Performance appraisal methods Essay Example for Free

Performance appraisal methods Essay In order to succeed in the market, companies need to ensure they provide efficient management of human resources. Companies can perform well only in such a case when all of the employees are able to realize their potential, apply their skills and make sufficient contribution to the development of the company. Performance appraisal is particularly important for all of the organizations because it enables them to determine the contribution of every employee to the performance of the company. Performance appraisal is currently one of the most important issues in human resources management which â€Å"continues to be a subject of interest and importance to human resource specialists. † (Hornsby et al. 1996, p. 10). Bernardin Klatt (1985); Hall, Posner, Hardner (1989); Maroney Buckley (1992); Thomas Bretz (1994) have all devoted considerable attention to the development of theoretical models of performance appraisal. How can a manager of the organization make a conclusion about the necessity to promote this or that employee, increase of decrease his salary, shift him to another department? How can the manager decide which employee needs special training or which can perform on the highest level without additional training? The most efficient tool in such a case is performance appraisal. If carried out correctly and on the basis of efficient methods, performance appraisal can be very helpful for the evaluation of employees’ work. â€Å"Companies that hope to succeed in todays competitive business environment must learn to identify their most capable employees for placement in key organizational appointments. To do this, managers should devote more attention to maximizing the effectiveness of performance appraisal systems. (Mcbey 1994, p. 23). Appraisal methods for the performance of the customer care supervisor in Fabulous. com require both the application of generally recognized methods of performance appraisal and their slight adjustment to the specification of the position. On one hand, this position needs to be appraised with the help of commonly used principles and methods. On the other hand, it requires deep understanding of the functions which customer care supervisor needs to perform daily, his responsibilities, all of the complication which can occur in the process of the fulfillment of his responsibilities. The choice of appraisal methods needs to be guided by the specifications of the position. In order to make a decision about the appraisal method which will be used for the position of customers care supervisor, it is necessary to analyze all of the most well-known methods of performance appraisal in relation to their effectiveness for this position. What needs to be kept in mind is that there is no possibility to find one completely efficient method. All of the methods will have both advantages and disadvantages. After more than 30 years of serious research†¦ it seems that little progress has been made in developing an efficient and psychometrically sound alternative to the traditional graphic rating scale. One major conclusion to be drawn from this research is that there is no easy way to get accurate and informative performance data. † (Rice 1985, p. 30). Even though there is no possibility to determine a completely accurate method, some tools of performance appraisal need to be used in any case because â€Å"timely, useful, and accepted feedback can help individuals make great strides toward optimal performance. (Coyens, Jenkins 2001, p. 34). Comparative standards include straight ranking method; alternative ranking method; paired comparison method; forced distribution method. All of these methods are inappropriate for the position of customer care supervisor due to the specifics of his activities. Comparative standards can be very efficient for the types of job in which employees need to do exactly the same kind of work and it is possible to tell the differences between their performance. However, the position of customer care supervisor is created in order to maintain a solid relationship with customers and supervise all of the major activities dealing with customer service in the company. This is not the type of job in which employees’ performance can be compared because it is hard to find the criterion of comparison in such a case. Comparative standards application in performance appraisal of customer care supervisor would lead to inaccurate results. Besides, in customer care it is particularly important to make emphasize on the further improvement of performance of the supervisor. Comparative standards do not provide any information on that point. The straight ranking method is the simplest and the most inaccurate because it only enables to compare employees. It does not let the appraisers to perceive the qualities of the employee himself. Alternative ranking method, paired comparison method and forced distribution methods can all be used in manufacturing companies and organizations of similar type but they will be completely useless when appraising customer care supervisor at Fabulous. com. Absolute standards include narrative essay; critical incidents method; weighted checklists; forced choice; Behaviorally Anchored Rating Scales (BARS); Behavioral Observations Scale (BOS). â€Å"With this style of appraisal, managers use written, absolute standards. Reviews are not based upon relative standing of the employee in a specific work group. Absolute methods facilitate intergroup comparison of employees in an organization. † (Mcbey 1994, p. 11). They are more efficient and could be applied for performance appraisal of the position of customer care supervisor. However, they have many disadvantages which need to be discussed. Narrative essay generally could give a good idea about the employee working at the position of customer care supervisor. However, it is more a qualitative description than a quantitative method of appraisal. It would not provide all of the important data about the performance of the employee. Critical incidents method is efficient only to some extent because it provides information about the employee’s behavior only in critical situations. The work of customer care supervisor does not always consist of critical situations, in fact, they are quite rare. That is why there is no sense the measure the employee’s performance with the help of this method. Weighted checklists can be useful but they have a very large impact of the appraiser’s opinion, and weighting coefficients can sometimes be applied incorrectly. Forced choice is not the most efficient method to be applied for the case of customer care supervisor because this method does not meet developmental needs and does not allow the appraiser to interpret the ratings correctly at times. Behaviorally Anchored Rating Scales (BARS) are used quite frequently nowadays. BARS uses expected performance levels as a basis for the appraisal. Behavior is judged by a job analysis and comments from those in the same or similar jobs. Behavioral statements are developed for each job in the organization and are anchored by numerical scales. † (Mcbey 1994, p. 12). However, this method has some important disadvantages. â€Å"Although BARS provides excellent specific behavioral guidance for employees, it is among the most complex and difficult performance appraisal system that can be introduced, especially for smaller organizations without significant human resource staff capabilities. † (Mcbey 1994, p. 2). Other authors also point at the complexity of this method: â€Å"While advocates of BARS, particularly the consultants who do a thriving business with it, claim its a great leap forward, critics point to several drawbacks. The lengthy job analyses and complex scale construction require a major investment of a companys time and money. A scale designed for use in one department may not apply in another. † (Rice 1985, p. 32). In our opinion, there is no sense to apply very complicated performance appraisal techniques in our case because the position which is being analyzed is not the key position in the company. Such complex techniques should rather be used for employees occupying positions of senior- and top management. Behavioral Observations Scale (BOS) are very similar to BARS in their complexity. â€Å"The BOS system observes past performance as the standard for appraisal. BOS offers many of the same benefits as BARS, most notably concrete examples to guide employee behavior and developmental difficulty. † (Mcbey 1994, p. 13). The application of this method is also not efficient for the position which is being analyzed due to its over-complexity. Objectives-based approaches include Management by Objectives (MBO) and work standards approach. These approaches are the most suitable for the performance appraisal of the customer care supervisor because it is particularly important for the employee in the position to achieve his goals. There are types of jobs in which the goals are pre-determined for many years ahead of time: for example, a salesperson needs to ensure he or she sells as much merchandise available in the store as possible. There are no adjustments of this goal or any corrections because it is universal. The position dealing with customer care and maintenance of successful relationship with customers is very challenging and deals with change in many aspects. The goals constantly need to be re-adjusted according to the needs to customers. The capability of the customer care supervisor to achieve all of the goals is the measurement of his success in this position and his adequate performance. There can be no better appraisal methods for this position than objective-based approaches. Management by Objectives (MBO) is very useful in this case. â€Å"MBO became popular because, in theory, it can be tailored to each individual job and because it lets subordinates know how their performance will be measured and gives them specific, mutually-agreed-on goals. (Rice 1985, p. 33). Its mechanism is relatively simple. â€Å"As customarily practiced today, supervisors and their subordinates sit down at the beginning of each year, or every six months, and agree (often in writing) on specific goals to be accomplished. At the end of the period, the supervisors evaluate their subordinates in terms of how well they have met those objectives. † (Rice 1985, p. 33). Work standards approach is similar to MBO except that organizations determine goals and appraisal techniques on the basis of their past experience. Of course, there are some disadvantages of this method which need to be taken into consideration. For example, â€Å"one major weakness is the difficulty of setting reasonable goals well in advance, when they may be vulnerable to factors outside the employees control, such as economic conditions, labor problems and price increases. † (Rice 1985, p. 33). At the same time, this disadvantage can be interpreted as an advantage in such a case if the goals are constantly re-adjusted according to the needs of the consumers. In such a case, the performance appraisal method will work efficiently.

