without using medications. 4.1 Detailed Plan of Massage Intervention Using the evidence identified, providers will be educated on massage therapy including frequency, duration, technique, and location. Providers will be educated on how to refer to the onsite massage therapist. Providers and caregivers will be educated on how to use the CMAI as this tool will be used to evaluate success in patients. Based on interactions with patients and presenting symptoms the provider will identify patients who struggle with agitation. They will use the CMAI to provide a baseline score before implementing massage therapy. Massage therapy will be provided by a licensed massage therapist. Massage will be applied to the back, shoulders, neck, hands, and feet, but the therapist will specifically target what each individual enjoys. The massage will last 20 minutes. Every patient will have therapy once a day, 5 days a week. The massage therapist will be in contact with the provider, and if needed massage may occur up to 14 times per week depending on the individual. Two caregivers will be responsible for completing the CMAI. They will conduct an initial evaluation and during both week 2 and 4 of the intervention (Margenfeld et al., 2019). After two weeks of massage therapy, if agitation outbursts continue and patients are at risk to harming self or others, caregivers will notify the provider. The provider will re-evaluate the need for other non-pharmacological interventions or medication. After 4 weeks of massage intervention, the CMAI score will be evaluated and if the individual’s score lowered, massage therapy will continue. If unsuccessful in controlling agitation, the provider will be educated to consider other MASSAGE THERAPY FOR AGITATION 10 non-pharmacological interventions, combination of non-pharmacological interventions or add medication. 5. Timetable Timeline Project Phase Goal Week 1-2 Create Awareness & Interest Identify long-term memory care facility Develop understanding of facility’s current practices- Collect baseline data how often outbursts occur and interventions taken nonpharmacological and pharmacological Educate providers on studies showing success of massage therapy as a non-pharmacological intervention Highlight advantages and anticipated impacts for adopting massage therapy Week 3 Build Knowledge & Commitment Educate stakeholders (Patients, families, caregivers, providers, massage therapists) Develop facility goals that target practice change Initial CMAI completed by caregiver or provider Begin implementation of massage intervention Trouble shooting implementation Week 4-7 Promote Action & Adoption Documentation of changes using CMAI at week 5 of intervention Continual education to caregivers and providers as needed CMAI at week 7 of intervention Week 8 Change Identification Evaluation Gap Analysis Report progress and updates Evaluate changes in facility practices Determine success of massage therapy intervention as first line treatment at facility Identify additional changes that should be implemented Week 9 Pursue Integration & Sustained Implementation Present results to stakeholders Encourage continued advancement of use of non-pharmacological interventions care at facility MASSAGE THERAPY FOR AGITATION 11 6. Data Collection Methods Data collection for this benchmark study was designed similar to previous systematic reviews data analysis. No data has been collected as this time as this is a benchmark study. Preintervention baseline data will be collected. This includes type of agitation, time of day, frequency of agitation, and frequency of antipsychotic medication administration if applicable. Types of agitation include verbal aggression, physically aggressive behaviors such as hitting, social disruption, or resistance to care. Other baseline data includes cognitive impairment from Mini-Mental State Examination (MMSE) and demographic data provided by the facility. An intervention log will be completed. This includes resident’s behavior pre- and post- intervention, and the massage therapist will record length of treatment, time of day, type of massage used, and time since last treatment. Additionally, if massage intervention was not used this will be recorded by provider with reasoning. Data analysis (descriptive statistics), similar to HollidayWelsh, Gessert, & Renier (2009) analysis will be used. This analysis uses demographic data, agitation scores from CMAI, and medication use. This data will be examined using ANOVA to determine if there is a positive effect in decreasing agitation in residents. 7. Discussion of Evaluation Based off the systematic reviews found during a literature search, to evaluate the effectiveness of massage therapy in controlling agitation in dementia, the Cohen-Mansfield Agitation Inventory (see below) will be used. CMAI is an inventory that contains a variety of behaviors and assesses the frequency of these behaviors. The questionnaire includes 29 agitation behaviors rated on a 7-point scale based on frequency, 1 being never and 7 is several times an hour. This inventory will be completed at baseline, at week 2 of intervention, week 4 of intervention, and 2 weeks post-intervention. According to Cohen-Mansfield (1991), “for MASSAGE THERAPY FOR AGITATION 12 analysis purposes, it is not useful to calculate a