Does staff cognitive demand influence staff attributions of challenging behaviour for individuals with dementia in care homes?

Bailey, Susannah Nicole

Clinical psychology
July 2007

Thesis or dissertation


Rights
© 2007 Susannah Nicole Bailey. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

There is a lack of a conceptual framework as to how cognitive demand and attributional variables interact and influence staff beliefs in response to challenging behaviour. This study tests the applicability of Gilberts (1989) attributions framework for understanding how staff cognitive demand influences staff attributions of challenging behaviour in a residential setting within Weiner's (1986) model of attributional dimensions. The use of this model may also serve to support the applicability of Gilberts' (1989) model in Geriatric settings in the context of previous research findings. The basic notion that is outlined in the introduction highlights that when we attempt to perform several operations at once, then this often results in the failure of the least automatic (most effortful) operation. A rationale for cognitive demand attributions is based on the research that has suggested that people go through a two-stage process when making attributions (Gilbert, 1989, 1991). Firstly, people assume that a person's behaviour is something to do with their disposition (internal factors) before an attempt is made to explain their attributions externally, accordingly taking into account external situational factors. It may be argued that if a person is already pre-occupied, distracted and experiencing high levels of cognitive demand when making an attribution about another person's behaviour, they may not get to the second stage, as making such adjustments needs more concentration and effort than the first step which occurs spontaneously and quickly (Gilbert & Osbourne, 1989). Therefore, the implication is that staff experiencing high levels of cognitive demand would be more likely to make negative and blaming internal dispositional attributions of challenging behaviour. They are more likely to report higher levels of controllability for the behaviour and report that they feel less optimistic that the behaviour would change and that it affects wider areas of their life.The study employed a cross-over experimental design. Participants were asked to watch 2 video clips of challenging behaviour, one under conditions of cognitive demand (cognitive demand) and one under conditions of no extra demand (non-demand condition). A total of 46 staff working in nursing and residential homes for the elderly completed a self-reported attributions questionnaire developed for the purpose of the study, demographics questionnaire and stress measures.

Results
In general, the hypothesised model in the current study was found to be partially supported as results suggest that cognitive demand does have a role in determining staffs attributions of internality. There is evidence that more internal attributions are made under cognitive demand conditions for aggressive behaviour. No support however was found for "other" behavioural classifications. More weighting was given in the interpretations for aggression as the content of the videos was considered to be more matched in terms of behavioural typologies displayed in the video clips. Partial support was found for the role of cognitive demand on attributions of controllability. A significant relationship was found between cognitive condition and attributional dimension of controllability for "other" behavioural classifications. The results indicate that participants attribute higher levels of controllability whilst under cognitive demand conditions than whilst under non-demand conditions. However, no such support for a relationship between cognitive condition and attributional dimensions of controllability for ratings of aggression was found. The model was not found to be generalised to the other attributional dimensions identified within Weiner's model - no support was found for the role of cognitive demand on the other main attributional dimensions (Stability, Generability. and Globality) for either "aggression" or "other" behavioural classifications. No effect of stress was found.

Conclusion
The study set out to test the applicability of Gilbert's (1989) attributional framework for understanding how staff cognitive demand influences staff attributions of challenging behaviour in a residential care setting and with reference to Weiner's (1986) attributional dimensions. The hypothesised model in the current study was found to be supported, as results suggest that cognitive demand does have a primary role in determining staff attributions of internality and controllability. The model was not found to be generalised to the other attributional dimensions identified within Weiner's model apart from partial support for the influence on control.

In conclusion cognitive demand was found to impair care staffs' ability to use contextual/situational information when forming causal attributions regarding an individual with dementia displaying challenging behaviour.

Publisher
Postgraduate Medical Institute, The University of Hull
Supervisor
Clarke, Chris
Ethos identifier
uk.bl.ethos.478945
Qualification level
Doctoral
Qualification name
ClinPsyD
Language
English
Extent
6 MB
Identifier
hull:12530
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