Violence in the Care of Adult Persons with Intellectual Disabilities - Term Paper Example

Critical analysis - Violence in the care of adult persons with intellectual disabilities Introduction Violence has long been a matter of concern for the staff members in the working condition where adult patients with learning disability find their prominent existence (Jackson, and Mannix, 2002; Jansen, et al. 2005; McKenna, et al. 2003; Secker, et al 2004). The present paper under the evaluative eye by means of critical review has its title as “Violence in the care of adult persons with intellectual disabilities” (Strand, et al. 2004). Thus, the paper’s topic holds its area of focus on the violence of adult persons as it holds its relevance with their care. It is also essential to point out that the violence in the adults only with intellectual disabilities has been stretched here with prominence. Numerous researchers have laid the area of their work on the violence in care of adult with learning disability (Bonner, et al. 2002; Coyne, 2002; Duxbury, and Whittington, 2005; Hegney, et al. 2003). This is because there is a rising demand in the in-depth study of the violence behavior in the adults in the care centre. The present topic holds a clear title and refers in a very straightforward manner of presence to the topic, which is essentially in demand. We would say that the lock and key arrangement of the topic with the text has been exhibited in the present paper. Strand (2004) and experts in the paper begin their essential focus of interest in the topic by providing a short background and literature review as relevant to the topic. They mention that violence holds its presence in the form of physical, psychological, financial, and sexual abuse. They also held their emphasis that the problem of violence in adults with intellectual disability is quite often underreported. It is also important to note here that the present study followed the ethical considerations as considered important for the conduction of the research on human particpants. Procedure The objective for the present study as presented by Strand and colleagues was to study the present picture with more relevance to the caregivers. The focus was held on the Swedish adult persons with intellectual disability and their caregivers’ in-group dwellings. Thus, we might say that the selection of participants holds relevance with the overall aim and objective of the research. It is important to mention that the best research finds its most authentic roof place in a good selection and application of design. In the present research, a total population based survey was carried out. For the purpose of data collection, a questionnaire was forwarded to 164 staff members. The staff members had their belonging from 17 care settings for adults with intellectual disability. The response rate as observed in the research study was 74%. Thus, it should be noted that reliability and validity features of the data to be collected was addressed. Collection of data from 17 different care settings does really reveal that the variation in the results due to change in the location has been kept under crucial consideration. However, we still recommend that a larger sample size of the staff members could have resulted in adding more confidence in the results obtained from the present research study. Questionnaire as a method of data collection presents certain advantages and the important one of them is that it is less expensive and less time consuming (Bassett, 20 00; Bishop, and Freshwater, 2004; Cormack, 2000). Considering the amount of work pressure as faced by the staff members in the care of adult with learning disability, it thus proved to be a better option. In addition, since more than 100 participants were included for the purpose of study, interview as a means of data collection was not a feasible option. The technical skill as required for conducting interview holds its absence in the case of questionnaire (Hendrick, 2000; Ogier, 1998; Parahoo, 1997; Silverman, 1997). Thus, once the questionnaire is constructed skillfully the investigator can employ anyone to administer it. One important feature of questionnaire as a means of data collection is that the responses obtained are in the handwriting of the person and thus are fully authentic. However, this benefit does not find its presence in the case of data collection from questionnaire through online means. Since in the present study online support was not practiced therefore the data as collected was in the hand writing of the staff members and thus led authenticity. Another important feature that questionnaire must have posed is that less pressure would have been placed on the staff members since it does not require immediate thinking and filling out. In addition for sample sizes as essential for the present study it was a better option to practice. However, like every scientific method this too respires its own deficiencies. One important drawback of questionnaire administration is that the staff members might have misinterpret the questions and there was no means to instruct them. In addition, the emotional responses of the staff members was not rightly or say completely collected by means of questionnaire. Since in the present study, the response to be collected was based on the violent situation as experienced by staff members, the inclusion of emotional response was an essential commodity of the experiment. This certainly sets way for a similar research study to be followed by means of collecting data through interview since questionnaire is an inefficient way to do so. This is also essential that many times participants do not like to place their controversial views on questionnaire and thus the need of interview as a means of data collection finds a dominant stand of survival. The study revealed that 122 staff members who were participants in the study had an experience of violent incidence towards an adult person with intellectual disability. Thus, the percentage of staff members with experience of violence as reported in the present study is very high. In addition, around 14% of the staff members admitted that they themselves have been perpetrators. Almost 61% of the staff members did even narrated the situations in which they were exposed to violence from adult person with intellectual disability. The most frequently reported violence in the collected data from the survey was that of physical violence. The common most cause reported for its prevalence was when