How Motivation Influences The Job Satisfaction Level Management Essay

How Motivation Influences The Job Satisfaction Level Management Essay 1.0 Introduction This study is carried out the important of motivation to influence job satisfaction in an organization, to understand the relationship between motivation and job satisfaction in an organization. In this chapter, will be focusing on research background, research objective, problem statement, and research question. 1.1 Research background The purpose of this study was to find out the impact of motivation on job satisfaction of employee in a organization. Motivation is a basic psychological process. A recent data-based comprehensive analysis concluded that competitiveness problems appear to be largely motivational in nature (Mine, Ebrahimi, and Wachtel, 1995). The management dilemma in many organizations and how they can improve the motivation of employees in the fast paced technological environment. Motives are expression of persons need. Hence they are personal and internal. They also can be incentive on the other hand are external to the person. Motivations are made part of work environment by management in order to satisfy the employees to accomplish task. Job satisfaction is positively affects individual performance. Job satisfaction positively affects individual performance (Petty et al. 1984; Judge et al. 2001; Kim 2005) and this make it highly relevant to investigate the cause of job satisfaction. According to Luthans (1998), motivation is the process of arouses, energizes, direct, and sustains behavior and performance. That is a process to influence people action and to achieve a desired task. There is also one of the way to influence people is to employ effective motivation which make the employee more satisfied and committed to their job. Money is a motivator but is not the only motivator. There is still having other incentives which can also serve as motivator. Employee attitudes relating to job satisfaction and organizational commitment are based on the field of organizational behavior and the practice of human resources management. Attitude has direct impact on job satisfaction. On the other hand, organizational commitment is focuses on their attitudes towards the entire organization. Although the relationship between satisfaction and commitment are strong, but there are more recent research shows that commitment cause satisfaction. 1.2 Problem statement There are many reasons why managers are keep facing the problem in organization. Resources, human and material, technology are a few issues confronting managers daily. The more important is the human aspect has question that has confused managers for a long time such as how can they make some employees perform better with satisfied in their job. According to Schofield (1998), an authoritative study conducted by the Sheffield Effectiveness Programme (a joint research project between the Centre for Economic Performance at the London Stock Exchange and the Institute for Work Psychology at the University of Sheffield) has shown that the way people are managed or motivated has a powerful impact on both productivity and profitability. The study which included measurement of levels of job satisfaction and organizational commitment of employees of 67 firms, found that 5% of the profitability variance, and 16% of the productivity variance between companies may be the different variance in job satisfaction levels between their employees. This study is demonstrated the important of job satisfaction, employees motivation and commitment in an organizational capability and effectiveness. According to Watson (1994) business has come to realize that motivated and satisfied workforces can deliver powerful to the bottom line. There are still many employees all over the world do not enjoy the level of job satisfaction and work motivation, because of that they keep seeking alternative employment to experience a higher degree of job satisfaction. Such action will influence an organizations ability to be profitable and successful over n extended period of time. According to Finck, Timmers and Mennes(1998) employees are excited and motivated by what they do will help business be achieve. 1.3 Research objective To find out the relationship between motivation and job satisfaction To determine the impact of motivation towards the employees job satisfaction. To analyze the way to improve the job satisfaction by using work motivation. 1.4 Research question What are the relationship between motivation and job satisfaction? What determine the impact of motivation towards the employees job satisfaction? How work motivation can improve job satisfaction? 2.0 Literature review 2.1 The relationship between motivation and job satisfaction 2.1.1 Motivation According to Pinder(1998 in Ambrose Kulik, 1999) work motivation may be regarded as a set of internal and external forces that initiate work-related behavior, and determine its form, direction, intensity and duration. The concept related to the work and influence on work behavior of both environmental forces. In workplace, work motivation are invisible, it is depends on personal behavior and responsibility of the job. Snell (1999) says that motivation is everything. Without motivation people will not deliver to their potential even the talented people. People that are motivated will perform well and improve the personal ability. He further asserts that company staff are very important in a business due to they are the image of the company that customer see. They have the potential to enhance the quality of service and have the power to influence or reduce the company profits. According to a model developed by Herzberg, motivation is influenced by maintenance and motivational factors. The important motivational factors are the work itself, achievement, growth, responsibility, advancement and recognition. There are basic internal motivators rather than external. The Maslow and Herzberg models are similar due to its focus on needs, but the difference can be seen from the point of views. Nel, Gerber, Van Dyk, Haasbroek, Schultz, Sono and Werner(2001) describe motivation as intentional and directional. Intentional is mean to personal choice and committed of action, and directional indicates being of a driving force aimed at achieving a specific goal. A people who get motivated will know they must achieve the specific goal even in the face of adversity. 2.1.2 Job satisfaction The concept of job satisfaction will be very important now a day. Managers feel that if they responsible for maintaining high levels of job satisfaction among their staff will helps to increase the productivity, absenteeism and staff turnover (Arnold Feldman, 1986). According to Locke (1976), job satisfaction was already significant since the first part of 20th century, for example, there are over 3000 related studies were published between 1935 and 1976 which an average of on publication every five days. Job satisfaction is regarded a s related to important employee and organizational outcomes, ranging from job performance to health and longevity (Spector, 2003). According to Gibson et al (2000) job satisfaction may be defined as an individuals expression of personal well-being associated with doing the job assigned. Job satisfaction depends on the level of internal and external and how the employees view those outcomes. The outcomes of job satisfaction have different values for different people. For some people, responsible and challenging work is negative value and depending on the education level and prior experience with work providing the internal outcomes. For other people, such work outcomes may have high positive values. Those differences would influence the level of jab satisfaction on the same job tasks. Bateman and Snell(1999) say if people feel fairly treated from the outcomes they receive, or the processes used, they will be satisfied. These authors mention that a satisfied worker is not necessarily more productive than a dissatisfied one due to sometimes people are happy with their jobs which dont have to work hard. 2.2 The impact of motivation towards the employees job satisfaction All employers want their workers to perform well of their abilities and they try to provide all the necessary resources and a good working environment in order to keep their employees motivated. However, motivation is a difficult factor to manage due to every employees wants or target does not always match with what the employers provide. Motivation and job satisfaction reinforce each other and work together, if the employee is satisfied on job performance he tend to be motivated. So that understand the employee needs can give better insight to managing human motivation. Frankl(1984) suggested that, motivation reflects peoples search for meaning and that job satisfaction may reflect the degree to which people have found meaning in their work. According to Sylvia and Hutchinson (1985), true job satisfaction is derived from the gratification of higher order needs such as social relations, esteem, and self actualization rather than lower- order needs 2.3 The way to improve the job satisfaction by using work motivation Motivation is very important in an organization nowadays, but not everyone satisfy when the motivation in processes. May be that is because the employers make the wrong way to motivate their employees. Because of that, there are few strategies helps to improve the job satisfaction such as salary, wages and conditions of service, money, staff training, information availability and communication. 2.3.1 Salary, Wages and Conditions of Service To use salaries as a motivator effectively, managers which are motivator must consider four major components of a salary structures such as job rate, payment, personal or special allowances, associated with factors and side benefit. Job rate is relates to the importance the organization attached to each job. Payment is to encourage workers or group by rewarding them according to their performance. Personal or special allowances, associated with factors are the scarcity of particular skills or certain categories of information professionals or with long service. Last but not least, side benefit represent holiday with pay, pensions, and so on. It is also important to ensure the salary structure of the organization will retained the same level of the market salary structure. 2.3.2 Money According to Akintoye(2000), money remains the most significant motivational strategy. Money is the major factor which able to motivate employee to increase the productivity of the company (Taylor, 1911). Incentive system will be able to improve job satisfaction, high performance, commitment. Katz, in Sinclair, et al. (2005) emphasizes the motivational power of money through the process of job choice. He explains that money has a very strong power to attract or motivate individually to achieve higher performance. For example, a employee will simple shift company for the greater financial reward of the job, if the differences of the workload of the job is similar with the current job. Banjoko(1996) mentions that many managers use money to reward or punish workers. 