PUBLIC ADMINISTRATION, Issue 2 2007
A CHANCE?
This article reports a study concerning perceptions of benefit fraud staff and of management concerning their own interviewing techniques and standards, and their views pertaining to a preferred model of interviewing. Interviewing fraud suspects forms an important task performed by Fraud Investigators (FIs) within the Department of Work and Pensions (DWP) in the UK. Given this significance, it is surprising that there has been little analysis of the skills used to do this task. Current training consists of a course centred on an interviewing framework called the PEACE model, which was originally developed for police use. The research outlined in this paper examined both FIs and their managers' perceptions and attitudes of the model and of their own practices. It was found that, while there was general support for the model, reservations were voiced over how effective PEACE may actually be in practice. These reservations centred on insufficient time to prepare for investigations along with a perceived inflexibility over the model's framework. In, addition, it was highlighted that the absence of any national supervisory framework for investigative interviews should give the organization cause for concern in ensuring standards. [source]

HYGIENE PERCEPTION: CONDITION OF HOTEL KITCHEN STAFFS IN ANKARA, TURKEY

JOURNAL OF FOOD SAFETY, Issue 2 2010
NEVIN SANLIER
ABSTRACT The study, which analyzed knowledge levels of the staff who work in food and beverage departments of hotels in Turkey about food safety, was carried out in December 2007,March 2008. Researchers applied face to face survey to 522 employees of seven hotels. The difference has been found meaningful statistically between kitchen and kitchenware hygiene, employee hygiene, food hygiene and general hygiene knowledge points and their education status and occupations in the result of the study (P < 0.05). On the other hand, a meaningful relationship has not been found statistically between food safety knowledge levels of the staff and their age ranges (P > 0.05). First, it is required to pay attention to the determining of the training needs of employees working for the enterprise, and to make a point of applying necessary training and seminars concerning the staff in each degree by making a training program. It has been determined that training, occupation and experience of the staff are so important in order to provide food safety in enterprises. PRACTICAL APPLICATIONS Each year, millions of people worldwide suffer from foodborne diseases and illnesses. Therefore, food-related infection is an important health problem in many countries. This study analyzed the knowledge levels of employees who work in the food and beverage departments. It has been found that there is a need to develop a state policy regarding education to be given to consumers and employees about food safety knowledge and practices. Education should be repeated with specific intervals to ensure that learnt information is turned into attitudes and behaviors; and procedures and processes should be controlled regularly. [source]

Lessons for Managing Creative Staff

DESIGN MANAGEMENT REVIEW, Issue 3 2006
Leonard J. Glick Faculty
First page of article [source]

Evaluation of a training program to improve clinicians' assessment of patient stability

DRUG AND ALCOHOL REVIEW, Issue 4 2009
ADAM R. WINSTOCK
Abstract Introduction and Aims. Public clinics in New South Wales (NSW), Australia play a central role in inducting and stabilising opioid dependent clients onto treatment before transfer to a community pharmacy. Clinical assessment of stability is a vital skill in ensuring that clients are appropriately and effectively transferred. A two-hour clinical training program was delivered to staff at 31 public clinics, that aimed to improve staff confidence in assessing client stability, and skills in negotiating the transfer of clients to community pharmacies. Design and Methods. Pre- and post-training evaluation was conducted examining self-ratings of confidence and ability in the assessment of client stability, and the perceived utility of a clinical algorithm to improve assessments. Follow-up was conducted 3 to 6 months post-training assessing individual and clinic level changes in clinical practice. Results. 205 staff completed pre- and post-training questionnaires. Staff demonstrated a moderate level of self-reported baseline knowledge and skills in assessing client stability (mean = 6.5; 1 = poor; 10 = excellent) that improved when re-assessed following the training (mean = 8.0). 76 staff responded to the follow-up questionnaire. , 75% reported some level of improvement in their approach to clinical practice regarding stability assessment, and 59% reported being more effective in identifying clients appropriate for community pharmacy transfer. Of 19 public clinics, 14 reported an increased focus on stability assessment. Nine clinics reported barriers to achieving changes in clinical practice. Discussion and Conclusions. This evaluation demonstrates that it is possible to implement a targeted clinical training package to staff that translates into positive changes in clinical practice.[Winstock AR, Lea T. Evaluation of a training program to improve clinicians' assessment of patient stability. Drug Alcohol Rev 2009;28:353,359] [source]

Paediatric emergency guidelines: Could one size fit all?

EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2009
Sarah Dalton
Abstract Objectives: The development of clinical practice guidelines (CPG) is a core task in EDs and CPGs are widely used. The process of CPGs development in Australian and New Zealand ED is unknown. We aim to describe this process in paediatric EDs and examine the feasibility of developing collaborative guidelines. Methods: A piloted questionnaire regarding CPG development, dissemination, implementation and evaluation was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. Specific questions regarding feasibility of combined guidelines were included. Results: All PREDICT EDs participated in the survey. All used CPGs in EDs and 12/13 had ED-specific guidelines. EDs had an average of 77 guidelines with approximately 5 new guidelines generated annually. Staff at most sites (10/13) also accessed guidelines from external sources. Most hospitals (10/13) had a guideline committee, generally comprising of senior ED and general paediatric staff. Guidelines were usually written by committee members and 10/13 hospitals adopted modified external guidelines. An average committee met six times a year for 90 min and involved seven clinicians. Most sites did not have a project manager or dedicated secretarial support. Few hospitals included literature references (3/13) or levels of evidence (1/13) in their guidelines. Most did not consider implementation, evaluation or teaching packages. Most sites (10/13) supported the development of collaborative guidelines. Conclusions: Paediatric EDs expend significant resources to develop CPGs. Collaborative guidelines would likely decrease duplication of effort and increase the number of available, current and evidence-based CPGs. [source]

Guardians and handlers: the role of bar staff in preventing and managing aggression

ADDICTION, Issue 6 2005
Kathryn Graham
ABSTRACT Aims To identify good and bad behaviors by bar staff in aggressive incidents, the extent these behaviors apparently reflect aggressive intent, and the association of aggressive staff behavior with level of aggression by patrons. Design, setting and participants Data on staff behavior in incidents of aggression were collected by 148 trained observers in bars and clubs on Friday and Saturday night between midnight and 2 a.m. in Toronto, Canada. Behaviors of 809 staff involved in 417 incidents at 74 different bars/clubs were analysed using descriptive statistics and three-level hierarchical linear modeling (HLM) analyses. Measurements Observers' ratings of 28 staff behaviors were used to construct two scales that measured escalating/aggressive aspects of staff behavior. Apparent intent level for bar staff was dichotomized into (1) no aggressive intent versus (2) probable or definite aggressive intent. Five levels of patron aggression were defined: no aggression, non-physical, minor physical, moderate physical and severe physical. Findings The most common aggressive behaviors of staff were identified. Staff were most aggressive when patrons were either non-aggressive or highly aggressive and staff were least aggressive when patrons exhibited non-physical aggression or minor physical aggression. Taking apparent intent into consideration decreased staff aggression scores for incidents in which patrons were highly aggressive indicating that some aggression by staff in these instances had non-aggressive intent (e.g. to prevent injury); however, apparent intent had little effect on staff aggression scores in incidents with non-aggressive patrons. Conclusion Although there is potential for staff to act as guardians or handlers, they often themselves became offenders when they responded to barroom problems. The practical implications are different for staff aggression with nonaggressive patrons versus with aggressive patrons. [source]

Using innovative group-work activities to enhance the problem-based learning experience for dental students

