title: "The educating nursing staff effectively (TENSE) study": design of a cluster randomized controlled trial.
abstract: BACKGROUND
  Challenging behavior exhibited by people with dementia can have adverse outcomes, like stress, low morale, low work satisfaction and absenteeism for nursing staff in long-term care settings. Training nursing staff to manage challenging behavior may reduce its impact. Although much of the research into training nursing staff shows methodological limitations, several studies find some effect of training programs on knowledge about and on management of challenging behavior. Effects on stress or burnout are almost not found.
  
  
  METHODS
  The TENSE-study is a randomized controlled study on 18 nursing home units (9 control, 9 intervention) investigating the effects of a continuous educational program for nursing staff about managing challenging behavior. Nursing staff of intervention units receive the program, nursing staff of control units do not and continue usual care. The primary outcome is stress experienced by nursing staff (N = 135). Secondary outcomes are: emotional workload, work satisfaction, stress reactions at work and knowledge about challenging behaviour of nursing staff; and frequency of challenging behavior, quality of life and social engagement of residents (N = 135). Because there are many unknown factors influencing the effect of the training, a process evaluation to evaluate sampling-, implementation- and intervention quality as well as barriers and facilitators to implementation will also be included in the analysis. Nursing staff could not be blinded to the intervention, but were blinded for the outcomes.
  
  
  CONCLUSIONS
  Strengths of this study are the (good) description of the intervention complemented by a process evaluation and the tailoring of the intervention to the wishes and needs of the nursing homes at any moment during the study. Sustaining the effects of the intervention by using follow up sessions is another strength. Possible drawbacks may be dropout because of the frailty of the elderly population and because nursing staff might move to another job during the study.
  
  
  BACKGROUND
  NTR (Dutch Trial Registration) number NTR3620.
authors.affiliation: Vitalis WoonZorggroep Eindhoven, Eindhoven, the Netherlands ; Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Theo J G M
authors.initials: TJ
authors.lastname: Hazelhof
authors.affiliation: Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Debby L
authors.initials: DL
authors.lastname: Gerritsen
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands ; Faculty of Health Science, University of Southampton, Southampton, UK.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands ; Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands.
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
keywords: Challenging behaviour; Dementia; Nursing staff; Stress; Training; Work satisfaction