| 1. |
- Antonsson, Helena, 1962-
(författare)
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Interaktion i särskilt boende för personer med utvecklingsstörning och utmanande beteende
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Många personer med utvecklingsstörning har kommunikativa svårigheter och har därför behov av att utveckla olika sätt att kommunicera för att kunna förstå andra och göra sig förstådda. Svårigheter i kommunikationen påverkar interaktionen mellan personer med utvecklingsstörning och deras vårdare. Detta ställer höga krav på vårdare att kunna tolka och förstå den enskilda individens sätt att uttrycka önskningar och behov. På samma sätt riskerar vårdares budskap att missförstås. Om vårdaren misslyckas att förstå den boendes kommunikation och vice versa, kan det leda till situationer med utmanande beteende exempelvis i form av vägran, verbal eller fysisk aggressivitet.Syfte: Det övergripande syftet med avhandlingen är att studera interaktion mellan vuxna personer med utvecklingsstörning och vårdare i gruppbostäder, samt att studera effekter av en utbildningsintervention för vårdare som arbetar i gruppbostäder.Metod: Avhandlingens samtliga delstudier har genomförts i gruppbostäder för personer med utvecklingsstörning bland boende och vårdare i ett län i norra Sverige. I studie I insamlades data kring 556 personer med utvecklingsstörning. I studie II och III deltog 16 vårdare och 11 personer med utvecklingsstörning. I studie IV deltog 7 vårdare. Studie I bygger på personalens skattningar av funktionsnivåer och förekomst av begränsningsåtgärder. I Studie II och III utgörs data av videoobservationer och narrativa intervjuer. I studie IV användes flera datainsamlingsmetoder i en mixed method design med både vårdarnas skattningar, med hjälp av instrument och semi-strukturerade intervjuer. Analys av materialet i studie II, III och IV har gjorts med kvalitativ innehållsanalys och i studie I och IV har data analyserats statistiskt.Resultat: I studie I framkom att av 556 boende hade 99 (18%) varit föremål för fysiska begränsningsåtgärder under den senaste veckan. Av dessa 99 hade nästan alla varit föremål för mer än en typ av begränsningsåtgärd. Den vanligaste begränsningsåtgärden var bälte i stol (74%). Användningen av begränsningsåtgärder var relaterade både till fysiska funktionsnedsättningar och till beteende.I studie II reflekterade vårdare över videoinspelad interaktion där vårdarna medverkat, både framgångsrik och misslyckad interaktion. Exempel på framgångsrik interaktion var att förstå tecken, kunna möta behov och hantera situationer med utmanande beteenden. Vårdarna reflekterade över att framgångsrik interaktion ledde till säkerhet, trygghet och självförtroende hos de boende. Vårdarna reflekterade även över de konsekvenser misslyckad interaktion fick i form av irritation, aggression och våld från de boende.I studie III studerades videoinspelad interaktion mellan 11 personer med utvecklingsstörning och 16 av deras vårdare. Verbal och icke-verbal interaktion identifierades. Fyra inspelade situationer valdes ut för att belysa framgångsrikt samspel. Resultatet visade att framgångsrikt samspel mellan personer med utvecklingsstörning och deras vårdare bland annat bygger på möjligheten att bekräfta varandra, dela vardagshändelser, ge tid och utrymme och på att använda ett kongruent och tydligt språk.I studie IV utvärderades effekterna av en web-baserad utbildningsintervention, vars syfte var att förbättra interaktionen mellan personer med utvecklingsstörning och vårdare samt att därmed reducera förekomsten av situationer med utmanande beteende. Resultatet visade att vårdarna hade förbättrat sin förmåga att hantera situationer med utmanande beteende och att förekomsten av utmanande beteende minskat. Vårdarna beskrev att den web-baserade utbildningen upplevts givande och möjlig att ta del av parallellt med arbetet.Slutsats: Fysiska begränsningsåtgärder förekommer i gruppbostäder för personer med utvecklingsstörning. Användningen av begränsningsåtgärder kan vara relaterade både till fysiska funktionsnedsättningar och till beteenden i samspelet mellan brukare och vårdare. Vårdare upplever användningen av fysiska begränsningsåtgärder svår och tröttande. Brott i kommunikationen mellan personer med utvecklingsstörning och deras vårdare kan leda till försvårad interaktion med risk för situationer med utmanande beteenden. När vårdare är framgångsrika i interaktionen med personer med utvecklingsstörning ger det tillfredsställelse både för de boende och vårdarna. Vårdarna upplever dock ofta hjälplöshet och osäkerhet i relation till hantering av situationer med utmanande beteende och efterfrågar utbildning. Web-baserad utbildning om interaktion med personer med utvecklingsstörning och utmanande beteende har i vår studie visat sig ge lovande effekter och bör vara möjlig att utveckla för både introduktion av nyanställda vårdare och för kompetensutveckling bland mer erfaren personal.
