The importance of the relationship between Developmental disabilities and Direct-Care

The importance of the relationship between Developmental disabilities and Direct-Care

Introduction

In facilities for individuals with developmental disabilities, Direct-Care staff are a valuable resource. The standard of the service is a direct reflection of the quality of their work (Hatton, et al., 1999). Furthermore, care workers form the foundation for the social networks of the service users (Sharrard, 1992). The importance of this relationship is clearly demonstrated within the wealth of literature available in this area. A functional interpersonal relationship between Direct-Care staff and service users facilitates the on-going compilation and evaluation of care plans, thus allowing accurate and comprehensive information to be gathered, even from service users with restricted communication skills (Kagan, 1990). This relationship plays a key role in ensuring the smooth running of the operations within the service and sees that service users receive the upper-most level of care.

Community based services for individuals with developmental disabilities are constantly challenged to provide the highest quality service within the constraints of the funding they receive. This is a task which has been made even harder recently by further budget cuts. Individuals who are employed by these types of organisations have to cope on a daily basis with the mental, physical and emotional difficulties experienced and displayed by their service users. It is logical to assume that without sufficient support, individuals will experience significant psychological and emotional pressures and stresses. Job stress is defined as:

“The harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury”(NIOSH, 1999).

In some studies it has been reported that up to a third of Direct-Care staff were suffering stress levels symptomatic of that of a mental health disorder (Hatton et al, 1999; 2004).

The Job-Demand-Control model (JDC: Karasek, 1979) is a leading theoretical model utilised in studies considering occupational or work-related stress. Simplistically the JDC model suggests that the combined effect of high demands and low control within a job role equates to the highest risk of work-related stress, irrespective of individual differences in appraisal or coping. In terms of the JDC model job demands primarily refer to psychological demands such as mental workload, organizational constraints on task completion or conflicting demands (Pelfrene, 2001). The model was further extended in the 1980’s to include a third dimension, worksite social support, suggesting that the effects are exacerbated in situations of low support. Thus becoming the Job Demand-Control-Support model (JDCS: Karasek, 1985). The imbalance of these three variables is a prominent feature within job roles in the area of Direct-Care work. It is therefore unsurprising that, according to a recent government survey in the United Kingdom, “workers in personal service occupations have statistically significant higher rates of both injury and ill health compared to all occupations” (HSE, 2009-2010).

Staff morale has been extensively investigated over the past twenty years in the caring professions and includes aspects such as staff stress, burnout, job satisfaction, and staff withdrawal (absenteeism and turnover). A number of factors have been identified as having an impact upon staff morale. Empirical tests of the model (JDCS) reveal that stress more often results from operational and organizational aspects of the job, rather than from dealing with difficult clients. Organizational factors such as participation in decision-making (control), supervision and social support are key and dominate related theories and studies (Rose, 1993; Hatton et al., 1999; Innstrand et al., 2004).

In support of the JDCS model, Akerboom and Maes (2006) observed that job demands were positively associated with emotional exhaustion. Social support co-workers were positively associated with job satisfaction, and social support supervisors were negatively associated with psychological distress. Furthermore, the study found that job demands and decision authority were central to a career’s level of emotional exhaustion and job satisfaction.

The Work Stress theory postulates that job demands are associated with the development of stress and burnout of employees (Dermouti, Bakker, Nachreiner, & Schaufeli, 2001). In order to meet these demands staff draw on a number of resources, helping to increase functionality and reduce workload (Dermouti et al., 2001; Lazarus, 1999). The resources can be psychological, physical, social or organizational (perceived support for example is a social resource). Social support is of particular relevance to care workers supporting individuals with developmental disabilities, as they tend to work in small teams. Research suggests that in this instance, colleagues are crucial sources of support within the work place (Ford & Honnor, 2000). Support may also be sought from a superior. There is evidence to suggest that the ability to talk openly to a supervisor about both personal and work related issues reduces reported levels of burnout (Ito, et al., 1999). The complex interplay between these relationships however is yet to be explored in sufficient detail.

