Date of Award
Doctoral Nursing Capstone Project
Doctor of Nursing Practice (DNP)
Dr. Karen Rich
Committee Chair Department
Committee Member 2
Dr. Anita Boykins
Committee Member 2 Department
Committee Member 3
Dr. Patsy Anderson
Committee Member 3 Department
Seventy-six percent of long term care (LTC) residents display behavioral disturbances associated with psychiatric disorders, including dementia, which “often occur in clusters and include depression, psychosis, aggression, agitation, anxiety, and wandering” (Agency for Healthcare Research and Quality [AHRQ], 2014 para. 2; Perkins, 2012). Forty percent of LTC residents with behavioral disturbances receive pharmacological treatments to manage their behavioral disturbances, but these medications have limited efficacy and significant adverse effects (Gustafsson, Karlsson, & Lövheim, 2013). This remains important because the population, ages 65 and older (approximately 88% of all LTC residents), represent the most vulnerable to the effects of pharmacological interventions (PIs; American Association of Retired Persons [AARP], 2007).
According to the United States (U.S.) Food and Drug Administration (FDA, 2005), the use of atypical antipsychotic medications for off-label purposes of treating behavioral disturbances in elderly residents with dementia in LTC facilities remains dangerous and can lead to death. Because of this, the FDA (2005) included a black-boxed warning in their labeling to describe the risks, noting these drugs remained unapproved for the treatment of behavioral disturbances in residents with dementia. Under the Food and Drug Administration Amendments Act (FDAAA), the FDA (2008) applied safety related changes to conventional antipsychotics drugs and atypical antipsychotic drugs.
The purpose of this capstone project involves developing a social marketing plan that may help decrease LTC nurses use of unnecessary PIs to address residents’ behavioral disturbances and to increase their use of non-pharmacological interventions (NPIs). Evidence of PIs long-term effectiveness is lacking and can cause further debilitating conditions. While the use of antipsychotic drugs should decline, the use of NPIs should increase, since NPIs remain highly effective. Concerning long-term effect, nurses remain important partners in the decision-making process of the patients receiving PIs. Using the 10-Step social marketing plan framework developed by Lee and Kotler (2016) and Kotter’s (2012) 8-Step Change Model, a social marketing plan was developed and presented to LTC administrators at a facility in Covington, La. The plan was aimed at efforts to replace PIs with evidenced-based NPIs in the care of LTC residents with behavioral disturbances. The LTC Administrator and the Director of Nursing (DON) were very satisfied with the quality of the plan’s content, proposed factors for the implementation of NPIs, their understanding of the benefits of the using NPIs, and their ease of understanding of the social marketing plan. They agreed to implement the plan as a social marketing campaign at the LTC facility.
Kela Spikes-Bickham, 2016
Bickham, Kela Spikes, "Development of a Social Marketing Plan to Decrease Long Term Care Nurses Use of Unnecessary Pharmacological Interventions to Address Residents' Behavioral Disturbances" (2016). Doctoral Projects. 33.