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PubMed2003

Staff reactions to self-injurious behaviours in learning disability services: attributions, emotional responses and helping.

OBJECTIVES: The aim of the study was to explore an amended version of Weiner's (e.g. Weiner, 1980) helping behaviour model potentially more specific to the context of care staff working with people with learning disabilities and challenging behaviours. DESIGN: Key elements of the helping model (causal attributions, affective responses, and helping behaviour) were assessed using self-report questionnaires. In contrast to previous research, helping behaviour was conceptualized as behaviour more or less likely to reinforce challenging behaviours rather than as willingness to expend extra effort in helping. Furthermore, dimensions of positive and negative affect associated with challenging behaviour were used. METHOD: A total of 123 care staff in adult services viewed one of two videos depicting a person with learning disabilities engaging in self-injurious behaviour. Information about the behaviour's function was manipulated in order to assess reinforcing staff helping responses. Staff completed self-report scales immediately after viewing the video material. RESULTS: There was very little evidence for the predicted associations between causal attributions and both positive and negative affect, and only one significant association between affect and reinforcing helping responses. Given this lack of association, we did not fully test Weiner's prediction that affect would mediate the impact of causal attributions on helping. CONCLUSIONS: We found no evidence that Weiner's helping model can be amended to account for staff working with challenging behaviour. Close examination of previous studies also reveals very few supportive data of Weiner's original formulation. Therefore, we discuss the potential utility of alternative models in addition to methodological and conceptual issues.

Adult↗
PubMed2005

Accident and emergency staff's perceptions of deliberate self-harm: attributions, emotions and willingness to help.

OBJECTIVES: The study applied Weiner's (1980, 1986) attributional model of helping behaviour to Accident and Emergency (A&E) staff's care of patients presenting with deliberate self-harm. It was hypothesized that where staff attributed precipitants of the act of deliberate self-harm to controllable, internal, and stable patient factors, then staff would display greater negative affect, less optimism, and less willingness to help the patient. DESIGN: Using four hypothetical scenarios in a two-factor between-subjects design, contextual factors describing a self-harm patient were manipulated. METHOD: Participants were 89 A&E medical and nursing staff. They were asked to rate attributions for the cause of the deliberate self-harm and their emotional responses, optimism for change, and willingness to help change the behaviour. Their general attitudes towards deliberate self-harm patients and perceived needs for training in the care of these patients were also assessed. RESULTS: The findings were consistent with Weiner's attributional model of helping. The greater attributions of controllability, the greater the negative affect of staff towards the person, and the less the propensity to help. The higher the ratings of stability of outcome, the less staff optimism for the success of their input. Male staff and medical staff had more negative attitudes, and medical staff saw less need for further training. CONCLUSION: Formulating A&E staff's responses to deliberate self-harm using a cognitive-emotional model offers the possibility of working with staffs' beliefs, emotions, and behaviour to improve the care and treatment of deliberate self-harm patients.

Adult↗
PubMed2004

Role and essential competencies of the frontline supervisors of direct support professionals in community services.

Although frontline supervisors are responsible for on-site management, supervision, and training of direct support professionals, research on the nature, content, and skills of the frontline supervisor role is rare. In this paper we describe results of 12 job analysis and three validation focus groups constituted to describe core competencies for supervisors in organizations providing community supports for people with disabilities. The focus groups involved 146 participants, including 97 direct support professionals, 40 frontline supervisors, and 7 managers who supervise frontline supervisors. The focus groups identified 14 competency areas in which frontline supervisors need to be proficient. In each competency area, between 4 and 26 specific competency statements were identified (a total of 142) along with 340 performance indicators.

Adolescent↗
PubMed2000

Helping our students meet the standards through test preparation classes.

Test preparation helps deaf students develop the skills they need to do well on standardized tests, particularly on a reading test format such as that used with the Stanford Achievement Test. The authors share information on how test preparation helps students to develop the skills required to do well on standardized reading tests by examining test-taking strategies and common language structures used in test items and how readers can learn to interpret them. The authors list the common errors made by their students and discuss remedial classes designed to address a range of test-taking and reading skills.

Achievement↗
PubMed1997

Fostering reader response and developing comprehension strategies in deaf and hard of hearing children.

