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Critical discussion

Describe about the Evidence Based Nursing?

In the paper “Carers Responses to Challenging Behaviour: A Comparison of Responses to Named and Unnamed Vignettes” there is an increased interest in the research focusing on the area of behavioural responses of people who care towards the challenging behavioural attributes of individuals with cognitive disorders. Several frameworks/ models are evaluated that concentrate on this particular aspect, and out of these models Weiner Model of helping (Weiner, 1995) has been able to secure much appreciation. According to the model, Weiner has suggested that more the control the carer has on his behaviour more patiently he could help the person with a disability (Dagnan and Cairns, 2005). There is considerable evidence based practice for the relevance of the Weiner’s model of helping on the general aggression based reaction, but there is inconsistent literature about its importance to the carer’s response to the challenging behavioural aspects of individuals with cognitive disorders.

In the paper “Management and treatment of challenging behaviours by “Kathy Lowe, David Allen, Sam Brophy, and Kate Moore” have considered various treatment strategies for the people with challenging behaviour and mental disabilities. The treatment strategies like physical restraint, seclusion, sedation and distraction were used and research data was obtained for 235 children and adults who were extreme cases of challenging behaviour rated by the carer’s and 276 were very challenging (Baron and Kenny, 1986). Trends were observed to identify the management and treatment for these people with challenging behaviour. It was found that written plan was needed for adults and no plan was needed for children, it gives no information on the extent of the scheme to be needed. These ideas to be formed are based on the sound functional analyses and consist of strategies based on proactive and reactive manner.

The title of the paper 1 is “Carers’ Responses to Challenging Behaviour: A Comparison of Responses to Named and Unnamed Vignettes”.

This paper is based upon the replies of carer towards people having challenging behaviour like anger, physical violence due to their cognitive disabilities. To understand this behaviour Weiner model of helping is introduced. In some evidence, it has been shown that Weiner Model of helping is irrelevant with no consistency. To understand this may research scientist have done evidence based research but it every research have showed that Weiner model of helping is relevant and have shown similar results as other evidence-based research.

The paper is based on the evidence that supports that the relevance of the Weiner model of helping to the behavioural response is inconsistent. According to Willner and Smith (2007), there are main three factors that are adding to this instability. The first factor is, in the majority of the studies, the helping actions are hardly functional afar from its inclination towards helping. Secondly, the model’s approach applicable to individuals might with different behaviour and thirdly the model includes the use of a variety of stimuli like unnamed cameo role, video appearance of acted reactions and reminded instances of real behaviour.

Title of Paper 1: Carers' Responses to Challenging Behaviour

In this paper, we would study the difference between the data obtained due to different stimuli to unnamed vignettes. The study done by Wanless and Jahoda (2002) have made comparisons on the provenance, sentiments as well as helping intentions regarding unnamed vignettes involving physical and verbal aggression to already reminded conflict. It was observed that there is more sympathy in carer’s behaviour in recalled situation as compared to conditions with unnamed vignette. The methodology adopted includes 62 paid carers with some psychological disorders are observed to acknowledge sentiments and intended behavioural responses in response to the behaviour offered by the known vignette and by the unnamed vignette. The methodology includes the use of Modified Attribution Style Questionnaire, Self-Injury Behavioural Understanding Questionnaire. The carers were enquired about the behavioural challenge they were facing in case of both named and unnamed vignettes. These behavioural challenges include mainly the aggressive behaviour in which the person with a learning disability may hit you and pulls your hair. The carer people have to rate this on the 7 point Likert scale that would indicate signs of “not at all” to “severe signs of violence” by the acknowledgement criteria of stability, internality, controllability and world-widely (Beck et al., 1979). The more the number of the score on scales the more relevancy it will indicate. The behavioural responses of the carer are emotions of sympathy and anger. Some variable including optimism and intention for helping was measured using 7 point Likert scale (Dagnan and Weston, 2006). The results found were same as Weiner’s model associated with two the kinds of stimuli. It has been observed that Carer people have contributed more internally as well as globally and have identified themselves as less hopeful in the case of behavioural challenges of individuals of known vignettes when compared with unknown vignettes. Data from the experiment have showed both the named as well as unnamed vignettes are constant in the process of supporting the Weiner Model of helping (Cohen et al. 2002). The study has concluded that the unnamed vignettes may undervalue the responses of carer people in response to the challenging behavior; however there is no proven evidence that there are any differences in the inter- relatedness between the unnamed and named vignettes.