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2009
R. Grady
Abstract Problem-based learning (PBL) in medical and dental curricula is now well established, as such courses are seen to equip students with valuable transferable skills (e.g. problem-solving or team-working abilities), in addition to knowledge acquisition. However, it is often assumed that students improve in such skills without actually providing direct opportunity for practice, and without giving students feedback on their performance. ,The Manchester Dental Programme' (TMDP) was developed at The University of Manchester, UK as a 5-year, integrated enquiry-led curriculum. The existing PBL course was redesigned to include a unique, additional PBL session (,Session 4') that incorporated an activity for the group to complete, based on the subject material covered during student self-study. A summative mark was awarded for each activity that reflected the teamwork, organisational and overall capabilities of the groups. This paper describes the different types of activities developed for the Session 4 and presents an analysis of the perceptions of the students and staff involved. The student response to the Session 4 activities, obtained via questionnaires, was extremely positive, with the majority finding them fun, yet challenging, and ,worthwhile'. The activities were perceived to enhance subject understanding; develop students' problem-solving skills; allow the application of knowledge to new situations, and helped to identify gaps in knowledge to direct further study. Staff found the activities innovative and exciting learning tools for the students. The Session 4 activities described here are useful educational resources that could be adapted for other PBL courses in a wide variety of subject areas. [source]

The UCLan community engagement and service user support (Comensus) project: valuing authenticity, making space for emergence

HEALTH EXPECTATIONS, Issue 4 2007
Soo Downe BA (Hons) RM MSc PhD
Abstract Objective, To develop and evaluate service user, carer and community involvement in health and social care education. Background, Despite the high policy profile of involvement issues, there appear to be no published accounts of schemes that have used a systematic whole-faculty approach to community engagement in health and social care higher education. Focus of this paper, The set up and early development of a faculty-wide community engagement project. Setting and participants, Staff from the faculty of health in one University, local service users and carers and community group project workers and local National Health Service (NHS) and public sector staff. Design, Participatory action research including document review, field notes, questionnaires and interviews. Analysis, Thematic analysis. The emerging themes were tested by seeking disconfirming data, and through verification with stake-holders. Results, Prior to the study, there were examples of community engagement in the participating faculty, but they occurred in specific departments, and scored low on the ,ladder of involvement'. Some previous attempts at engagement were perceived to have failed, resulting in resistance from staff and the community. Despite this, an advisory group was successfully formed, and project framing and development evolved with all stake-holders over the subsequent year. The four themes identified in this phase were: building accessibility; being ,proper' service users/carers;moving from suspicion to trust: mutually respectful partnerships as a basis for sustainable change; and responses to challenge and emergence. Conclusions, Successful and sustainable engagement requires authenticity. Many problems and solutions arising from authentic engagement are emergent, and potentially challenging to organizations. [source]

Improving the quality of health information: the contribution of C-H-i-Q

HEALTH EXPECTATIONS, Issue 3 2002
Tom Hain MSc RGN RSCN FAETC
The quality of information should be the key driver in communicating health messages to the public. Staff at The Centre for Health Information Quality (C-H-i-Q) have worked with an extensive list of partner organizations from a range of disciplines. These stakeholders express a desire to see improvement in the standards of patient information, and display a willingness to embrace new approaches in order to achieve change. The result is an increasingly significant contribution in the development of the information-exchange model of health-care, where the aim is to maximize public confidence in health information. Key activities include defining principles of quality assurance, engaging with stakeholders, and developing tools and training for producers and providers of health information. [source]

,They survive despite the organizational culture, not because of it': A longitudinal study of new staff perceptions of what constitutes support during the transition to an acute tertiary facility

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 5 2005
Robyn Fox RN RM AgedCareCert GradCertMgt GradCertHRM DNE BEdStud MNsgLdrship
Increasing difficulties of recruitment and retention of nursing staff strongly indicate that organizations should identify factors that contribute to successful transition of new staff to the workplace. Although many studies have identified problems facing new staff, fewer studies have articulated best practices. The purpose of this longitudinal study was to ascertain what new staff perceived as supportive elements implemented by the organization to assist their integration. Sixteen staff in Phase I and 12 staff in Phase II attended focus groups. The focus groups at 2,3 months provided specific information, with particular emphasis on negative interactions with other staff members and inadequate learning assistance and support. Different themes emerged within the focus groups at 6,9 months. Staff discussed being ,self-reliant' and ,getting to know the system'. Participants indicated that these skills might be beneficial to new staff in the development of organizational ,know how' and resourcefulness, rather than relying on preceptor support that, unfortunately, cannot be always guaranteed. [source]

