Learning by Doing and Learning by Observing: Training Parents in Saudi Arabia to Implement the Natural Language Paradigm

The present study trained six parents of children with Autism Spectrum Disorder to implement the Natural Language Paradigm in Saudi Arabia. Three of the parents participated in direct training using a Behavioral Skills Training (BST) model involving instructions, modeling, rehearsal, and feedback. As each of the three parents were being trained directly an additional parent observed the training (i.e., there were three trainee-observer dyads). While all of the parents learned from observing other parents being trained directly, only one observer met the predetermined performance criteria after observation alone, with the other two requiring direct training using BST. The parents demonstrated maintenance of their skills at follow-up, and social validity evaluations were strong. In addition, all parents implemented the NLP procedures at mastery criteria in another setting during generalization probes. Implications for further training research are provided.     

Assessing the Effects of a Staff Training Package on the Treatment Integrity of an Intervention for Self-Injurious Behavior

Self-injurious behavior (SIB) is an aberrant behavior that frequently occurs among individuals with intellectual and developmental disabilities. SIB may negatively affect both consumers and staff members. Staff members may not be adequately trained on how to use procedures to effectively reduce SIB or they may use those procedures inconsistently. The purpose of the present study was to evaluate the effectiveness of a staff-training package (i.e., role-playing, in vivo training, feedback paired with contingent money, and an escape contingency) in teaching three staff members (one paraprofessional and two direct care staff members) how to implement intervention plans, with high levels of integrity, developed to reduce SIB. Staff members’ fidelity to the intervention plan was monitored in person and remotely. When the researchers were physically present in the environment, all staff members accurately implemented the intervention plan in role-play situations and with the actual consumers (in vivo training) when they received feedback and money based on their fidelity to the intervention plan. Additionally, in the researchers’ absence, staff members only implemented the intervention plan with high levels of integrity when they received feedback and money based on their fidelity to the intervention plan. The results of this study support the need for ongoing feedback (and perhaps money) to promote high levels of fidelity to intervention plans when used by staff members in the absence of an observer (or researcher).     

Evaluation of the Dissemination of Active Support Training and Training Trainers

The aim of the present study was to replicate active support (AS) and train the service managers of community housing services as trainers in so doing. Training was conducted in three phases: (1) in 22 houses, it was led by one of the researchers, with identified managers assisting (Apprenticeship); (2) in 16, it was led by a manager who had participated in the previous phase, assisted by the researcher (Supervision); and (3) in 36 houses, it was undertaken independently by managers who had participated in the previous two phases (Independent). Changes in the extent of planned activity, resident involvement in domestic, social and community activities, the observed staff:resident interaction, and observed resident engagement in activity were evaluated. Resident views about the introduction of AS were canvassed. Active support training was fully implemented in the first two phases, but not in the third. There was an increase in planned activity in all phases after AS training. Significant increases in assistance and resident engagement in activity were found in the first two phases, but not in the third. Active support was shown to be of greater benefit to people with more severe disabilities. The resident feedback was positive. The approach taken to training managers as trainers was not sufficient to enable them to implement the training in its entirety during the third phase. The absence of change in this phase indicated the necessity of the practical interaction training, which was the element mainly missed out. Since AS was once again shown to be an effective approach for people with more severe intellectual disabilities, the challenge of creating a widespread ability to train staff within community housing services requires further effort.     

Training Educational Staff in Functional Behavioral Assessment: A Systematic Review

Interventions for challenging behavior are more likely to be effective when based on the results of a functional behavioral assessment. Research to date suggests that staff members in educational settings may not have the requisite levels of expertise or support to implement behavioral assessment procedures and design corresponding behavior support plans. The current review sought to examine the nature and effectiveness of Functional Behavioral Assessment (FBA) training described in the literature. Twenty-five studies were examined in relation to type of FBA method used, training procedure, behavioral function and intervention outcome. Training was provided in indirect, observational and experimental functional assessment procedures. Video modeling, lectures, feedback and written protocols were some commonly used training procedures. Interventions derived from results of these assessments were used in twelve studies to treat problem behavior. Social validity and treatment integrity outcomes across all studies are reported. The implications of these findings for research and practice are discussed along with directions for future research.     

