Direct assessment of quality of care in a geriatric nursing home

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Perceived Meeting Effectiveness: The Role of Design Characteristics

Purpose  The aim of this investigation was to test hypotheses about meeting design characteristics (punctuality, chairperson, etc.) in relation to attendees’ perceptions of meeting effectiveness. Design/Methodology/Approach  Two studies were conducted: Study 1 investigated meetings attended in a typical week (N = 958), whereas Study 2 examined the last meeting attended on a particular day (N = 292). Findings   A number of design characteristics (in particular agenda use and quality of facilities) were found to be important in predicting perceived effectiveness. Attendee involvement served as a key mediator variable in the observed relationships. Neither meeting type nor size was found to affect the relationships of the design characteristics and involvement with effectiveness. Meeting size, however, was negatively related to attendee involvement. Implications  The findings help us to better understand relationships between design characteristics and attendees’ perceptions of meeting effectiveness. Meeting organizers can use the findings to guide administration of meetings, with potential to enhance the quality of meetings. Originality/Value   Meetings are a common organizational activity but are rarely the focus of empirical research. The use of two complementary studies, to our knowledge, provides a unique account of the contribution of design characteristics to perceptions of meeting effectiveness. Received and reviewed by former editor, George Neuman.     

Depressed nursing home residents' activity participation and affect as a function of staff engagement

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8 to 45 weeks, 5 minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity; however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.     

Severely disturbed adolescents in community care

The purpose of this research was to study key concepts related to deinstitutionalization and community facilities for emotionally disturbed adolescents. This study was conducted in two phases: In Phase I, a statewide survey was mailed to all licensed group-care providers; in Phase II, field research methods were used to collect data on five small residential facilities, each serving between four and sixteen residents. An average of 35 hours was spent observing in each facility and a total of 53 interviews were conducted with staff, residents, and administrators. Survey results indicate that a total of 125 licensed group-care agencies in Massachusetts serve 4081 residents of all ages and disabilities in residential programs. At least sixty of these facilities accept adolescents, and seventy-four of them have state approval as residential schools for youngsters with special educational needs. Findings from the field research phase indicate that small group-care facilities place an emphasis on treatment and therapeutic intervention. The therapeutic activities in five facilities share similar features, and a classification scheme based on these similarities is offered. Other findings indicate that small residential facilities are not necessarily community-based, and that living in a small facility does not ensure integration into the community. A four-point scale is presented to measure the range of possible community-oriented activities. Four origins of decision-making about community activities are noted. Other findings indicate that the facilities are characterized by a high degree of staff/resident interaction, and that they possess some characteristics of total institutions, mediatory institutions, and families; the results suggest that these facilities are a new type of social setting with no direct correlation to other types of institutions.     

Correspondence between resident- and staff-report on the QABF: Do justice-involved youth agree with residential staff?

Residents in juvenile residential treatment facilities (JRTFs) often display various emotional, behavioral, and educational needs. Researchers have recently developed behavioral interventions to increase residents' appropriate behavior such as cooperation with facility staff instructions, accepting feedback from facility staff, and tolerating unpleasant events. However, there is not a generally accepted tool for assessing the operant function of residents' problem behavior in JRTFs. For various logistical reasons, indirect functional assessments may be more appropriate in a JRTF than manipulating either antecedent or consequent events. This study obtained scores on the Questions About Behavior Function (QABF) assessment for 17 residents from two dormitory staff members for each resident. To increase the number of respondents, each resident completed a QABF for their own behavior. Results revealed moderate to high correspondence (i.e., agreement) for highest and lowest potential operant function of problem behavior between combinations of JRTF staff and residents. These preliminary findings suggest additional research with the QABF in JRTFs is warranted.     

Le développement d’un outil de mesure des comportements inadaptés au travail auprès de directions d’établissements scolaires du Québec

This study focuses on developing a measuring tool for unsuitable behaviour in the workplace. The tool has been developed from school principals. To do so, exploratory factor analyses have been conducted. Data have been collected from 232 senior staff members from school facilities across Quebec. Participants were invited to answer an online questionnaire. The results obtained help to classify inappropriate work behaviour into one factor. In addition to its theoretical value, this research brings several significant contributions to practice.     

AN INSTITUTIONAL STAFF TRAINING AND SELF-MANAGEMENT PROGRAM FOR DEVELOPING MULTIPLE SELF-CARE SKILLS IN SEVERELY/PROFOUNDLY RETARDED INDIVIDUALS

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implication for future research and continued development of effective staff training and management programs.     

