Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Despite demonstrations of the utility and cost effectiveness of behavioral programming, such techniques are not commonly employed in psychiatric inpatient settings. Several explanations for this have been proposed, including inadequate levels of training and competence in behavioral programming among prevalent treatment staff. This study employed a multiple choice inventory to assess behavioral knowledge among subjects representing several direct care disciplines commonly found in inpatient psychiatric settings. The results support assertions of relatively low levels of behavioral knowledge among disciplines that are most prevalent in such settings. The implications of these results for initiatives to enhance behavioral knowledge and skills are discussed.     

Friendship closeness inventory: development and psychometric evaluation

This study developed a psychometrically sound measure of closeness in Australian men's (n = 59) and women's (n = 77) same-sex friendships, the Friendship Closeness Inventory. Subscales were developed to measure both masculine and feminine styles of closeness in three domains of Emotional Closeness, Behavioural Closeness, and Cognitive Closeness. The inventory was subjected to reliability checks which supported the reliability of each scale, and factor analyses which supported the 3-factor design. Correlations among ratings on subscales suggested that the affective, behavioural, and cognitive dimensions are distinguishable but related components of friendship. Group comparisons indicated that women rated themselves closer to their same-sex friends on the affective dimension than men. Researchers have suggested that sex-role socialisation may partly account for sex differences in self-ratings of emotional expressiveness in friendships. There were no significant differences between men's and women's ratings on the behavioural and cognitive aspects of friendships. The cognitive element may need further exploration in further scale development as it measures only one aspect of cognitive closeness: the perceived influence of friends. Pending further validation, the inventory appears potentially useful for research exploring affective, behavioural, and cognitive elements of young men's and women's friendships.     

Observations on the behaviour of patients in a state mental hospital and a general hospital psychiatric unit: A comparative study

The study sought to compare the naturally occurring behaviour of psychiatric patients within a traditional mental hospital ward and a general hospital psychiatric unit. Direct behavioural observations were undertaken to determine the pattern of behaviour exhibited by patients, the amount of time spent in interaction, with whom interaction took place and the content of that interaction. Data were reliably collected by trained observers, using a 10 category behaviour scale. Within each setting 10 psychotic patients, matched for age, sex and diagnosis, were the subjects and 30 min of behaviour was recorded for each subject. Observations revealed that patients in the mental hospital exhibited more disturbed behaviour, and spent less time in interaction, than did those in the general hospital unit. However, the amount of time patients spent interacting with staff was comparable in the two settings, despite marked differences in staffing levels. Analysis of the content of interaction that did occur indicated that the manner in which staff responded to patients' behaviour was not consistent with the application of a behavioural engineering approach to the modification of abnormal behaviour. While staff in both settings were indiscriminate in the way in which they responded to appropriate and inappropriate patient behaviour, a rather more punitive style of interaction was observed in the mental hospital environment. It is concluded that, from a behavioural perspective, neither setting achieved an optimum therapeutic environment.     

AIDS knowledge among black drug users: an issue of reliability

This study examined the reliability of an inventory measuring AIDS-related knowledge among 553 black drug users. Data were collected from a socially high-risk community in Birmingham, Alabama. The KR-20 reliability scores were computed from the inventory for each drug-use group. The KR-20 reliabilities ranged from .39 to .57. These findings may suggest that the inconsistent reports of the predictive power of AIDS knowledge among drug users reported in previous studies might be related to the low internal consistencies of the inventory.     

Behavioural analysis of ward rounds within a general hospital psychiatric unit.

A naturalistic observational procedure was used to examine the content of staff verbal interaction during the ward rounds of two inpatient teams in a general hospital psychiatric unit. Observers reliably rated staff discussion of 10 neurotic and 10 psychotic inpatients, using a nine category behavioural scale. The major focus of this scale was the extent to which three broad orientations, viz the medical, psychotherapeutic and sociotherapeutic models, were utilized by the staff. It was found that an eclectic approach was used by staff in their discussion of patients' aetiology, treatment and prognosis. However, the medical model was primarily utilized to formulate patient care, with the sociotherapeutic approach being employed for approximately one-third of the time. The psychotherapeutic orientation was only used 2.9% of the total time that patients were discussed. This pattern of use of the three orientations was consistent across the psychotic and neurotic patient groups. The behavioural data were found to be at variance with the degree to which staff believed the models should be applied. Analysis of the amount of time during which each professional group spoke in the ward rounds, and the rate at which they were found to make denned ‘authority statements’, indicated that a hierarchical model of management operated in the unit. These findings are related to the concept of shared power and responsibility within the therapeutic team.     