A comprehensive evaluation of a train-the-trainers model for training education staff to assemble adaptive switches

We evaluated a train-the-trainers program for training education staff to assemble adaptive switch mechanisms. The adaptive switches were designed to assist persons with severe mental and physical handicaps in operating various electrical apparata. In Phase 1, a five-step training program (written and verbal instructions, modeling, performance practice and feedback) was used to train four teachers to assemble an adaptive switch. Also in Phase 1 social validity data were collected which supported the importance of adaptive switches for persons with severe physical impairment, as well as the need to train switch assembly skills to human service personnel. In Phase 2, the four teachers used the same five-step training program to train 22 teacher assistants to assemble an adaptive switch. Acceptability measures indicated that training was well received by the teachers (trainers) and assistants (trainees), and time efficiency measures indicated an average of less than two hours of training time was necessary for every two trainees. Effects of the training program were replicated in Phase 3 with two staff from another school. Results of the program are discussed in regard to using a train-the-trainers model as a means of upgrading staff skills, and helping reduce the gap between educational technology presented in the professional literature and that reflected in routine service settings.     

Strategies for maintaining integrity of a behavioral intervention

The purpose of this article is to address issues in maintaining the integrity of a behavioral intervention. Examples are provided from a recently completed study on how to train research staff and monitor the integrity of the intervention. In this exemplar, the integrity of the behavioral intervention was addressed by the design of the study and research staff training. Throughout the study, the integrity of the behavioral intervention was monitored by delineating a checklist of topics that must be addressed, critiquing audiotapes of the intervention, and discussing incomplete or missing elements with the research staff.     

Depression in palliative care settings: the need for training for nurses and other health professionals to improve patients' pathways to care

Depression is highly prevalent in patients receiving palliative care; however, detection rates are low, with many patients who suffer with depression continuing to go undetected and untreated. A number of factors unique to this setting, as well as issues relating to staff knowledge and self-efficacy working with depression, may impede the detection of patients who are depressed by professional health care staff. Although programmes aimed to train nurses and other allied health staff in depression may be an effective way to improve detection rates, there have been few studies investigating the efficacy of these interventions. This article draws upon recent literature to provide a narrative review of barriers to detection and factors relating to professional palliative care staffs' ability to provide pathways to care for patients who suffer with depression in this setting. Previously evaluated training programmes are reviewed and the argument is made that further development and empirical evaluation of depression training interventions for staff in this setting will provide services with evidence-based methods of training nurses and other professional care staff and improve the pathways to care for patients who suffer with depression.     

Bicultural training for new graduates

This article demonstrates the success of a bicultural training program in helping new graduates successfully integrate the transition from student to staff nurse. It describes how to implement this program and how to train 'trainers' for it. Results based on turnover rates and cost-effectiveness verify its usefulness.     

Nursing shortages: let's be flexible

The following paper is a report outlining a significant work pattern change in an acute cardiac ward at a large Brisbane-based private hospital. The nursing staff expressed the desire for more flexible rostering and the opportunity to work 12-hour shifts. After agreement was reached between the hospital, the union and the Industrial Relations Board, guidelines were put in place and a Flexible Rostering System was proposed and trialed. An 80% consensus of staff was required both to proceed with the trial and to implement any permanent changes. Initially, the trial was conducted for three months and extended to six months. The shifts trialed were between four and 12 hours in length with varied starting and finishing times. The Flexible Rostering System was evaluated using feedback from staff surveys and the results of a staff vote. In addition, patient feedback, incident reports, financial and managerial evaluation of staff costs, hours per patient day utilised, sick leave, and the use of permanent staff for voluntary extra shifts were also monitored. The outcome of the trial was positive with over 80% of staff voting to implement the Flexible Rostering System permanently. A significant reduction in sick leave of 41% and improved retention of skilled registered nursing staff was noted. There was no increase in the number of incident reports or patient complaints. Both patients and nurses commented on the improved continuity of care. Salaries and wages were within budget. Staff surveys showed positive feedback such as increased morale, increased flexibility with rosters, decreased fatigue levels, improved patient assessment on night duty and an increase in number of days off. In conclusion, the Flexible Rostering System has been accepted as a positive change for staff and is cost effective for the hospital. In light of nursing shortages, the outcome of this trial cannot be ignored.     

Changing staff attitudes to the sexuality of people with mental handicaps: an evaluative comparison of one and three day workshops

This paper reports on an evaluation of two workshops designed to change the attitudes and behaviour of staff towards the sexuality of people with mental handicaps. The workshops were of different duration, one day and three days respectively. They had some activities in common, but the three day workshop allowed a more extensive coverage of the issues. Evaluation of the workshops was generally positive, both in terms of staff feedback and attitude change, as measured using an attitude inventory. On completion of both workshops staff expressed attitudes that indicated they would be more willing than before to assist the people in their care in making informed sexual choices. The three day workshop was significantly more effective in changing attitudes than die one day workshop. The difficulties in making any conclusions beyond immediate attitude change are discussed, and suggestions for further research are made. However, it is suggested that this type of workshop can form an important part of basic training for staff and that such work should be developed and extended.     

