Quality of care for people with mental handicap and challenging behaviour : an investigation of the impact of staff training in goal attainment scaling and behavioural procedures
Abstract
This study examined the contribution to quality of care
of a goal planning technique called Goal Attainment
Scaling and its impact upon the quality of life of people
with severe mental handicaps and challenging behaviour.
The study also seeks to establish the utility of
employing Goal Attainment Scaling as a means of
evaluating clinical nursing performance,
This study essentially aims to bring about changes in the
care practices of nurses using a comprehensive staff
management procedure. The study was designed as a four
phase intervention using a multiple baseline design
across three wards in a hospital for people with mental
handicaps. Staff on three wards (n = 41) were initially
trained over three phases in the use of Goal Attainment
Scaling and other procedures. Training was carried out by
a combination of workshops and individual tuition which
incorporated the use of individualised learning contracts
for staff. The fourth phase consisted of establishing
weekly meetings to set objectives for staff to achieve
that were specifically related to material covered in
training. If targets were achieved, staff performance was
followed by letters of recognition from managers and by
financial donations to ward funds.
Dependent measures included frequency of challenging
behaviour, quality of staff-resident interaction and
engagement, ward activity, residents' adaptive behaviour,
staff attitudes and goals set by staff. Results indicate
that adaptive behaviour increased by small but
statistically significant levels. Levels of challenging
display a mixed pattern of results, as do levels of ward
activity and quality of interaction, although encouraging
trends may be identified. Despite some increases,
residents still spend significant amounts of time
unoccupied. The number of goals set increased throughout
the study, particularly in phase four, data for staff
attitudes were not used because of the low compliance
rate and changes indicated below.
Considerable problems were encountered with turnover of
staff and other organisational changes outwith the
researcher's control which compromised both the quality
of training given to staff and, by virtue of this, the
final results. Statistically significant relationships
were found to exist between staff turnover and
interaction.
The implications of this study are discussed and
recommendations made for future research.
Type
Thesis, PhD Doctor of Philosophy
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