Care Delivery and Nursing Management - Coursework Example

Care Delivery and Nursing Management I. Introduction The tasks of this paper are: 1. To identify a person with a learning disability who requires, or is receiving, an intervention for their behavior; or identify a person with a learning disability who required, or received, an intervention for their behavior within a previous placement setting. The behavior may be one that arises from a mental health condition; or affects the person's health; or challenges practitioners and services; or may cause harm to the person; or which impacts on their social image. This paper also requires the conduct of a comprehensive review of available literature, which will be used to analyse the evidence base underpinning the chosen behavioural intervention and which relates this to the chosen individual’s circumstances. The review of literature will thus explore behavioural theory and behavioural forms of intervention and consider their appropriateness with regard to the origins and manifestations of the person’s behaviour or behaviours. A Behavior Intervention Plan (BIP) takes the findings tallied in a Functional Behavioral Assessment and then employs them to formulate a definitive plan of action to channel a patient's behavior. Sometimes, a BIP may consist of options to alter the context to stop or prevent the behavior sought to be controlled from being triggered at all, supply affirmative reinforcement to encourage positive behavior, use intentional ignoring to evade abetting negative behavior, and may include ways to change the environment to keep behavior from starting in the first place, provide positive reinforcement to promote good behavior, employ planned ignoring to avoid reinforcing bad behavior, and provide the necessary auxiliary so that the student would not be impelled to behave out of frustration or fatigue (Mauro 2004). II. Review of Related Literature The theory of reasoned action was formulated by Martin Fishbein and Icek Aizen (1975, 1980). This theory was developed from past works that originally began as a theory of attitude, that subsequently produced studies on attitude and behavior. According to Hale, et al (2003, p. 259), the theory was “born largely out of frustration with traditional attitude-behavior research, much of whuch found weak correlations between attitude measures and performance of volitional behaviors." The theory of reasoned action is a derivative of the social psychology framework. The theory is composed of three general propositions, namely: behavioral intention (BI), attitude (A), and subjective norm (SN). Basically, theory of reasoned action proposes that the behavioral intention of a person is dependent on the attitude of the subject about the behavior and subjective norms (BI = A + SN). The theory posits that if a person has the intention to act out a certain behavior then there is a likelihood that the person will actually do it. It also presupposes that the intent of a person is influenced by two factors: the attitude of a person towards the behavior and the subjective norm. If a person intends to do a behavior then it is likely that the person will do it. Furthermore a person's intentions are themselves guided by two things: the person's attitude towards the behavior and the subjective norm. Behavioral intention measures a person's relative strength of intention to perform a behavior. Attitude consists of beliefs about the consequences of performing the behavior multiplied by his or her valuation of these consequences. Subjective norm is seen as a combination of perceived expectations from relevant individuals or groups along with intentions to comply with these expectations. In other words, "the person's perception that most people who are important to him or her think he should or should not perform the behavior in question" (Azjen and Fishbein, 1975). To state the definition a little differently: the volition (voluntary) of a person's behavior can be predicted by the person's attitude toward that behavior and how he/she thinks other people would think of them if they were the ones who performed the behavior. The attitude of a person, in combination with subjective norms, constitutes the intention that underlies the behavior. According to Fishbein and Ajzen, attitudes and norms are given the same weight and significance when it comes to attempts to predict behavior. They say that it depends on the individual and the particular circumstances of the person. "These factors might be very different effects on behavioral intention; thus a weight is associated with each of these factors in the predictive formula of the theory. For example, you might be the kind of person who cares little for what others think. If this is the case, the subjective norms would carry little weight in predicting your behavior” (Miller, 2005, p. 127). The theory of reasoned action has been given a lot of attention and interest especially in the disciplines of consumer behavior. The rationale for this is that aside from the ability of the model to satisfactorily predict the intentions of consumer, it is also able to function as "relatively simple basis for identifying where and how to target consumers’ behavioral change attempts” (Sheppard, Hartwick, & Warshaw, 1988, p. 89). Hale et al. (2003) assert that the theory of reasoned action has undergone validation and counter-validation in various research works across different disciplines, which includes dieting (Sejwacz, Ajzen, & Fishbein, 1980), using condoms (Greene, Hale, & Rubin, 1997), consuming genetically engineered foods (Sparks, Shepherd, & Frewer, 1995), and limiting sun exposure (Hoffman, 1999). However, the theory has its limitations and extensions. Sheppard et al. (1988) concur with the basic propositions of the theory but assert some exceptions to the theory. They say that an indicator or measurement of behavioral intention measure would be able to forecast what voluntary act would be performed, except when the intention is latered before the subject actually performs the behavior or when the intention measurement employed does not have basis on any criterion "in terms of action, target, context, time-frame and/or specificity” (p. 325). Furthermore, Sheppard et al. (1988) assert that a majority of the research thus far conducted using the model has employed the theory of reasoned action to investigate events and phenomenon which were not among those originally within the scope of the theory. For these researchers, their was very little expectation that the theory would prove reliable in such investigations. Much to the contrary of their predictions, they discovered that the model performed beyond their expectations and was able to satisfactorily predict objectives as well as predict activities involving concrete options among different