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| 2. |
- Truong, Anh, et al.
(författare)
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Caring for Persons With Intellectual Disabilities and Challenging Behavior : Staff Experiences With a Web-Based Training Program
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clear and effective communication is a prerequisite to provide help and support in healthcare situations, especially in health, and social care services for persons with intellectual disabilities, as these clients commonly experience communication difficulties. Knowledge about how to communicate effectively is integral to ensuring the quality of care. Currently, however, there is a lack of such knowledge among staff working in the disabilities sector, which is exacerbated by challenges in the competence provision in municipal health and social care services. Therefore, the aim of the study was to explore staffs' experience of web-based training in relation to their professional caring for persons with intellectual disabilities and challenging behavior. The intention is to move toward well-evaluated and proven web-based training in order to contribute to competence provision in this specific context.Methods: Fourteen semi-structured interviews were carried out with individual staff members to gather data regarding their experiences with web-based training in relation to their profession. The collected data were analyzed using qualitative content analysis with a focus on both manifest and latent content.Results: The staff's experiences with the web-based training program were presented as a single main theme: "Web-based training for staff initiates a workplace learning process by promoting reflections on and awareness of how to better care for persons with intellectual disabilities and challenging behavior." This theme contained three categories which are based on eight sub-categories.Conclusion and clinical implications: The benefits of web-based training for workplace learning could clearly be observed in the strengthening of professional care for persons with intellectual disabilities and challenging behavior. Staff members claimed to have gained novel insights about how to better care for clients as well as about the importance of interactions in their encounters with clients. Professional teamwork is crucial to providing effective care for persons with intellectual disabilities and challenging behavior. Hence, future research aimed at investigating the views of other healthcare professionals, such as registered nurses, is recommended to improve the competence provision within municipal health and social care services and thereby enhance the quality of care.
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| 3. |
- Truong, Anh, et al.
(författare)
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Caring for Persons With Intellectual Disabilities and Challenging Behavior : Staff Experiences With a Web-Based Training Program
- 2022
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Ingår i: International Conference on Work Integrated Learning. - Trollhättan : University West. - 9789189325302 ; , s. 39-41
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: The quality of care for persons with intellectual disabilities (ID) is affected by many factors, including the knowledge of the professionals. Educational training in, for example, general communication was identified as a priority issue among healthcare professionals working with persons with IDs, as it is the basis for a better understanding of the clients and their behavior, which can otherwise be perceived as problematic and challenging. Challenging behaviors (CB) have been reported by professionals as problems they frequently witness or experience and/or struggle to manage in the daily work. Yet they do not always have access to such training nor to the resources needed to practice skillful communication when supporting persons with IDs. In addition, challenges concerning the competence provision in the sector are likely to contribute to further deterioration of the situation.Earlier research has shown that web-based training for staff within healthcare settings can generate good results. In addition to being able to participate during work hours, staff can also overcome access issues in the delivery of training. With this study, we hope to advance an existing web-based training program with the intention to move toward well-evaluated and proven training in order to contribute to competence provision in the context of health and social care.Aim: To explore staff experiences with a web-based training program in relation to their professional care for persons with ID and CB. Methods: Staff working in residences for people with ID within municipal health and social care were