助推手卫生的行为干预策略

保持手卫生是感染防控的重要策略,但是如何提高其依从性成为预防传染性疾病和减少医疗机构获得性感染的一大挑战。以行为科学为基础的手卫生助推干预以更“隐性”的方式将洗手转变为一种可自动触发的行为习惯,弥补了以知识分享和健康宣教为主的传统手卫生干预策略的诸多局限性。基于影响机制的不同,手卫生助推干预策略可分为提供决策信息、优化决策选项、影响决策结构、提醒决策方向4个大类的框架体系。多模式助推策略的有效性也已在实践中得到印证,但目前还非常缺乏在中国社会文化情境下开展的助推洗手行为的干预研究,今后可尝试基于行为科学理论有针对性地在医院、学校和社区等公共场所开展此类干预研究和实践,为感染防控、疾病预防和改善公共健康做出相应的贡献。     

员工被上司信任感的形成机制

员工感知到上级对自己的信任是成功建立上下级信任关系的重要前提。然而,学界和业界对员工被上司信任感的形成机制却知之甚少。符号互动理论与社会信息加工理论为深入探究员工被信任感产生的机理提供了理论视角。根据这两个理论,我们提出授权与培养这两种管理行为是影响员工被上司信任感产生的重要因素;授权与培养对员工被上司信任感影响的有效性依赖于员工的目标导向、上司的可信度以及团队焦虑水平;员工被上司信任感的产生会影响员工的忠诚与敬业奉献,影响程度受制于上司所面临的管理风险。     

Human operant performance: Sensitivity and pseudosensitivity to contingencies

Undergraduates' button presses occasionally produced points exchangeable for money. Left and right buttons were initially correlated with multiple random-ratio (RR) and random-interval (RI) components, respectively. During interruptions of the multiple schedule, students filled out sentence-completion guess sheets describing the schedules, and points were contingent upon the accuracy of guesses. To test for sensitivity to schedule contingencies, schedule components were repeatedly reversed between the two buttons. Pressing rates were consistently higher in ratio than in interval components even when feedback for guesses was discontinued, demonstrating sensitivity to the difference between ratio and interval contingencies. The question was whether this sensitivity was based directly on the contingencies or whether it was rule-governed. For two students, when multiple RR RI schedules were changed to multiple RI RI schedules, rates became low in both components of the multiple RI RI schedule; however, subsequent prevention of point deliveries for the first few responses in any component produced high rates in that component. For a third student, response rates became higher in the RI component that provided the lower rate of reinforcement. In each case, performance was inconsistent with typical effects of the respective schedules with nonhuman organisms; it was therefore plausible to conclude that the apparently contingency-governed performances were instead rule-governed.     

A BEHAVIORAL SYSTEM FOR ASSESSING AND TRAINING CARDIOPULMONARY RESUSCITATION SKILLS AMONG EMERGENCY MEDICAL TECHNICIANS

Many deaths from cardiopulmonary arrest can be prevented by the prompt and effective administration of cardiopulmonary resuscitation (CPR). In this study, we examined the standard training program for teaching CPR to emergency medical technicians (EMTs). We developed an alternative experimental program whereby the behaviors involved in CPR were assessed easily and in greater detail. This assessment provided the basis for a system in which effective CPR skills were reinforced and problems were corrected. Subjects who were trained in CPR according to this experimental program performed more effectively than subjects in the standard program. In addition, retention (maintenance) measures indicated that experimental subjects continued to perform well, often more effectively than professionally employed EMTs.     

A DIRECT PROMPTING STRATEGY FOR INCREASING RECIPROCAL INTERACTIONS BETWEEN HANDICAPPED AND NONHANDICAPPED SIBLINGS

We investigated the effects of a sibling training procedure, consisting of direct prompting and modeling, on the occurrence of reciprocal interactions between nonhandicapped and handicapped siblings. Data were obtained for training, generalization, and follow-up. Results of a multiple-baseline design across three pairs of siblings showed that: (a) direct prompting of interactions was an effective strategy for increasing reciprocal interactions between handicapped and nonhandicapped siblings; (b) the training procedure resulted in increased levels of initiations and responsiveness to initiations; (c) reciprocal interactions between siblings generalized to larger play groups or across settings; (d) reciprocal interactions between handicapped subjects and untrained, nonhandicapped peers increased without direct training; (e) the siblings' levels of interactions were maintained at 6 mo follow-up; and (f) these findings were judged socially valid by the siblings' parents.     

ENHANCING THE SOCIAL ENVIRONMENTS OF ELDERLY NURSING HOME RESIDENTS: ARE HIGH RATES OF INTERACTION ENOUGH?

We investigated the social validity of a common intervention (i.e., serving food during a social hour) that has been reported to facilitate social interaction among nursing home residents. Using a group reversal design, rates of interaction were measured. In addition, the vocal content of the interactions was recorded and coded by raters blind to condition. Rates of interaction more than doubled during the treatment phases, but ineffective vocal behavior accounted for the bulk of the increase. Results suggest the need to examine the utility of such programs in nursing homes.     

SELF-MONITORING OF ATTENTIONAL BEHAVIOR VERSUS SELF-MONITORING OF PRODUCTIVITY: EFFECTS ON ON-TASK BEHAVIOR AND ACADEMIC RESPONSE RATE AMONG LEARNING DISABLED CHILDREN

I investigated the differential effects of self-monitoring of attentional behavior and self-monitoring of productivity on on-task behavior and academic response rate. Subjects were four learning disabled children with significant attentional problems. Results indicated relatively equivalent increases in on-task behavior over baseline during all treatment phases. Academic response rate also improved under both interventions, with self-monitoring of productivity showing a superior effect for one subject, an equivalent effect for one subject, and less dear results for two subjects.     

THE CLASSWIDE PEER TUTORING PROGRAM: IMPLEMENTATION FACTORS MODERATING STUDENTS' ACHIEVEMENT

We conducted a study designed to assess implementation of the classwide peer tutoring program and the relationship between implementation variation and student outcome. A clinical replication design was used. Five volunteer elementary teachers were trained to implement the program; their implementation was monitored for 19 consecutive weeks during 1 school year. Overall, the results indicated that specific variations in program implementation were associated with students' responses to treatment. It was also demonstrated that different teachers' applications of the program produced differential levels of student outcome. Implementation factors related to lower spelling achievement were (a) reduced opportunities to receive program sessions, (b) reduced probabilities of students' participation in program opportunities, (c) too many students assigned unchallenging spelling words, and (d) reduced rates of daily point earning reflecting lower levels of spelling practice during tutoring sessions. The implications of these findings and methods of preventing these implementation problems are discussed in the context of quality assurance and social validity.     

DENTIST-IMPLEMENTED CONTINGENT ESCAPE FOR MANAGEMENT OF DISRUPTIVE CHILD BEHAVIOR

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.