated with intentions to initiate an antipsychotic and negatively associated with intentions to initiate a psychosocial intervention. However, a salient message to avoid antipsychotics had limited influence on nurses’ treatment intentions and was associated with increased intentions to initiate antipsychotics in facilities with higher rates of antipsychotic use. The oversight condition did not demonstrate adequate internal validity, which may have caused its lack of effect on treatment intentions.

Clinical Implications: Nurses’ perceptions of the local prevalence of antipsychotic use is associated with their treatment intentions. However, increasing the visibility of a message discouraging antipsychotic use may have limited utility in influencing nurses’ intentions to initiate an antipsychotic or psychosocial intervention.

KEYWORDS:

• Behavior problems
• nursing
• nursing home
• treatment decision making

Acknowledgments

The authors would like to thank the nurses and nursing homes who participated in this project. The ideas and opinions expressed herein are those of the authors alone, and endorsement by the U.S. Department of Veterans Affairs or any of its affiliates is not intended and should not be inferred.

Disclosure Statement

Each author signed a form for disclosure of potential conflicts of interest. No authors reported any financial or other conflicts of interest in relation to the work described.

Ethical Principles

The authors affirm having followed professional ethical guidelines in preparing this work and obtaining institutional review board approval for this project. To the best of our ability, we have ensured the privacy of participants and their data in the reported results.

Additional information

Funding

This research was supported by an intramural grant from the College of Arts and Sciences, University of Louisville, Louisville, Kentucky.