The effects of the Positive Environment Program (PEP) on the behaviors of adults with profound cognitive and physical disabilities

This study evaluated the effects of the Positive Environment Program (PEP) on the behaviors of residents and staff in a state‐operated residential facility during a 2½ year period. The participants included 19 adult residents with profound cognitive and physical disabilities and 11 staff members who worked with them. Data were collected on alertness, leisure material availability, engagement, staff interactions, and resident affect during two samples of data collection six months prior to implementation of PEP. Training was then provided to staff on positive interaction skills. Following the training, researchers implemented a monitoring program and a staff incentive program. The results of this project showed improvements in staff interactions, resident interaction with leisure materials, improved levels of alertness, and increases in a ‘happiness index’. The benefits and limitations of this project as well as future research are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Social class and wellbeing among staff and students in higher education settings: Mapping the problem and exploring underlying mechanisms

Within Higher Education (HE), staff and students from lower social class backgrounds often experience poorer wellbeing than their higher social class counterparts. Previous research conducted outside educational contexts has linked social class differences in wellbeing with differences in the extent to which low and high social class individuals feel respected (i.e., status), in control (i.e., autonomy), and connected with others (i.e., inclusion). However, to our knowledge, there has been no research that has investigated these psychosocial needs within HE settings. Furthermore, inclusion, status and autonomy are correlated, yet little is known about how these psychosocial needs contribute to wellbeing simultaneously, and independently, of one another. To fill these gaps, we report the results of two studies; firstly with HE students (Study 1; N = 305), and secondly with HE staff (Study 2; N = 261). Consistently across studies, reports of poor wellbeing were relatively common and more than twice as prevalent amongst lower social class staff and students compared to higher social class staff and students. Inclusion, status and autonomy each made a unique contribution and accounted for the relationship between social class and wellbeing (fully amongst students, and partially amongst staff members). These relationships held across various operationalizations of social class and when examining a range of facets of wellbeing. Social class along with inclusion, status and autonomy explained a substantial 40% of the variance in wellbeing. The present research contributes to the literature exploring how social class intersects with psychosocial needs to impact the wellbeing of staff and students within HE.     

Occupational Stress in University Staff

A survey was conducted of all staff members of an established Australian metropolitan university. The overall response rate for noncasual staff was 72% (77% for general staff and 65% for academic staff) resulting in a sample of N = 2,040. High levels of psychological stress were observed, despite the fact that trait anxiety and job satisfaction were normal. Psychological distress was highest and job satisfaction lowest among academic staff engaged in both teaching and research. In general, university staff reported high levels of autonomy and social support from colleagues. However those engaged in both teaching and research reported increased pressure arising from funding cuts to universities, resulting in heavier teaching loads and greater difficulty in securing research funds, as well as a decline in facilities and support for both teaching and research. The results are discussed in relation to the Demand–Control and Person–Environment Fit models of job stress.     

Objective assessments of quality of life: How much do they agree with each other?

Information was collected on 14 objective measures of service quality in 15 staffed houses for people with learning disabilities. Measures or dimensions of the measures were grouped under six headings: (1) quality of housing; (2) social and community integration; (3) social interactions; (4) development; (5) activity; and (6) autonomy and choice. Rank order correlation coefficients were calculated to explore the extent to which different quality assessments within each category agreed. Overall, there was a reassuring level of agreement. Some of the lack of agreement found could be attributed to the fact that, even though addressing the same general area, measures were focused on subtly different facets of the phenomenon under study. Other disagreement seemed to stem from the interaction between the nature of the information and the process for obtaining it. Comparisons between measures which required staff to give an opinion about how the setting was organized, and those which either required staff to comment on resident activity or employed independent observation, tended to disagree. The study illustrates that the basis for translating a multidimensional definition of quality into measurable terms is developing. Further research to examine the interrelationship between measurement approaches is warranted.     

A randomized controlled trial of instructional coaching in high-poverty urban schools: Examining teacher practices and student outcomes

Job-embedded professional development is needed to effectively and efficiently enhance teachers' use of evidence-based practices in high-poverty urban communities. This study employed a three-cohort, waitlist controlled, randomized block design to investigate the effectiveness of the Classroom Strategies Coaching Model (CSC) in 14 high-poverty urban elementary schools. The CSC Model is guided by observations of teachers' instructional and behavioral management practices as measured by the Classroom Strategies Assessment System. Primary dependent measures included teacher use of evidence-based practices, student academic engagement, and teacher ratings of class wide student academic and behavior functioning along with perceived instrumental support, emotional support, and stress. The sample included 2195 students and 106 teachers randomly assigned to CSC coaching or waitlist control. Multilevel negative binomial modeling revealed that teachers in the CSC coaching condition had significant improvements in the frequency of academic praise (used 1.74 times more frequently) and behavior praise (used 2.10 times more frequently) as compared to teachers in the waitlist control condition. Multilevel linear models revealed that, relative to the waitlist control condition, teachers in the CSC coaching condition demonstrated significant improvements in quality of instruction (d = 0.52), behavior management (d = 0.60), and class wide student academic engagement (d = 0.41). Teachers reported significant improvements in class wide student academic (d = 0.96) and behavioral functioning (d = 1.24), instrumental support (d = 0.90) and emotional support (d = 1.04). No change was found for teacher stress. Implications for research and practice are reviewed.     