Job and educational level of company managers: their relations with job satisfaction

In a previously published study, we used a Satisfaction Inventory to measure the job satisfaction of managerial staff (the Inventaire de Satisfaction Appliqué aux Cadres , ISAC). The method of construction and certain metric qualities of the inventory were explained (Frances, 1983).     

The Vocational Rehabilitation Counselor on Mental Patient Treatment Teams

This study asked the question: What are the role expectancies of treatment personnel in the treatment community and are they consistent across patients' emotional condition? An 83-item inventory was developed and administered under three different sets of instructions, each characterizing a different patient condition. Treatment staff and administrators were asked to rate items on the basis of the level of expectancy they held for their team vocational rehabilitation counselor. The analyses suggest that treatment staff and counselors do not agree on role expectations and that patient condition is a significant mediating variable.     

Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

Effectiveness and Effects of Promotion Strategies for Behaviour Change: Solar Water Disinfection in Zimbabwe

Solar water disinfection (SODIS) is a sustainable method of water treatment. Despite the simplicity and many advantages of SODIS, past behaviour change campaigns have seen limited success. This study aims to compare intervention strategies in their efficiency in changing behaviour and to analyse which behavioural factors are differentially affected. The following factors were analysed in this study: intention, subjective norm, behavioural control, beliefs, habits, frequency of talking, knowledge and tension. The promotion strategies used in this intervention study were promoters, a pass‐on task, prompts, public commitment and disseminating knowledge with inducing tension. Inhabitants of high‐density areas near Harare, Zimbabwe, were interviewed at different points in time. High SODIS consumption was achieved when the promoter intervention was followed by a memory‐aiding technique such as prompts or public commitment. Consequently, this combined‐intervention strategy increased all behavioural factors and kept them at a high level. A continued pass‐on task alone did not change behaviour and had decreasing effects on several behavioural factors. When the pass‐on task was combined with disseminating knowledge with inducing tension, high SODIS water consumption was also reached, but several behavioural factors stayed at a low level. More effective intervention strategies are identified and discussed.     

Androgens and aggression in man: A controlled case study

A controlled case study is reported of the behavioural effects of androgen treatment in an institutionalised hypogonadal mentally retarded male patient. This man was previously treated with intramuscular depot injections of testosterone esters; however, treatment had to be stopped as the androgens allegedly precipitated frequent bouts of violent behaviour. Using ratings of behaviour by hostel staff, replacement therapy was restarted using the new orally effective androgen, testosterone undecanoate (TU). Gradually increasing the replacement dose of TU in a double-blind fashion resulted in no stimulatory effect on aggressive behaviour. Possible reasons for the differential behavioural response to the two androgen preparations are presented.     

New branches on the Tree of Knowledge. Challenges for systemic family therapists

Faced with today's challenges, I question whether the framework for family therapy provided by systemic thinking is sufficient when working with children and teenagers. The aim of this paper is not to argue for an eclectic model for therapy, but rather to encourage a critical dialogue between various bodies of knowledge. The paper raises the discussion of how family therapists relate to knowledge external to the therapy field. Contemporary developmental psychology, neurobiology, behavioural genetics and group socialization theory are highlighted as useful bodies of knowledge for family therapists. Examples from clinical practice are used to illustrate this.     

Counselling and the schizophrenias

Schizophrenia is the collective name given to allied psychiatric disorders each of which has received a number of different professional interpretations. A primary counselling task is to help staff resolve conflicts over treatment, and give them support during their care of patients. Counselling patients and families, particularly through opportunities provided by self-help groups, is also discussed. The specialised work of genetic, psychoanalytical and behavioural counselling is considered, and stress is laid on the importance of counselling the adolescent schizophrenic for whom early help is vital to prevent deterioration. The article focuses on those areas where marriage guidance counsellors, social workers and probation officers are most likely to be consulted.     

What the eyes already ‘know’: using eye movement measurement to tap into children's implicit numerical magnitude representations

To date, a number of studies have demonstrated the existence of mismatches between children's implicit and explicit knowledge at certain points in development that become manifest by their gestures and gaze orientation in different problem solving contexts. Stimulated by this research, we used eye movement measurement to investigate the development of basic knowledge about numerical magnitude in primary school children. Sixty‐six children from grades one to three (i.e. 6–9 years) were presented with two parallel versions of a number line estimation task of which one was restricted to behavioural measures, whereas the other included the recording of eye movement data. The results of the eye movement experiment indicate a quantitative increase as well as a qualitative change in children's implicit knowledge about numerical magnitudes in this age group that precedes the overt, that is, behavioural, demonstration of explicit numerical knowledge. The finding that children's eye movements reveal substantially more about the presence of implicit precursors of later explicit knowledge in the numerical domain than classical approaches suggests further exploration of eye movement measurement as a potential early assessment tool of individual achievement levels in numerical processing. Copyright © 2009 John Wiley & Sons, Ltd.     

