Nurses' intentions to initiate an antipsychotic or behavioral intervention with nursing home residents : the role of norms, being evaluated, self-efficacy, time pressures, and staffing.

Abstract

Design and Methods:A total of 158 nurses from 28 long-term care facilities were randomized to one of four conditions within a two (injunctive norm: salient vs. not salient) x two (sense of evaluation: salient vs. not salient) between-participants design in this cross-sectional study. The nurses responded to a case study that depicted a resident with dementia-related behavioral difficulties and the dependent variables were their intent to initiate an antipsychotic or a behavioral intervention. The nurses completed self-report measures of their self-efficacy, time pressures, perceived staffing, descriptive norms, v attitudes, and outcome expectancies. Multi-level modeling was utilized to examine the effect of the two conditions and explore the correlates of the nurses' intentions. Results:The provision of a salient injunctive norm and/or a sense of evaluation were not associated with lower intentions to initiate an antipsychotic or higher intentions to initiate a behavioral intervention. Individuals working in facilities with higher rates of antipsychotic use had greater intentions to utilize an antipsychotic when presented with an injunctive norm than individuals working in facilities with lower rates of antipsychotic use. The nurses' self-efficacy, attitudes, perceived descriptive norms, and outcome expectancies did not moderate the effect of an injunctive norm on their treatment intentions. Perceived staffing was related to intent to start an antipsychotic but not a behavioral intervention, and perceived time pressures were not related to the nurses' intentions.