2.3.3 Staff Training No matter how computerized an organization, high productivity depends on the level of motivation and the effectiveness of the workforce. Staff training is an essential strategy for motivating workers. An organization must have good training programme. This will give the employee opportunities for self-improvement and development to meet the challenges and requirements of new equipment and new techniques of performing a task. 2.3.4 Information Availability and Communication One way managers can stimulate motivation is to give relevant information on the consequences of their actions on others (Olajide, 2000). According the researcher, there is no known organizations in which people do not usually feel there should be improvement in the way department communicate, cooperate, and collaborate with one another. Information availability brings a powerful pressure between the employees, where two or more people running together will run faster than when running alone. By sharing information, subordinates compete with one another. 2.4 Theoretical framework Motivation n Salary, Wages and Condition of Service Job Satisfaction Money Staff Training Information Availability and Communication Dependent variable Independent variable 2.4.1 Analysis path The framework shows that the two variables in the research proposal, motivation is the independent variable. From this research I have identify that salary, wages and condition of service, money, staff training, information availability and communication are the motivational factors that affect job satisfaction level. The dependent variable in this research would be job satisfaction. From the framework, we will understand the relationship between motivation and job satisfaction. Job satisfaction will be interrupt by the motivation method or strategies. On the other hand, motivation strategy is also able to enhance the job satisfaction level. 3.0 Methodology 3.1 Introduction In this section, we slightly describe the research methodology use in the study to know how motivation affects in job satisfaction and using the data collection to analysis the data for the study. To find out the relationship between motivation and job satisfaction, impacts and the strategy to improve job satisfaction level in a organization. 3.2 Data Resources According to Bell (1995), primary data are such data that does not yet include any interpretations and analysis from other people. Secondary data on the other hand is data that is analyzed and include someones interpretation of the data (Bell, 1995). Secondary data was chosen for this research due to the cost and time saving for collect data that needed for the research (Hair, Money, Samouel, and Page, 2007), According to Saunders et al (2007), primary data is expensive which compare to secondary data. In additional, Hair et al (2007) emphasizes that most of the secondary data are free of charge or either can be purchase in a cheaper price. 3.3 Data Analysis Procedure The secondary resources needed in order to be able to fulfill the purpose of this proposal are mainly journal articles and textbook. When searching for secondary data search engine such as Google Scholar, Emerald and others. KBU International College has provided student a huge variety of reference books. Google search engine is the advancement of technology which allowed us to get information conveniently and quickly to obtain various journals from the website which allowed us to understand the research objectives. Emerald website which can access through it using Anglia Ruskin University account is easy to obtain various journals which needed for the research. Less text book are used in this research as the source from the library about our research questions. 3.4 Hypothesis Null Hypothesis H0: There is no relationship between motivation and job satisfaction Alternative Hypothesis H1: There is a relationship between motivation and job satisfaction Null Hypothesis H0: Motivation cannot affect job satisfaction level Alternative Hypothesis H2: Motivation can affect job satisfaction Null Hypothesis H0: Motivation unable to improve job satisfaction Alternative Hypothesis H3: Motivation able to improve job satisfaction 4.0 Limitation The research could have done more accurately if more resources which could be obtain to support the research. There are limited resources provided in KBU International College library. However, KBU does provide student access to Emerald Insight website which contains many research journals and the college had already paid the fee, but student are still allowed to access to the website within the college premises. In additional, this research only used secondary data collection which easy to obtain. Most of the secondary data come from other authors opinion and their personal findings. Because of that, this research may be inaccuracy due to the opinion from the author might disagree with research and opinion done by other author around the world. 5.0 Ethical consideration The information of the people who provide information to the study would not show to the others when the study done to protect the human right of privacy. There is the action that should be taken. The information provider are willing to provide the information to finish the study and not being force. During the research, the information collected would not be modify as to maintain the accuracy of the information which been collected. 6.0 Executive Summary From the study done, we know that the motivation was so important in an organization which can affect the job satisfaction level. By the way, the relationship between the employee motivation and job satisfaction using the right way to motivate the employee; thus enhancing the job satisfaction level and the organization at the same time. When motivation and job satisfaction are reinforced together as one, motivation and job satisfaction can increase the working performance of employees. Besides that, there are several strategies used to enhance the working performance. The strategies used are such as; Salary, Wages and Conditions of Service strategy, Money strategy, Staff Training strategy, and lastly the Information Availability and Communication strategy. Using all this strategy will further develop the working condition to the highest level of job satisfaction. To sum it up as a whole, motivation and job satisfaction are co-related because when the motivation to work increases, emp loyee will have a higher job satisfaction, thus creating maximum output for the organization. 7.0 Gantt Chart Activity FEBRUARY MARCH APRIL MAY Week number 1 2 3 4 1 2 3 4 1 2 3 4 1 2 Read literature Finalize objectives Draft literature review Read methodology literature Devise research approach Draft research strategy and method Enter data into computer Draft findings chapter Update literature read Complete remaining chapters Submit to tutor and await feedback Revise draft, format for submission Print, bind Submit

Judicial Corruption in the United States Essay -- Jurisprudence, Ethic

The problem of judicial corruption in United States is immense. The Sixth Amendment in the United States Bill of Rights refers to the right to a speedy, fair and public trial. Unfortunately, our judicial system does not always maintain these rights. The United States judicial system is very corrupt and most of our country’s citizens do not know how corrupt it actually is. When thinking about the judicial system, words that come to mind are justice, morality, and fairness. Sadly, these words are not accurate descriptions of this system. Correct depictions of today’s judicial system are corruption, rigged courts, extortion, and phony trials. Our legal system does not bring truth or justice to our courtrooms. Overcoming this corruption is not easy for the average citizen or anyone who is not in on the â€Å"game†. This problem affects everyone, but only benefits four types of people; the judges, the lawyers, the clients paying thousands more to the lawyers to win their case, and the police. Judges today are not playing fair, and they are accepting bribes from equally corrupt lawyers that are desperate to win a case and improve their case winnings over their losses. The lawyers are asking for more money from the clients so that they can secretly hand over cash to the lawyers and ask for â€Å"favors† in the courtroom. With all of this injustice, comes fear implanted in the client, who is then willing to spend more on a lawyer to guarantee their success in a case; â€Å"fear and injustice equals more money for lawyers and judges†(Sachs). Many people know about or have witnessed this corruption taking place and numerous attempts to rid of it have been made. It is not an easy task attempting to bring justice to where justice should be made. There ... ...ut the Local Bar or Bar Association - Aren't They Supposed to Go After Crooked Lawyers and Judges?† FAQ on US Judicial and Legal Corruption. Blogspot. Web. 31 Oct. 2011. Sachs, Les. â€Å"So the Current State of Legal Corruption, is Really Supported by Both Political Parties, the Democrats and the Republicans Together?† FAQ on US Judicial and Legal Corruption. Blogspot. Web. 31 Oct. 2011. Sachs, Les. â€Å"Is it True that Once I Become a Victim of Judicial and Legal Corruption, I Basically Become an "Outlaw" to the Whole Legal System in America?† FAQ on US Judicial and Legal Corruption. Blogspot. Web. 31 Oct. 2011. Fine, Victoria. † My Dad Tried to Right a Wrong, Now He's Behind Bars Unjustly.† Huffington Post. Huffington Post. 12 Jan. 2010. Web. 31 Oct. 2011. Hays, Tom. â€Å"Judges On Wrong Side Of The Law.† CBSNEWS.com. CBSNEWS. 7 May. 2009. Web. 31 Oct. 2011

Immigration to Ellis Island :: Informative Essay

Immigrants came to American in search of freedom and opportunity. They mostly came by steamship. Examinations and vaccinations of the immigrants needed to be done. Both immigrants and their baggage had to be disinfected before they could leave Ellis Island. At the entrance to the Lower Bay of New York Harbor, the immigrants were inspected for contagious diseases like, smallpox, yellow fever, and measles. After which they were filed to the reception area. They had to climb three floors of stairs as medical officers watched them for signs of lameness, shortness of breath, heart conditions and mental conditions. The next examination was called the eyelid lift. The doctors used a hook to lift the eyelids to look for trachoma. Trachoma is " an easily spread infection of the eye. Repeated occurrences scar the upper eyelid, eventually turning it inward. The eyelashes then scratch the cornea, leading to blindness." Chalk marks were put on their clothes to indicate what was wrong. A few were, Sc for scalp disease, G for goiter, K for hernia, L for lameness and S for senility. The final test was to answer 29 questions including: name, sex, marital status, occupation, nationality, ability to read and write, race, physical and mental health, how much money they had, prison records, and if they were polygamists or anarchists. When the immigrants passed these tests they could exchange their gold, silver and money for American money and buy railroad tickets to go anywhere they wanted in America.

