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.