A grounded theory study on work related stress in professionals who provide health & social care for people who exhibit behaviours that challenge

Providing direct health and social care services for people who exhibit behaviours that challenge can be a highly stressful occupation. Existing literature has suggested that there is a need to develop further theoretical understanding of how work related stress can be reduced in professions that consist of providing care for people who exhibit behaviours that challenge. The aim for this study was to use a Classic Grounded Theory approach to develop a theoretical framework to illustrate a common issue that could influence work related stress levels experienced when managing behaviours that challenge in health and social care settings. A series of focus groups and 1:1 semi-structured interviews were conducted to explore the articulated experiences of 47 health/social care professionals who provide care for people who exhibit behaviours that challenge. This led to the development of Therapeutic Engagement Stress Theory (TEST), which illustrates that the perceived capacity to therapeutically engage with people who exhibit behaviours that challenge is an issue that can influence the levels of stress experienced by health/social care professionals. TEST provides a framework that could be applied to identify specific factors that inhibit staff to successfully deliver caring interventions for people who exhibit behaviours that challenge, and also inform bespoke support mechanisms to reduce stress in health/social care professionals

Autism: Understanding Behaviour

Being a parent is a demanding role. It places demands on our tolerance, our time, our energy levels, our coping skills and our physical stamina. But in the end the large majority of us consider that the attachments we form with our children, the pleasure they give us, the opportunities to contribute to their lives and the affection we receive back is all worth it. From the moment of our child's birth we attune to their movement and vocalisation, and in the dance of interaction we hope they attune to us. As our daughters and sons develop, we observe changes in the nature of our interactions. Development necessitates changes in bodies and minds, and so we adapt our own expectations and anticipation of our child’s behaviour to retain synchronicity and share common experience. The changes in our engagements reflect the development in reaching common milestones in the nature of parent-child interaction, primarily initiated by the anticipated development of the child. Ultimately, we expect that our children will become adults and each family may have a set of expectations that may or may not be reached. For a range of cultural, ethical and legal reasons, our children generally become adults in their own right at the age of 16, but it should be remembered that they never stop being our sons and daughters, and the bonds developed in childhood are equally as strong when our children become adults. Most of us cope well with the demands our children make of us, although we can feel an overwhelming sensation of frustration from time to time. However, some of us find it difficult to cope at times. Irrespective of disability, some parents are just more able to cope than others, and from time to time all of us need help, whether it be from family members, friends or outside agencies. Parents of autistic children are no different in their coping resources than any other parent, but they can be faced by a range of what they may see as confusing behaviour from their child that can alter how they engage. For some families this can place unanticipated demands, create challenging situations and stress within parent-child interactions, particularly when in public settings where the stakes are high and social cost significant. This chapter discusses the demands placed on parent-child interactions. It aims to provide some guidance as to how to derive meaning through interaction and offer some tips and strategies that will facilitate engagement. While this chapter is primarily aimed at parents and carers of autistic children as well as practitioners working with autistic children, not all of the information or strategies will be relevant or appropriate for a particular child. Each person and situation is unique, so it’s important to think about how the issues discussed here relate to your own context

The parent programme: a psycho-educational intervention for parents of children with autism

Background Having a child with autism places significant demands on parents. Few interventions address parental understanding of the meaning behind child behaviour, and the relationship this has with parental stress. Parent-mediated interventions focus on behaviour exhibited by the child and ignore parental stress. This study assesses the impact of a psycho-educational intervention, which assists parents to derive meaning from their child’s behaviour. Aims The overall aim was to investigate if an intervention targeted exclusively at parents would: • Reduce parent stress associated with Child Characteristics • Reduce parent stress associated with Parenting Characteristics • Facilitate changes in parental coping styles Methods A quantitative approach was adopted to evaluate the impact of the intervention. Measures of parental stress (Parenting Stress Index) and parental coping (Ways of Coping, Revised) were taken at three time intervals; prior to, at a mid-point, and at the end of the intervention. Results Questionnaires were completed by 71 parents and the results were computed using a repeated measures analysis of variance (ANOVA). There was a statistically significant change within the parent and child domains of the Parenting Stress Index (p. 0.0005), with parents showing less stress associated with interpretations of their child’s behaviour, and significant changes in their use of problem-focussed coping. Conclusion Parent-mediated interventions that target parent characteristics associated with child behaviour, are inexpensive and have significant benefit. However, we require further research to explore the relationship between stress and coping variables in parents of children with autism to inform the future direction of intervention.awd_pdtunpub1632_ethesesunpu

Impact of a nurse-led intervention to improve screening for cardiovascular risk factors in people with severe mental illnesses. Phase-two cluster randomised feasibility trial of community mental health teams

