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The Effectiveness of Multistrategies on Disruptive Vocalization of People With Dementia in Institutions: A Multicentered Observational Study

Palese, Alvisa; Menegazzo, Elisa; Baulino, Francesca; Pistrino, Raffaella; Papparotto, Carla

Journal of Neuroscience Nursing: August 2009 - Volume 41 - Issue 4 - p 191-200
doi: 10.1097/JNN.0b013e3181aaaab2

The aim of this study was to evaluate the effectiveness of the daily interventions used by the nurses on disruptive vocalization (DV). DV includes all types of disturbing or unacceptable vocal expression: repetitive vocalization, verbal or nonverbal utterances, presented as inappropriate language, repeated and insistent demands, repeated calling out, shouting, complaining, or moaning that does not pertain to their circumstances or environment. A convenience sample of five nursing homes from the north of Italy, in the Friuli Venezia Giulia region, was included in the study. A randomized selection of 87 daily shifts was selected. Institutionalized patients with dementia, but with no associated psychiatric disorders, were eligible. Nurses involved in the study added patients progressively. Nurses involved were asked to keep diaries to record strategies and durations for each episode of DV encountered during the allotted shift. In the total amount of observation time (36,540 minutes), 23.6% (8,653 minutes) of nursing care time involved working with and managing DV patients. The nurses recorded an average of 6.5 (302/46) vocalizations on morning shifts and 7.3 (302/41) during afternoon shifts, with an average duration of about a quarter of an hour each. Managing DV with multistrategies reduces the duration of the DV episode and increases the perceived effectiveness of management.

Elisa Menegazzo, BCN RN, is a staff nurse at the University of Udine, Udine, Italy.

Francesca Baulino, BCN RN, is a staff nurse in the Specialist Surgical Department, Azienda Ospedaliero-Universitaria Udine, Udine, Italy.

Raffaella Pistrino, BCN RN, is a staff nurse at the Nursing Home, Istituto Geriatrico per Anziani, Udine, Italy.

Carla Papparotto, MSC BCN RN, is the director of nursing services, Nursing Home, Tarcento, Udine, Italy.

Questions or comments about this article may be directed to Alvisa Palese, MSN BCN RN, at She is an associate professor in nursing sciences at the University of Udine, Udine, Italy.

© 2009 American Association of Neuroscience Nurses