M.Cur. (Psychiatric Nursing) / Caring for intellectually disabled people can be demanding for student nurses who are still novices in the profession. To ensure optimal nursing care is received, student nurses must have both an understanding of and a positive attitude towards intellectually disabled people. Nursing intellectually disabled people is a challenge that can have an impact on a person‟s body, mind and spirit therefore, student nurses need to have the ability to deal with stressful situations and environments. Student nurses need to be prepared to care for patients with long-term challenges, such as intellectual disabilities. These patients require a caring relationship that facilitates an enhanced awareness of life and health experiences. The caring relationship also facilitates health and healing processes as it involves the authentic and genuine needs of patients. This research aimed to explore and describe lived experiences of student nurses caring for intellectually disabled people in a public psychiatric institution, and to formulate guidelines for the facilitation of mental health of these student nurses. A qualitative, exploratory, descriptive and contextual design was used. Data were collected through individual in-depth interviews, focusing on the question “How was it for you to be working at this institution?” Thematic analysis was used to analyse the collected data and a consensus discussion was held with the independent coder. Ten participants were interviewed and five, who were not comfortable with interviews, wrote naïve sketches. Trustworthiness was assured by adhering to Lincoln and Guba‟s principles, that is, credibility, transferability, dependability, and confirmability. Four ethical principles were demonstrated throughout the research namely, principles of respect for autonomy, non-maleficence, beneficence, and justice. Three themes emerged from the data. Firstly, student nurses experience a profound unsettling impact on their wholistic being when caring for intellectually disabled people. iv Secondly, they develop a sense of compassion and a new way of looking at life, and lastly they require certain educational, emotional and spiritual needs to be met. Guidelines were formulated to facilitate the mental health of student nurses caring for intellectually disabled people in a public psychiatric institution.

In the present study, the effects of (a) unit-dose packaging to facilitate self-monitoring of medication-taking behavior and (b) positive verbal reinforcement to maintain the reactive effects of self-monitoring were evaluated in six psychiatric outpatients.

Three severely developmentally delayed institutionalized adolescent individuals were treated for severe self-injurious behavior over a three month period. Treatment consisted of positive practice overcorrection, restraint delivered as a reinforcer for an absence of self-injury, and increased interaction during task training sessions. Treatment was faded for two of the individuals in successive steps involving decreased restraint and interaction. Self-injurious behavior was reduced in all cases. Prosocial behaviors increased with reductions in self-injurious behavior.

A review of legal provisions and practices and current psychological theory and research concerning the mentally retarded indicated inconsistencies between the law and current theory, Laws have been based on archaic models which fail to consider the heterogeneity of those classified as retarded and their potential for development and training. Retardation professionals have agreed that normalization of institutionalized mentally retarded and mainstreaming in education are preferable principles. Research comparing the effects of community living and institutionalization and effects of special and integrated classes was sparse and inconclusive; the major thrust of research has been on the 4% of all mentally retarded who are institutionalized. Legal attitudes toward the retarded have changed only in the area of institutionalization, particularly guaranteeing due process during commitment. Litigation has been involved in habilitation and the least restrictive alternative, the legal counterparts to normalization. Courts have relied on constitutional, statutory, tort and contract theories and deal mainly with the institutionalized retarded. Laws imposed on the non-institutionalized retarded have demonstrated a particularly restrictive parens patriae attitude. Cases have been inconsistent, resulting in no clear standard as yet. A more recent trend has been on legislation which is more consistent than litigation. Recommendations based on theory and research and status of present laws included the following: 1) more emphasis on research of retarded in the community, on community living versus institutionalization, and on special education versus integrated, mainstreamed classes; 2) development of national standards incorporating the principle of normalization and a developmental approach to services; re-evaluation and amendment of present laws to expand the rights of non-institutionalized and 4) adoption of legislation giving all mentally retarded a right to habilitation, establishing a committee to develop and revise minimum standards, creation of a monitoring team to periodically review each patient's treatment plan and formulation of a manual setting forth minimum treatment levels.

No description available.