武警部队部分医护人员复合伤急救知识现状调查

目的了解武警部队医护人员对复合性损伤急救知识掌握程度。方法采用问卷调查法,根据战伤救治标准、第四版医疗护理技术操作常规及相关参考文献自行设计问卷,对相关医院的医护人员进行调查,并将调查结果用SPSS统计软件进行分析。结果医护人员对急救知识的掌握程度与复合伤知识相比较,差异具有显著性(P<0.05);且在护士群体中,不受学历、工作年限和职称的影响,急救知识掌握程度普遍好于复合伤知识;医生与护士相比较,对于急救知识的掌握程度无显著性差异(P>0.05),而对复合伤知识掌握程度医生好于护士(P<0.05)。结论部队医院的医护人员对于复合伤知识掌握欠缺,应建立有效的培训机制,对医护人员尤其是护理人员进行复合伤知识的培训。     

应用学生标准化病人提高护生健康评估能力的有效性研究

目的 研究学生标准化病人（SSP）对提高护生健康评估能力的效果.方法 在学生志愿者中培训、遴选SSP;由SSP对护生进行操作辅导和考核评价;分析考核成绩及问卷调查结果.结果 SSP评分与教师评分之间存在高度正相关（r分别为0.652与0.684）,SSP可以评价教师难以评价的内容;能及时、便利地对护生进行辅导;训练和考核后SSP对考生的及时反馈有利于护生能力的提高;SSP不仅能提高护生的操作技能,还能提高人际沟通能力和关爱意识;绝大多数考生对SSP满意度高.结论 应用SSP对护生进行健康评估操作训练与考核很有必要,是一种客观、公正、合理、有效的教学方法.     

Learning on a simulator does transfer to clinical practice

Aim of the study

Cricoid pressure is recommended during positive pressure ventilation CPR and during anaesthesia when there is a risk of regurgitation. Studies suggest that cricoid pressure is frequently applied incorrectly placing patients at risk of regurgitation. Simulation training has been shown to improve the performance of cricoid pressure on a simulator, but whether simulation training improves the clinical performance of cricoid pressure was unknown. The aim of our study was to determine if simulator training improved the clinical performance of cricoid pressure.

Methods

101 medical students and nursing staff were recruited and randomised to receive cricoid pressure simulator training with or without force feedback. Subjects then applied cricoid pressure to an anaesthetised patient while standing on a force plate. The main outcome measure was the number of subjects who applied a mean force of 20–30 N during their trial.

Results

Significantly more subjects (20/53, 38%) in the feedback group applied force in the appropriate range (20–30 N) compared to the control group (9/48, 19%) (p = 0.035, chi square test). The feedback group applied significantly higher forces than did the control group (p = 0.029, Mann–Whitney U test).

Conclusion

Simulation training with force feedback significantly improved the performance of cricoid pressure in the clinical setting. Simulation training should be used more frequently to train and maintain resuscitation skills.     

早期康复护理干预对脑卒中肢体运动功能的影响

目的：探讨早期康复护理干预对脑卒中肢体运动功能的影响。方法：８６例脑卒中患者分研究组及对照组,除常规治疗外,研究组患者从急性期开始即由康复护师制订并实施早期康复计划。结果：两组治疗前、治疗后一个月、治疗后三个月经Ｂｒｕｎｎｓｔｒｏｍ分级、Ｆｕｇｌ－Ｍｅｙｅｒ运动项目积分及ＡＤＬ评分比较,研究组均优于对照组（Ｐ＜０．０５,Ｐ＜０．０１）。结论：早期康复护理介入对降低脑卒中病死率、致残率、减少并发症等均有重要意义     

Training parents to implement communication interventions for children with autism spectrum disorders (ASD): A systematic review

This review identifies procedures used to train parents to implement communication interventions to children with autism spectrum disorders. Systematic search procedures identified 11 studies that met predetermined inclusion criteria. Across studies, 60 parents were trained to implement Pivotal Response Training, Enhanced Milieu Teaching, Natural Language Paradigm, or Early Start Denver Model. The mean time spent training parents was 17 hours. Training procedures used most often included: (a) verbal instruction and/or instruction manuals, (b) in vivo practice, (c) role playing, (d) modeling by trainer, and (e) reviewing videos of intervention sessions. Improvements in parent ability to implement intervention and child communication were ubiquitous. However, a paucity of studies in which baseline parent behavior was measured, coupled with the absence of studies evaluating individual training procedures, precludes definitive statements regarding the most effective and efficient approach to parent training and, therefore, warrant future research.     