The majority of these studies have focused on individuals employed within residential and institutional facilities. Only four studies have been found that have collected data from Direct-Care staff working in respite services (Harris & Thomas, 1993; Gardner & Rose, 1994; Lawson & O’Brien, 1994; Mascha, 2006). In spite of this fact, published results suggest that, when compared with residential units, stress levels were higher and support levels lower in respite units (Harris & Thomas, 1993). Furthermore, research to date has largely over-looked the presence of part-time staff in this type of establishment and bank staff do not seem to be taken into account at all. This could be regarded as an oversight – this type of staff are particularly vulnerable due to the casual nature of their employment. They may not, for example, have easy or regular access to supervision or colleague support, despite the fact that they are being exposed to the same stressors as full time staff on a regular basis.

There is a very minimal amount of qualitative data available on this area of discussion with the majority of previous research being descriptive or correlational in nature. Although measures based on the theories outlined above may have good psychometric properties, they are limited in terms of capturing interpersonal support (Harris & Rose, 2002). Qualitative techniques of data analysis were applied to open-ended questions in a study looking at staff morale in day care centres for adults with intellectual disabilities. Analysis of this data revealed three main categories of stressors; working conditions for staff (excessive work-load, under staffing), issues relating to the nature of the job (challenging behaviour of service users, inability to make a difference) and lack of teamwork and communication between staff members (Mascha, 2006). The use of qualitative methods allows for the accurate value of practical and emotional support provided by colleagues and others to be captured. Lazarus (1999) advocated that quantitative studies should be supported by other in-depth research approaches to explore individual appraisal.

The present study aims to explore various factors affecting individuals currently employed in Direct-Care roles. In particular, the study aims to provide a more comprehensive understanding of the true nature of working in the field of Direct-Care and the obstacles facing managers and staff. Therefore, the research will draw from two studies, adopting a mixed-measures approach. The studies will consist of an Internet based survey and of a series of face-to-face interviews (to be completed by a sub-sample of participants). The current study will focus specifically on staff involved in Direct-Care of individuals with developmental disabilities in both residential and respite settings. Individuals employed on the bank team will be recruited as well as permanent full-time and part-time staff.

The aims of the present study therefore are:

To investigate working conditions and job demands of individuals currently employed in Direct-Care roles.
To investigate how physically demanding a Direct-Care role is and sources of stress for care workers.
To identify self-reported sources of support and coping strategies for Direct-Care staff.
To explore the levels of job satisfaction and motivation.

Method

A mixed method approach was employed in order to produce a more complete picture about the true nature of working in the Direct-Care industry. Neither quantitative nor qualitative methods of data collection and analysis are sufficient in isolation. Used independently, both approaches to psychological research are limited in their ability to capture trends and details in any given situation. The use of qualitative methods expands upon quantitative results, thereby enhancing the aims of the present study. In addition to this, the validity of the obtained interview data is improved by the complementation of other methods.

Due to the time limitations of this project, a concurrent triangulation design has been used. This offers the advantage that both forms of data can be collected at single period in time, therefore being more practical and efficient than a sequential approach. Despite the shared time frame, data for both studies has been collected and analysed separately, enabling the researcher to better understand the research problem.

This project received approval from Loughborough University’s ethics committee. The data collected by the present investigation will also be forming part of the ‘Working Late’ project, a new study being carried out at Loughborough University’s Work and Health Research Centre. The project aims to help ensure that all individuals are able to maintain their ability to work by facilitating healthier working lives.

Participant Organisations

In order to conduct both the structured survey questionnaires and semi-structured employee interviews, employees from four separate care homes were invited by the researcher to participate in the study. Participants were a convenience sample of staff working with intellectual disabilities within a local service in Hertfordshire. Recruitment techniques included telephone calls and emails to the homes, as well as directly contacting individual staff members. Participants in the current study were sourced from a public sector organisation, which provides all aspects of care to individuals with a range of developmental disabilities (in both residential and respite settings). The inclusion criterion was that staff had day-to-day contact when at work in supporting people with intellectual disabilities. Staff members with purely administrative duties did therefore not take part in this study. Participants were adequately informed of the purpose of the survey and assured anonymity of their responses. Participants were allowed to discontinue their participation in either study whenever and if they so desired.