An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.     

Contributions of the EPN paradigm to HIV prevention: A preliminary study

This study examined the relation between HIV knowledge, behavioural change and Eysenckian personality variables. Neuroticism and Lie Scale correlated negatively with HIV disease knowledge in a general population that had not received HIV disease education. Among those who had received HIV education, Psychoticism, Extraversion and Neuroticism all correlated with unsafe sexual behaviour. Implications of this study for HIV education and for prevention are discussed.     

Human behaviour in severe tunnel accidents: Effects of information and behavioural training

Immediate user self-evacuation is crucial in case of fire in road tunnels. This study investigated the effects of information with or without additional virtual reality (VR) behavioural training on self-evacuation during a simulated emergency situation in a road tunnel. Forty-three participants were randomly assigned to three groups with accumulating preventive training: The control group only filled in questionnaires, the informed group additionally read an information brochure on tunnel safety, and the VR training group received an additional behavioural training in a VR tunnel scenario. One week later, during the test session, all participants conducted a drive through a real road tunnel in which they were confronted with a collision of two vehicles and intense smoke. The informed and the behaviourally trained participants evacuated themselves more reliably from the tunnel than participants of the control group. Trained participants showed better and faster behavioural responses than informed only participants. Interestingly, the few participants in the control group who reacted adequately to the scenario were all female. A 1 year follow-up online questionnaire showed a decrease of safety knowledge, but still the trained group had somewhat more safety relevant knowledge than the two other groups. Information and especially VR behavioural training both seem promising to foster adequate self-evacuation during crisis situations in tunnels, although long term beneficial behavioural effects have to be demonstrated. Measures aiming to improve users’ behaviour should take individual difference such as gender into account.     

Is knowledge of family history related to psychosocial functioning? Comparison of adolescents living in institutional care and adolescents living with their biological families

We tested adolescents growing up in institutional care and adolescents living with their birth families using the ‘Do you know?’ scale and other measures of psychosocial functioning. We found that children living in group homes knew significantly less of their family history, exhibited more behavioural problems and had a more external locus of control. Moreover, the correlations between self-esteem and knowledge of family history were significantly different between the groups. This may suggest that the contribution of the knowledge of family history to self-esteem is different depending on the quality of family history. We also found a significant correlation between locus of control and behavioural problems for the children in institutional care, but not children living with their birth families, which may indicate that their behavioural problems may partially stem from the sense of lack of control over their lives.     

“Sharing in people's pain is not an easy thing to do”: Cognitive Behavioural Therapists' understandings of compassion in the workplace

Objectives

Compassion is central to the aim of improving patient care and staff well-being within healthcare systems. To inform service development, explorations of experiences and meanings of compassion are needed. This study explored cognitive behavioural therapists ' understandings of compassion within their work environment.

Design

A qualitative study was conducted using semistructured interviews and interpretative phenomenological analysis (IPA).

Methods

Data were obtained from five practicing cognitive behavioural therapists.

Results

Two superordinate themes were developed, each with two subordinate themes. CBT therapists reported entering the profession with intrinsic motivation to care for others. They further developed an interest in compassion with exposure to clients and ongoing professional development in compassion-focused therapy (CFT). Compassionate work environments helped to facilitate compassionate practice; however, for many, workplaces were perceived to lack compassion. Challenges were encountered when negative workplace interactions left therapists feeling fatigued, distressed and demoralised. There was a desire for recognition and to be seen as more than a “work machine,” the experience of which was a threat to retaining therapists within the profession.

Conclusions

Current recruitment and training processes are producing staff with skills and motivation to deliver compassionate care. However, lack of compassion within workplaces can be a barrier to actioning these skills and motivations. Research needs to focus on how to effectively implement and run systems that are compassionate for both staff and clients. To provide compassionate care, staff need work environments that show compassion to them. These findings provide some insights into and practical suggestions regarding how this can be achieved.     

Knowledge of drug-related health problems among injecting drug users: Implications for the transmission of HIV infection

Abstract

In a project that investigated the HIV-related risk behaviour of injecting drug users, respondents were categorized along dimensions of expertness in HIV/AIDS knowledge and knowledge about drug-related health problems. Knowledge about drug-related health problems was found to be significantly associated with sharing. Better informed respondents were less likely to share injecting equipment and to predict they would share in future. They were more likely to adopt consistent injecting hygiene, seek information about AIDS, and perceive themselves as in control of their lives. No significant relationships were observed between sharing and HIV/AIDS knowledge. The data have relevance for AIDS educational strategies, since knowledge about AIDS and HIV transmission appears to be insufficient to induce behavioural change. Greater emphasis on the health problems that afflict most injectors may be a way of encouraging general harm minimization.