The title of the paper 2 is “Management and treatment of challenging behaviour by “Kathy Lowe, David Allen, Sam Brophy, and Kate Moore.”

This paper is based on the strategies used treating as well as managing the challenging behavioural attributes and mentally disables people. The treatment strategies used were the use of restraint, physical stress, seclusion, sedation as well as a distraction (Fleming et al., 1996). The treatment plans were provided to all the adults as well as children and various levels of results were found. Some written plans were also written for children as well as for very challenging behaviour adults. Sound functional analysis wrote the programme and reactive strategies were used.

This paper is based on the challenging behaviour faced by the disabled or handicap persons (cognitive and learning disabilities) including the various outcomes such as exclusion, physical violence, abusive language, neglect, stress to the caregiver and increased risk to service cost. Among these people with the disabilities, about 10 to 15 percent of them have been found to have particular challenging behavioural attributes as well as the usefulness of therapeutic intercessions. In the study done by Emerson in 2002, they have used restraint for 28 % to 67% of the children and around 15 to 3percent of the grownups or adults and 1-6% and 15% to 35% were sedated correspondingly. Robertson et al. (2005) have also conducted a study in which he reported the use of reactive strategies like restraint, seclusion, sedation in between 13 % to 48%. However there is insufficient proof for the utilisation of antipsychotics for the purpose of reducing the aspects of the challenging behaviour of people, it has been found to be effective for only 44% – 80% of the people with learning disability. Robertson and his colleagues in 2005have found that 58% to 83% of the carer people have reported that they have individual programme plans for reducing the challenging behaviour while some of about 50% to 64 % have indicated that they have some intervention plans. Some of those intervention plans include the use of reactive strategies (Kiernan, Reeves and Alborz, 1995). The most common response was obtained for distraction in both the cases of children and as well as adults, with a greater number as compared to one third of the total number of adults and children who most commonly possess challenging behavioural attributes have been given physical restraint and a quarter of people was given seclusion as a strain. About two-fifths of the most challenging adults were given the sedation as a strategy but no children were treated with the sedative approach. Written behavioural plans were made for extremely challenging adults and 62% of those who are very challenging and about 20 % of the children (Lowe et al. 2004). The overall conclusion to this study have suggested that the written plans for behaviours are increasingly used for improving the behavioural challenges faced by the carer in the community-based residential facilities mainly targeted towards the grown-ups, however have observed very less changes in the children’s behaviours, specifically those who live in their own respective homes (Harris P & Russell O (1989). Besides this, there are some exceptional cases of adults for which no written plans are available as these adults have extreme challenging behaviours.

Title of Paper 2: Management and Treatment of Challenging Behaviour

The thought is written on the reflective models given by Rolfe et al. (2001). The reflection framework is explained in a straightforward manner that is based on three central questions including “What? So What? Now What?. The following study is based on the behavioural challenges faced by the carer of people with cognitive disability and learning disability. This reflective model by Rolfe, Freshwater &Jasper will help us in reaching to a conclusion which would help us in improving our practice for good management and designing treatment strategies for the mentally challenged people so that their behaviour could be improved and would become easier for the carer people to take care of them (Harris and Russell 1989).

What – for improvement of behavioural challenges faced by carer Weiner model of helping was introduced. But some evidence-based literature has shown inconsistency in the Weiner model of helping. To uncover this various studies by the researcher was done in which paid carer people were taken and they have to take care of people with mentally challenge nature. It consists of named ad unnamed vignettes to which carer have to give care. The methodology includes the use of Modified Attribution Style Questionnaire, Self-Injury Behavioural Understanding Questionnaire (Oliver, Murphy and Corbett, 1987). The studies have shown same results as Weiner Model of helping. For management of behavioural challenges, various treatment strategies were provided based on sound functional analysis and methodology includes the use of reactive strategies including physical restraint, sedation, seclusion, and distraction. The studies have shown that these approaches have provided some improvement in behaviour and have proven reliable but not entirely safe.   

So what – the studies have concluded that the carer people have provided care both internally as well as globally to named as well as unnamed vignettes but in the case of known vignettes the response was less hopeful. The data obtained from various studies have showed similarity with Weiner model of Helping. Another study for the management of behavioural challenge has suggested the use of use of written plans as well as the use of active strategies based on the sound functional analysis (Dagnan, Trower and Smith, 1998).