In response to the increasing use of children's trade books in school reading programs, this article reviews the use of real text, drawing on the application and interaction of two distinct perspectives: reader response theory and comprehension instruction. The authors propose the need to combine knowledge of instruction with the new focus on the role of the reader within response theory and within comprehension research. This article suggests how comprehension instruction and response to literature activities can intersect in the classroom for students who are deaf or hard of hearing. Explicit models and instructional strategies are discussed in the framework of this bimodal approach to reading. A sample list of high quality children's books, including several trade books that feature deaf or hard of hearing characters and issues, is provided as a resource for teachers.

Child↗
PubMed2006

Cooperation is fleeting in the world of transposable elements.

Composite transposons are key vehicles for the worldwide spreading of genes that allow bacteria to survive toxic compounds. Composite transposons consist of two smaller transposable elements called insertion sequences (ISs), which flank the genes that permit such survival. Each IS in a composite transposon can either transpose alone, selfishly, or it can transpose cooperatively, jointly with the other IS. Cooperative transposition can enhance an IS's chance of survival, but it also carries the risk of transposon destruction. I use game theory to show that the conditions under which cooperative transposition is an evolutionarily stable strategy (ESS) are not biologically realistic. I then analyze the distribution of thousands of ISs in more than 200 bacterial genomes to test the following prediction of the game-theoretical model: if cooperative transposition was an ESS, then the closely spaced ISs that characterize composite transposons should be more abundant in genomes than expected by chance. The data show that this is not the case. Cooperativity can only be maintained in a transitional, far-from-equilibrium state shortly after a selection pressure first arises. This is the case in the spreading of antibiotic resistance, where we are witnessing a fleeting moment in evolution, a moment in which cooperation among selfish DNA molecules has provided a means of survival. Because such cooperation does not pay in the long run, the vehicles of such survival will eventually disappear again. My analysis demonstrates that game theory can help explain behavioral strategies even for mobile DNA.

Animals↗
PubMed1992

Adapting to waiting lists for coronary revascularization. Do Canadian specialists agree on which patients come first?

STUDY OBJECTIVES: To assess specialists' adaptation to long waiting lists for coronary revascularization, and their acceptance of a formal queue-ordering schema proposed by an expert panel. DESIGN: Mail survey of practitioners in referral centers using 49 hypothetical case scenarios. Scenarios were rated for maximum acceptable delay prior to coronary surgery, on a scale with seven interventional time frames graded from emergency to three to six months' permissible delay. The survey included the proposed schema and rating system; respondents were invited to differ as they saw fit. HYPOTHETICAL PATIENTS: Assumed uniformly to be middle aged with typical angina, but clinical factors varied, eg, severity and stability of angina, response to medical therapy, coronary anatomy, and noninvasive test results. PHYSICIAN SUBJECTS: There were 122 respondents, for a 60 percent response rate, including a majority of cardiac surgeons and invasive cardiologists on staff in Ontario teaching hospitals. MEASUREMENTS AND RESULTS: Fifty-seven percent rated some scenarios for acceptable waiting times of three to six months; another 39 percent rated their least urgent scenarios to wait six weeks to three months. Interpractitioner agreement was high: for 48/49 scenarios, at least 75 percent of urgency ratings fell within two contiguous points on the scale. Symptom status was the dominant determinant of waiting time, with mean maximum acceptable wait of 74 days for patients with mild-moderate stable angina but three days for those receiving parenteral nitroglycerin (p less than 0.00001). About half the ratings matched those predicted based on the original panel's consensus criteria; 90 percent were within one scale point. CONCLUSIONS: Specialist practitioners in Ontario have adapted to waiting lists for coronary artery bypass surgery/percutaneous transluminal coronary angioplasty, and assess the priority of hypothetical patients in similar ways and in reasonable accord with formal queue-ordering criteria. This behavior may help mitigate the impact of resource constraints, allowing delay of services for those with less acute need--a potential contrast to delayed access in America based on low income or lack of insurance.

Attitude of Health Personnel↗
PubMed1978

Aspects of illness behavior in patients with facial pain.

Results of recent studies have suggested that factors other than clinical signs and symptoms have a significant role in determining whether people seek treatment for perceived facial pain and mandibular dysfunction. The concept of "illness behavior" can be used to investigate this problem. Knowledge of a patient's illness behavior patterns helps enable the dentist to understand who seeks care for symptoms of facial pain and mandibular dysfunction; why the care is sought; the meaning of the symptoms to the patient; and the patient's response to treatment.