the adult patient with intellectual disability did not respond to the instructions by the caregiver or when both acted in violence. The presence of violence led the feeling of less courage to fight the situation in the staff members. Thus, in several instances the complexity of the violent situation was also referred to the mangers. The results as presented by the research study do make a good addition to the present knowledge available on the subject. The representation of the results from the analysis of the data does present that the Strand and colleagues had thorough knowledge of data analysis by statistical means. The paper concluded that violence has been accepted as a natural part of the daily care for adult persons with intellectual disability. In addition, most of the observed violence is physical and psychological and holds its presence in close helping situations. Throwing a detailed light on the results and discussions presented in the paper under critical consideration The results were broadly divided into three important parts and they were as under:  Violence towards adult persons with intellectual disabilities  Violence towards staff members  Feelings, management and prevention First we would like to throw some light on violence towards adult persons with intellectual disabilities as presented in the results of the paper under consideration. It was found that around 35% of the total respondents who were admitted during the past year had witnessed a violent incident when adults with intellectual disabilities were the victims (Strand, et al., 2004). And around fourteen percent admitted that they had made use of violent method for some reason or the other towards an adult person with learning disabilities. It was also put forth to the scientific knowledge by few persons that happening of violence was almost a daily phenomenon. Thus, the number of violent cases taking place, the happenings of physical abuse is worth a genuine consideration. The frequency of the types of violence taking place has also been reported in the results of the present paper. The staff members (n=43) reported frequency of violent incidences per type directed towards adults with intellectual disability for a given month were highest for physical and were followed by psychological and neglect. The sexual abuse cases were minimum and had a reporting of one case in a year. Other cases that were minimum in happening were the financial (thrice a month) and maltreatment (twice a month). In the other part, the violent situation was described and a core story of violence towards an adult person with intellectual disability was presented. The next essential point of consideration is that of violence towards staff. Around 61% of the participants in the study reported that they have been exposed to violence in the last one year from an adult pateint with intellectual disability in the working premises. The staff members reported frequency of violence incidents per type directed towards themselves on one month basis were highest for physical (eleven times a month) and were followed by psychological (five times a month). The violent incident that most rarely occurred was those pertaining to sexual (once in a year) and financial (once in a year) issue. The results were then followed by description of the violent situation and presentation of score story of violence towards staff members. The research results also presented the feelings, management and prevention as of the staff members in dealing with the adult patients with intellectual disabilities. It was stated that irrespective of the direction of the violent acts feelings of powerlessness or inadequacy gained prominence of existence after the violent situation. Most of the staff members who were exposed to the violent situation experienced negative feelings. The feelings usually comprised of guilt, loneliness, shock, and of lower potential to mange such situations. The discussion of the research under review brought several facts based on results obtained. It sated that violence can be a risk factor for both the patient and the staff member. However, the results as presented in the research need to be authenticated to a greater extent by further research in this area. This is also because the percentage of violent cases as revealed in the paper under discussion are significantly higher than those presented in other studies (Arnetz et al., 1996; Astro¨m et al., 2002; Lundstro¨m, 2000; Menckel et al., 2000; Saveman et al., 1999) running parallel to this. Another point that was brought to scientific platform from the results is that most of the violent cases involved men (20-30 years old) with female staff members. Thus, the need of recruiting male staff so as to cope up with the situation was again realized (Nolan et al., 1999 and Akerstro¨m, 1994). Another point that was considered crucial was the need to provide specialist training to the staff members. The attempts to make the staff members realize the potential side effects of anti-psychotic drugs in the induction of violence were considered as of crucial importance. Validity and reliability as relevant to the present study As we know, content validity refers to how well the content of a test measures the entire domain (under the focus of investigation) and is related to the characteristics being measured. Thus, content validity helps us to know whether the content of a test is representative of the desired universe of content. Thus, it describes the extent to which the sample of items is a reflection of dimensions to which we wish to generalize. In the present study, the dimension of interest was based on the violence in care of adult with learning disability. For example, in defining the construct of adults with learning disability, the research was specifically addressed to the care groups, which provide service to them. It is essential to note that criterion related validity refers to the extent to which a measure of a concept indicates an association with some independent or external indicator of the same concept. In the present study, the criterion related validity was addressed with scientific understanding. Although predictive validity was not addressed in the present research, (Predictive validity is studied when the criterion is measured sometime after the data has been obtained on the predictor). A reference to the concurrent validity was made with some efficiency. This is in the manner that the nurses were required to report their both present and past experiences of