An observational evaluation of the effects of nurse training in behaviour therapy on unstructured ward activities and interactions

Abstract

The effects of a five-day in-service training in behaviour therapy for psychiatric nurses were assessed by naturalistic observations in three NHS long-stay wards. The observations focused on nurses' and patients' independent and interactive behaviours as a function of the course of training, during an unstructured part of the ward programme. A comparison of the behaviourally trained nurses and their colleagues indicated that the training had produced no systematic effect on independent activities and was associated with significantly less frequent or appropriate interactions with patients. These findings were contrasted with the nurses' proficiency in their structured use of behavioural techniques and led to an interpretation of patient control over their use of these new skills in default of staff management procedures. More broadly, the findings were regarded as an elaboration of the respective roles of staff training and management in institutional change. They were also viewed as evidence that circumscribed and short-term evaluations may be contradicted by more 'ecological' evaluations, which unobtrusively observe the broader consequences of our interventions into systems. In the long term these consequences may ultimately determine the effectiveness of our training endeavours and hence there is a pressing need for more process evaluations of the present kind.

An Ecological Validation of Nurse Training in Behaviour Therapy

“…There are many potential measures of the generalization of staff training, and it is consistent with the ecological orientation to examine a wide variety of these, in the expectation that some will show training to have undesirable consequences (Campbell etal., 1982). For example, naturalistic observations of nurses, patients and the interactions between them revealed that following in-service training nurses made more frequent use of punishment and were generally less adequate behavioural engineers than their as yet untrained colleagues (Milne, 1984e). To understand such findings it may again prove valuable to pursue an ecological perspective, since this focuses attention on such nurse-patient interdependencies and contingencies as the patients' "coercion" of the would-be nurse-therapists (Sanson-Fisher and Jenkins, 1978).…”

Malfeasance and Regaining Nursing’s Moral Voice and Integrity

“…Moreover, studies have repeatedly documented low levels of knowledge and competence in behavioural technologies by direct care staff, including nursing staff. [32][33][34][35] Situational factors: the context of psychiatric care in the USA Contexts are culturally and historically situated times and places. The context of experience is the world as persons realize that world by way of interactions and transactions among multiple individuals and multiple proximal and distal systems of values, ideologies, and environmental events.…”

Introduction to the Special Issue on Training Psychologists and Nonpsychologists in Cognitive and Behavioural Procedures

“…Inhibiting factors reported by the trainees included organisational restraints. Other attempts at training nonpsychologists have also found that the skills taught have not transferred to the actual service setting (e.g., Milne, 1985). Part of the problem may rest with the fact that attempts at dissemination which focus only on changing the behaviour of individuals within a service system rather than the behaviour of the system itself, a "bottom-up" approach, ignore political and systemic variables that powerfully shape the behavior of individuals (Bernstein, 1982).…”