Adolescent↗
PubMed2004

"I'm not the only one!" group therapy with older children and adolescents who have learning disabilities.

Children and adolescents with learning disabilities (LD) are vulnerable to psychosocial difficulties. Both the detrimental impact of LD on social adjustment and the significance of peer relations for developmental needs make group therapy a natural intervention. Despite modifications that are required due to their cognitive deficits, many students with LD fit the criteria and can benefit from group psychotherapy. In this paper, a model of group therapy for older children and adolescents with LD is presented. The approach is informed by a combination of self psychology, mutual aid, and interpersonal group therapy. The leaders use special techniques to accommodate the LD and to foster the group process. Examples are presented to illustrate the approach.

Adolescent↗
PubMed2006

Care: giving, receiving and meaning in the context of mental illness.

Understanding the dynamics of caregiving is essential to providing effective support to individuals and families living with serious mental illnesses. Yet, research in this area has typically explored caregiving without consulting mentally ill people. This paper adds this overlooked viewpoint by exploring the experience of care relationships by people diagnosed with schizophrenia. A secondary analysis of interview data from 21 individuals reveals that relevant dimensions of care relationships include: providers of care; types of care received; self-care; contested practices in care; negotiating practices; recipients of care; and types of care provided to other people. Addressing care within this broader conceptualization can contribute to developing interventions for individuals and families that more fully recognize the potential for people with mental illnesses to be active participants in care relationships.

Attitude to Health↗
PubMed2001

Recognizing and responding to a suicide crisis.

Data from therapists who were treating 26 patients when they committed suicide were utilized to identify signs that warned of a suicide crisis. Three factors were identified as markers of the suicide crisis: a precipitating event; one or more intense affective states other than depression; and at least one of three behavioral patterns: speech or actions suggesting suicide, deterioration in social or occupational functioning, and increased substance abuse. Problems in communication between patient and therapist were identified as factors interfering with crisis recognition. Evaluation of the identified affects and behaviors may help therapists recognize a suicide crisis.

Adolescent↗
PubMed1997

Two varieties of helping in drunk-driving intervention: personal and situational factors.

OBJECTIVE: This study examined personal characteristics and contextual factors among college students who had made an attempt to prevent someone from driving drunk. The study was guided by findings from prior research and the arousal/cost-benefit model of helping. Both passive and assertive interventions and their efficacy were considered. METHOD: Questionnaire data were obtained from 388 students: 206 (68%) had intervened in a DUI situation (63% women). Self-reports of the person (e.g., moral obligation), the situation (e.g., perceived danger) and the type (passive, assertive) and success of the interventions were gathered. RESULTS: Of all interventions used 73% were successful; the median number of interventions used was three. Of the assertive interventions used in DUI situations 57% were successful compared to 47% of the passive interventions. Path analyses revealed that being older relative to the intervenee and greater sobriety of the intervenor predicted more interventions of both types. Personal commitment to intervention, amount of perceived danger and less alcohol consumption increased assertive interventions, whereas talking with someone about the potential DUI person increased the number of passive interventions. The success of both passive and assertive interventions were dependent upon the number of each of these interventions used. However, the more passive interventions were attempted, the less likely the success of an assertive intervention. CONCLUSIONS: The current findings extend our understanding of the psychosocial factors associated with informal DUI intervention, particularly concerning the choice and success of passive versus assertive interventions. Several of these significant predictors support laboratory research findings on helping and the arousal/cost-benefit model, while others do not.

Adult↗
PubMed2003

College attendance and risk-related driving behavior in a national sample of young adults.