violence in the care of adults with learning disability. An essential difference between reliability and validity is that reliability refers to the rationale underlying the test itself and is thus important for its interpretation. As we can see that the data collected form the staff members was from 17 different care groups. This certainly helps to benefit the results from the reliability as examined in different situations. An area of our recommendation to the present research article However, we strongly recommend that the paper could have had better weight age if a short description of the means that can be adopted as a solution for the prevalent situation of violence in care could have been presented. In addition, the application of yoga, meditation, and spiritual inclination called the drumming effect could have been proved fruitful as an inclusive regimen of the questionnaire. For example, the staff members could have been asked that how many of them after experiencing drumming effect or practicing yoga and meditation felt that they had gained strength to address the situation with more patience and courage. Recommendations from the staff members as to what probable solution do they think can help lower the burden of violence as experienced by them should have been presented. We therefore believe that an area of substantial value in the progress of science discipline as applicable to the observed violence in care of adult persons with intellectual disability could have been addressed in the present survey but was neglected for inclusion. The relevance of the present study to the clinical practice as presented by Strand and experts is to provide additional training to the staff members in terms of communication skills. The need of training has also been emphasized by other research experts (Badger, 2004). However, this is not the most crucial relevance of the research in clinical practice. The object of further research has to be posed on the development of tolerance in the individuals. It is not that the staff members do not know the importance of polite behavior. It is that the politeness extinguishes itself during care delivery. Thus, the focus should be in the development of tolerance and patience and thereby assure better behavior from the staff members. As previously discussed, this can be achieved with dominance by the addition of drumming effect, yoga, and mediation within the daily routine of the staff members. Thus, we would like to state that relevance as proposed by the researchers of the paper is not appropriate and should be considered for revision. Conclusion The present study has an overall competitive stand in the scientific scenario of knowledge imaparting techniques. However, similar studies with a bigger sample size shall certainly be appreciated. Such studies shall add greater depth and applicability to the study in the present discussion. References Akerstro¨m M. (1994) Violence and Threats in Nursing. Documentation of a National Interview Study from Sweden (in Swedish) (No. 1993:3). The Department of Sociology, University of Lund, Lund. Arnetz J.E., Arnetz B.B. & Petterson I.-L. (1996) Violence in the nursing profession: occupational and lifestyle risk factors in Swedish nurses. Work and Stress 10, 119–127. Astro¨m S., Bucht G., Eisemann M., Norberg A. & Saveman B.-I. (2002) Incidence of violence towards staff caring for elderly. Scandinavian Journal of Caring Sciences 16, 66–72. Badger, F. and Mullan, B. (2004) Aggressive and violent incidents: perceptions of training and support among staff caring for older people and people with head injury. Journal of Clinical Nursing 13:4, 526-533. Bassett, C. (2000) Implementing research in the clinical setting. London: Whurr. Bishop, V. and Freshwater, D. (eds.) (2004) Nursing research in context. Macmillan: Basingstoke. Bonner, G., Lowe, T., Rawcliffe, D. and Wellman, N. (2002) Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. Journal of Psychiatric and Mental Health Nursing 9:4, 465-473. Cormack, D. (2000) The research process in nursing. London: Blackwell. Coyne, A. (2002) Should patients who assault staff be prosecuted?. Journal of Psychiatric and Mental Health Nursing 9:2, 139-145 Duxbury, J. and Whittington, (2005) Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing 50:5, 469-478. Hegney, D., Plank A. and Parker, V. (2003) Workplace violence in nursing in Queensland, Australia: A self-reported study. International Journal of Nursing Practice 9:4, 261-268. Hendrick, J. (2000) Law and ethics in nursing and health care. Chellenham: Stanley Thomas. Jackson, D., and Mannix J. (2002) Who would want to be a nurse? Violence in the workplace – a factor in recruitment and retention. Journal of Nursing Management 10:1, 13-20 Jansen G., Dassen, T., Groot, G. and Jebbink. (2005) Staff attitudes towards aggression in health care: a review of the literature. Journal of Psychiatric and Mental Health Nursing 12:1, 3-1. Lundstro¨m M. (2000) Violence in the Care for Persons with Mental Retardation (in Swedish). Master Thesis, Department of Nursing, Umea° University, Umea° McKenna, M., Poole, S., Smith, N., Coverdale, J. and Gale, C. (2003) A survey of threats and violent behaviour by patients against registered nurses in their first year of practice. International Journal of Mental Health Nursing 12:1, 56-63. Menckel E., Carter N. & Viitasara E. (2000) Violence towards caregivers of persons with developmental disabilities. Developing a system for recording challenging behaviour. WORK: A Journal of Prevention, Assessment, and Rehabilitation 15, 3–8. Nolan P., Dallender J., Soares J., Thomsen S. & Arnetz B. (1999) Violence in mental health care: the experiences of mental health nurses and psychiatrists. Journal of Advanced Nursing 30, 934–941. Ogier, M. (1998) Reading research. 2nd edition. London: Bailliere Tindall Parahoo, K. (1997) Nursing research: Principles, process and issues. London: Macmillan. Saveman B.-I., A ° stro¨m S., Bucht G. & Norberg A. (1999) Elder abuse in residential settings in Sweden. Journal of Elder Abuse & Neglect 10, 43–60. Secker J., Benson A., Balfe E., Lipsedge M., Robinson S. and Walker J. (2004) Understanding the social context of violent and aggressive incidents on an inpatient unit. Journal of Psychiatric and Mental Health Nursing 11:2, 172-178. Silverman, D. (1997) Qualitative research. London: Sage. Strand M., Benzein E. and Saveman B-I. (2004) Violence in the care of adult persons with intellectual disabilities. Journal of Clinical Nursing13, 506–14. Read More