Exercise in a Bottle Essay -- Health Diet Weight Loss Papers

Exercise in a Bottle Imagine that it is a Friday night and you are up having a little midnight snack and watching some television. Feeling guilty for eating at such a late hour, you begin to flip through the stations when something catches your eye. It is an infomercial, and usually you just flip right through these, but for odd some reason you decide to watch this one. How could you possibly resist not watching? The commercial begins by showing gorgeous blondes in bikinis, and buff studs in speedos stuffing their faces with hamburgers, pizza, chips and everything that you know should not be eaten in quantity (if at all)! The amazing thing is that these â€Å"people† all have society’s ideal bodies. They are toned, tan, and thin in all of the right places. The commercial proceeds to boast how these women and men never exercise. They don’t need to because they take Enforma’s Exercise in a Bottle! Well now they have gotten your attention--look great, eat what you want and neve r exercise? It sounds way too good to be true! This is what miracle product, Exercise in a Bottle, will promise its potential buyers. But the questions, how does it work, what are they and how do its ingredients work, does it work, and are there any side effects are all key questions to be explored before taking Exercise in a Bottle. After I saw the commercial one night when I was up late snacking with my best friend, I admit that I was definitely tempted to pick up the phone and place an order. I even came close to falling into all of the hype and excitement surrounding this new product when I began my research, but after seeing a more scientific approach to the product, I have changed my mind. WHAT IS EXERCISE IN A BOTTLE? Exercise in a Bottle ... ... EXERCISE. 30(12): 1730-7, 1998 December. 3. Effects of resistance training and Chromioum Picolinate on body composition and skelatal muscle in older men by, Campbell WW., Joseph LJ., Davey SL., Cyr-Campbell D., Anderson RA., and Evans WJ.. JOURNAL OF APPLIED PHYSIOLOGY. 86(1): 29-39,1999 January. 4. Chromium Picolinate Toxicity; by, Cerulli J., Grabe DW., Gauthier I., Malone M., and McGoldrick MD.. ANNALS OF PHARMACOTHERAPY. 32(4) : 428-31, 1998 April 5. Chronic Renal failure after ingestion of over-the-counter chromium picolinate; by, Wasser WG., Feldman NS., and D'Agati VD. 6. http://www.cellular-phone.com/enformal/products.html 7. http://www.enformanatural.com/enforma.html 8. http://st2.yahoo.com/koolatron/enformasystem.html 9. http://www.evitality.net/store/detail/htm?ID=5 10. www.swmed.edu/library/consubj/fitness.htm

Joseph Conrad †Heart of Darkness The Real World Essay

In Heart of Darkness, Joseph Conrad relies heavily on the differences between appearances and reality to develop conflict in the story. From the appearance of the ivory trade and the continent of Africa, to the image of Kurtz himself, Conrad clearly shows us that appearances can be deceiving. As Marlow relates his story, the reader is drawn into a world of contradictions. These contradictions challenged the widely accepted European views of that time. When Marlow begins his quest to sail his ship up the Nile river to partake in the adventure and excitement that is the ivory trade, he describes the enterprise as a â€Å"noble cause† (pg 6). Marlow’s aunt called him â€Å"an emissary of light, something like a lower sort of apostle† whose purpose was to â€Å"‘ [wean] those ignorant millions from their horrid ways'† (pg 10). Yet through Conrad’s use of diction, our first image of the ivory trade is an image of darkness, death, and despair: â€Å"pieces of decaying machinery† (pg 12) â€Å"shadows of disease and starvation† â€Å"picture of a massacre or a pestilence† (pg 14). This may have been a harsh criticism of the British colonialism in Africa, and revealed the hypocrisy of those in the ivory trade who claimed to be civilizing the savages: â€Å"It was as unreal as everything else-as the philanthropic pretense of the whole concern †¦ The only real feeling was a desire to †¦ earn percentages† (pg 21). Throughout the story, the African jungle is presented as a dark and alien landscape with â€Å"the lurking death, †¦ the hidden evil, †¦ [and] the profound darkness of its heart† (pg 28) of an â€Å"unknown planet† (pg 32). To Marlow, while he was in the heart of the African jungle, the â€Å"earth seemed unearthly† (pg 32). Yet, as he ventured deep into this jungle and comes into contacts with its savage natives, he feels a â€Å"remote kinship† (pg 32) with them. He understands that this is his ancestry in the far off past, and views Africa as â€Å"an accursed inheritance† (pg 32). This furthers the conflict of Marlow’s fear and loathing of this primitive land, and his feeling of belonging and appreciation of this savage lifestyle. Finally, perhaps the most interesting contradictions of appearance and reality are those in Kurtz himself. When Marlow first encounters Kurtz, he  comments that his name â€Å"means short in German† but that â€Å"[h]e looked at least seven feet long† (pg 54). He goes on to generalize this contradiction to his entire life: â€Å"the name was as true as everything else in his life-and death† (pg 54). He appeared to be weak and feeble as â€Å"an animated image of death† (pg 55), yet throughout the story we find that he is strong and powerful, frequently being compared to Jupiter: â€Å"‘he came to them with thunder and lightning'† (pg 51). In his great work for the Suppression of Savage Customs he â€Å"[appealed] to every altruistic sentiment†. Yet, at the end in a footnote, scribbled the words â€Å"‘Exterminate all the brutes!'† (pg 46). Perhaps this biggest irony of Kurtz is how all the world viewed him as a creature of light with â€Å"his promise,† â€Å"his greatness,† â€Å"his generous mind,† and â€Å"his noble heart† (pg 70), yet, in the end, his noble heart was the Heart of Darkness. In the end, the contrasts between the appearance and reality of the ivory trade, of Africa, and of Kurtz, provide a backdrop of confusion in which Marlow struggles with nature and truth, and, in the end finds himself superior for it. Joseph Conrad challenges the views of his nineteenth century civilized and sheltered readers. Yet, this message still bears meaning for us today. We, who rely upon the media and news for all of our information have little idea of the reality of life in far off places like Africa, Afghanistan, and Peru. The savage jungle still exists, and most of us are still blissfully unaware of how our perceptions of such places, of such people, holds up to the reality of life there.

