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The psychological impact of aggressive service-user behaviours on direct-care staff in learning disabilities services.

Mitchell, Georgia; (1997) The psychological impact of aggressive service-user behaviours on direct-care staff in learning disabilities services. Doctoral thesis (Ph.D), UCL (University College London). Gold open access

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A multivariate cross-sectional survey design was used to investigate the relationships between stress-related outcomes and exposure to aggressive service-user behaviour among direct-care staff in learning disabilities services and the role of mediating and moderating factors. The sample consisted of 83 participating direct-care staff, across 23 community residential facilities for adults with learning disabilities, all providing care for at least one individual known to exhibit aggressive behaviour. A battery of self-report questionnaires were completed and returned anonymously by participating staff and a standard service-related questionnaire was completed by each respective service unit manager to assess the characteristics of the participating staff teams as a whole and the overall characteristics of the service-users cared for. The selection of independent and dependent variables measured in the staff questionnaire was based on Lazarus and Folkman's transactional-process model of stress and coping (Lazarus & Folkman 1984). Staff exposure to aggressive service-user behaviour was conceptualised as a specific stressor which was hypothesised to contribute to a range of important staff outcomes such as general psychological distress, staff burnout and job dissatisfaction, through intervening risk and predictor variables such as staff attributions, perceptions of self-efficacy, and negative emotional responses to aggression. These variables were measured in relation to a hypothetical aggression-related vignette. Coping strategies used in relation to service-user aggression were hypothesised to exert a moderating effect on the emotional responses of staff. Multiple regression analyses were used to examine the relative importance of predictors of each of the staff outcomes measured. The descriptive analysis showed that staff were found to report more frequent use of problem-focused and emotion-focused coping strategies, in relation to service user aggression, than a group of coping strategies referred to as 'less adaptive coping'. However, only the latter was found to be an important coping variable in predicting staff outcomes in the regression equations, with direct effects on staff burnout and also indirect effects on burnout through depression-related emotional responses to service user aggression. This mediating factor was found to be more important than anxiety-related emotional responses in predicting the staff outcomes measured in this study. Staff exposure to service-user aggression, perceived self-efficacy and staff attributions along the dimensions of personal control and locus of causality were not found to be associated with either negative emotional responses to aggressive service-user behaviour or any of the staff outcomes measured in this study. However, attributions of external controllability were found to have direct effects on staff burnout. Given that several hypotheses about the relationships between variables were not confirmed in this study, the general model on which this study was based was adjusted to be more applicable to stress and coping in the context of staff responses to service-user aggression in learning disabilities services. The reconstruction of the model was guided by a path analysis of estimated relationships between variables. The negative consequences of less adaptive coping strategies and depression-related emotional responses in relation to service-user aggression suggested by the results of this study, were discussed with regard to their implications for staff training and support. It was suggested that work on staff emotions may be crucial in reducing staff stress and also in reducing aggressive service-user behaviour which, in turn, may be maintained by the responses of staff.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The psychological impact of aggressive service-user behaviours on direct-care staff in learning disabilities services.
Open access status: An open access publication
Language: English
Additional information: Thesis digitised by ProQuest.
URI: https://discovery.ucl.ac.uk/id/eprint/10103862
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