The overt behaviour scale (OBS): a tool for measuring challenging behaviours following ABI in community settings

OBJECTIVES: The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS. METHOD: Two adult community-based samples of people with ABI were recruited. Sample 1 (n= 30) were concurrently evaluated on the OBS by two raters and again 1 week later to test stability. Other validating scales were also administered. Sample 2 (n= 28) were clients of the ABI Behaviour Consultancy who were treated for challenging behaviours and were administered the OBS before treatment commenced and then again 4 months later. RESULTS: Inter-rater reliability and stability coefficients for the OBS total score was strong (0.97 and 0.77, respectively). Initial evidence of convergent and divergent validity was shown by the differential pattern of correlations with other measures. Moderate-to-strong coefficients (range 0.37-0.66) were observed between the OBS and other measures that had behavioural content (i.e. Mayo-Portland Adaptability Inventory, Current Behaviour Scale, Neurobehavioural Rating Scale-Revised). Divergent validity was shown by the lack of correlation between the OBS and the sub-scales of these tools that do not measure challenging behaviour. Finally, responsiveness was demonstrated with a significant decrease in OBS scores in the expected direction over the 4-month period. This improvement was confirmed by corroborating evidence from key informants. CONCLUSION: The OBS shows promise as a reliable, valid and responsive measure that can be used for the systematic assessment of challenging behaviours in community settings.

Challenging behaviour profiles of people with acquired brain injury living in community settings

Primary objective: To determine the type and severity of challenging behaviours among a cohort of brain-injured persons referred to a community-based behaviour management service; and to determine whether different behaviour profiles were associated with aetiology of brain injury.
Methods and procedures: A sample of clients (n= 190) referred to the ABI Behaviour Consultancy for assessment and treatment of challenging behaviours was evaluated using the Overt Behaviour Scale (OBS) and other measures of disability and support needs.
Main outcomes and results: The most common challenging behaviour categories were, in order of frequency: verbal aggression, inappropriate social behaviours and lack of initiation. Clients typically exhibited four categories of challenging behaviour and multiple kinds of the behaviours represented by each category. There was some evidence of differences in occurrence of specific behaviours associated with aetiology of brain injury, particularly for hypoxia and alcohol-related brain injury.
Conclusions: A systematic assessment of challenging behaviours in community settings has revealed the profiles of broad behavioural disturbance that can occur following ABI. Assessing the breadth of disturbance is important in understanding a client's presentation and thus planning appropriate behaviour management interventions.

Momentary lives : supporting people with acquired brain injury

Personal adjustment following an acquired brain injury is influenced by a comprehensive, complex, and dynamic range of factors. This study found that a useful approach to service provision in the ABI sector would involve a holistic approach that addresses all life domains of the individual within an ecological systems framework.

An overview of previous studies in stakeholder management and its implications for construction industry

Purpose – The purpose of this paper is to provide an overview of previous studies in the field of stakeholder management, and propose implications for the construction industry.

Design/methodology/approach – Three major databases are searched: ABI, EI CompendexWeb, and ISI web of knowledge. Papers are searched on topic by using the keywords of “stakeholder management”, “management of stakeholders” and “management of stakeholder”. A brief review of the abstracts and conclusions of these papers is conducted to filter out the irrelevant and/or duplicate papers. After filtering, 159 articles with content relevant to stakeholder management are selected for analysis.

Findings – An overview of previous studies reveals that research interest in stakeholder management has turned to the descriptive approach. Through a critical review of stakeholder management process, three main problems of previous studies are identified: very few methods and tools are available to identify all stakeholders and their interests; limited studies involve the change management about the stakeholders' influence and relationship; and few studies are capable of reflecting the influence of the entire relationship network in practice.

Research limitations/implications – Two implications for the construction industry are suggested: establish a practical framework for managing stakeholders; and apply social network theory (SNT) in developing a stakeholder relationship model.

Originality/value – The overview and implications lead to new knowledge and an improved understanding of the management of multiple stakeholders in construction projects. The perspective of SNT avoids the deficiency of Freeman's dyadic ties model, and the project managers can make decisions in response to the stakeholder behaviours according to the entire relationship.

