EVALUATING A SUPERVISION PROGRAM FOR DEVELOPING AND MAINTAINING THERAPEUTIC STAFF-RESIDENT INTERACTIONS DURING INSTITUTIONAL CARE ROUTINES

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.     

The Association Between Delirium and Cognitive Decline: A Review of the Empirical Literature

Delirium is a common neurobehavioral syndrome that occurs across health care settings which is associated with adverse outcomes, including death. There are limited data on long-term cognitive outcomes following delirium. This report reviews the literature regarding relationships between delirium and cognitive impairment. Psych Info and Medline searches and investigation of secondary references for all English language articles on delirium and subsequent cognitive impairment were carried out. Nine papers met inclusion criteria and documented cognitive impairment in patients following delirium. Four papers reported greater cognitive impairment among patients with delirium than matched controls. Four papers reported higher incidence of dementia in patients with a history of delirium. One study found 1 of 3 survivors of critical illness with delirium developed cognitive impairment. The evidence suggests a relationship between delirium and cognitive impairment, although significant questions remain regarding the nature of this association. Additional research on delirium-related effects on long-term cognitive outcome is needed.     

ICU不能回避的课题：生命支持系统的撤除

ICU内生命支持系统不但应得到充分的使用,在适当的时候也应予以撤除。“适当”包括两方面含义：患者已经康复和患者已无可能康复,共同点在于继续使用生命支持系统已经无助手患者及家人的福祉。患者终末期管理已成为ICU专门领域,与其他专门领域同样需要相当的知识与能力。     

老龄化社会中ICU的困境面面观

高龄、且长期罹患多种疾病的患者,病情一旦进展到必须接受有创机械通气的阶段,则康复机会极小,生存质量极差,不应划入急性可逆性范畴;而应转入社区医疗,加强现代健康观、死亡观教育,提供多种解决方案,不必一概纳入全方位支持监护系统,更不应常规给予有创机械通气、CRRT、亚低温治疗、肠内及肠外营养作为长期替代治疗。     

PEER TRAINING OF SAFETY-RELATED SKILLS TO INSTITUTIONAL STAFF: BENEFITS FOR TRAINERS AND TRAINEES

A peer training program, in which experienced staff trained new staff, was evaluated as a method for teaching and maintaining safety-related caregiver skills in an institutional setting for the developmentally disabled. Three sets of safety-type skills were assessed in simulated emergency situations: responding to facility fires, managing aggressive attacks by residents, and assisting residents during convulsive seizures. Using a multiple-baseline research design, results indicated that the peer training program was an effective method of training the three types of emergency skills to new direct care staff. The program also appeared effective in improving the skills of the peer trainers. Perhaps most importantly, results indicated that if experienced staff functioned as peer trainers for particular emergency skills, then their proficiency in those skills maintained over time whereas their proficiency declined in emergency skills for which they did not act as peer trainers. Social validity information collected from available staff 23 months after the program was completed supported the utility of the training in terms of staff responses during actual emergencies. Also, acceptability measures indicated that staff liked participating in the program. However, some inconsistencies between staff verbal reports and performance-based measures of acceptability were noted. Results are discussed regarding the overall effectiveness of the peer training program, the importance of maintenance strategies for safety-related skills, and the need for multidimensional analyses of staff acceptability in staff training/management research.     

ICU医务人员在心脏死亡器官捐献中面临的伦理问题及对策

心脏死亡器官捐献是目前解决器官移植工作器官短缺的关键性举措,参与器官捐献过程的ICU的医务人员需要直接面临对潜在捐献者的治疗照护、临终护理、死亡判定等诸多伦理问题.应加强ICU医务人员器官捐献伦理知识的普及教育并完善相关法律制度,以保证器官捐献工作的健康、可持续发展.     

外资企业员工群体间应激的比较

本研究采用测量和问卷调查的方法考察了广东外资企业中的三类员工 (即内地员工、港澳员工和本地员工 )共 2 2 7名被试和内地国营企业员工共96名被试的应激及其相关因素。被试应激水平的组间比较表明 :外资企业员工的应激水平均显著高于国营企业员工 ;外资企业各类员工之间在应激水平上均存在显著差异 ;外资企业员工的进厂时间与被试的应激水平呈倒 U型曲线关系 ,而员工的学业与应激水平呈 U型曲线关系。回归分析表明 :外资企业中各类员工的应激有共同的相关因素 ,也有各自特殊的相关因素。     

COMPETENCE IN ASPECTS OF BEHAVIORAL TREATMENT AND CONSULTATION: IMPLICATIONS FOR SERVICE DELIVERY AND GRADUATE TRAINING

This study examined the extent to which competence in applying behavioral procedures (timeout from positive reinforcement) was sufficient to establish competence in teaching others to apply the same procedures. During baseline, graduate students attempted to instruct parents with a history of child abuse and neglect in the use of time-out. Students were then instructed in the use of time-out until they achieved proficiency in a role-play context. They then reattempted to instruct the parents. Finally, the students were instructed in certain consultation skills (i.e., teaching others to apply behavioral procedures) and again attempted to instruct parents in the application of time-out. Observations of students' consultation skills, parents' proficiency at administering time-out, and children's compliance to parental instructions revealed that explicit training in behavioral consulting skills was necessary to produce improvements in these behaviors. Students' proficiency at administering time-out was insufficient to enable them to instruct others in its application. These results were corroborated by surveys of both students and staff. The implications for graduate training and service delivery are discussed.     

ASSESSMENT AND TRAINING OF CLINICAL INTERVIEWING SKILLS: ANALOGUE ANALYSIS AND FIELD REPLICATION

Two studies were conducted to assess and train clinical interviewing skills. In Experiment 1, eight university practicum students (“therapists”) and either role played or volunteer “clients” were audiotaped during simulated interviews. Following the collection of baseline data on both therapist and client responses, training was provided by way of written materials, classroom instruction and practice, and quizzes. Results of a multiple baseline design across subjects showed improvements in therapists' interviewing skills and subsequent increases in client responding. Experiment 2 replicated and extended the research to a hospital outpatient clinic, in which therapists interviewed the parents of children with behavior problems. In addition, four months following the completion of Experiment 2, follow-up data collected during a maintenance condition showed continued high levels of therapist and client behavior. Finally, a panel of expert peers indicated that each response category was judged highly relevant to the behavioral assessment process.     

PYRAMIDAL TRAINING: A LARGE-SCALE APPLICATION WITH INSTITUTIONAL STAFF

This study evaluated an indirect method of training 45 institutional direct care staff to conduct behavioral programs. Three supervisors were trained to improve teaching behaviors (instructions, prompts, and consequences) used by the direct care staff while working with severely and profoundly handicapped residents. In addition to training, daily feedback was provided to supervisors regarding performance of their staff. Results of a multiple baseline analysis across teaching behaviors (instructions, prompts, and consequences) and content areas (communication and gross motor skills) showed that providing training and feedback to supervisors resulted in increases in correct teaching behavior by direct care staff. However, teaching behavior newly learned in one content area (communication) did not generalize to the other area (gross motor skills). Data collected on resident behavior showed small but noticeable improvement in terms of correct responses and attending behavior during programming. Results are discussed in terms of the benefits of a pyramidal approach to training institutional staff.