A Behavioral Analysis of Staff-Patient Interactions in a Psychiatric Setting

Niemeier, Dianne F.; Kus, Robert J.; Kerr, Jean A. C.; Davis, Marcella Z.

doi:10.1177/019394598300500402

Cited by 12 publications

(14 citation statements)

References 10 publications

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“…The relatively low scores attained by registered nurses, practical nurses, and psychiatric aides are notable in that these staff are most prevalent, and, in most hospitals, will be the only disciplines which provide direct care coverage across all three shifts. This result is consistent with previous observations (Burdett and Milne, 1985;Niemeier, 1983;Gelfand et al, 1967) that nursing and aide staff in public psychiatric hospitals are typically poor behavioral managers. This result also supports the assertion by Gardner and Cole (1987) that the majority direct care staff in public inpatient settings probably lack the necessary behavioral knowledge and skills.…”

Section: Discussionsupporting

confidence: 93%

“…Several observational studies have noted that nursing and aide staff in public psychiatric hospitals are typically poor behavioral managers (Burdett and Milne, 1985;Niemeier, 1983;Gelfand et al, 1967) and most behavioral interventions require considerable staff effort at the lowest levels of the nursing hierarchy. These personnel are often not inclined to treat patients, but, rather, to keep them from acting out and being a problem (Gardner and Cole, 1987;Boudewyns et al, 1986).…”

mentioning

confidence: 99%

“…A major contributing factor to this situation is that the staff responsible for treatment programming frequently do not have a level of training and competence in behavioral principles that is necessary to develop, implement, and supervise quality therapeutic treatment plans, especially for persons with complex clinical problems (Gardner and Cole, 1987). Several observational studies have noted that nursing and aide staff in public psychiatric hospitals are typically poor behavioral managers (Burdett and Milne, 1985;Niemeier, 1983;Gelfand et al, 1967) and most behavioral interventions require considerable staff effort at the lowest levels of the nursing hierarchy. These personnel are often not inclined to treat patients, but, rather, to keep them from acting out and being a problem (Gardner and Cole, 1987;Boudewyns et al, 1986).…”

mentioning

confidence: 99%

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Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Donat

McKeegan

1990

Behavioral Interventions

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Despite demonstrations of the utility and cost effectiveness of behavioral programming, such techniques are not commonly employed in psychiatric inpatient settings. Several explanations for this have been proposed, including inadequate levels of training and competence in behavioral programming among prevalent treatment staff. This study employed a multiple choice inventory to assess behavioral knowledge among subjects representing several direct care disciplines commonly found in inpatient psychiatric settings. The results support assertions of relatively low levels of behavioral knowledge among disciplines that are most prevalent in such settings. The implications of these results for initiatives to enhance behavioral knowledge and skills are discussed.The high level of demand for public services for chronic psychiatric patients has exerted pressure on public sector providers to devise treatments that are cost effective. Therapeutic approaches that are behavioral in orientation have been demonstrated to be cost effective for schizophrenics and other severely disturbed psychiatric populations, in both inpatient (Paul and Lentz, 1977) and outpatient (Liberman, et al., 1987) settings. Paul and Lentz (1977), for example, concluded that a behavioral token economy is the treatment of choice for chronic psychiatric inpatients when compared to active 'milieu' treatment programs or the medication/custodial care routine commonly provided to these patients.Despite demonstrations of the utility and cost effectiveness of behavioral programming in psychiatric settings, these techniques have not been widely adopted by practitioners in the field (Liberman et af., Bellack, 1986;Burdett and Milne, 1985;Moss, 1983). In a survey of 152 Veterans Administration Medical Centers, for example, only 20 reported having a behavioral training unit of any kind (Boudewyns et al., 1986). In a recent study of staff behavior in public inpatient psychiatric facilities within the State of Virginia, the observers concluded that ward environments reinforced passive institutionalized behavior, and, in some cases, actually promoted behavioral management problems. Treat-008&558 I /90/020095-09$05.00

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Donat

McKeegan

1990

Behavioral Interventions

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“…These staff are critical in creating a unit-wide environment rich in positive reinforcement of adaptive behaviorÐthe backbone of differential reinforcement interventions. Without training in reinforcement procedures, paraprofessional staff have been found to be inconsistent in the reinforcement of client behavior (Niemeier, 1983). Thus, staff must be trained in the consistent and timely delivery of reinforcement in response to speci®c behavioral targets, progressive shaping procedures, and fading for generalization techniques, all applied in a natural and supportive manner.…”

Section: Introductionmentioning

confidence: 99%

Teaching social‐learning procedures to paraprofessionals working with individuals with severe mental illness in a maximum‐security forensic hospital

Jones¹,

Menditto²,

Geeson³

et al. 2001

Behavioral Interventions

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This study describes an integrated technical method for teaching learning-based interventions to paraprofessionals working in a maximum-security psychiatric facility as a social-learning program was implemented. This training approach combines brief didactic instruction with live demonstration and guided practice in speci®c procedures. Comparisons between baseline and post-training functioning of staff were made using ongoing direct observational assessment data. Results revealed that following training and program implementation staff were much more active overall, interacted with clients far more often, and engaged in much lower rates of job-irrelevant activity. Moreover, following training direct observational data of the patterns of staff±client interactions showed that staff were much more likely to demonstrate interactions re¯ective of learning-based interventions than at baseline. These results have important implications for clinicians and administrators attempting to implement behavioral rehabilitation programs.

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“…The literature does not support staff members' skills and abilities in making meaningful assessments of patients. For example, when she conducted a naturalistic study that included nurses and nursing assistants, Niemeier (1983) observed that adult patients' desirable behaviors were inadequately reinforced. These observations were confirmed in a later study by Burdett and Milne (1985).…”

Section: Assumption 2 Unit Stnff Rnembtrvs Know How To Recopizr Potementioning

confidence: 99%

Faulty Assumptions Associated With the Use of Restraints With Children

Mtrhr

Anderson

2001

J Child Adolescent Psych Nursing

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A Behavioral Analysis of Staff-Patient Interactions in a Psychiatric Setting

Cited by 12 publications

References 10 publications

Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Teaching social‐learning procedures to paraprofessionals working with individuals with severe mental illness in a maximum‐security forensic hospital

Faulty Assumptions Associated With the Use of Restraints With Children

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