The environmental transactions of mentally retarded adults were investigated in three community-based programs as a measure of client adjustment to community living. Specific features of the interaction between clients and the physical and social environment were identified and evaluated. The research settings and subjects were: a group home (7 clients/4 staff); a semi-independent apartment setting (13 clients/4 staff); and a work adjustment program (11 clients/5 staff). Methodological procedures were: observational procedures, including the Community Interaction Assessment instrument, a form of behavior mapping which emphasized social interaction, and the Bales Interaction Process Analysis, an observational technique for structured groups; the structured questionnaires which make up the Moos Multiphasic Environmental Assessment Procedure (MEAP); and unstructured observations and interviews, used as procedures in the various settings in the larger community. Results were presented in terms of the particular features of the physical and social environment which were related to the incidence of social interaction. Rank order correlations of the MEAP residential and staff data revealed a significant positive relationship among all three settings, indicating similarities across all research settings in staff and resident characteristics. A significant positive correlation was also found in the group home and apartment environmental evaluations, indicating strong similarities in staff attitudes in the two residential settings. An analysis of variance indicated a significant difference in the MEAP policy data obtained for the three settings, suggesting important differences primarily in the areas of policy choice, resident control, and provision for privacy. Normative data was presented for the residential programs based on MEAP findings. Results were discussed in terms of the implications of findings for design, program, and community integration issues and suggestions for future research were presented.

Single subject research procedures were used to evaluate the following effects of Mellaril, a neuroleptic, on adaptive and disruptive behaviors of three institutionalized retarded people: (1) documentation of social interactions, activity level, vocational performance, repetitive motoric behavior, disruptive incidents, and possible tardive dyskinesia to determine which behaviors changed during drug and placebo conditions, and (2) individualized clinical evaluation to determine whether drug therapy decreased disruptive behavior and increased or interfered with adaptive functioning. Each subject received individualized Mellaril dosages and served as his/her own control in reversal designs. All subjects were abruptly withdrawn from the drug. One subject (125 mg.) underwent B-A-B while two subjects (60 mg., 250 mg.) underwent B-A-B-A phases, where B indicated the drug condition and A indicated the placebo condition. Each phase lasted approximately one month. A fourth subject underwent B-A phases and was dropped from the study due to an epileptic convulsion. Pharmacotherapy for this disorder confounded Mellaril-behavior relationships. A trained observer recorded occurrence of behavior on weekdays within the institution including 15 minutes per subject in residential settings and five minutes per subject in vocational settings. Institutional staff documented daily frequencies of incidents including aggression and property destruction. Institutional staff, the trained observer, and the subjects were not told the timing of drug/placebo changes. The results indicated that the following behaviors increased following drug withdrawal: vocational performance, talking, looking at and proximity to others, and talking/laughing to self. Activity level decreased upon drug withdrawal. The following patterns of disruptive behavior were subject-unique: one subject (250 mg.) clearly showed the most incidents while on-drug; one subject (60 mg.) did not show changes during the first drug withdrawal, but showed increases during the second; and the third subject (125 mg.) engaged in incidents at steadily increasing rates during all conditions. The applicability of single subject designs to applied behavioral pharmacology is discussed. Variables within an applied setting which potentially obfuscate drug-behavior relationships are identified. Suggestions for future research are offered.

Fifteen hospitalized adolescents were used as subjects. An individually consequated token economy was in effect during baseline. Measures were taken of work output, attending behavior, and disruptive behavior. During the treatment phase, reinforcement was contingent upon the performance of a randomly selected subgroup. Following the treatment phase, the individual token system was reinstated for baseline-2 measures. The mean performance of the group during baseline was compared to performance under treatment conditions for work output and attending behaviors. In addition, performance of the contingent subgroup was compared to performance of the non-contingent group. No significant t values were obtained. With failure to obtain significant t values, the null hypothesis was not rejected, i.e., the two conditions were not proven significantly different.

Behavior-specific praise has been shown to increase rate of desired behaviors for individuals with intellectual and developmental disabilities, though it is rarely used by caregivers in residential facilities for adults with disabilities. Prompting in the form of tactile stimulation has been demonstrated to increase rate of behavior-specific praise delivered by teachers and caregivers. The purpose of the current study was to increase the quantity and quality of behavior-specific praise statements that were delivered by caregivers to individuals at a large residential facility for adults with disabilities. A tactile prompting device (Gymboss Interval Timer and Stopwatch) was provided to the caregivers and set to vibrate for one second at intervals of five minutes, for a total of six intervals. Instructions were provided to the caregivers to deliver behavior-specific praise statements, for appropriate behaviors, to their assigned clients every time a vibration occurred. Examples of behavior-specific praise statements were provided to the caregivers before each session, but no feedback was delivered during the prompting phase. Results indicated that a tactile prompting device was effective at increasing rate of behavior-specific praise statements delivered by caregivers in as little as one session.

University of Macau / Faculty of Education