Disruptive Behavior at Hospitals and Factors Associated to Safer Care: A Systematic Review

Disruptive behavior creates a dysfunctional culture that has a negative impact on work relations and influences the quality of care and safety of the patient. The objective of the present work is to provide the best methodological quality scientific evidence available on disruptive behavior at a hospital, the aspect associated with the safety of the patient, and its impact on quality of care. For this, we included studies that addressed the prevalence of disruptive behaviors observed in the area of hospital health and its professionals. The selection, eligibility, data extraction and evaluation of the risk of bias stages were conducted by two researchers, and any discrepancies were solved by a third researcher. The data presented show that disruptive behaviors are frequently observed in the daily life of health professionals, and compromise the quality of care, the safety of the patient, and can lead to adverse effects. The results presented indicate that the appearance of disruptive behaviors compromises the quality of care, the safety of the patient, and the appearance of adverse effects, and can also affect the physical and mental health of the health professionals. PROSPERO registration number: CRD42021248798.

Caregiving Self-efficacy as a Mediator of Negative Emotional States and Potentially Harmful Behaviors

Potentially harmful behaviors (PHB), such as wanting to scream at or hit a care recipient, are more likely when caregivers experience higher levels of stress. The current study expands on this research and identifies caregiving self-efficacy (SE) for dealing with disruptive behaviors as a mediator of the relationship between caregiver distress and PHB. Multilevel mediation models were tested using a sample of 244 caregivers of persons with dementia assessed three times over a one year period. In two separate models, SE mediated the relationship between caregiving burden/depression and the frequency of wanting to yell or scream at the care recipient in the past six months. Individuals with higher levels of depression and burden had lower levels of SE for dealing with disruptive behaviors. As SE decreased, the risk of potentially harmful behaviors increased. This mediation effect occurred at the within and between subject levels of the model. A significant indirect effect at the within-person level suggests that at timepoints where caregivers experienced more distress, they had lower self-efficacy and increased PHBs. Similar effects were observed at the between person level. These data suggest that both caregiver distress and self-efficacy are important intervention targets for minimizing PHBs.

Caregiving during the Covid-19 pandemic: Factors associated with caregiver stress and cognition

Caregivers are critical in helping persons with dementia (PWD) live at home longer, but the caregiving experience is associated with increased risk of physical (Vitaliano et al., 2003; Son et al., 2007; Fonareva & Oken, 2014) and cognitive decline among caregivers (Pertle et al., 2015; Lathan et al., 2016; Vitaliano et al., 2017). The present study examined the caregiver experience during the time of the Covid-19 pandemic including factors associated with caregiver stress, burden, and self-reported cognition (i.e., prospective and retrospective memory errors). In a sample of 56 caregivers of PWD, caregiver stress was positively associated with reports of greater life change resulting from Covid-19 and a greater frequency of care recipient depressive and disruptive behaviors; however, caregiver stress was not associated with care recipient memory problems. Additionally, caregiver burden was negatively associated with ratings of preparedness for the pandemic, but not with availability of support services or the amount of time spent caregiving. Further, frequencies of prospective and retrospective memory mistakes were positively associated with perceived stress, but not with caregiver burden. These findings reveal that caregivers of PWD report greater experiences of stress associated with the Covid-19 pandemic and other facets of their caregiving responsibilities (e.g., care recipient depressive and disruptive behaviors, frequency of memory mistakes). This work is a first step in identifying areas in which caregivers need assistance and expanding the literature on caregiver cognition by measuring self-reported everyday memory performance.