Nursing-Sensitive Outcome Implementation and Reliability Testing in a Tertiary Care Setting

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003
Julia G. Behrenbeck
PURPOSE To describe the NOC outcomes most relevant for specialty nursing practice and in selected field sites representing the continuum of care; to assess the adequacy of measures (reliability, validity, sensitivity, specificity, practicality); and to describe the linkages among nursing diagnoses, interventions, and outcomes in clinical decision making. METHODS Data were collected on 434 patients during the 12-month data collection period at a tertiary care center: cardiac surgery intensive care (n= 76), cardiac transplant unit (n= 153), and medical unit (n= 205). Medical diagnoses of patients on the two cardiac units were related to cardiac disease. Medical diagnoses of patients on the medical unit were extremely varied (ranging from e.g., gout to pneumonia). Data were collected on 65 separate outcome labels for a total of 633 ratings. FINDINGS In the cardiac transplant ICU, data were collected on 42 outcomes: 30 had an average interrater reliability of ,85%, and 16 had an absolute agreement interrater reliability of ,85%. In the cardiac surgery ICU, data were collected on 30 outcomes: 25 had an average interrater reliabilty of ,85%, 6 had an absolute agreement interrater of ,85%. In the medical unit, data were collected on 45 outcomes: 41 had an average interrater reliability of ,85%, 14 had an absolute agreement interrater reliability of ,85%. Four outcomes have been implemented into the documentation system for all patients: Tissue Integrity: Skin and Mucous Membranes, Mobility Level, Knowledge: Disease Process, and Coping. CONCLUSIONS Overall, nursing staff were very positive about having the opportunity to participate in nursing research. Staff were able to think about the relative status of their patient and how nursing care contributes to the patient's recovery. They appreciated the opportunity to discuss this with a colleague during the interrater exercise. Increased familiarity with NOC allows staff members to determine which outcomes comprise core nursing-sensitive outcomes for their clinical setting. [source]

Incontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation units

INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2009
Geraldine McCarthy MSc
Background., Bladder and bowel incontinence is a major health care problem, which adversely affects the lives of many individuals living at home or in health service facilities. Current approaches to continence care emphasize comfort, safety and reduction of risk, rather than detailed individualized assessment and management. The literature illustrates a gap between evidence and actual practice and emphasizes the context of care as being a key element for successful implementation of evidence based practice. Aims., To identify prevalence of bowel and bladder incontinence and its management, investigate continence knowledge and describe the professional practice environment within a rehabilitation unit for older people. Method., An integrated evaluation of continence prevalence, staff knowledge and the work environment was adopted. Results., Findings revealed a high incidence of incontinence (60% urinary, 3% faecal, 37% mixed) a lack of specific continence assessment and specific rationale for treatment decisions or continuation of care. The focus was on continence containment rather than on proactive management. Staff demonstrated a reasonable knowledge of incontinence causation and treatment as measured by the staff knowledge audit. The evaluation of the work environment indicated a low to moderate perception of control over practice (2.39), autonomy in practice (2.87), nurse doctor relationship (2.67) and organizational support (2.67). [source]

Pharmacy support staff involvement in, and attitudes towards, pharmacy-based services for drug misusers

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 6 2009
Jenny Scott
Abstract Objective This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training. Methods The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants. Key findings Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services. Conclusions Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange. [source]

Room for improvement: nurses' and physicians' views of a post-operative pain management program

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010
C. S. HARTOG
Background: The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. Methods: A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. Results: Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08±1.27 standard deviation), but the success of pain management on the ward was rated as 7.32±1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85±1.82; nurses consistently rated levels higher than physicians. Staff over- or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy. Conclusion: Despite staff's high personal priority and well-established APS and pain management program, post-operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches. [source]

Low level laser therapy for healing acute and chronic wounds , the extendicare experience

