{"doi":"10.1111/jgs.18635","title":"Knowledge and attitudes of patient safety attendants in managing hospitalized older adults with delirium and dementia","abstract":"Delirium and dementia are extremely common among hospitalized older adults and are often associated with functional and cognitive decline.1, 2 Pharmacologic treatments for preventing and managing delirium and dementia behavioral problems are limited, often ineffective, and have significant side effects.3-5 Non-pharmacological management, such as providing orientation, engaging in activities and a calming environment, is, therefore, of primary importance.6 Hospitals often use patient safety attendants (PSAs) (“sitters”) for one-to-one observations to reduce the use of physical restraints and psychotropic medications.7-9 The goal of this needs assessment was to examine the knowledge, skills, and attitude of PSAs regarding management of delirium and dementia in older hospitalized patients. This is the initial need assessment step of a quality improvement (QI) project to improve the adoption and implementation of evidence-based nonpharmacological management of delirium and dementia. The core elements are drawn from the translating research into practice (TRIP) model10 and represents the first three steps (Supplementary Table S1). We used sequential explanatory design to summarize the evidence, identified the barriers to implementation, and PSAs perception by mixed methods. This project was conducted after institutional IRB approval at a tertiary academic medical center. Performance assessment was performed in two phases. Anonymous survey in phase 1 has 6 items on confidence to manage behavioral problems, 9 items on engagement strategies, and 5 items on job satisfaction. After 6 months, focused group interviews were conducted with hospital PSAs. Descriptive statistics of survey data compared hospital PSAs with PSAs from agency (agency PSAs) using Fisher's exact test for categorical variables and Wilcoxon rank-sum test or Likert items. We used qualitative content analysis to analyze the focused group interview transcripts. Out of 85 PSAs, 45 hospital PSAs (100%), and 21 agency PSAs (52.5%) participated in the survey (Supplementary Table S2). The majority were female (88%), Black (79%), and between 25 and 44 years of age (59%). Most of the PSAs reported confidence in their skills to work as PSAs (80% hospital PSAs and 73% agency PSAs). Majority of PSAs (>90%) reported helping patients with activities of daily living followed by connecting with families as part of their job training (Figure 1). Both PSA groups ranked high job satisfaction (>85%) and many felt that the COVID-19 pandemic had affected their job performance (50% hospital PSA and 42% agency PSA). The responses regarding being a valuable member of the team were variable; less hospital PSAs agreed (55%) as compared to agency PSAs (72%). Five focused group interviews were conducted, 4 sessions were in-person (range 2–6; n = 15) and the 5th virtually on Zoom (n = 8). Audio recordings of the interviews were transcribed by an outside agency, except for the zoom recording (Table 1). Using grounded theory, PI and the research assistant parsed for new insight on the themes from the survey as well as any new themes introduced.11 “The kind of stuff I learn on the job, was not part of my training.” “I don't know what to do except for calling the nurse for help when patient is getting combative.” Our study adds to the existing literature by highlighting the specific challenge that PSAs have in differentiating delirium and dementia among older hospitalized patients to possibly deeper systemic issues impacted by COVID-19. Our study also reflects the importance of addressing communication challenges with nurses and other staff members, in addition to providing evidence-based engagement tools to PSAs. Our results are relevant for hospital and health system leadership to address role-setting for PSAs and to inform future training programs. Our work also draws attention to the importance of integrating PSAs, many of whom are minority and female workers, to be more valued and integrated as he","journal":"Journal of the American Geriatrics Society","year":2023,"id":386881,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9563,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1155351,"name":"Danelle Cayea","orcid":"0000-0003-2061-2007","position":1,"is_corresponding":false},{"id":899537,"name":"Sean Tackett","orcid":"0000-0001-5369-7225","position":2,"is_corresponding":false},{"id":1155352,"name":"Michele Bellantoni","orcid":"0000-0001-8525-2247","position":3,"is_corresponding":false},{"id":1155722,"name":"Jacqueline Massare","orcid":null,"position":4,"is_corresponding":false},{"id":1012866,"name":"H. Marshall Ward","orcid":null,"position":5,"is_corresponding":false},{"id":888763,"name":"Nancy L. Schoenborn","orcid":null,"position":6,"is_corresponding":false},{"id":264350,"name":"Esther S. Oh","orcid":"0000-0002-9638-5763","position":7,"is_corresponding":false},{"id":1155350,"name":"Shaista U. Ahmed","orcid":"0000-0003-4784-6970","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T01:18:00.717763Z","pmid":"37850722","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}