Effects of Behavioral Interventions on Disruptive Behavior and Affect in Demented Nursing Home Residents Essay

Behavioral interventions might ameliorate them and have a positive effect on residents’ mood (affect). Objectives: This study tested two interventions—an activities of daily living and a psychosocial activity intervention—and a combination of the two to determine their efficacy in reducing disruptive behaviors and improving affect in nursing home residents with dementia. Methods: The study had three treatment groups (activities of daily living, psychosocial activity, and a combination) and two control groups (placebo and no intervention). Nursing assistants hired specifically for this study enacted the interventions under the direction of a master’s prepared gerontological clinical nurse specialist. Nursing assistants employed at the nursing homes recorded the occurrence of disruptive behaviors. Raters analyzed videotapes filmed during the study to determine the interventions’ influence on affect. Results: Findings indicated significantly more positive affect but not reduced disruptive behaviors in treatment groups compared to control groups. Conclusions: The treatments did not specifically address the factors that may have been triggering disruptive behaviors. Interventions much more precisely designed than those employed in this study require development to quell disruptive behaviors. Nontargeted interventions might increase positive affect. Treatments that produce even a brief improvement in affect indicate improved quality of mental health as mandated by federal law. Key Words: affect †¢ Alzheimer’s disease †¢ behavior therapy †¢ dementia †¢ nursing homes Nursing Research July/August 2002 Vol 51, No 4 proximately 1. 3 million older Americans live in nursing homes today (Magaziner et al. , 2000). By 2030, with the aging of the population, the estimated demand for long-term care is expected to more than double (Feder, Komisar, & Niefeld, 2000). Thus, nursing home expenditures could grow from $69 billion in 2000 to $330 billion in 2030 (Shactman & Altman, 2000). About half of new nursing home r esidents have dementia (Magaziner et al. , 2000). The disease has an impact on four major categories of functioning in persons with dementia. These are disruptive behavior (DB), affect, functional status, and cognition (Cohen-Mansfield, 2000). This article will focus on the first two categories. Disruptive behavior has received much more attention than affect has (Lawton, 1997), perhaps for three reasons. First, more than half (53. 7%) of nursing home residents display DB with aggression (34. 3%) occurring the most often (Jackson, Spector, & Rabins, 1997). Second, DB threatens the wellbeing of the resident and others in the environment. Consequences include: (a) stress experienced by other resiCornelia K. Beck, PhD, RN, is Professor, Colleges of Medicine and Nursing, University of Arkansas for Medical Sciences. Theresa S. Vogelpohl, MNSc, RN, is President, ElderCare Decisions. Joyce H. Rasin, PhD, RN, is Associate Professor, School of Nursing, University of North Carolina. Johannah Topps Uriri, PhD(c), RN, is Clinical Assistant Professor, College of Nursing, University of Arkansas for Medical Sciences. Patricia O’Sullivan, EdD, is Associate Professor, Office of Educational Development, University of Arkansas for Medical Sciences. Robert Walls, PhD, is Professor Emeritus, University of Arkansas for Medical Sciences. Regina Phillips, PhD(c), RN, is Assistant Professor, Nursing Villa Julie College. Beverly Baldwin, PhD, RN, deceased, was Sonya Ziporkin Gershowitz Professor of Gerontological Nursing, University of Maryland. A Note to Readers: This article employs a number of acronyms. Refer to Table 1 to facilitate reading. 219 220 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 1. Acronyms Term Activities of daily living Analysis of variance Apparent affect rating scale Arkansas Combined Disruptive behavior(s) Disruptive behavior scale Licensed practical nurse(s) Maryland Mini mental status exam Negative visual analogue scale Nursing home nursing assistant(s) Observable displays of affect scale Positive visual analogue scale Project nursing assistant(s) Psychosocial activity Research assistant(s) Acronym ADL ANOVA AARS AR CB DB DBS LPN MD MMSE NVAS NHNA ODAS PVAS PNA PSA RA decreases in targeted behaviors (Gerdner, 2000; Matteson, Linton, Cleary, Barnes, & Lichtenstein, 1997). However, others reported nonsignificant reductions (Teri et al. , 2000), no change (Churchill, Safaoui, McCabe, & Baun, 1999), or increased behavioral symptoms (Mather, Nemecek, & Oliver, 1997). These studies used nursing home staffs to collect data, had sample sizes below 100, and measured an array of DB with different assessments. Only in the last decade have researchers investigated affect. Compared to studies to reduce DB, far fewer studies have measured interventions using affect as an outcome measure. Studies reported positive outcomes on affect from such interventions as simulated presence therapy (Camberg et al. , 1999), Montessori-based activities (Orsulic-Jeras, Judge, & Camp, 2000), advanced practice nursing (Ryden et al. , 2000), music (Ragneskog, Brane, Karlsson, & Kihlgren, 1996), rocking chair therapy (Watson, Wells, & Cox, 1998), and pet therapy (Churchill et al. , 1999). The studies on affect used global measures that relied on observer interpretation, which could have compromised objectivity. Theoretical Bases A number of conceptual frameworks have guided intervention research on persons with cognitive impairment (Garand et al. , 2000). The theoretical basis for this study was that individuals have basic psychosocial needs, which, when met, reduce DB (Algase et al. , 1996) (Table 2). The interventions, one focusing on activities of daily living (ADL) and the other focusing on psychosocial activity (PSA), and a combination (CB) of the two, were developed to meet most of the basic psychosocial needs that Boettcher (1983) identified. These included territoriality, privacy and freedom from unwanted physical intrusion; communication, opportunity to talk openly with others; self-esteem, respect from others and freedom from insult or shaming; safety and security, protection from harm; autonomy, control over one’s life; personal identity, access to personal items and identifying material, and cognitive understanding, awareness of surroundings and mental clarity. The section on study groups specifies which interventions were designed to meet which needs. Positive affect usually accompanies interventions that meet basic psychosocial needs (Lawton, Van Haitsma, & Klapper, 1996). Several researchers and clinicians have suggested that displays of affect may offer a window for revealing demented residents’ needs, preferences, aversions (Lawton, 1994), and responses to daily events (Hurley, Volicer, Mahoney, & Volicer, 1993). The study reported here dents and staff; (b) increased falls and injury; (c) economic costs, such as property damage and staff burn-out, absenteeism, and turnover; (d) emotional deprivation such as social isolation of the resident; and (e) use of physical or pharmacologic restraints (Beck, Heithoff, et al. 1997). Third, before the Nursing Home Reform Act (Omnibus Budget Reconciliation Act, 1987), nursing homes routinely applied physical and chemical restraints to control DB with only moderate results (Garand, Buckwalter, & Hall, 2000). However, the Act mandated that residents have the right to be free from restraints imposed for discipline or convenience and not required to treat the residents’ medical symptoms. Thus, research ers have tested a wide range of behavioral interventions to reduce DB and replace restraints. The Act (1987) also stipulated that all residents are entitled to an environment that improves or maintains the quality of mental health. Interventions that promote positive mood or affect fulfill this entitlement. Therefore, this article will report the effects of an intervention to increase functional status in activities of daily living (Beck, Heacock, et al. , 1997), a psychosocial intervention, and a combination of both on reducing DB and improving affect of nursing home residents with dementia. TABLE 2. Basic Psychosocial Needs Relevant Literature Literature suggests that behavioral interventions offer promise in managing DB. A wide range of modalities and approaches have been tested: (a) sensory stimulation (e. g. , music); (b) physical environment changes (e. g. , walled garden); (c) psychosocial measures (e. g. , pet therapy); and (d) multimodal strategies. Many studies found significant Territoriality Communication Self-esteem Safety and security Autonomy Personal identity Cognitive understanding Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 221 adopted the inference by Lawton et al. (1996) that frequent displays of positive affect when basic psychosocial needs are met might indicate improved emotional wellbeing. is leg continually and without apparent reason needs redirection. This intervention lasted 45–60 minutes a day during various ADL. PSA Intervention. A PNA also conducted the PSA intervention, which involved 25 standardized modules designed to meet the psychosocial needs for communication, selfesteem, safety and security, personal identity, and cogni