De Twentse ZorgCentra, Den Alerdinck 2, 7608 CM Almelo, The Netherlands.
Res Dev Disabil. 2013 May;34(5):1397-407. doi: 10.1016/j.ridd.2013.01.032. Epub 2013 Mar 6.
Data were collected from 121 staff members (20 direct support staff teams) on background characteristics of the individual staff members and their teams (gender, age, years of work experience, position and education), the frequency and form of aggression of clients with an intellectual disability (verbal or physical), staff members' attitudes towards aggression, and the types of behavioural interventions they executed (providing personal space and behavioural boundary-setting, restricting freedom and the use of coercive measures). Additionally, client group characteristics (age of clients, type of care and client's level of intellectual disability) were assessed. Multilevel analyses (individual and contextual level) were performed to examine the relations between all studied variables and the behavioural interventions. The results showed that for providing personal space and behavioural boundary-setting as well as for restricting freedom, the proportion of variance explained by the context (staff team and client group characteristics) was three times larger than the proportion of variance explained by individual staff member characteristics. For using coercive measures, the context even accounted for 66% of the variance, whereas only 8% was explained by individual staff member characteristics. A negative attitude towards aggression of the direct support team as a whole proved to be an especially strong predictor of using coercive measures. To diminish the use of coercive measures, interventions should therefore be directed towards influencing the attitude of direct support teams instead of individual staff members.
数据收集自 121 名工作人员(20 个直接支持人员团队),包括个体工作人员及其团队的背景特征(性别、年龄、工作年限、职位和教育)、具有智力障碍的客户的攻击频率和形式(言语或身体)、工作人员对攻击的态度,以及他们执行的行为干预类型(提供个人空间和行为界限设定、限制自由和使用强制措施)。此外,还评估了客户群体特征(客户年龄、护理类型和客户智力障碍程度)。进行了多层次分析(个体和环境水平),以检查所有研究变量与行为干预之间的关系。结果表明,对于提供个人空间和行为界限设定以及限制自由,环境(工作人员团队和客户群体特征)解释的方差比例是个体工作人员特征解释方差比例的三倍。对于使用强制措施,环境甚至解释了 66%的方差,而只有 8%可以用个体工作人员特征来解释。整个直接支持团队对攻击的消极态度被证明是使用强制措施的一个特别强有力的预测因素。因此,为了减少强制措施的使用,干预措施应该针对影响直接支持团队的态度,而不是针对个体工作人员。