Study 1: Employee survey

Research Participants

Direct-Care staff across four respite and residential Direct-Care homes were invited to volunteer for the study by completing the online survey questionnaire. A small number of paper-based questionnaires were also distributed to Direct-Care staff that were not computer literate or did not have easy access to the Internet. All completed questionnaires were returned directly and anonymously to researchers and stored in a secure location. All participants were asked questions on demographics (e.g. age and gender), their occupational health and well-being. A total of ninety-five questionnaires were distributed to Direct-Care staff of which a 38.9% response rate was achieved. Of the 37 participants who completed the survey, two were male, thirty-three were female and two did not specify a gender. Participant ages ranged from 20-67 years with a mean age of 36.12 years.

Measures

Participants were asked to complete a 25-minute online survey questionnaire. Loughborough University’s Work and Health Research Centre developed the survey that was utilised by this study for the Working Late Project (See Appendices 1 & 2). The questionnaire asks participants a series of questions about their current job role, well-being, and their feelings towards work. It also asks questions relating to occupational health services and current physical activity levels. These were all indicated by self-report measures. The data will be analysed using the statistical software package SPSS10 and descriptive statistics produced.

Study 2: Interviews with multi-level Direct-Care Staff

Research Participants

Due time and funding limitations only participants from one of the four homes that participated in Study 1 were invited to take part in semi-structured interviews. Staff were made aware of the research by senior management team and volunteered to participate in the study. Ten participants were recruited in total. Participants at that time were all employed by a respite facility that provided Direct-Care to children and young people with developmental disabilities. This facility was selected as it represents a Direct-Care setting largely ignored within the literature. All ten participants were female and ages ranged from 22-62 years. A sample of ten participants was deemed adequate to achieve variation. The small sample included management, senior staff, full-time staff and a bank worker.

Interview Schedule and Analysis

The interviews aimed at enhancing the understanding of the findings from the surveys. The interview schedule was developed based on findings from previous studies in the area of interest. The semi-structured interview schedule allowed participants to reveal as much information on the topics of interest as they each felt comfortable doing so. The questions aimed to elicit information regarding: working conditions and job demands (Can you please discuss a few factors, which you feel affect your ability to manage your work demands and perform all your work duties?), sources of support and coping (Do you have any coping strategies for work related stressorsPlease can you describe these?), as well as job satisfaction (On the whole are you currently satisfied with your job and why?). All participants received the same interview schedule with some questions re-phrased according to the participant’s job-role. The schedule was initially piloted and subsequently refined. In order to reduce interviewer bias, the interviews were all conducted by the same researcher and mechanically recorded to provide a permanent record, allowing them open for verification by other researchers. The method of audiotaping was selected due to its cost effective nature and ease of use. There is also no reliable evidence to suggest that audiotaping constrains what respondents are willing to say (Breakwell, p. 249, 2006).

The recorded interviews were transcribed verbatim and analysed using template analysis. The template approach to qualitative analysis involved the researcher developing a list of codes prior to conducting the interviews. These were based on themes identified in previous textual data, or in other words a ‘template’. Whilst codes are defined a priori, subsequent interpretation of the material allows for expansion of the original template.

In the first phase of analysis, the transcripts were repeatedly and carefully read. The initial codes were guided by both the interview schedule and the aims of the study. The data set was coded using a predetermined template and grouped into codes and themes. The initial codes were continuously refined and modified with emergent themes from the qualitative data. These codes included those for topics that arose spontaneously throughout the interviews. The data under each theme was summarized and verbatim quotations were used in support.

Results

Study 1: Employee Survey

A response rate of 38.9% was achieved by returned questionnaires (N=37), of which 32.4% (N=12) were completed questionnaires. Surveys were received from all four facilities to which they were distributed. Of the 37 participants 33 were Female, 2 were Male and 2 did not specify a gender. All surveys were completed between the 14th March and the 18th April 2011. On average participants employed on a Full-time basis worked 38 hours per week, whilst those employed on a part-time basis worked 16.77 hours per week. The majority (65.6%, N=13) of participants surveyed either did not have access to an occupational health service or were unaware of its existence (Aim 3).

In relation to Aim 4, the survey included measures of job satisfaction and job motivation. Job motivation was measured using a six-item scale developed by Warr, et al (1979). The measure consisted of a seven-point Likert scale. Participants were required to indicate to what degree they agreed with a series of statements from ‘strongly disagree-strongly agree’, including “My opinion of myself goes down when I do this job badly”. Responses of the individual participants were summed to produce a score for the measure, with a range of 6-42. High scores relate to high intrinsic job motivation. 6 participants were removed from the data set due to missing data. With regard to the scores, the overall Median was 36 with a range of 18. Descriptive statistics in relation to employment status were also investigated; a further two participants were removed as their status of employment was not specified (Table 1). With participants employed on a permanent full-time basis reporting the highest level of intrinsic job motivation.

