THE EFFECTS OF PERFORMANCE FEEDBACK ON THE SAFETY OF CLIENT LIFTING AND TRANSFER

Individual written and verbal performance feedback was examined to determine its influence on the safety with which physically disabled clients were transferred. Two client-transfer techniques were task analyzed and six direct service providers' on-the-job performance was measured weekly. A multiple baseline across settings and subjects was used to evaluate effects of the feedback. Consumer satisfaction and the costs of the procedures were also assessed. Results showed that feedback was consistently followed by improvements in safe performance. These improvements tended to maintain as feedback was faded. Participants favorably rated the feedback procedure and consistently recommended its use with other staff.     

Evaluating the relative effects of feedback and contingent money for staff training of stimulus preference assessments

Performance feedback has facilitated the acquisition and maintenance of a wide range of behaviors (e.g., health-care routines, seat-belt use). Most researchers have attributed the effectiveness of performance feedback to (a) its discriminative functions, (b) its reinforcing functions, or (c) the combination of the two. In this study, we attempted to evaluate the relative contributions of the discriminative and reinforcing functions of performance feedback by comparing a condition in which the discriminative functions were maximized and the reinforcing functions were minimized (i.e., performance-specific instructions without contingent money) with one in which the reinforcing functions were maximized and the discriminative functions were minimized (i.e., contingent money with no performance-specific instructions). We compared the effects of these two conditions on the acquisition of skills involved in conducting two commonly used preference assessments. Results showed that acquisition of these skills occurred primarily in the condition with performance-specific instruction without contingent money, suggesting that the delivery of performance-specific instructions was critical to skill acquisition, whereas the delivery of contingent money had little effect.     

Motivational interviewing for employment: An exploration of practitioner skill and client change talk

Motivational interviewing (MI) is an evidenced-based approach for building and strengthening motivation for change. The effect of MI training on practitioner conversations with unemployed clients within a government work and income service was evaluated using a mixed-method approach, comprising a multiple-baseline across practitioner (n = 5) design and a pre/post quasi-experimental design. After workshop MI training, practitioners demonstrated greater MI skills in conversations with clients, and MI skills were maintained during the period of post-workshop feedback and coaching. There was also more change talk spoken by clients in conversations that occurred post-MI workshop training compared to pre-training, suggesting increased motivation for change.     

Dementia and Suffering in Nursing Homes

SUMMARY

This paper uses case studies of challenging behaviour associated with dementia to demonstrate, firstly, that disturbed behaviour is often a manifestation of suffering caused by multiple phenomena such as medical problems or the care environment. Addressing these causes instead of simplistically ‘treating the behaviour’ usually reduces the behaviour. Secondly, staff distress with a particular difficult resident is often caused by more general fundamental problems such as a lack of support or knowledge. Addressing these problems reduces staff distress. Finally, results from a Swedish intervention study are presented. They show that suffering for both staff and residents can be reduced, and quality of life improved, by providing increased autonomy for hands-on staff, systematic emotional support, and collaboratively developing care plans based on each resident's emotional and physical needs, rather than the problems they present.     

ICU的核心内容及临床思维要点

危重症患者存在急性的、全身性的、动态发展的病理生理改变（临床综合征）。ICU主要任务是：准确地识别和有效地调整患者的这种病理生理学状态／过程,促使其稳定。对危重病患者病情分析判断的原则是：在综合分析的基础上,要动态观察各种指标的变化,包括对治疗的反应性;在整体晓念的指导下、要注意个体化的特殊性。诊疗原则是：抓住最主要的...     

进修人员在双向转诊中作用的研究

我国人口分布范围广,医疗资源主要集中在大、中城市,合理利用有限的医疗资源,解决看病难,看病贵,实现有效转诊,是我们当前面临的一个难题。研究显示：通过进修医生转诊率高,迅速,患者及家属满意率高;对符合转诊要求,需要下转的患儿100例通过进修人员下转患者率96％,直接下转率65％。由此可见通过进修医生对患者进行双向转诊效果...     

围绕ICU的几个问题的思考

ICU是现代医学中的新兴事物,发挥着重要作用,但是围绕ICU方方面面问题,无论是业界还是公众还有许多争论及认识上的误区,有待研究探讨,比如ICU是否是一个真正意义上的独立学科?ICU的业态形式?ICU一定是高投入高装备吗?ICU注定是高消费?ICU有人文伦理缺失的特权吗?本文试图对这些问题给予一点作者的观察和己见。     

High Aspirations: Differences in Employee Satisfaction Between University Faculty and Staff

Employee satisfaction surveys were examined for five universities in the US, UK and Canada, selected because they presented results for faculty and other staff separately. Faculty consistently score more negatively on employee satisfaction across a wide range of areas. The most negative responses are for areas such as personal/worklife balance, work demands/workload, university direction, and whether the employee would choose to work at the same institution again/would recommend it for employment. The results are consistent with previous studies which have shown that education level is negatively associated with job satisfaction. The results suggest that university faculty have high aspirations, since in a number of indicators faculty working conditions appear superior to those of staff (tenure; average income; sabbatical leaves; work control; involvement and consultation in university decision-making), although junior faculty prior to tenure may experience more stress than staff. Employers undertaking employee satisfaction surveys need to take into account systematic differences in aspirations among their employees, when interpreting survey results.     

Towards emotional containment for staff and patients: developing a Work Discussion group for play specialists in a paediatric ward

This paper describes the evolution of a staff Work Discussion group run by a child psychotherapist in a teaching hospital for more than 15 years. It offers insight into the emotional experience of both NHS staff and patients as seen through the lens of the discussion of the staff’s work. The author identifies three main stages in the evolution of this group, as trust and the feeling of a safe space gradually developed. The first stage was identifying and understanding the emotional experience of patients, through the use of observational skills and psychoanalytic concepts; the second emerged as staff began to include their own emotional experience in the narrative; the last stage saw a qualitative shift in the staff’s capacity to share the pain generated by the work, knowing about it through holding it in the group’s mind and being able to reflect on it, allowing them to process experience in a way that made the work more bearable – akin to Bion’s concept of ‘containment’. This evolution is illustrated with relevant vignettes in the light of some theoretical and historical considerations. The paper demonstrates the value of Work Discussion groups in terms of indirectly supporting hospitalised patients, as well as promoting staff’s resilience and professional capacities in difficult contexts.