choices. In conclusion, Sheppard et al. (1988) harps on the "strong predictive utility" of the model. They assert that this strong predictive utility extends to situations and activities which do not fall inside the parameters of conditions that were initially designated for the application of the model to remain plausible. But this does not mean that such applications beyond the initial scope did not necessitate modifications and refinements in the theory, particularly in the areas of goal and choice domains (p 338). Some other exceptions were propounded by Hale et al. (2003). They say that aim of the TRA is to explain volitional behaviors." According to Hale et al, the explanatory scope of the theory does not include a wide range of behavior. For instance, the theory cannot explain spontaneous, impulsive, habitual, the result of cravings, or simply scripted or mindless (Bentler & Speckart, 1979; Langer, 1989). The reason for excluding such behaviors is that there is doubt as to the voluntariness of these actions. These acts may not be attended by a "conscious decision on the part of the actor” (p. 250). Revisions and extensions have been incorporated into the theory of planned behavior by Ajzen himself. According to Ajzen, Perceived behavioral control, which is a major predictor, has been added to the model of planned behavior. The inclusion of this major predictor is intended to factor in the times when the person has the intention to carry out a certain conduct or behavior, but the doing of the act is prevented or stymied by the lack of confidence or the inability of the person to control his own behavior (Miller, 2005). In a research article, Donaldson and Normand (2009) posits that obesity has become a primary cause of medical problems and ailments in America, a lot of which can be remedied by heightening physical movement and conducting more activity. In consequence, the necessity for increased interventions directed towards more physical movement and activity is sharply felt. In their study, Donaldson and Normand packaged an intervention consisting of goal setting, self-monitoring, and feedback. The intervention program was evaluated across five participants in multiple baseline design with a brief reversal for three of the five participants. The intervention package showed increases in the calorie expenditure for all five participants. In their study, Rapp, et al (2009) conducted an examination of "the vocal stereotypy of three boys who were diagnosed with Autism Spectrum Disorder (ASD)." When the results of functional analyses were reported, the findings resulted in the conclusion that the vocal stereotypy of each participant was sustained by consequences other than social ones. For two participants, verbal reprimands were provided contingent on vocal stereotypy in the presence of a red card (RC). For the third participant, after verbal reprimands alone did not decrease vocal stereotypy, toys were withdrawn contingent on vocal stereotypy in the presence of the RC. For all three participants, vocal stereotypy was permitted without programmed consequences in the presence of a green card (GC). The results showed that vocal stereotypy came under inhibitory control of the RC for only one of the three participants. The potential utility of using punishment to develop stimulus control of automatically reinforced problem behavior in academic settings is briefly discussed." Schadler, et al (2009) examined the separate effects of two signals employed during therapy and treatment with noncontingent reinforcement (NCR)." The first signal was functional analyses. The results indicated that problematic behavior displayed by two different persons with disabilities in grwoth and development was contingent on affirmative reinforcement from their social environment. To compare and contrast the effects of a timer (NCR-visual) to a vocal statement, Schadler, et al. reversed the design. The alternate design indicated within the parameters of an NCR procedure, when the stimulus would come back. Findings indicate that NCR tended to reduce the behavioral problems for the two individuals. Also, for one of the participants, the reduction in behavioral problems that can be attributed to NCR-visual condition to a larger extent than the NCR-vocal condition. Hagopian and Toole (2009) studied "the effects of response blocking and competing stimuli on stereotypy and aggression were examined in an analysis conducted with a young girl diagnosed with autism and intellectual disability. Application of the functional analysis on the stereotypic behavior showed that blocking stereotypy tended to heigten the levels of aggression. On the other hand, when competing stimuli was provided during treatment analysis, without the disadvantage of blocking, the result was a sharp decrease in the two topographies. We are thus able to conclude from these results that when competing stimuli is supplied, there is greater likelihood to manifest alternate conduct other than blocking." Tilli and Spreat (2009) state that the paramount objective of their study was to estimate the risks related to the employment of extraordinary personal restraints at a residence for individuals with impairments in intellectual growth and development. The supplementary objective of their study was to find out if there were correlations to restraint-related injury. The findings showed that a third of restraints caused an injury. However, this should be qualified since all were minor injuries. As regards its ability to predict, the study discovered that frequency of aggressive behavior use was the best single predictor of restraint-related injury. Stichter, et al. (2009) The importance of effective instruction on student academic and social achievement has been well documented. Strong classroom management and the use of high rates of opportunities to respond (OTR) have been two advocated classroom practices to positively impact student performance. This article presents an analysis of data collected across 35 general education classrooms in four elementary schools, assessing instructional variables associated with OTR. The relationship among OTR, measures of classroom management, and student work products was analyzed across Title and non-Title schools. Results indicate that teachers in the present study used components of OTR at rates similar to past research, but there were clear differences among Title I and non-Title schools. In addition, as teacher use of key instructional variables increased or decreased, other key variables posited as necessary by the literature often suffered. Implications for future research are discussed for students in high- and low-risk general education classrooms. Sansosti and Powell-Smith (2008) say that goal of their research work was to look into the effects of computer-presented Social Stories