offered the web-based training. In total 20 residences in a medium-size city in Sweden were included in this study. After completed training, fourteen semi-structured interviews were carried out with individual staff members to gather data regarding their experiences with web-based training in relation to their profession. The informants constituted of 11 women and 3 men, aged 27–55. Of the nine informants who had received upper secondary school education, five had specialized in the care of persons with IDs. More precisely, one informant had received higher vocational education, whereas the remaining four had received university education in the social sciences. The work experience with persons with IDs ranged from 8 to 30 years. The interviews were based on two open -ended questions: “What is your experience of attending the web-based training?” and “What do you think about the web-based training in relation to your daily work with persons with IDs and CB?” Follow-up questions were directed in such a way as to encourage the staff to freely share their experiences. This study has an inductive approach. The collected data were analyzed using qualitative content analysis as described by Graneheim and Lundman (2014). Results: The staff’s experiences with the web-based training program in relation to their professional care for persons with IDs and CB were presented as a single main theme: “Web-based training for staff initiates a workplace learning process by promoting reflections on and awareness of how to better care for persons with IDs and CB”. This theme contained three categories: “Web-based training provides freedom but also requires responsibility, both of which affect the learning outcome”, “The learning process contributes to generating insights about caring” and “The mutual impact of training and the opinions of staff about learning for the care of persons with IDs and CB”. These categories were based on eight sub-categories.Overall, the staff claimed that they had gained novel insights into the profession and into the caring process for the clients. Opinions about clients and CB changed somewhat, and the staff was inspired to adopt new ways of working which ultimately benefited interactions with the client. At the same time, requests were made for additional group discussions, and the desire for better planning to enhance learning among the staff was expressed.Discussion: In this study, web-based training seemed to have had a stimulating effect on workplace learning. Sharing self-reflections with group members in addition to individual study is essential for stimulating and consequently extracting knowledge from training. In the preparation of the training, close attention was paid to how to enable both individuals and social processes in learning but, judging from the results, further developments should focus on optimizing the effect of social interaction.Additionally, organizational support appears to be relevant for improving learning outcomes. However, prior research has shown significant differences in perceived workplace learning support from different occupational groups. Higher-status occupations offer a workplace environment that is more conducive to learning than that of lower-status occupations.These aspects must be addressed and overcome to fully develop the competence provision and counteract potential negative consequences in terms of job satisfaction and well-being among professionals working with persons with IDs.Conclusions and clinical implications: Our findings illustrate the complexity of providing staff training in the workplace through a web-based training program. Beyond the benefits of web-based training for workplace learning, some challenges also emerged. We conclude that web-based training, workplace organization, and individuals’ opinions each have an important impact on the learning outcome. To reach the best possible outcome, however, resources need to be invested in all three parts concurrently. This knowledge can contribute to the development of competence provision in municipal health and social care services more generally, where similar circumstances in terms of a notable downward trend in competence provision prevail, a pattern that could have negative impact on the welfare of the professionals.In addition to knowledge, cooperation in both healthcare and social services was also highlighted to improve care for persons with IDs and CB. In order to better meet their needs, professional teamwork is critically important. Hence, future research should investigate the views of other professionals e.g. nurses regarding education and competence development. This approach would enrich our knowledge and understanding of how the competence provision could be enhanced in this context to contribute to social sustainability in the sector.