INTERNATIONAL WOUND JOURNAL, Issue 2 2008
Anita E Saltmarche
Abstract The purpose of the study is to assess the effectiveness of low level laser therapy for wound healing when combined with the Extendicare Wound Prevention and Management Program. Sixteen residents at a Canadian Extendicare nursing home had a total of 27 sites treated consisting of 23 open wounds and 4 ,at risk' areas. Of the 23 open wounds, two wounds in between toes were not able to be ,traced' and deemed ,immeasurable' wounds, resulting in 21 open, measured wounds. The four ,at risk' (closed) areas were treated preventatively. Pressure, venous insufficiency and diabetic wounds were included. The majority (12/21) or 57·1%, of the wounds were chronic (,3 months duration) and 42·9% were acute (<3 months duration). The primary outcome measures included the PUSH Tool score, EZ GraphTM tracings and photographs. Secondary outcome measures were employed to better understand potential barriers to successful integration into clinical practice. Feedback on the effectiveness of low level laser therapy, the education program and determinations of hands-on relevance was sought from staff. At the end of the 9-week trial, the majority (61·9%) of the 21 wounds achieved significant improvement (,50% wound closure). Nine (42·8%) had 100% closure. Some improvement was seen in 14·3% and 23·8% of wounds demonstrated no change. Chronic and acute wounds had similar improvement. None of the wounds in this debilitated, frail population deteriorated during the study and no negative consequences of treatment were encountered. Without staff support, even if new technology has positive clinical outcomes, success would be limited. Staff rated low level laser, easy to learn and use, effective for the majority of their residents worth the additional time. Staff requested a continuation of low level laser even after study completion. [source]

The Effects of Staffing on In-Bed Times of Nursing Home Residents

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004
Barbara M. Bates-Jensen PhD, CWOCN
Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents. Design: Descriptive, cross-sectional study. Setting: Thirty-four southern California NHs. Participants: A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test. Measurements: Cross-sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests. Results: In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001). Conclusion: In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in-bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in-bed time should be considered, and further research should seek to inform the development of such recommendations. [source]

The Minimum Data Set Weight-Loss Quality Indicator: Does It Reflect Differences in Care Processes Related to Weight Loss?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2003
Sandra F. Simmons PhD
Objectives: To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss. Design: Cross-sectional. Setting: Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile,low prevalence) quartile and five NHs in the upper (75th percentile,high prevalence) quartile on the MDS weight-loss quality indicator. Participants: Four hundred long-term residents. Measurements: Sixteen care processes related to weight loss were defined and operationalized into clinical indicators. Trained research staff conducted measurement of NH staff implementation of each care process during assessments on three consecutive 12-hour days (7 a.m. to 7 p.m.), which included direct observations during meals, resident interviews, and medical record abstraction using standardized protocols. Results: The prevalence of weight loss was significantly higher in the participants in the upper quartile NHs than in participants in the lower quartile NHs based on MDS and monthly weight data documented in the medical record. NHs with a higher prevalence of weight loss had a sig-nificantly larger proportion of residents with risk factors for weight loss, namely low oral food and fluid intake. There were few significant differences on care process measures between low- and high-weight-loss NHs. Staff in low-weight-loss NHs consistently provided verbal prompting and social interaction during meals to a greater proportion of residents, including those most at risk for weight loss. Conclusion: The MDS weight-loss quality indicator reflects differences in the prevalence of weight loss between NHs. NHs with a lower prevalence of weight loss have fewer residents at risk for weight loss and staff who provide verbal prompting and social interaction to more residents during meals, but the adequacy and quality of feeding assistance care needs improvement in all NHs. [source]

Active Support, Participation and Depression

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2010
Roger J. Stancliffe
Background, Staff training in Active Support is designed to enable direct support staff to increase the engagement and participation of people with intellectual disabilities in a range of daily activities. Method, Residents (n = 41) and staff of nine group homes participated. The effectiveness of Active Support was evaluated with a pre-test:post-test design, using a number of standardized assessments and other questionnaires, with group home staff as informants. These assessments were conducted before Active Support training and an average of 6.5 months later. Results, Following implementation of Active Support residents experienced significant increases in domestic participation and adaptive behaviour. There were significant decreases in internalized challenging behaviour, overall challenging behaviour and depression. There was no significant pre,post change in other forms of challenging behaviour. Conclusions, Our findings confirm and extend previous Active Support research showing that implementation of Active Support is followed by increased resident participation in activities. The significant improvements in adaptive behaviour, challenging behaviour and depression are of particular interest as the present study is among the first to report such effects. The study's limitations are discussed. [source]