OBJECTIVE: This study examined and sought to explain the relationship between college attendance and indicators of risk-related driving (drinking and driving, seatbelt use) among young adults who participated in the 1999 National Household Survey on Drug Abuse (NHSDA). METHOD: In-home interview data collected from 11,549 18-25 year olds were analyzed to examine the relationship between full- or part-time college status, drinking and driving and seatbelt use. Logistic regression analyses were conducted to determine whether full- or part-time college attendance would be associated with drinking and driving and seatbelt use when adjusting for demographics and age of onset of alcohol use, and whether these relationships would be explained by place of residence (e.g., dormitory), psychosocial factors (e.g., propensity for risk taking, disapproval of driving after drinking) and past-month heavy drinking. RESULTS: The prevalence of drinking and driving in the past year was highest for full-time college students (34.2%), followed by part-time students (32.8%) and other young adults (27.9%). Full-time students were also more likely to report always wearing a seatbelt as a driver (76.1%) or passenger (70.1%) than were part-time students (71.8%, 68.6%) and other young adults (62.7%, 56.7%). These relationships persisted when adjusting for demographic characteristics and age of onset of alcohol use. The higher level of drinking and driving among full-time students was partially explained by psychosocial factors and past-month heavy drinking, but the higher level of drinking and driving among part-time students was not explained by these variables. The higher levels of seatbelt use among full- and part-time college students were also not explained by place of residence, psychosocial factors or heavy drinking. CONCLUSIONS: College students are more likely than other young adults to drink and drive, but are also more likely to wear a seatbelt as a driver or passenger. This pattern of drinking and driving behavior may help to explain similar rates of fatal alcohol-related traffic crashes among college students and other young adults. Additional research is needed to better understand why college students are more likely to drink and drive and wear seatbelts than other young adults in the same age group.

Adult↗
PubMed2004

Helping, spirituality and Alcoholics Anonymous in recovery.

OBJECTIVE: The purpose of this study is to examine how helping activities and spirituality--perhaps key influences on sobriety--change over recovery. The study also explores interrelations among Alcoholics Anonymous (AA), helping and spirituality. METHOD: Questionnaires were administered to recovering alcoholics (118 men, 80 women) recruited at AA and Women for Sobriety meetings, treatment programs and through personal connections. A helping scale measured Recovery Helping (8-item alpha = 0.78), Life Helping (12-item alpha = 0.62), and Community Helping (6-item alpha = 0.60). The Daily Spiritual Experiences scale assessed two components of spirituality identified by factor analysis: Theism and Self-Transcendence. Two components of an AA scale, Involvement and Achievement, were also treated separately on the basis of factor analysis. RESULTS: Structural equation modeling revealed that longer sobriety predicted significantly more time spent on Community Helping, less time spent on Recovery Helping and higher levels of Theism, Self-Transcendence and AA Achievement. Model covariances revealed that both AA components were related to more Recovery Helping and higher Theism. Both spirituality components related to all forms of helping, with one exception. CONCLUSIONS: The findings highlight important changes in helping with length of sobriety. As their sobriety accumulates, recovering alcoholics seem to devote less time to informal helping and more time to organized community projects--perhaps indicating evolving needs and abilities. The results also suggest roles for AA and spirituality in encouraging helping, and they indicate that some forms of spirituality relate to AA affiliation. Future work might establish whether and when helping in different domains contributes to the maintenance of abstinence and to other drinking-related outcomes.

Adult↗
PubMed2005

A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder.

