Baltes M, Neuman E, Zank S,

1994,

Reviewed by Professor Alistair Burns,
Department of Old Age Psychiatry,
Wythenshawe Hospital, Manchester

Methods

This study was carried out to examine whether a staff training programme (focussing on communication skills, knowledge about ageing and basic behaviour principles) could alter the interaction between staff and elderly residents in long-term institutions characterised by a “dependency support” and “independence ignore” approach which usually occurs. Three institutions were selected to take part in the training programme (which took place in Germany) – a state run nursing home, a religiously affiliated nursing home and a ward in a geriatric hospital. The training programme had three components which were activated in two steps – the first being a more theoretical part where knowledge was conveyed in ten group sessions and a second step which was more practice orientated which involved the transfer of this knowledge to everyday nursing care. The knowledge was geared at three components – knowledge about an application of basic communication skills, updated facts about ageing and basic behavioural principles in the management of desirable behaviour. In the second stage, each participant designed, implemented and evaluated a behaviour modification plan with one resident. Target behaviours such as brushing one’s teeth, cleaning one’s glasses, shaving oneself were selected by the staff member in conjunction with the resident. The behaviour modification programme was based on shaping a reinforcing behavioural procedure. Staff interactions with the selected residents were videotaped during the implementation of the behaviour modification programme. A pre-imposed control-group design was used. Pre- and post- assessments consisted of daily observations of staff/resident interactions over a 6 week period, collected by trained observers using a coding scheme and electronic data collection apparatus. Because of the fear of being taped, random assignment could not be assured so that all staff volunteers in each institution made up the experimental group.

Key findings

The study showed significant changes, specifically a decrease in dependence supported behaviour of staff and an increase in their independence supportive behaviour with an increase independent behaviour of residents and an increase in independence related interactions between staff and patients was seen.

Critical analysis

This study adds to the body of literature showing that interactions between staff and residents can be greatly improved by increasing the knowledge of staff and by involving them in programmes directed at improving the care of individual residents. It certainly challenges what is seen by many as a common practice, ie, to support people who are needy and to ignore people who are doing fine on their own and as such the possible implications of this study goes beyond those seen at face value. The study is important in that it also demonstrates that the exact nature of the intervention is probably not that crucial but the mere fact that something is carried out is important. The two stage nature of any intervention, ie the provision of knowledge followed by its practical implementation is also an important conclusion of the study.

Social work/policy implications