tive understanding through engagement in meaningful activity while respecting the individual’s unique cognitive and physical abilities (Baldwin, Magsamen, Griggs, & Kent, 1992). The intervention was chosen because it: (a) provided a systematic plan for the PNA to address some of the participant’s basic psychosocial needs; and (b) represented clinical interventions that many long-term care facilities routinely used, but had not been formalized into a research protocol or systematically tested. Each module contained five psychosocial areas of content (expression of feelings, expression of thoughts, memory/recall, recreation, and education) and stimulated five sensory modalities (verbal, visual, auditory, tactile, and gustatory/olfactory). For instance, Activity Module I involved life review, communicating ideas visually (identifying and making drawings), clapping to different rhythms, massaging one’s face, and eating a snack. Initially, many participants tolerated less than 15 minutes of the activity but eventually habituated and participated 30 minutes. CB Intervention. This treatment consisted of both the ADL and PSA interventions and lasted 90 minutes daily. Placebo Control. This involved a one-to-one interaction between the participant and PNA. It controlled for the effect of the personal attention that the PNA provided to the three treatment groups. The PNA asked the participant to choose the activity, such as holding a conversation or manicuring nails. It lasted 30 minutes a day. No Intervention Control. This condition consisted of routine care from a NHNA with no scheduled contact between participants and the PNA. Instruments: Disruptive Behavior Scale. The 45-item disruptive behavior scale (DBS), designed to construct scores based on the occurrence and severity of behaviors, assessed the effect of the interventions on DB (Beck, Heithoff et al. 1997). Gerontological experts (n 29) established content validity, and interrater reliability tests yielded an interclass correlation coefficient of . 80 (p . 001). Geropsychiatricnursing experts weighted the behaviors using a Q-sort to improve the scale’s capacity to predict perceived patient disruptiveness. Factor analysis identified four factors (Beck et al. , 1998). Two corresponded to two—physically aggressive and physically nonaggressive—of the three categories from the factor analysis of the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989). The third category of the Inventory was verbally agitated; in contrast, the factor analysis of the DBS produced a third and fourth category—vocally agitated and vocally aggressive. To obtain a score for the DBS, a trained individual completed a DBS form for every hour of a shift by check- Methods The primary aim was to conduct a randomized trial of the ADL and PSA interventions individually and in combination (CB) for their effect on DB and affect on a large sample of nursing home residents. The experimental design consisted of three treatment groups (ADL, PSA, and Combined) and two control groups (placebo and no intervention). Individual residents were assigned to one of the five groups at each of seven sites in Arkansas and Maryland, which controlled for site differences. To demonstrate the practicability of the interventions and assure adherence to the treatment protocols, certified nursing assistants were hired and trained as project nursing assistants (PNA). They implemented the interventions Monday–Friday for 12 weeks. Afterward, one-month and two-month follow-up periods occurred. Nursing assistants employed by the nursing homes (NHNA) recorded DB. To measure affect, raters were hired for the study to analyze videotapes filmed during intervention. Research Subjects: The sample initially consisted of 179 participants. The study design allowed for the detection of an improvement in DB scores on the Disruptive Behavior Scale (DBS) (Beck, Heithoff et al. , 1997) across time of at least 1. 6 units with a power of 80%. This power calculation assumed that the repeated measures would be correlated with one another at 0. 60. Inclusion criteria were age 65; a dementia diagnosis; a Mini Mental Status Exam (MMSE) (Folstein, Folstein, & McHugh, 1975) score of 20; and a report of DB in the previous two weeks. To form a more homogeneous group for generalizing findings, exclusion criteria were a physical disability that severely limited ADL; a psychiatric diagnosis; and a progressive or recurring medical, metabolic, or neurological condition that might interfere with cognition or behavior. Study Groups: ADL Intervention. A PNA used the ADL intervention during bathing, grooming, dressing, and the noon meal based on successful protocols that improved functional status in dressing (Beck, Heacock et al. , 1997). It attempted to meet residents’ psychosocial needs for territoriality, communication, autonomy, and self-esteem to promote their sense of safety and security. The intervention also tried to respect participants’ cognitive and physical abilities by prescribing three types of strategies specific to the individual participant. First, strategies to complete an ADL address specific cognitive deficits. For example, the person with ideomotor apraxia needs touch or physical guidance to start movements. Second, standard strategies are behaviors and communication techniques that work for almost everyone with dementia. For example, the caregiver gives a series of one-step commands to guide the resident to put on her shoe. Third, problem-oriented strategies address particular disabilities such as fine motor impairment, physical limitations, or perseveration. For example, a subject who rubs his hand back and forth on 222 Effects of Behavioral Interventions ing the behaviors that occurred. The score for a behavior was the frequency (0–8) times the weight. The item scores were summed to obtain each of the four subscale scores. Mini Mental Status Exam. The Mini Mental Status Exam (MMSE) (Folstein et al. 1975) provided a global evaluation of participants’ cognitive statuses for screening subjects for the study. Test-retest reliability of the MMSE is . 82 or better (Folstein et al. ). Cognition is assessed in seven areas, and scores lower than 24 out of 30 indicate dementia. Nursing Research July/August 2002 Vol 51, No 4 Observable Displays of Affect Scale. The Observable Displays of Affect Scale (ODAS) (Vogelpohl & Beck, 1997), designed to rate videotaped data, contains 41 behaviors categorized into six subscales of positive and negative facial displays, vocalizations, and body movement/posture. Raters indicate presence/absence of each behavior during five 2-minute intervals from a 10minute videotape. Scores range from 0–5 for each item. The range of scores for each scale is: facial positive (0–20), Aggression during bathing facial negative (0–20), vocal positive (0–45), vocal negative (0–50), body could stem from physical positive (0–30), and body negative discomfort or rough (0–40). Interrater reliabilities (Kappa handling coefficients) for the ODAS range from . 68–1. 00, and intrarater reliability is . 97–1. 00. Ten gerontological nursing experts established content validity (Vogelpohl & Beck). Apparent Affect Rating Scale. The Apparent Affect Rating Scale (AARS) (Lawton et al. , 1996) is designed for direct observation of persons with dementia and contains six affective states: pleasure, anger, anxiety/fear, sadness, interest, and contentment. (In later work, Lawton, Van Haitsma, Perkinson, & Ruckdeschel [1999] deleted contentment). Each item has a noninclusive list of behaviors that might signal the presence of the affect from which observers infer the affect. The observer assigns a score of 1 to 5 to measure the duration of the behavior. Visual Analogue Scales. The Positive Visual Analogue Scale (PVAS) and Negative Visual Analogue Scale (NVAS) (Lee & Kieckhefer, 1989; Wewers & Lowe, 1990) are two 10centimeter lines on separate pages for rating positive and negative affect. The PVAS has end anchors of â€Å"no positive affect† and â€Å"a great deal of positive affect. † The NVAS has end anchors of â€Å"no negative affect† and â€Å"a great deal of negative affect. † Scores range from 0 to 100. Procedure: The study consisted of six phases: (a) preliminary activities, (b) a three-week normalization/desensitization period, (c) a 12-week intervention period, (d) a onemonth follow-up period, (e) a two-month follow-up period, and f) a videotape analysis. Preliminary Activities. The institutional review boards at the University of Arkansas for Medical Sciences and the Univer- sity of Maryland approved the research. Each nursing home identified residents with dementia and sent letters informing persons responsible for the residents that researchers would be contacting them. Responsible persons could return a signed form if they did not want to participate. Willing responsible persons received a telephone call explaining the study followed by a mailed written description along with two consent forms. Those willing kept one consent form for their records and signed and mailed back the other. Screening involved a review of the residents’ charts, recording their diagnoses, and interviews with the staff to find evidence of DB during the previous two weeks. Each resident took the MMSE to meet inclusion criteria. Within each