There remain large discrepancies between pediatricians' practice patterns and the American Academy of Pediatrics (AAP) guidelines for the assessment and treatment of children with attention-deficit/hyperactivity disorder (ADHD). Several studies raise additional concerns about access to ADHD treatment for girls, blacks, and poorer individuals. Barriers may occur at multiple levels, including identification and referral by school personnel, parents' help-seeking behavior, diagnosis by the medical provider, treatment decisions, and acceptance of treatment. Such findings confirm the importance of establishing appropriate mechanisms to ensure that children of both genders and all socioeconomic, racial, and ethnic groups receive appropriate assessment and treatment. Publication of the AAP ADHD toolkit provides resources to assist with implementing the ADHD guidelines in clinical practice. These resources address a number of the barriers to office implementation, including unfamiliarity with Diagnostic and Statistical Manual of Mental Disorders criteria, difficulty identifying comorbidities, and inadequate knowledge of effective coding practices. Also crucial to the success of improved processes within clinical practice is community collaboration in care, particularly collaboration with the educational system. Such collaboration addresses other barriers to good care, such as pressures from parents and schools to prescribe stimulants, cultural biases that may prevent schools from assessing children for ADHD or may prevent families from seeking health care, and inconsistencies in recognition and referral among schools in the same system. Collaboration may also create efficiencies in collection of data and school-physician communications, thereby decreasing physicians' non-face-to-face (and thus nonreimbursable) elements of care. This article describes a process used in Guilford County, North Carolina, to develop a consensus among health care providers, educators, and child advocates regarding the assessment and treatment of children with symptoms of ADHD. The outcome, ie, a community protocol followed by school personnel and community physicians for >10 years, ensures communication and collaboration between educators and physicians in the assessment and treatment of children with symptoms of ADHD. This protocol has the potential to increase practice efficiency, improve practice standards for children with ADHD, and enhance identification of children in schools. Perhaps most importantly, the community process through which the protocol was developed and implemented has an educational component that increases the knowledge of school personnel about ADHD and its treatment, increasing the likelihood that referrals will be appropriate and increasing the likelihood that children will benefit from coordination of interventions among school personnel, physicians, and parents. The protocol reflects a consensus of school personnel and community health care providers regarding the following: (1) ideal ADHD assessment and management principles; (2) a common entry point (a team) at schools for children needing assessment because of inattention and classroom behavior problems, whether the problems present first to a medical provider, the behavioral health system, or the school; (3) a protocol followed by the school system, recognizing the schools' resource limitations but meeting the needs of community health care providers for classroom observations, psychoeducational testing, parent and teacher behavior rating scales, and functional assessment; (4) a packet of information about each child who is determined to need medical assessment; (5) a contact person or team at each physician's office to receive the packet from the school and direct it to the appropriate clinician; (6) an assessment process that investigates comorbidities and applies appropriate diagnostic criteria; (7) evidence-based interventions; (8) processes for follow-up monitoring of children after establishment of a treatment plan; (9) roles for central participants (school personnel, physicians, school nurses, and mental health professionals) in assessment, management, and follow-up monitoring of children with attention problems; (10) forms for collecting and exchanging information at every step; (11) processes and key contacts for flow of communication at every step; and (12) a plan for educating school and health care professionals about the new processes. A replication of the community process, initiated in Forsyth County, North Carolina, in 2001, offers insights into the role of the AAP ADHD guidelines in facilitating development of a community consensus protocol. This replication also draws attention to identification and referral barriers at the school level. The following recommendations, drawn from the 2 community processes, describe a role for physicians in the collaborative community care of children with symptoms of ADHD. (1) Achieve consensus with the school system regarding the role of school personnel in collecting data for children with learning and behavior problems; components to consider include (a) vision and hearing screening, (b) school/academic histories, (c) classroom observation by a counselor, (d) parent and teacher behavior rating scales (eg, Vanderbilt, Conner, or Achenbach scales), (e) consideration of speech/language evaluation, (f) screening intelligence testing, (g) screening achievement testing, (h) full intelligence and achievement testing if discrepancies are apparent in abbreviated tests, and (i) trials of classroom interventions. (2) Use pediatric office visits to identify children with academic or behavior problems and symptoms of inattention (history or questionnaire). (3) Refer identified children to the contact person at each child's school, requesting information in accordance with community consensus. (4) Designate a contact person to receive school materials for the practice. (5) Review the packet from the school and incorporate school data into the clinical assessment. (6) Reinforce with the parents and the school the need for multimodal intervention, including academic and study strategies for the classroom and home, in-depth psychologic testing of children whose discrepancies between cognitive level and achievement suggest learning or language disabilities and the need for an individualized educational plan (special education), consideration of the "other health impaired" designation as an alternate route to an individualized educational plan or 504 plan (classroom accommodations), behavior-modification techniques for targeted behavior problems, and medication trials, as indicated. (7) Refer the patient to a mental health professional if the assessment suggests coexisting conditions. (8) Use communication forms to share diagnostic and medication information, recommended interventions, and follow-up plans with the school and the family. (9) Receive requested teacher and parent follow-up reports and make adjustments in therapy as indicated by the child's functioning in targeted areas. (10) Maintain communication with the school and the parents, especially at times of transition (eg, beginning and end of the school year, change of schools, times of family stress, times of change in management, adolescence, and entry into college or the workforce).

Adolescent↗
PubMedDate not supplied

[Nursing care syndrome].

This paper has as a principal goal to describe the 'nursing care syndrome' that appears while nursing care is provided. From the conceptualization of 'nursing care syndrome' besides other aspects, it points out the difference between the latter and the iatrogenicities as well as between the clinical syndromes and the nursing care ones.

Helping Behavior↗