Staff Morale in Day Care Centres for Adults with Intellectual Disabilities

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2007
Katerina Mascha
Background, Levels of burnout, job satisfaction and intended turnover of staff working in day care centres for adults with intellectual disabilities are investigated in relation to role clarity, staff support and supervision, and coping strategies used by staff. Materials and methods, Thirty six direct-care staff of four day care centres in the UK were administered the Maslach Burnout Inventory, The Staff Support Questionnaire (SSQ), and The Shortened Ways of Coping (Revised) Questionnaire (SWC-R). Results, Although staff reported high levels of job satisfaction, they experienced moderate degrees of emotional exhaustion and personal accomplishment and reported a high propensity to leave the service. Factors identified as relating to staff morale were staff support and supervision, role clarity, wishful thinking, staff cooperation, and other practical issues regarding the day-to-day running of the service. Conclusions, Staff in day care services for people with intellectual disabilities experience similar stressors to those experienced by staff in residential facilities with the informal culture of the service being of most importance to staff morale. Suggestions for the enhancement of staff morale are provided. [source]

A Communication Training Programme for Residential Staff Working with Adults with Challenging Behaviour: Pilot Data on Intervention Effects

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 1 2007
Andy Smidt
Background, Challenging behaviour often serves a communicative function. It therefore stands to reason that the residential staff working in developmental disability services require training to foster appropriate communicative interactions with adults with challenging behaviour. Method, Eighteen members of staff working in three residential services participated in a 4 week communication training programme. The programme focused on staff attitudes to and beliefs about challenging behaviour, communicative interactions between staff and residents and working as a team. Objective measurements were made of the effects of the training programme on staff use of augmentative and alternative communication, praise and use of inappropriate language in a multiple-baseline design across three organizations. Changes in the rate of challenging behaviours among the residents were also evaluated. Results, As staff's use of AAC and praise increased, and inappropriate language decreased, there was some concomitant decrease in residents' levels of challenging behaviour; however, these results were not sustained in the long-term. Conclusion, This pilot data suggest that an approach to staff training based on modifying attitudes and beliefs is potentially beneficial to both staff and residents. [source]

Staff who Work with People who have Intellectual Disabilities: The Importance of Personality

JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2003
John Rose
Background, Previous research into stress in staff who work with people with intellectual disabilities has concentrated on the organizational determinants of stress and has tended to overlook the relative contribution of individual differences. A model was proposed to describe possible relationships between work-based stressors, staff support, personality, coping strategy and psychological outcome. Methods, A survey methodology was used with care staff in community-based homes for people with intellectual disability. Results, Analysis of the model explored how these variables might affect one another in their relationship to psychological outcomes. The most significant findings of this research was the direct effects found between personality (neuroticism), coping style (wishful thinking) and stress. A significant interaction was also observed between job demands and neuroticism. Conclusions, These research findings highlight the importance of personality factors in determining stress levels in staff and suggest several possible intervention strategies. One intervention point may be to teach self-management techniques to help some staff cope with periods of high demand, particularly those reporting high levels of neuroticism. [source]

Seclusion and Restraint of Children: A Literature Review

JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 4 2000
John Julian Allen BSN
TOPIC. Nurses' attitudes toward the use of seclusion and restraint with children. PURPOSE. To review recent literature concerning these controversial interventions, and to examine possible alternative therapeutic interventions. SOURCES. Selected published nursing and psychiatric literature 1987 to 1998. CONCLUSIONS. Staff have a positive attitude toward the use of seclusion and restraint. A theory of pozoer and control may explain their use when many alternative, less restrictive interventions are available. [source]

Zero tolerance of abuse of people with intellectual disabilities: implications for nursing