home, female residents who passed these screens were randomized to one of the five groups by a drawing, but males were assigned to the five groups to ensure even distribution of their small number. Simultaneously, research staff members were hired and trained. Normalization/Desensitization. For the next three weeks, each PNA accompanied a NHNA to learn the routines of the facility but did not help care for potential study participants. A videotape technician placed a camera that was not running in the dining and shower rooms to desensitize residents and staff to its presence. In addition, nursing home staffs participated in two-hour training sessions on the DBS. Throughout the study, a gerontological clinical nurse specialist trained any new NHNA and retrained if behaviors reported on the DBS differed from those she observed during randomized checks. Intervention. During the 12-week intervention period, the first three weeks were considered baseline and the last two weeks postintervention. The PNA administered the treatment/s or placebo five days a week. Every day, they asked participants to give their assent and espected any dissents. During weeks 11–12 (postintervention), the PNA prepared the participants for their departure by telling them that they were leaving soon. To facilitate data collection, a separate form of the DBS for each of the three eight-hour daily shifts was developed. Eight one-hour blocks accompanied each item of the scale. The NHNA placed a check mark in the block that corresponded to the hour when the NHNA observed the behavi or. The NHNA completed the DBS on all participants during or at the end of a shift. In addition, a technician videotaped participants in the treatment and placebo groups every other week during an interaction with the PNA and no intervention group monthly during an ADL. The technician monitored positioning and operation of the camera from outside the room or behind a curtain to respect the participants’ privacy. One-Month and Two-Month Follow-up. One month and two months after the research team left the nursing home, Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 223 esearch assistants (RA) retrained nursing home staffs on the DBS. The NHNA then collected DB data on their shifts Monday–Friday for one week. tervention, week 16 as one-month follow-up, and week 20 as two-month follow-up. Participants with fewer than six observations at any time period were omitted. For each period, a total DBS score represented an averVideotape Analysis. The videotapes ranged in length from age of the participant’s data for the t hree shifts of each day less than five minutes to 40 minutes, depending on the across the five days of the observation week. Therefore, activity and the participant’s willingness to cooperate with total DBS scores were obtained for baseline (M of weeks the treatment (baseline and control participants’ tapes 1–3), intervention (M of weeks 4–10), postintervention (M tended to be shorter). To standardize the opportunity for of weeks 11–12), first follow-up (M of week 16), and secbehaviors to occur, an editor took 10-minute segments ond follow-up (M of week 20). The same procedure from the middle of baseline and final treatment eek tapes yielded subscale scores for physically aggressive, physically and randomized them onto videotapes for rating. Because nonaggressive, vocally aggressive, and vocally agitated videotaping occurred to ensure appropriate implementabehaviors for each of the five time periods. tion of interventions, the treatment groups had more A repeated measures analysis of variance (ANOVA) usable videotapes than the control groups did. consisted of two between- subjects and one within-subjects A master’s prepared gerontological factors. The between-subjects factors nurse specialist intensively trained six were intervention group and state (AR raters on the Observer III Software or MD) to account for regional differSystem (Noldus Information Technolences in scoring DB, and the withinogy, 1993) for direct data entry and subjects factor represented DBS scores the affect rating scales. The raters for the five different time periods. Each reached . 80 agreement with the speanalysis allowed for testing by intervencialist on practice tapes before they tion group, time period, and state. The Screaming may started rating the study videotapes. nalysis of the interaction effect of She monitored reliability for each tape intervention group by time period express pain or monthly, retrained as needed, and rantested the hypothesis that the intervenself-stimulation domized the sequence of rating the tions would decrease DB across time in scales. The raters entered the ODAS treatment conditions as compared to and AARS data directly into a comcontrol conditions. The analysis was puter using the Observer. The system repeated five times, once for each suballowed raters to watch videos repeatscale of the DBS and once for the total edly in actual time and slow action to score. Level of significance was set at document behaviors objectively and 0. 05. The researchers believed that the precisely. The raters indicated their small group sizes justified the liberal perception of the participants’ positive and negative level of significance. For the videotape analysis, analyses of affect by placing a vertical mark at some point between covariance occurred for the 14 variables observed from the the two end anchors of the PVAS and NVAS. They videotapes during intervention. The baseline score served marked neutral affect as negative. s a covariate for the final score. While a multivariate analysis would have been desirable, it would have had Intervention Integrity: The PNA and video camera techniinsufficient power with this number of variables and subcian underwent two weeks of intensive training on general jects. The 14 univariate analyses do inflate the Type I error aging topics, stress management, information on dementia, rate. and confidentiality/privacy issues. Training also involved instruction on the study interventions, DBS, and research Results protocols. Of the 179 initial participants, 36 did not finish; the greatA gerontological clinical nurse specialist viewed treatest attrition occurred in the no intervention control group. ment and placebo videotapes biweekly in a private office to Attrition resulted from death (39%), withdrawal of fammonitor PNA compliance with research protocols, provide ily’s consent or at nursing home staff’s request (26%), discorrective feedback to PNA, and help PNA recognize and charge (18%), and change in health status/medications meet participants’ needs as they changed during treatment. hat did not meet inclusion criteria (17%). This left 143 The possibility for contamination appeared to be low participants: 29 in the ADL, 30 in PSA, 30 in CB, 30 in the because NHNA were unlikely to change their care practices placebo, and 24 in the no intervention, but 16 with incomand had little opportunity to observe PNA. Further, NHNA plete data were dropped. Table 3 gives the demographic were b linded to the hypothesis of the study, the nature of the statistics for the 127 participants with complete data. No interventions, and the participants’ group assignments, statistically significant demographic differences emerged although they probably could identify the no intervention among the five groups. In short, this sample primarily conparticipants. sisted of elderly, white females with severe cognitive impairment. Analysis: Reviewers checked for completeness of all data. For the videotape analysis, the final number was 84 The researchers designated intervention weeks 1–3 as baseparticipants with 168 videotape segments. Most were line, weeks 4–10 as intervention, weeks 11–12 as postin- 224 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 3. Description of the Sample by Intervention Group No Intervention 19 89. 5 78. 9 84. 2 86. 47 (6. 37) 11. 47 (6. 43) ADL Number in group Percent female Percent white Percent widowed Mean age (SD) M MMSE (SD) 28 78. 6 82. 1 64. 3 82. 29 (8. 40) 11. 44 (7. 69) PSA 29 82. 1 85. 7 66. 7 82. 18 (7. 64) 10. 65 (6. 76) CB 22 81. 8 77. 3 77. 3 82. 82 (9. 81) 7. 91 (5. 41) Placebo 29 75. 9 86. 2 75. 9 86. 45 (6. 92) 11. 11 (6. 39) Total 127 81. 0 82. 5 72. 8 83. 64 (7. 97) 10. 55 (6. 64) Note. ADL = activities of daily living; PSA = psychosocial activity; CB = combination. emale (79%) and widowed (69%) with a mean age of 83 (SD 7. 44). Participants had a mean score of 10 (SD 6. 34) on the MMSE, indicating moderate to severe cognitive impairment. Table 4 displays the means and standard deviations for the DBS overall and the four subscales across the five time periods for the five groups. No significant differences emerged for the interventi on-by-time interaction for any of the dependent variables. Thus, the results failed to support the hypothesis that the interventions would decrease DB across time in treatment groups as compared to control groups (statistical analysis tables on Website at: http://sonweb. nc. edu/nursing-research-editor). However, the main effect of state was significant in three analyses. Arkansas recorded significantly more behaviors than Maryland did for the dependent variables of physically nonaggressive (p . 001), vocally agitated (p . 001), and overall DBS (p . 