Optimists and pessimists: attitudes of nursing staff towards the development potential of mentally handicapped patients in their charge

The Constructional Approach to “Problem Behaviour” in an Institutionalized Setting

This paper describes the successful application of a behavioural intervention to the inappropriate behaviour of a severely mentally handicapped hospital resident. The intervention was based on the Constructional approach and at sixth week follow-up the effects had been maintained. Furthermore, there was evidence that these had generalised to other behaviours. Significant changes were noted in the attitudes of direct care staff and it is suggested that these may have been attributable to the nature of the approach used. The Constructional approach was considered ethically and practically superior to alternatives which would have concentrated alone on reducing or removing behaviour in the client's limited repertoire.

Effect of unexpected outcomes and causal attributions on key workers' expectancies of goal attainment

Goal planning is an integral part of the role of the key worker in services for people with intellectual disability. The present study investigated the effect of the Weiner stability-expectancy principle on unexpected outcomes in goal planning. Four hundred and twenty-two actual goal attainment scales were constructed, with each scale describing the key workers' expected levels of outcome. Two hundred and twenty-six (54%) unexpected outcomes, both successful and unsuccessful, were then rated by key workers to provide a causal explanation for each outcome. These explanations were then grouped according to whether the attributions represented stable or variable causes. Finally, key workers were asked to provide a new expectancy rating to forecast future goal attainment. Two predictions from Weiner's model were confirmed by statistical analysis: (1) that success attributed to stable factors would lead to higher revised forecasts of goal attainment than success attributed to variable factors; and (2) that failure attributed to stable factors would lead to lower revised forecasts of goal attainment than failure attributed to variable factors. The results of the present study confirm that stability attributions do alter key workers' revised forecasts of goal attainment. The results are discussed in terms of the possible consequences for key worker behaviour, such as goal abandonment, differential treatment of service users and the need for a knowledgeable approach to performance appraisal by managers.

The Mental Impairment and Evaluation Treatment Service: staff attitudes and staff-client interactions

This study describes and evaluates a new short-term residential service for adults with mild learning difficulties and challenging behaviour, the Mental Impairment Evaluation and Treatment Service. The study examines staff attitudes towards management practices, towards the potential achievement of individuals with learning difficulties, the staff's perceived involvement in decision making, and also the nature of their interaction with the clients, in two different settings on the Unit. The Unit's management practices were found to be client-orientated in nature and staff were more in agreement with client-orientated than institution-orientated management practices. Staff were generally optimistic about clients' potential and felt involved in decision making. Correlations between certain staff characteristics, attitudes and interactions are discussed. The study extends the range of services that have been evaluated in this way, and provides a description of the service in its early stages, which will provide an important comparison point for it when it is more permanently established.

A comparison of practices, attitudes and interactions in two established units for people with a psychiatric disability

This study evaluates and compares aspects of residential care in a community hostel setting and a hospital setting for people with a psychiatric disability. The clients were assessed to establish their level of general functioning, the comparison indicating there was no significant difference between the two groups on the measure used. A previously published protocol was used as a method of comparing the units. The findings indicated that the hospital unit was more individually orientated both in practices and staff attitudes, and had staff who were more optimistic about clients' potential accomplishments. No differences were found between perceived involvement of staff in decision making, or staff resident interactions. These findings have implications for the 'Care in the Community' movement, as they indicate that the nature of a service is as important as its location. They suggest that the relocation of services to the community in itself will not automatically overcome some of the difficulties associated with institutional care.

A new unit for long-stay psychiatric patients: organization, attitudes and quality of care

The present study describes and evaluates aspects of care in a new residential unit for chronic patients. The findings suggest that the unit is relatively resident-orientated in its management practices and that the staff are similarly orientated in their attitudes. Staff also hold generally optimistic attitudes to residents' potential accomplishments and consider themselves highly involved in decision-making. They also show high levels of positive interactions with the residents. Various aspects of staff attitudes and behaviour are positively correlated with seniority or length of time on the unit. The results are discussed in terms of the unit's organizational structure and its possible impact on residents' functioning.