JOURNAL OF CLINICAL NURSING, Issue 22 2008
Robert Jenkins
Aims., This paper explores the concept of ,zero tolerance' to abuse in the context of the professional responsibilities of all nurses. The workability of zero tolerance will be considered in light of findings of a study into abuse. Background., Registered nurses are led to believe that zero tolerance of abuse of patients is the only philosophy consistent with protecting the public. However, the approach of zero tolerance is not without its difficulties. Staff, particularly registered nurses, who come into contact with people with intellectual disabilities have a professional responsibility to prevent and report all forms of abuse. Design., This study used a multiphase, multimethod approach (literature review, survey and focus groups). Methods., The results reported here relate to the focus group stage of the study. There were 70 participants in the focus group who worked either as direct care staff with people with intellectual disabilities or as investigators of abuse. Results., Analysis of recurrent themes indicated that both individual (e.g. a positive value base) and systemic factors (e.g. environment) seemed to have an impact on how staff will respond to abuse. Conclusions., This study found that a ,hierarchy of abuse' existed among staff who worked with people with intellectual disabilities. Individual staff members seemed to be ,weighing up' what they perceived as serious abuse before reporting areas of concern. This is in contrast to a philosophy of zero tolerance which registered nurses have to adhere to. Relevance to clinical practice., There needs to be a consistent approach to abuse and nurses need to have appropriate training in which to gain confidence in their role in preventing, identifying and responding to abuse of patients or clients. [source]

Prevalence and associated factors of pneumonia in patients with vegetative state in Taiwan

JOURNAL OF CLINICAL NURSING, Issue 7 2008
Li-Chan Lin PhD
Aims., The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan. Background., Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia. Methods., Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations. Results., The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14·2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91·2%. The mean duration of tube-feeding was 73·21 SD 55·33 months. A total of 90·4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia. Conclusion., Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population. Relevance to clinical practice., Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS. [source]

Nature, extent, and causes of bullying among personality-disordered patients in a high-secure hospital

AGGRESSIVE BEHAVIOR, Issue 3 2004
Jane L. Ireland
Abstract The present study explored the perceptions and experiences of the nature, extent and causes of bullying among personality-disordered patients, with a subsidiary aim of exploring differences in perceptions between staff and patients. The sample was selected from the Personality Disorder Unit of a high secure hospital. The total sample consisted of 60 participants, 30 patients and 30 staff. Participants engaged in a semi-structured interview based on that developed by Brookes [1993] and modified by Ireland and Archer [1996] and Ireland [2002a]. The interview assessed their perceptions and experiences of patient-to-patient bullying. One fifth of patients and staff reported that they had seen a patient being bullied in the previous week. One-fifth of patients reported that they had been bullied in the previous week and less than one tenth reported that they had bullied others. The most frequent types of bullying reported were theft-related, verbal abuse, being made to do chores, physical assaults and intimidation. One fifth of the sample reported that sexual abuse took place. Victims were generally perceived to be ,easy targets' that were vulnerable, either physically or emotionally. Staff identified a wider range of victim types than patients. The results highlight how patient-to-patient bullying does occur and is an important issue worthy of further research. A number of similarities were found between the current findings and those of prison-based research suggesting that both hospitals and prisons share a number of environmental similarities that help to explain why bullying takes placed in secure forensic settings. Aggr. Behav. 30:229,242, 2004. © 2004 Wiley-Liss, Inc. [source]

Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

AGGRESSIVE BEHAVIOR, Issue 1 2003
Julie Cunningham
Abstract The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff-reported injury prediction that could be obtained from the staff-completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self-injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff-reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal-directed activities in human aggression. Aggr. Behav. 29:31,40, 2003. © 2003 Wiley-Liss, Inc. [source]

Incident Command System as a Response Model Within Emergency Operation Centers during Hurricane Rita

JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 3 2008
Leslie D. Lutz
This study examines the degree to which the use of the Incident Command System (ICS) influenced the performance of Texas emergency operations centers (EOCs) during Hurricane Rita. Staff in evacuation, transition, and host county EOCs completed a questionnaire that assessed demographic variables, EOC physical environment, ICS experience, ICS implementation, and team climate. The results indicated that the duties each ICS section performed varied substantially from one EOC to another. Moreover, ICS experience and ICS implementation lacked statistically significant correlations with team climate, even though EOCs' physical environments did. Finally, staff from emergency relevant agencies (e.g., public works and social services) seemed to have more problems with ICS than did staff from emergency mission agencies (e.g., fire and police departments). Thus, there needs to be further study of ICS application in emergencies other than structural and wildland fires, as well as the development of new ICS training materials for emergency relevant agencies to supplement the current ICS training materials for emergency mission agencies. [source]

The role of support staff in promoting the social inclusion of persons with an intellectual disability

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 8 2010
R. McConkey
Abstract Background Past studies have found that people supported in more individualised housing options tend to have levels of community participation and wider social networks than those in other accommodation options. Yet, the contribution of support staff in facilitating social inclusion has received relatively scant attention. Methods In all 245 staff working in either supported living schemes, or shared residential and group homes, or in day centres completed a written questionnaire in which they rated in terms of priority to their job, 16 tasks that were supportive of social inclusion and a further 16 tasks that related to the care of the person they supported. In addition staff identified those tasks that they considered were not appropriate to their job. Results Across all three service settings, staff rated more care tasks as having higher priority than they did the social inclusion tasks. However, staff in supported living schemes rated more social inclusion tasks as having high priority than did staff in the other two service settings. Equally the staff who were most inclined to rate social inclusion tasks as not being applicable to their job were those working day centres; female rather than male staff, those in front-line staff rather than senior staff, and those in part-time or relief positions rather than full-time posts. However, within each service settings, there were wide variations in how staff rated the social inclusion tasks. Conclusions Staff working in more individualised support arrangements tend to give greater priority to promoting social inclusion although this can vary widely both across and within staff teams. Nonetheless, staff gave greater priority to care tasks especially in congregated service settings. Service managers may need to give more emphasis to social inclusion tasks and provide the leadership, training and resources to facilitate support staff to re-assess their priorities. [source]

Characteristics and experiences of children and young people with severe intellectual disabilities and challenging behaviour attending 52-week residential special schools

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2007
N. Pilling
Abstract Background This study sought to gather information about the characteristics and experiences of children and young people with severe intellectual disabilities and severe challenging behaviour attending 52-week residential special schools. Method Staff of nine schools completed postal questionnaires on the characteristics and experiences of 156 pupils. Results Those attending residential schools are predominantly male, teenagers and in long-term placements. Most have limited communication skills and autistic spectrum disorders. All display high numbers of challenging behaviours, many of them serious. Children have a greater range and complexity of needs than pupils at day severe learning difficulties (SLD) schools, albeit with some overlap. Conclusions Children at 52-week residential schools present needs that both families and local services struggle to meet. Residential placement may provide the intensity of educational input and social support that is required, but may increase the vulnerability of the children. Local alternatives to residential schools should be investigated. [source]

Staff in services for people with intellectual disabilities: the impact of stress on attributions of challenging behaviour

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2005
D. Rose
Abstract Background There is a lack of a conceptual framework as to how stress and attribution variables interact and influence staff behaviour in response to challenging behaviour. To address this, a model is tested examining the impact of stress on attributions of challenging behaviour within Weiner's model of helping. Method A total of 107 staff working in community homes for people with intellectual disabilities completed a self-report questionnaire that measured stress, burnout, attributions, emotions, optimism and helping behaviour in response to challenging behaviour. Results Partial support was found for the role of attributions and emotions. However, although staff reported high stress levels and moderate burnout, this did not appear to relate to their reporting of thoughts and feelings regarding challenging behaviour predicted by Weiner's helping model. It was not possible to fully test the helping model, as the ,help' variable was not normally distributed. Conclusions There was little evidence to suggest that stress has a primary role in determining staff responses when examined within Weiner's model of helping. Limited support in general was offered for Weiner's helping model. Potential conceptual difficulties and clinical implications are explored and alternative models for future research are discussed. [source]