002). Further, the main effect of time was significant for overall DBS (p . 002) and the four subscales of physically aggressive (p . 001), physically nonaggressive (p . 027), vocally aggressive (p . 021), and vocally agitated behaviors (p . 008). The significance resulted from increased DB after the PNA had left the home (generally from intervention or postintervention to first follow-up). For the videotape analysis, the hypothesis stated that treatment groups, compared with control groups, would display more indicators of positive affect and fewer indicators of negative affect following behavioral interventions. In general, neither the positive nor the negative affect scores were particularly high, indicating that this sample had relatively flat affect. Results from the analysis of covariance tests supported increased positive affect but not decreased negative affect. Compared to the control groups, the treatment groups had significantly more positive facial expressions (p . 001) and positive body posture/movements (p . 001), but not more positive verbal displays on the ODAS. The treatment groups displayed significantly more contentment (p . 037) and interest (p . 028) than the control groups did on the AARS. For the negative affects on the AARS, the treatment groups had a shorter duration of sad behaviors (p . 007) than the control groups did. Comparison of VAS scales likewise showed that the treatment groups displayed more positive affect (p . 012). Discussion In contrast to other studies (e. . , Hoeffer et al. , 1997; Kim & Buschmann. , 1999; Whall et al. , 1997), this study found no treatment effect on DB. The interventions were a synthesis of approaches believed to globally address â€Å"triggers† of DB and meet psychosocial needs (Boettcher, 1983). They did not address the specific factors that might have been triggering the particula r behavior (Algase et al. , 1996). Such triggers include under/over stimulation, unfamiliar or impersonal caregivers, and particular individual unmet psychosocial needs. For example, aggression during bathing could stem from physical discomfort or rough handling (Whall et al. 1997). Interventions much more individually designed require development. Increasing DB across all groups was reflected in the DBS scores at 1-month follow-up. Two factors may explain this increase. First, the PNA had warned participants that they would be leaving. Second, the ADL and CB participants no longer received care from the familiar PNA, and PSA, CB, and placebo participants no longer had a daily activity or visit. The increased stress and time constraints for NHNA as they resumed caregiving of the ADL and CB participants may explain the heightened DB in the control groups. Such changes may trigger increased behavioral symptoms in persons with dementia (Hall, Gerdner, Zwygart-Stauffacher, & Buckwalter, 1995). Two measurement issues may have affected outcomes. First, observers view behaviors differently (Whall et al. , 1997) and come to expect particular behaviors from certain residents (Hillman, Skoloda, Zander, & Stricker, 1999). If the NHNA were accustomed to a participant’s DB pattern, such as persistent screaming, they may have overlooked decreases in that behavior. Initial training and retraining of raters occurred as needed; however, some Nursing Research July/August 2002 Vol 51, No 4 Effects of Behavioral Interventions 225 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period No Intervention (n = 19) Mean (SD) 408. 71 (427. 24) 303. 69 (408. 44) 281. 97 (410. 85) 418. 31 (630. 58) 292. 85 (405. 15) 114. 66 (202. 89) 90. 85 (182. 70) 77. 98 (173. 15) 130. 92 (257. 12) 128. 20 (195. 67) 191. 97 (157. 75) 117. 11 (112. 30) 118. 23 (137. 08) 154. 46 (225. 05) 100. 45 (153. 30) 55. 16 (74. 70) 42. 89 (54. 54) 33. 26 (47. 06) 64. 72 (77. 89) 28. 09 (37. 02) (continues) DB Category Time Period DBS total Baseline ADL (n = 28) Mean (SD) 172. 51 (191. 47) 182. 45 (181. 3) 164. 56 (154. 95) 207. 22 (205. 58) 190. 70 (291. 06) 20. 67 (30. 52) 32. 59 (51. 29) 15. 02 (26. 10) 44. 18 (100. 62) 21. 45 (36. 47) 95. 50 (105. 28) 87. 58 (87. 58) 85. 04 (89. 60) 88. 81 (85. 69) 148. 75 (187. 28) 22. 85 (32. 10) 28. 37 (32. 50) 21. 15 (26. 54) 30. 72 (48. 95) 18. 28 (24. 55) PSA (n = 29) Mean (SD) 348. 02 (467. 50) 306. 81 (393. 03) 303. 24 (367. 54) 373. 17 (533. 05) 300. 20 (366. 42) 85. 87 (199. 01) 83. 94 (167. 53) 82. 82 (166. 93) 113. 49 (235. 71) 81. 30 (151. 85) 162. 41 (206. 65) 130. 82 (142. 72) 133. 92 (145. 97) 141. 47 (188. 99) 164. 92 (223. 63) 49. 64 (93. 15) 43. 80 (64. 6) 37. 90 (53. 43) 54. 47 (90. 33) 40. 26 (45. 26) CB (n = 22) Mean (SD) 287. 66 (373. 73) 300. 84 (379. 33) 286. 21 (365. 78) 374. 10 (510. 10) 312. 83 (433. 18) 68. 84 (126. 18) 67. 14 (137. 79) 61. 04 (127. 78) 92. 68 (205. 52) 60. 40 (131. 54) 136. 67 (189. 03) 124. 64 (164. 49) 125. 99 (157. 78) 159. 97 (202. 75) 146. 53 (201. 83) 34. 49 (55. 91) 40. 73 (52. 60) 31. 18 (33. 85) 36. 95 (42. 70) 32. 82 (51. 32) Placebo (n = 29) Mean (SD) 325. 96 (337. 14) 337. 60 (328. 94) 336. 80 (366. 55) 389. 92 (434. 43) 319. 15 (384. 59) 49. 26 (90. 24) 62. 10 (112. 71) 59. 67 (106. 37) 76. 79 (165. 45) 48. 25 (101. 4) 167. 01 (177. 80) 164. 62 (161. 48) 175. 36 (189. 80) 201. 68 (212. 06) 87. 67 (127. 38) 47. 20 (79. 70) 39. 55 (57. 74) 32. 69 (55. 77) 29 . 30 (47. 60) 30. 18 (52. 85) Intervention Postintervention 1 month follow-up 2 month follow-up Physically aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Physically nonaggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up Vocally aggressive Baseline Intervention Postintervention 1 month follow-up 2 month follow-up 226 Effects of Behavioral Interventions Nursing Research July/August 2002 Vol 51, No 4 TABLE 4. Weighted Scores for Disruptive Behavior by Intervention Group and Time Period (Continued) NoIntervention (n = 19) Mean (SD) 47. 65 (97. 22) 68. 32 (103. 13) 68. 01 (116. 62) 84. 50 (112. 48) 73. 07 (117. 12) DB Category Time Period Vocally agitated Baseline ADL (n = 28) Mean (SD) 33. 49 (84. 39) 33. 91 (62. 52) 43. 17 (72. 10) 43. 48 (64. 39) 50. 53 (117. 95) PSA (n = 29) Mean (SD) 46. 92 (98. 70) 52. 84 (96. 03) 52. 50 (90. 78) 68. 22 (98. 89) 48. 89 (92. 33) CB (n = 22) Mean (SD) 62. 49 (98. 97) 70. 43 (110. 85) 69. 08 (107. 29) 82. 14 (118. 97) 75. 80 (129. 67) Placebo (n = 29) Mean (SD) 50. 0 (92. 05) 48. 25 (81. 63) 48. 59 (72. 20) 63. 74 (95. 30) 54. 11 (80. 61) Intervention Postintervention 1 month follow-up 2 month follow-up Note. Scores were created by assigning each behavior with a severity weight prior to summing and then averaging across day and then week(s). DBS = disruptive behaviors; ADL = activities of daily living intervention; PSA = psychocial activity inte rvention; CB = combination of the two interventions. NHNA appeared to continue to consider participants’ behaviors, such as repetitive questioning, to be personality characteristics or attention-seeking efforts rather than DB. Thus, they may have under-reported behaviors. Further, staff may prefer withdrawn behaviors, such as isolating self and muteness (Camberg et al. , 1999), and view them as nonproblematic. Second, categorizing a behavior as disruptive without understanding its meaning to the person with dementia may be conceptually flawed. For example, screaming may express pain or self-stimulation. Two design features may explain differences between the findings of this study and others. First, this study had both placebo and no intervention control conditions. Just a few other studies randomized subjects to treatment or control groups or included two control groups (e. g. , Camberg et al. , 1999). In most studies, control conditions preceded or followed treatment conditions (e. g. , Clark, Lipe, & Bilbrey, 1998). In both designs, subjects served as their own controls, which limits examination of simultaneous intra- and extra-personal events that might affect DB frequency. Second, many control groups came from separate units or different nursing homes (e. g. , Matteson et al. , 1997), which makes it difficult to control for differences in environment, staff relationships, and personalities. This study occurred at seven sites in two different geographical areas, but at each site, the randomization of female participants distributed the groups across all nursing units to control for environmental and staff characteristics. Acknowledged limitations include the following. First, in spite of the large overall sample, the group sizes were small (range 19–30) with the greatest loss in the no inter- vention group. Larger groups might have provided more definitive findings on the relationship between behavioral interventions and DB frequency as Rovner et al. (1996) did (treatment group 42; control group 39). Second, NHNA served as data collectors because using independent observers would have been cost-prohibitive. These results suggest that future intervention research should consider the individual characteristics of the person with dementia (Maslow, 1996) and the triggers of the behavior (Algase et al. , 1996). Studies that have individualized interventions have demonstrated decreased DB (Gerdner, 2000; Hoeffer et al. , 1997). Researchers need to continue to refine methods for identifying what works for whom (Forbes, 1998) to minimize the prevalent trial-anderror approach to DB management.