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| 4. |
- Truong, Anh
(författare)
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Developing an educational intervention to support work-integrated learning among professionals in health and social care for individuals with intellectual disabilities
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Continuing education in the workplace has become a crucial part of contemporary working life, in alignment with modern labor market policies advocating lifelong learning. Work-integrated learning (WIL) is aimed at supporting professional development as part of lifelong learning, emphasizing both theoretical and practical knowledge alongside interactive engagement. Despite its significance, WIL within the context of educational interventions geared toward supporting learning and development among professionals remains an under-researched domain compared to its application in higher education focused on student learning. Previous research has shown that the learning process among professionals may follow a different logic compared to that of students in higher education. This dissertation highlights the development of an educational intervention from both an effectiveness and theory-based perspective, with WIL based on socio-constructivism serving as the point of departure. The intervention was aimed at professionals in municipal health and care for individuals with intellectual disabilities. The intention behind studying these professionals’ learning and development was to extend our knowledge of the ways in which the educational intervention influenced the professionals’ learning process and to reveal key aspects that must be considered in further developments of the intervention. Such knowledge contributions can potentially improve and expand future educational efforts aimed at professionals.The development of the educational intervention followed a pragmatic process consisting of three stages described in four individual papers. Data were collected through surveys and individual semi-structured interviews, which were then analyzed using statistical calculations and qualitative content analysis.The findings illustrated that learning and development among professionals did not follow a straightforward trajectory from the completed educational intervention to the learning outcome. The intervention, consisting of web-based lectures and structured group reflections, was found to support the professionals’ learning, with group reflections acting as a catalyst for collective learning and for the integration of theoretical knowledge into daily practice. However, creating the conditions needed for all participants to engage in group reflections was a key issue and should not be taken for granted in future educational initiatives in which group reflections are intended to be used. Likewise, organizational support and encouragement were found to constitute an important driving force in the professionals’ learning. Overall, learning and development among professionals are complex and influenced by multiple factors and mechanisms. Addressing these complexities requires a simultaneous focus on three fundamental elements: the actors involved in the learning process, the educational intervention itself, and the surrounding context. This can be best accomplished through a structured and systematic approach to the developmental process of the intervention. Such an approach could strengthen professionals’ commitment to lifelong learning and contribute to sustainable educational efforts, both economically and socially.
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| 5. |
- Truong, Anh, et al.
(författare)
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Staff’s self-reported frequency and management difficulty of challenging behavior among persons with intellectual disabilities in connection with web-based training
- 2022
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Ingår i: International Conference on Work Integrated Learning. - Trollhättan : University West. ; , s. 42-45
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Healthcare professionals, nationally and internationally, experience that exposure to persons withintellectual disabilities (ID) during education is often insufficient. Professionals within the sector urge enhancedtraining that will better prepare them for working with their clients. Providing care and support to persons with IDis complex and places high demands on the professionals such as knowledge about ID and cha llenging behaviors(CB) as well as communication and interaction. Earlier studies have shown that knowledge deficiencies in theseareas may prevent healthcare professionals from understanding their clients and their behaviors, particularly thosebehaviors considered to be challenging.However, staff working with persons with ID reported CB as a problem they could not always address in thedesired manner while performing their work duties. This predicament was shown to often generate stress, angerand powerlessness among staff, increasing the likelihood of burnout. Helping staff to better understand and bebetter prepared prior to meeting, communicating and interacting with persons with ID, especially concerningaddressing CB, could therefore help to establish and maintain a healthy work environment and sustainable workinglife.In this study, we investigated the impact of web-based training on the staff´s perception of the frequency andmanagement difficulties of CB among persons with ID in residential settings in Sweden. The training addressedthe topics ID and CB as well as communication and interaction and was offered to the staff working in theresidences. Since the basic assumption was that CB is a consequence of interrupted communication and interactionbetween staff and persons with ID, we hypothesized that by introducing web-based training focusing on ID andCB as well as communication and interaction, the frequency of CB and degree of management difficulty of CB indaily care would be reduced.Aim: To explore staff’s perceptions about CB among clients with ID in residential settings before and after a web -based training program, specifically addressing ID and CB as well as communication and interaction.Research questions1. Do staff report a lower frequency of CB among clients with ID in residential settings after the web -basedtraining?2. Do staff