Background: People with severe mental illnesses (SMI) are at increased risk of cardiovascular disease (CVD). Clinical guidelines recommend regular screening for CVD risk factors. We evaluated a nurse led intervention to improve screening rates across the primary-secondary care interface.Methods: Six community mental health teams (CMHTs) were randomised to receive either the nurse led intervention plus education pack (n = 3) or education pack only (n = 3). Intervention (6 months): The nurse promoted CVD screening in primary care and then in CMHTs. Patients who remained unscreened were offered screening by the nurse. After the intervention participants with SMI were recruited from each CMHT to collect outcome data. Main outcome: Numbers screened during the six months, confirmed in General Practice notes.Results: All six CMHTs approached agreed to randomisation. 121 people with SMI participated in outcome interviews during two waves of recruitment (intervention arm n = 59, control arm n = 62). Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year, with less than 20% having been screened for each risk factor. After the trial, CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure (96% vs 68%; adjusted Odds Ratio (OR) 13.6; 95% CI: 3.5-38.4), cholesterol (66.7% vs 26.9%, OR 6.1; 3.2-11.5), glucose (66.7% vs 36.5% OR 4.4; 2.7-7.1), BMI (92.5% vs 65.2% OR 6.5; 2.1-19.6), and smoking status (88.2% vs 57.8% OR 5.5; 3.2-9.5) and have a 10 year CVD risk score calculated (38.2% vs 10.9%) OR 5.2 1.8-15.3). Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse.Conclusions: The nurse-led intervention was superior, resulting in an absolute increase of approximately 30% more people with SMI receiving screening for each CVD risk factor. The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention, but the response rate for outcome collection was disappointing; possibly a result of the cluster design. The trial was not large or long enough to detect changes in risk factors.Trial Registration: International Standard Randomised Controlled Trial Registration Number (ISRCTRN) 58625025

Field Tests of the Varroa Treatment Device Using Formic Acid to Control Varroa destructor and Acarapis woodi

ABSTRACT The Varroa Treatment Device (VTD) filled with 85% formic acid (FA) was field tested for honey bee parasitic mite control in the Piedmont region of South Carolina from February-October, 1996. Three apiaries with 28 honey bee colonies were used in this test. Each colony was housed and managed in one, 10-frame Langstroth hive body and one 10-frame Illinois super. Two VTD/FA treatments, one Apistan treatment and one control were replicated seven times for comparison of varroa and tracheal mite levels. Treatments were: (1) two 60-day treatments with the VTD/FA; (2) continuous VTD/ FA treatment except during the 2-month nectar flow period; (3) two 42-day treatments with Apistan; and (4) VTD with sawdust but no FA as a control. Initial treatments were placed in colonies on 19 February, and the second treatments of VTD/FA and Apistan were administered on 6 August. The VTD/FA treated colonies were serviced at approximately two week intervals during the treatment periods. Samples of approximately 300 adult bees were collected for mite diagnosis (alcohol wash method) on 23 January, 11 April, 10 June, 6 August, and 15 October. One hundred pupae from each colony were extracted and checked for varroa on the same dates beginning 11 April. Thirtythree adult bees from each sample were also diagnosed for tracheal mites by the thoracic disc method. Varroa mite counts on adult bees collected from all treatments were significantly less than the control for the August and October samples. Although varroa mite counts on extracted bee pupae from most treatments were significantly less than the control for the August sample, the Apistan treatment was the only treatment that maintained significant varroa control in the brood for the October sample. Although the results of this test indicate that the VTD/FA is less effective than Apistan in controlling varroa mites, the VTD/FA provides a viable alternative varroa mite control in combination with other mite control measures, especially as an early season treatment

Elevated levels of hair cortisol concentrations in professional dementia caregivers

Providing care for people with dementia can be a highly stressful profession. Hair Cortisol Concentration (HCC) levels have been used as a biological marker for HPA axis activity to demonstrate that informal caregivers of people with dementia could be vulnerable to chronic stress. The current study aimed to progress the findings of research conducted with informal caregivers and is the first study to assess HCC as a biological indicator of stress in professional carers of people with dementia. HCC levels were compared between 32 professional dementia caregivers (30 females with a mean age of 45.83 and 2 males with a mean age of 24.50), 45 employees working in higher education settings (42 females with a mean age of 38.66 and 3 males with a mean age of 31.89) and 88 undergraduate students (67 females with a mean age of 24.04 and 21 males with a mean age of 23.91). Analysis of HCC was used to assess HPA axis activity over 1 month. A one-way ANCOVA, with age and gender being included as covariates, revealed that higher levels of HCC were observed in professional dementia carers than people who worked within higher education settings and undergraduate students. The results indicated that professional dementia caregivers may experience stress to the extent of activating biological stress responses at a greater frequency in comparison to people who work in higher education and undergraduate students. However, no significant differences were observed in the perceived stress levels reported across dementia caregivers, professionals working in higher education, and undergraduate students. These findings highlight the requirement to ascertain the extent to which work-related tasks or other factors, specific to the profession of caring for people with dementia, could elicit heightened HPA stress reactivity

Towards evolutionary ambient assisted living systems

Ambient Assisted Living (AAL) is advocated as technological solutions that will enable the elderly population maintain their independence for a longer time than would otherwise be the case. Though the facts motivating the need for AAL are indisputable, the inherently heterogeneous nature and requirements of the elderly population raise significant difficulties. One particular challenge is that of designing AAL systems that can evolve to meet the requirements of individuals as their needs and circumstances change. This demands the availability of an adaptive, open, scalable software platform that incorporates a select combination of autonomic and intelligent techniques. Given that the first generation of AAL systems will be deployed in the near future, it is incumbent on designers to factor this need for evolution and adaptivity in their designs and implementations. Thus this paper explores AAL from a number of prospective and considers an agent-based middleware approach to realising an architecture for evolutionary AAL.Science Foundation Irelan