Body satisfaction is associated with Transtheoretical Model constructs for physical activity behavior change

Despite advancements in health behavior theory and practice, less than half of the United States population meets physical activity recommendations. Two cross-sectional studies (n = 432; n = 1455) were conducted to explore associations between body satisfaction and Transtheoretical Model (TTM) constructs proposed to explain the physical activity behavior change process. A series of regression analyses were conducted, controlling for demographic and TTM variables, as appropriate. Results indicate that body satisfaction significantly explains 2–8% of variance in the TTM constructs responsible for promoting stage movement. Furthermore, body satisfaction was significantly associated with stages of change representing short (>6 months) and long-term (>5 years) maintenance of physical activity. Future research should continue to examine these construct relationships using more rigorous research designs, with the ultimate goal of implementing body satisfaction components alongside traditionally effective TTM interventions to improve physical activity maintenance.     

Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.     

Clinical Frequencies Recording System: Standardizing staff observations by event recording

Certain aspects of staff performance and resident behavior are less adequately assessed by standardized time sampling procedures than by complete recording of the incidence of specified events. An approach to gathering such data through systematizing the observations of clinical staff — the Clinical Frequencies Recording System — is described. Scores from the Clinical Frequencies System reflect the rate per opportunity with which individual behaviors are performed, with computer summarization providing higher-level behavioral indexes for research and evaluation purposes. Staff training and system implementation are discussed, and reliability and validity data from a system employed on two different treatment units over a period of several years are presented.The research reported in this article was supported, in part, by Public Health Service Grants MH-15553 and MH-25464 from the National Institute of Mental Health.Presented at the 87th Annual Meetings of the American Psychological Association, New York City, September 1979, as part of a symposium on New assessment systems for residential treatment, management, research, and evaluation.     

Understanding organizational resilience in elite sport: An exploration of psychosocial processes

ObjectivesAlthough organizational resilience research has identified the characteristics of elite sport organizations that successfully deal with significant change, further research is needed to understand how they function. The objective of this study was to explore the psychosocial processes underpinning organizational resilience in elite sport.Design and methodUsing interviews supplemented by timelines compiled from documentary analysis of public online sources, data was gathered during 43 interviews with 22 participants from 10 elite sport organizations across an 8-month period. Participant roles included chief executive officers (n = 5), directors (n = 7), board members (n = 2), middle managers (n = 4), support staff (n = 2), head coach (n = 1), and senior athlete (n = 1). Reflexive thematic analysis of the data was conducted from a critical realist standpoint.ResultsThe data analysis yielded two core processes of sensing (internal and external mechanisms, diversity of perspectives, evaluating and monitoring) and adapting (mirroring current resource availability, open and frequent communication, acute versus chronic change), and two supporting processes of strengthening resources (quality and quantity of human and financial resources, relationships as source of additional resources) and shielding from risk (internal risk mitigation, external influencing). These data were interpreted to indicate that these processes are not sequential, or temporally distinct, but instead cumulatively contribute towards an organization’s resilience capability.ConclusionsAs the first empirical investigation exploring the psychosocial processes underpinning organizational resilience in elite sport, the results provide a unique framework and practical implications to help those working in and with elite sport organizations successfully navigate uncertainty and change.     

Observed staff engagement predicts postive relationships and well-being in a physical activity-based program for low-income youth

Positive youth development (PYD) programs aim to support long-term well-being in young people by building their strengths and assets. PYD program staff are pivotal in achieving this goal, as positive staff-youth interactions are associated with well-being in youth. Much of this research relies on youth perceptions of interactions with staff. A better understanding of how observed staff behaviors are associated with youth outcomes would provide guidance for developing interventions regarding effective staff behaviors. This study examined associations between observed staff behaviors and youths' perceptions of their relationships with staff and well-being. Participants were recruited from a summer physical activity-based PYD program for underserved youth. Staff (N = 24, 16 women, 8 men) were observed by researchers to evaluate their engagement, interaction, safety, and support behaviors. Youth from diverse backgrounds (N = 394; 47% girls, 53% boys; M_age = 10.20; 44% Latino/a) completed measures of their perceptions of relationships with staff (mutual respect, autonomy support, and care), and well-being (hope, self-esteem, and social competence) at the end of the program. Structural equation modeling indicated that observed staff engagement positively predicted youth perceptions of their relationships with staff and well-being. Youth perceptions of positive social relationships with staff also positively predicted their well-being. Staff who create opportunities for youth to reflect and respond to program activities are perceived as valuing, making genuine connections, and considering the opinions and feelings of youth. Developing ways to enable staff to build relationships with youth that include these features is an important avenue for future research.