report a lower degree of management difficulty of CB among clients with ID in residential settings afterthe web-based training?Methods: A within-subjects study design was applied in which the participants were exposed to the treatment –in this case, web-based training – and measurements were made using the survey instrument “Checklist ofChallenging Behavior” (CCB) before and after exposure to examine any potential changes that occurred.Cluster sampling was conducted whereby 20 residential facilities were included. All staff in those residences wereoffered web-based training and invited to participate in this study.A total of 212 participants accepted the invitation to the survey by filling in CCB and accordingly systematicallyrate the frequency of CB among the clients and the own difficulty in managing these behaviors as perceived byparticipating staff. The CCB includes 41 items related to topographies of aggressive and other CB divided alongthe dimensions of physical violence/aggressive behavior, property destruction, miscellaneous behavior and mentalillness. The CCB was developed by Harris and Humphreys, who assessed the instrument’s content validity andinter-rater reliability. The researchers concluded that the instrument was a reliable indicator of the presence orabsence of CB. All measurements were based on five-point scale.43First, descriptive analysis was performed to summarize the characteristics of the sample. Central measurementswere presented as the mean and dispersion by standard deviation. As the data were represented on an ordinal scale,the Wilcoxon signed-rank test was used to determine whether a lterations existed between the responses before andafter training concerning the frequency of CB and management difficulty of these behaviors.Considering the number of calculations performed, a significance value of p < 0.05 was established. In addition,p-values < 0.1 were interpreted as tendencies. In order to contribute to indications of practical significance, acorrelation coefficient r was calculated by converting the z-values, as described by Pautz and Olivier, of those subitems with significant values. According to the rule of thumb for interpretation of Cohen’s r: 0.1 = small effectsize, 0.3 = medium effect size and 0.5 = large effect size.Results: The demographic description revealed that, of those who provided information about their job ty pe andlevel of education, approximately 87% worked as support assistants in the facilities, and most had completedsecondary education. The analysis showed that, after training, staff self-reported a significantly lower degree offrequency on the dimension of property destruction, on the sub-item “damaging others’ clothes, furniture, or otherobjects”. Similarly, a significant difference was revealed in the dimension of mental illness. In addition, regardingthe management difficulty of CB, the analysis revealed that, after training, staff self-reported a significantly lowerdegree of management difficulty on all sub-items on the dimension of property destruction. However, the effectsizes were considered small. Apart from that, the calculations also showed tendencies towards significance on anumbers of sub-items e.g biting, throwing things at people, breaking windows and absconding.Discussions: The observed reduction in the frequency of CB after the web-based training may have been due toenhanced knowledge and understanding by staff of CB among their clients, which could have consequently ledthem to no longer consider these behaviors as challenging. In earlier research, it was found that the amount ofknowledge possessed by staff could act as a significa nt predictor of their behavioral responses to CB. Accordingly,it is reasonable to suspect that the reduced management difficulty of CB as perceived by staff may have been dueto their enhanced knowledge of such behaviors, which impacted their views and behavioral responses to CB.Considering the formal education the majority of the staff have and the complexity of the job within this sector, itwould be unreasonable to expect all of the staff to have the capability to perform all job duties without sufficientopportunities to expand their knowledge and improve their skills with the support of the relevant healthcareorganization. This aspect has been equally emphasized to promote a healthy and sustainable workplace from theview of Work-Integrated Learning.Conclusion: Considering the complexity of meeting the needs of persons with ID, in addition to job -specificknowledge, collaboration with multi-professional teams is also recommended. As such, routinely training tosupport Work-Integrated Learning should be offered to all professionals involved in caring for individuals withintellectual disabilities to reinforce social sustainability in the sector.
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| 6. |
- Truong, Anh, et al.
(författare)
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Staff’s self-reported frequency and management difficulty of challenging behaviour among persons with intellectual disabilities in connection with web-based training
- 2022
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Ingår i: Nordic journal of nursing research. - : SAGE Open. - 2057-1585 .- 2057-1593. ; 43:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Providing care and support to persons with intellectual disabilities (ID) requires in-depth knowledge about ID and challenging behaviour (CB) as well as communication and interaction. Knowledge deficiencies in these areas may prevent staff from understanding their clients and their behaviours, particularly those behaviours considered to be challenging. The aim of this study was to explore staff’s perceptions about CB among clients with ID in residential settings before and after a web-based training programme using the survey instrument ‘Checklist of Challenging Behaviour’ (CCB). The CRe-DEPTH guideline has served as a guide in this study. Upon completion of the training, staff perceived a reduced frequency of CB as well as reduced management difficulty of CB among clients. As such, training should routinely be offered to all staff in residential settings, but also healthcare professionals in general responsible for caring for clients exhibiting CB to ensure, improve and reinforce the quality of care and support provided to them.
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