Melbourne School of Population and Global Health - Theses

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Type: Masters Research thesis × Subject: aged care ×

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    An exploration of the model of reciprocal determinism in aged care environments
    van Dort, Pauline Troy ( 2010)
    Introduction: Once dementia progresses to the later stages, behavioural and psychological symptoms of dementia (BPSD) can be prevalent. Many aged care workers have limited training and education in managing BPSD. This often impacts negatively on the quality of care provided to residents, and outcomes for the staff, including increased stress and job dissatisfaction, leading to turnover and subsequent staff shortages. One of the latest Australian government initiatives aimed at addressing many of the issues influencing resident and staff outcomes, is the Dementia Behaviour Management Advisory Services (DBMAS). This study evolved from the evaluation of the DBMAS. The evaluation was atheoretical; often the case in health care research and evaluation. Applying a theoretical model to understand the factors prevailing in aged care environments is needed. Aim: To explore the model of reciprocal determinism in aged care environments. Reciprocal determinism proposes there is a dynamic interaction between (a) personal factors, (b) environmental factors, and (c) behaviour; all factors can influence, and be influenced, by the other factors. Methodology: Involved combining two key sources of data: (i) literature relating to the application of the model of reciprocal determinism in work environments; (ii) secondary analysis of data from a client survey evaluating the DBMAS. The structured survey sought information relating to resident BPSD, effect of BPSD on staff, services provided by the DBMAS, and the impact of those services on residents (BPSD, quality of life), and staff (including skills, confidence, stress). The survey was administered (over the telephone) by the researcher. RACFs were selected on the basis that staff had used the services of the DBMAS in their jurisdiction, within August to November, 2008. At the end of the data collection period (December 2008), 137 respondents (82.5%) of 166 eligible RACFs had participated. Analysis of data primarily involved a series of cross-tabulations, where Chi sq and Fisher’s Exact tests were used to examine possible associations between various factors. Results: The literature indicates the model has not been applied in aged care environments; however, elements of the model have been examined. For example, staff self-efficacy/confidence, and stress (personal factors), resident behaviour, staff training and education (environmental factors), staff turnover (behaviour). Existing models capture many of the factors operating within aged care environments. These models were developed using an inductive approach, where the data lead the development of the theory, whereas the model of reciprocal determinism adopted a deductive approach, where social cognitive theory guided its development. The model of reciprocal determinism has proved useful when exploring other work environments, including organisational safety culture. Data collected from the client survey, provided support for possible associations between different factors within the model. For example, (i) the DBMAS intervention (environmental) was significantly positively associated with staff personal factors (skills p = .023; confidence p = .001; stress p = .002), particularly if the level of services was medium or high; (ii) the DBMAS intervention was reported to be successful in reducing the most difficult resident BPSD (environmental) to manage; (iii) improvements in staff personal factors were significantly associated with staff behaviour (skills X care time p = .000; confidence X care time p = .002; stress X care time p = .000), and (skills X absenteeism p = .020; confidence X absenteeism p = .033; stress X absenteeism p = .002). Conclusion: Overall, results were supportive of the model’s utility. Suggestions of its ability to provide insights and innovative methods for intervention design, management, and research/evaluation are provided. Although the study is exploratory, and should be viewed from a hypotheses generating perspective, this heuristic model has considerable value for focussing on the “bigger picture”, and not analysing various aspects within aged care, in isolation.