Function Focused Care: A Certified Nurse Assistants Training

Karen Paschel, BSN, RN, DNP Student

University of Missouri

Function focused care (FFC) educational training for certified

nursing assistants are necessary because:

• FFC is a nursing intervention designed to maintain or restore

the older adult’s functional ability in long-term care1

• Majority of the day is spent performing passive activities not

geared towards optimizing physical function2,3,4,5,6

• Certified nurse assistants (CNAs) are usually seen completing

daily care activities without the older adults’ participation1

• FFC focus on staff engagement of the older adult in his/her

daily care activities in an effort to increase activity1

Background

Design

• FFC training with pre-test and post-test

Outcome Measures

• Nursing Assistant Theoretical Testing of Restorative Care Activities (NATTRCA) immediately prior

and immediately after the educational training

• Nursing Assistants’ Care Behavior Checklist

Inclusion/Exclusion Criteria

• Employed as CNA

• Ability to read and write English

• CNAs employed as restorative aides were excluded

• To preserve privacy, there were no personal care observations

FFC Training Content

• The definition and concept

• Comparison of task and function focused approach

• FFC challenges

• Factors that influence challenges

• How CNAs can assist with challenges

• Safety and use of the environment

• Effective communication and cognitive impairment

•14 CNAs participated in training and completed pre/post-test

• NATTRCA post-test scores taken immediately after the training (mean = 93.14, SD = 7.49) were

significantly increased (t = - 4.68, df = 13, p <.001)

• Encouragement of independent feeding (N = 168) was observed more frequently than the other

behaviors with the behavior performed 66.66% (N = 112) of the time

• Demonstration of active range of motion (N = 35) was performed 5.9% (N = 14) of the time

• Encouragement of independent feeding increased but not significantly (χ2 = 2.355, df = 1, p = .125)

(Graph 1)

• Encouragement of active range of motion did not significantly improve (χ2 = .305, df = 1, p = .581)

(Graph 2)

Implementation

The project director would like to thank Dr. Lorraine Phillips

(Committee Chair), Dr. Miriam Butlar Committee Member),

Cynthia Handrich, RN, BSN, MS (Committee Member), Dr.

Jan Sherman, and Frontier Health & Rehabilitation.

Ikprmb@mail.missouri.edu

http://nursing.missouri.edu/index.php

• CNA’s knowledge improved after FFC training

• CNA use of FFC activities improved after FFC training

•Future efforts should increase the number of CNAs who

participate in training

•Future efforts should include personal care observations

• Provide a training prior to implementing FFC as an

intervention

Conclusion

References

Acknowledgements

Results

To determine if introducing a training program consisting of FFC

education increased:

1. Staff knowledge related to FFC

2. Staff use of FFC during routine activities in dining and

common areas when compared to the standard of care

without the addition of FFC training

• Outcome 1

10% of CNAs will participate in the FFC training and

complete the pre and post-test

• Outcome 2

CNAs will have an increased knowledge of FFC after the

completion of the educational training

• Outcome 3

CNAs use of FFC during routine activities in dining and

common areas will increase by 3%

Purpose

Outcomes

1. Gruber-Baldini, A. L., Resnick, B., Hebel, R., Galik, E., &

Zimmerman, S. (2011). Adverse events associated with the Res-

Care Intervention. JAMDA, 12, 584-589.

doi:10.1016/j.jamda.2010.05.011

2. Ice, G. H. (2002). Daily life in a nursing home has it changed in

25 years? Journal of Aging Studies, 16, 345-359

3. Omnibus Budget Reconciliation Act. (1987). Pub. L. 100-203,

420 (a), 4211 (a). Rockville, MD: HCFA, USDHHS

4. Resnick, B., Boltz, M., Galik, E., & Wells, C. (2013). Reliability

and validity of the physical capability assessment. Clinical

Nursing Research, 22, 7-29

5. Galik, E. M., Resnick, B., Gruber-Baldini, A., Nahm, E., Pearson,

K., & Pretzer-Aboff, I. (2008). Pilot testing of the restorative care

intervention for the cognitively impaired. Journal of American

Medical Directors Association, 9, 516-522.

doi.10.1016/j.jamda.2008.04.013

6. Galik, E., Resnick, B., Hammersla, M., & Brightwater, J. (2013).

Optimizing function and physical activity among nursing home

residents with dementia: Testing the impact of function-focused

care. The Gerontologist, 1-14. doi:10.1093/geront/gnt108 c