The informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge

Purpose Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

On the Uncanny Similarities Between Police Brutality and Client Mistreatment

Direct-care staff are responsible for carrying out behavior-analytic services in a culture that perpetuates systemic racism and other problematic systems that can lead to the mistreatment of clients. Limited data exist on factors that influence the mistreatment of clients, so behavior analysts must look to better-studied comparison contexts as a way to identify risk-factors. Police brutality is one context where problematic systems are apparent. Therefore, examining variables known to affect police brutality offers one way to identify aspects of direct-care staff implementation of behavior-analytic treatment that may harbor similar systems. The purpose of this paper is to examine variables associated with police brutality as risk-factors for the mistreatment of clients in direct-care settings. The primary risk-factors discussed include racial-bias, warrior mentality, lack of transparency and accountability, and ineffective intervention. This paper concludes that the field of behavior analysis needs sensitive data collection methods and systematic evaluation of risk-factors to better protect clients from mistreatment.

Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?

More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.

Experience-Based Co-Design to Develop an Injury Prevention Intervention in Skilled Nursing Facilities

Experience-based co-design (EBCD) improves clinical effectiveness and safety by incorporating end-user perspectives in the design of clinical interventions. To refine a centralized, multi-component fall-related injury prevention service (IPS) to be tested in skilled nursing facilities (SNFs) in a pragmatic trial, we employed a modified EBCD process. We first conducted in-depth interviews with SNF residents, family members, and staff (n = 28; three facilities in two states) regarding their experiences in falls prevention. We then engaged these and other stakeholders from multiple institutions (n=4) in a day-long co-design workshop with our interdisciplinary research team. Building upon themes drawn from the analysis of interviews, we targeted three intervention components that were refined during the workshop: de-prescribing process, osteoporosis treatment, and educational videoconferences. Key outcomes from the ECBD process included development of strategies to ensure that: (1) residents, families, and SNF staff are involved in communication about residents identified as high risk for fall-related injury, and in related treatment decisions; (2) approaches to monitoring for unintended consequences from the injury prevention plan are clearly understood by direct care staff and are compatible with existing workflow; (3) treatment plan risks and benefits are presented in a manner easily understood by stakeholders; and (4) staff education conferences build trust with the IPS nurse and provide direct care staff with support and advice about challenging cases. EBCD is a feasible approach to strengthen intervention development in SNFs and can lead to testable new ideas for protocol refinement to address diverse stakeholder perspectives.

The influence of humor on workplace mentoring and employee attitudes

Organizations are under continual pressure to cultivate an environment in which employees feel valued and committed, and mentoring provides one channel through which this may be achieved. In particular, the dynamics characterizing the mentoring relationship are of paramount importance. In the current study of 108 direct-care staff at a psychiatric hospital, we investigated the influence of 2 aspects of these dynamics—mentor humor style and the frequency with which humor is used—on protégé satisfaction with the mentoring relationship and on several key work-related outcomes (i. e., organizational commitment, job satisfaction, and turnover intentions). Overall, mentor humor style and frequency were both positively associated with protégés' mentoring satisfaction. Furthermore, mentoring satisfaction favorably influenced protégés' affective organizational commitment and job satisfaction, both of which were inversely related to their turnover intentions. Theoretical and practical implications of these results, along with the role of indirect effects, are discussed.