Evaluation of training designed to prevent and manage patient violence

This study was designed to determine whether the test responses of mental health care workers (n = 118) showed significant improvement after attending a training session about managing violence. Four variables (knowledge, attitude, self-efficacy, and behavioral intention) were measured before and after staff attended a training program that consisted of two commercial programs: the Nonviolent Crisis Intervention (CPI) and Handle with Care. The Nonviolent Crisis Intervention is designed to teach staff how to prevent and control disruptive behavior of clients. "Handle with Care" is a combination of lecture and demonstration of self-defense skills and restraining methods for staff who work with potentially assaultive patients. The research team used a one group, pretest/posttest study design for the evaluation. The study location was an acute care psychiatric hospital located in the southwestern United States. Hospital staff completed a pretest, participated in a 12-hour intervention, and completed a posttest immediately after the intervention. The evaluation of staff responses demonstrated improvements in posttest scores that were significant for knowledge, attitude, self-efficacy, and behavioral intention to use the training techniques. More research is needed regarding evaluation of programs that train mental health care workers to prevent and manage patient violence. Such research can help us develop more effective programs.     

Partnering with patients and families in designing visual cues to prevent falls in hospitalized elders

Prevention of falls in hospitalized elderly is critical to avoid injury and maintain independence. As part of a comprehensive program, nursing staff in a medical telemetry unit partnered with patients and their families to design and implement an educational poster to prevent falls. Ongoing patient/family feedback was used to modify the poster until it was appealing and effective for patients. The effort resulted in a marked decrease in falls on the unit over the pilot period.     

Staff Training Regarding Choice Availability for Persons with Mental Retardation: A Preliminary Analysis

Quality of life and choice availability remain critical aspects of new treatment programs for persons with mental retardation. The present study preliminarily investigated a brief training program for staff members to increase choice availability in living environments. A program of education, modeling, role-play, and feedback was used over a 5–week period for staff members in two intermediate care facilities. Two other facilities served as controls. Results indicated significant improvement in overall level of choice availability from preintervention to follow up for the treatment but not the control group. Contrary to expectations, however, levels of adaptive and maladaptive behavior remained unchanged. This study indicates that a cost-effective training program may be useful for enhancing choice availability in the short-term, but that other choice-oriented procedures may be necessary to generate further changes in effective behavior.     

电脑平衡仪视觉反馈训练对偏瘫患者平衡功能和步行能力的影响

目的观察平衡仪视觉反馈训练对偏瘫患者平衡功能和步行能力的影响。方法40例脑卒中后偏瘫患者分为视觉反馈组和平衡板训练组各20例;在常规康复训练的基础上,视觉反馈组采用平衡仪提供的模式进行平衡训练;平衡板组应用平衡板进行平衡功能训练,采用Berg平衡量表(BBS)和 Holden步行能力评分在治疗前和治疗5周后对两组患者进行评定。结果治疗前,两组患者的BBS和Holden步行能力无显著性差异(P>0.05);治疗后,视觉反馈组改善的程度大于平衡板组(P<0.01)。结论平衡仪视觉反馈训练对脑卒中偏瘫患者的平衡功能和步行能力的具有明显的促进作用。     

Effects of immediate feedback on learning auditory perceptual voice quality evaluation

The study investigated the effect of immediate feedback in training listeners to perceive subtle differences in voice quality, a perceptual skill that is important for speech-language pathologists. Sixty naive listeners were randomly assigned to a feedback group (Group F), a no feedback group (Group NF), and a no training group acting as a control group (Group C). The task was to evaluate the severity of a perceptual voice quality (breathiness) by using a reference-matching paradigm. All participants took part in three rating sessions (pre-training, 2 days after training and 1 week after training). Group F and Group NF participated in a training session immediately after the first rating session, where Group F practiced with immediate feedback given and Group NF practice with no immediate feedback given. The results showed that Group F and Group NF had significant improvement after training, but Group F did not retain the improvement in the third rating session. The use of a reference-matching training paradigm without giving frequent immediate feedback is suggested for auditory-perceptual voice evaluation training. The most effective frequency of immediate feedback is yet to be determined.