and video models on the social communication skills of three children with High-Functioning Autism/Asperger's Syndrome (HFA/AS). Applying a multiple-baseline across-participants design, computer-presented Social Stories and video models were implemented. The methodology involved directly observing the participants' identified target behaviors. These data were collected twice every week during break periods (e.g., recess). As a whole, the data gathered showed that the combination in treatment formulas was effective in the improvement ability of the participants to communicate with one another. But this must be qualified by the fact that two cases needed modifications to allow access to social reinforcement. Also, results showed that all three subjects were able to maintain their level of skills in communication during follow-up sessions two weeks later. However, they observed that generalization of skills proved true for only one of the subjects of the study. The work of Sansosti and Powell-Smith, validates and supports proof of the proposition that a combined intervention implemented using computers could possibly be a beneficial method for addressing deficiencies in social skill for persons with HFA/AS. Todd, et al. (2008) concludes that scholars are realizing more and more that behavior support in schools is a three-tier prevention effort in which universal interventions are used for primary prevention, targeted interventions are used for secondary prevention, and intensive interventions are used for tertiary prevention. According to Todd, et al., there is an increase in scholarly literature which claim and successfully demonstrated that the frequency of problem behaviors can be effectively addressed by and decreased by applying targeted interventions. For instance, the Check In—Check Out Program (CICO) is turning into a respected program employing targeted intervention. This work by Todd, et al. looks into the problem of determining whether there is a functional relation between implementing CICO and reducting behavioral problems. The findings show that there is a functional correlation between the implementation of CICO with four elementary school—age boys and a reduced problem behavior. The study also reviewed the clinical and conceptual implications that can be inferred from the findings, as well as the methodological limitations, and future research directions. von Mizener and Williams (2009) “provides an overview of the empirical effects of students' academic choices on academic performance (e.g., amount, quality, and rate of work). Twenty-nine separate experiments within 26 publications were included in the review. The choices involved performance goals and standards, the nature of assignments, instructional support within assignments, and rewards for academic performance. Sadler and Sugai (2009) say that the objective of their study is to come up with a description of the development and 10-year implementation of the effective behavior and instructional support model in a midsized northwestern Oregon school district. The study was conducted because of several important observations. Among these were sustained reductions in the discipline of students in terms of referral rates, a higher proportion of students on track for early reading benchmarks, and improvements in special education evaluation of learning disabilities were being experienced within the school district. These results were correlated with how effective practices were being integrated systematically. These integration efforts include capacity building development among professionals, affirmative behavior support throughout the school, advance literacy, early intervention, and special education evaluation and identification using student responsiveness to intervention. At the level of the school and the district, a system of support was put up for the students through behavior and academic facilities. There are also interventions specialized areas. These were implemented for students who were observed to be struggling with behavior and/or academic challenges. Butler and Luiselli (2007) conducted “a functional analysis with a 13-year-old girl who had autism documented that her problem behavior was maintained by escape from instruction.” The findings show that some specified kinds of requests can be correlated with the highest frequency of problem behavior. These were discovered through additional assessments. Subsequently, use of a noncontingent escape combined with faded instruction were able to lead to the attainment of reductions in response. Another finding is the increases in intervention tended to increase the frequency of requests propounded to the minor. The significance of the study lies in the fact that it underscored the the relevance of pinpointing particular sources of control over escape-maintained problem behavior and effecting change through the manipulation of variables antecedent to the problem behavior. Vismara and Lyons (2007) states that “various explanations have been offered in the literature on the underlying cause of joint attention deficits in autism.” However, according to them, the fact that autistic children have the capability to produce joint attention though they lack the social motivation to share their interests with other individuals can be an alternative explanation to identify the cause of joint attention in autism. Results of their study indicated an “immediate increase in joint attention initiations when perseverative, or highly preferred, interests were incorporated within the motivational techniques of PRT. Some of the results of their study point to collateral increases in joint attention initiations toward less preferred interests, as well as improvements in the quality of interaction between the children and caregivers. Findings are discussed in terms of theoretical and clinical implications for understanding the role of motivation in the development of joint attention in autism.” Feng, et al. (2008) “investigated the effects of a theory-of-mind (ToM) and social skill training program on the ToM assessments and social interactions of a sixth-grade high-functioning student with autism. A multiple probe design across behaviors and settings was conducted to evaluate the training program on the participant's learning outcomes. The results showed a functional relationship between the intervention and the participant's skill mastery. Specifically, the participant's appropriate social interactions increased substantially across time and settings with similar improvements in the ToM test scores. The participant's teachers, mother, and peers responded positively to the intervention, indicating their acceptance of the training procedures and outcomes.” III. References 1. Ajzen, I., & Fishbein, M. (1980). 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