Exploring the Effect of Training on PPA Skills: A Preview of a Pre-Post Assessment with USI-PAC Learners

Exploring the Effect of Training on PPA Skills: A Preview of a Pre-Post Assessment with USI-PAC Learners post page

Beth A. D. Nolan

By Beth A. D. NolanJuly 15th, 2019

Exploring the Effect of Training on PPA Skills: A Preview of a Pre-Post Assessment with USI-PAC Learners

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by Beth A. D. Nolan. Ph.D.
PAC Director of Research and Policy


In partnership with Positive Approach to Care® (PAC), the University of Southern Indiana Center for Healthy Aging and Wellness continues to generate incredible results on the data gathered with the PAC Program!

The USI/PAC research team will be presenting a study on the Positive Physical Approach™ (PPA) at the American Public Health Association annual conference in Philadelphia this November. The authors include Swateja Nimkar, Mary Catherine (Katie) Ehlman (PAC Certified Independent Trainer and Coach), Pamela Thomas (PAC Certified Independent Trainer), Beth Nolan, Dinko Bacic, and Teepa Snow. The study is titled Assessing changes in nursing home staff’s initial approach to engage PLwD after participating in an innovative dementia training program: A pilot study.  This paper addresses a gap in the scientific literature outlining how to initiate an interaction with people living with dementia (PLwD) to meet their unique individual needs.

The purpose of the paper was to examine the change in how nursing home staff members approach PLwD from before to after attending a PAC Certification Course (Trainer and Coach). The research participants were the learners from a 2016 USI/PAC Trainer/Coach certification course for 12 nursing home teams in southwest Indiana. 

The participants were given the task to get “Mr. Smith” to go to lunch.  They were filmed in this task six weeks before the training, and at lunch on day two of the onsite certification course. The PLwD (“Mr. Smith”) was a standardized patient. A standardized patient is a person recruited and trained to take on the characteristics of a real person living with a disease, and thereby affording learners an opportunity to learn and to be evaluated on learned skills in a simulated clinical environment.  In this study, the standardized patient was a PhD Occupational Therapist, who specialized in geriatrics and was also a professional actor.  His portrayal of the physical manifestations of the changes that occur in the brain for frontotemportal dementia rivaled Teepa’s portrayals.

The results were two-fold. First, participants more fully executed the steps of PPA after the course. Second, and perhaps more importantly, a current standard of practice about how staff members approach PLwD was established with this paper.

The researchers used a 12-step coding system to assess participants’ use of PPA with the standardized patient from pre-course (M=11.59, SD=3.36) to post-course (M=22.0, SD=2.50; paired differences mean was t(16) = -11.419, p <.000). When looking at each step individually, all participants used more steps of the PPA after training than before:  a paired t-test and Wilcoxon signed-rank test showed a significant positive change (p<.05 in ten of the 12 steps of the protocol) in approaching a standardized patient after the certification (t(16) = -11.419, p <.000).

Future research will continue to methodically build the scientific evidence for the value of PPA! This fall, the team will use computer-generated, facial coding technology to assess the emotional reactions of a PLwD as they are approached using PPA as compared to a standard, friendly greeting.  This research may be able to tie what we learned in this study to the positive outcomes of our PLwD when we use PPA!

To get  involved with the Building a Dementia-Competent Nursing Home Workforce project, visit USI's Dementia Website or contact Beth Nolan with Teepa Snow’s PAC.

Beth A. D. Nolan, Ph.D. is the Director of Research and Policy, and serves as a Lead Mentor and Trainer for Positive Approach® to Care (PAC). Formerly an Assistant Professor and the Senior Associate Director for the Evaluation Institute at the University of Pittsburgh's Graduate School of Public Health (PITT), Dr. Nolan received her Ph.D. in applied gerontology, and holds master’s degrees in Human Development and in Applied Behavior Analysis. She completed her internship with the National Academy of Social Insurance at the National Academy on an Aging Society, and her post-doctoral training in geriatric psychiatry at Western Psychiatric Institute and Clinic, Pittsburgh, PA. While at PITT, she worked with a variety of human service agencies to translate and implement evidence-based programs for behavioral health, criminal justice, medicine, and senior living. Dr. Nolan now works to help move caregivers to become care partners.


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