To what extent do nurses use research in clinical practice? A systematic review

Background : In the past forty years, many gains have been made in our understanding of the concept of research utilization. While numerous studies exist on professional nurses' use of research in practice, no attempt has been made to systematically evaluate and synthesize this body of literature with respect to the extent to which nurses use research in their clinical practice. The objective of this study was to systematically identify and analyze the available evidence related to the extent to which nurses use research findings in practice.

Methods : This study was a systematic review of published and grey literature. The search strategy included 13 online bibliographic databases: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, HAPI, Web of Science, SCOPUS, OCLC Papers First, OCLC WorldCat, ABI Inform, Sociological Abstracts, and Dissertation Abstracts. The inclusion criteria consisted of primary research reports that assess professional nurses' use of research in practice, written in the English or Scandinavian languages. Extent of research use was determined by assigning research use scores reported in each article to one of four quartiles: low, moderate-low, moderate-high, or high.

Results : Following removal of duplicate citations, a total of 12,418 titles were identified through database searches, of which 133 articles were retrieved. Of the articles retrieved, 55 satisfied the inclusion criteria. The 55 final reports included cross-sectional/survey (n = 51) and quasi-experimental (n = 4) designs. A sensitivity analysis, comparing findings from all reports with those rated moderate (moderate-weak and moderate-strong) and strong quality, did not show significant differences. In a majority of the articles identified (n = 38, 69%), nurses reported moderate-high research use.

Conclusions : According to this review, nurses' reported use of research is moderate-high and has remained relatively consistent over time until the early 2000's. This finding, however, may paint an overly optimistic picture of the extent to which nurses use research in their practice given the methodological problems inherent in the majority of studies. There is a clear need for the development of standard measures of research use and robust well-designed studies examining nurses' use of research and its impact on patient outcomes. The relatively unchanged self-reports of moderate-high research use by nurses is troubling given that over 40 years have elapsed since the first studies in this review were conducted and the increasing emphasis in the past 15 years on evidence-based practice. More troubling is the absence of studies in which attempts are made to assess the effects of varying levels of research use on patient outcomes.

Environmental scanning literature - past, present and future research propositions

The purpose of this paper is to establish research propositions that can potentially fill research gaps in the literature of environmental scanning. Major databases such as ABI/INFORM, and Emerald have been searched to gather literature. The literature on environmental scanning is reviewed with an aim to identify patterns in scanning practices as well as research gaps in the extant literature. Three major phases of the development and three main characteristics of the literature have been identified. Four propositions are suggested to fill the research gaps in the literature of the environmental scanning practices; namely, firm characteristics, market orientation, and top management cognition perspective. Further empirical research is needed to test the four propositions in order to provide a full picture for the environmental scanning literature. The contributions of this paper are: 1) the revelation of the evolution of the environmental scanning literature; 2) the identification of research gaps in the environmental scanning literature; 3) the establishment of propositions through which future research can further the knowledge of environmental scanning.

Pretend play of children with acquired brain injury : an exploratory study

Objective: This exploratory study aimed to describe the self-initiated pretend play of three children who had sustained an acquired brain injury (ABI). No previous research was found.

Methods: Three children aged 3.0–6.0 years were recruited through purposive sampling. Pretend play ability was assessed using the Child-Initiated Pretend Play Assessment.

Results: Two of the three children scored below the range expected for children their age and one child scored above the range, indicating a wide range of pretend play ability for the children. None of the children could sustain their engagement in pretend play to complete the time of the assessment.

Conclusion: Complex pretend play ability is a functional assessment of cognitive ability involving sequential planning, problem-solving, language and social understanding. Cognitive fatigue is argued to explain the children's limited ability to engage in play for the time expected for their ages. More research is required.

Modelling skill acquisition in acquired brain injury

Acquired brain injury (ABI) is a debilitating condition often requiring extensive rehabilitation. Although cognitive rehabilitation is concerned with overcoming a skills deficit, the application of skill acquisition research in this context has been non-existent. Examining post-injury learning in terms of the qualitative variables associated with different phases of skill acquisition is likely to be beneficial in assessing patient status and monitoring progress, as well as identifying changing needs over the course of learning. However, current models of skill acquisition overlook the potential impact of variables such as emotion, implicit learning, metacognition, motivation, and strategies that can be leveraged to improve skill acquisition. The current paper attempts to lay the groundwork for modelling and improving skill acquisition in ABI.

Environmental contributions to social and mental health outcomes following pediatric stroke

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.