Now what – from this study it could be learnt that intellectually disable people are facing challenges in society as the people do not understand them, neither they are accepted. Due to this, they have a change in their behaviour that comes out on the people who care for them (Oliver, Murphy and Corbett 1987). So it is important to help them and design some strategies that could assist them in improving their behaviour. By using the properly designed treatment strategies, the challenging behaviour may improve and this would not pose any problems for the carer people.

Conclusion

The study concludes that the responses of carer towards people having challenging behaviour like anger, physical violence due to their cognitive disabilities should be improved. To understand this behaviour Weiner model of helping is introduced. Many researchers have studied and found similar results with Weiner model of helping. Management of the behavioural challenges faced by carer people has used various strategies that have helped us in improving our practice for good management and designing treatment strategies for the mentally challenged people so that their behaviour could be enhanced and would become easier for the carer people to take care of them. Trends were observed to identify the management and treatment for these individuals with challenging behaviour. The responses of carer towards people having challenging behaviour like anger, physical violence due to their cognitive disabilities are considered. To understand this behaviour Weiner model of helping is introduced. Some written plans were also written for children as well as for very challenging behaviour adults. The use of these active strategies has shown an immediate response in the challenging behaviour. Therefore, in this study, all the main aspects are covered with regards to the challenges faced by the carer of people with cognitive disability and learning disability.

References

Baron R. M. & Kenny D. A. (1986) The moderator mediator variable distinction in social psychological research – conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182.

Beck A. T., Ward C. H., Shaw B. F. & Emery G. (1979) Cognitive Therapy of Depression (Trans.). Wiley, New York, NY.

Cohen J., Cohen P., West S. G. & Aiken L. S. (2002) Applied Multiple Regression Correlation Analysis for the Behavioural Sciences (Trans.). Lawrence Erlbaum Associates Inc, New York, NY.

Dagnan D. & Cairns M. (2005) Staff judgements of responsibility for the challenging behaviour of adults with intellectual disabilities. Journal of Intellectual Disability Research 49, 95–101.

Dagnan D. & Weston C. (2006) Physical intervention with people with intellectual disabilities: the influence of cognitive and emotional variables. Journal of Applied Research in Intellectual Disabilities 19, 219–222.

Dagnan D., Trower P. & Smith R. (1998) Care staff responses to people with learning disabilities and challenging behaviour: a cognitive-emotional analysis. British Journal of Clinical Psychology 37, 59–68.

Emerson E (2002) The prevalence of use of reactive management strategies in community-based services in the UK. In: D Allen (Ed) Ethical Approaches to Physical Interventions. Responding to challenging behaviour in people with intellectual disabilities. Kidderminster: BILD.

Fleming I, Caine A, Ahmed S & Smith S (1996) Aspects of the use of psychoactive medication among people with intellectual disabilities who have been resettled from long-stay hospitals into dispersed housing. Journal of Applied Research in Intellectual Disabilities 9 (3) 94–205.

Harris P & Russell O (1989) The Prevalence of Aggressive Behaviour among People with Learning Difficulties (Mental Handicap) in a Single Health District. Bristol: Norah Fry Research Centre, University of Bristol.

Kiernan C, Reeves D & Alborz A (1995) The use of anti-psychotic drugs with adults with learning disabilities and challenging behaviour. Journal of Intellectual Disability Research 39 (4) 263–74.

Lowe K, Allen D, Brophy S et al (2004) Mapping the Service Needs of Children and Adults with Learning Disabilities and Challenging Behaviour: Summary report.Cardiff: Special Projects Team, Bro Morgannwg NHS Trust Learning Disability Directorate.

Lucas V. L., Collins S. & Langdon P. E. (2009) The causal attributions of teaching staff towards children with intellectual disabilities: a comparison of ‘vignettes’ depicting challenging behaviour with ‘real’ incidents of challenging behaviour. Journal of Applied Research in Intellectual Disabilities 22, 1–9.

Oliver C, Murphy G & Corbett JA (1987) Selfinjurious behaviour in people with mental handicap: atotal population study. Journal of Mental Deficiency Research 31 147–62.

Robertson J, Emerson E, Pinkney L et al (2005) Treatment and management of challenging behaviours in congregate and non-congregate community-based supported accommodation. Journal of Intellectual Disability Research 49 (1) 63–72.

Rolfe, G., Freshwater, D., Jasper, M. (2001). Critical Reflection in Nursing and the Helping Professions: a User’s Guide. Basingstoke: Palgrave Macmillan.

Weiner B. (1995) Judgements of Responsibility: A Foundation for a Theory of Social Conduct (Trans.). The Guilford Press, New

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