Table 1 – Medians and Ranges for Job Motivation, with relation to employment status

Median± RangePermanent Full-time (N=19)Permanent Part-time(N=4)Fixed-term/Temporary Contract (N=6)Total(N=31)
JobMotivation36 ± 1539 ± 1035.5 ± 1636 ± 18

Job satisfactionrefers to one’s own feelings or state of mind in relation to the nature of their work. Job satisfaction can be influenced by variety of factors such as supervision, organization policies and administration, salary and work/life balance. Self-reported levels of job satisfaction were measured using a three-item scale taken from the Michigan Organisational Assessment Questionnaire. The seven-point Likert scale was scored by averaging the responses, with a possible score range of 1-7. High scores were indicative of high levels of job satisfaction. 5 participants were removed at this stage from the data set due to missing data. The overall Median score was 4.67, with a Range of 3.33. Descriptive statistics in relation to employment status were also investigated, a further two participants were removed as they did not specify their employment status (Table 2). Medians of all three statuses of employment were the same.

Table 2 – Medians and Ranges of Job Satisfaction, with relation to employment status

Median± RangePermanent Full-time (N=19)Permanent Part-time(N=5)Fixed-term/Temporary Contract (N=6)Total(N=32)
JobSatisfaction4.67 ± 2.334.67 ± 24.67 ± 1.674.67 ± 3.33

The General Health questionnaire 12 (GHQ 12) was utilised by the survey to assess participant’s general well-being. The GHQ 12 uses a four-point Likert scale. Participant’s individual responses were summed to give an overall score, with a maximum score of 36. Six participants were removed due to missing data. The higher the score the more severe the condition, the overall Median for participants who completed the measure in full was 12, with a Range of 17. Descriptive statistics in relation to employment status were also investigated; a further two participants were removed as their status of employment was not specified (Table 1). With participants employed on a permanent full-time basis reporting the highest levels of psychological distress.

Table 3 – Medians and Ranges of GSQ 12 scores, in relation to employment status

Median ± RangePermanent Full-time (N=18)Permanent Part-time(N=5)Fixed-term/Temporary Contract (N=6)Total(N=31)
GHQ 1213 ± 1613 ± 611 ± 712 ± 17

Study 2: Interviews

All participants who were interviewed were female and were employed by a respite facility for children and young people with developmental disabilities. All participants had completed the online survey (Study 1) prior to being interviewed. Five main themes were identified from the transcribed interviews; sources of stress, coping strategies, colleague support, job satisfaction and motivation, and impact of budget cuts. The themes are summarised below along with illustrative quotes and include both positive and negative aspects of Direct-Care Staff’s experiences.

Sources of Stress

With respect to questions concerning sources of stress, participants generally identified more than one stressor. Analysis of the text illuminated three key and recurring categories; working conditions, the nature of the job, and lack of teamwork and communication. Out of the three aforementioned categories, working conditions were the most consistently cited source of stress. There is reference in all ten transcripts to poor staffing levels. As illustrated by Participant Seven:

“I find trying to get the certain amount of staff and working slightly over children than there is staff…I think sometimes it can make the unit-unsafe by having that and you know not enough staff to support the children’s needs.”

The problem of understaffed shifts is linked in the transcripts to reports of excessive demands and a pressurised work environment, which is made worse by limited resources. Some participants reported feeling as though it was not possible to meet what was asked of them:

“It is high pressure, it is fast paced…I don’t feel that I do manage to complete the tasks and things that are required within my role (Assistant Manager) and I find that quite frustrating and unsatisfactory” (Participant Five).

Multiple interviewees highlighted issues relating to the nature of the job as significant sources of stress. Issues including challenging behaviour, long working hours and the inability to make a difference. Furthermore, staff are required to perform dual roles having to balance administrative duties with practical care. All junior full-time staff reported this as a source of pressure and tension. Finally, due to the inflexibility of the team, lack of teamwork emerged as a source of discontent. However, participants were sure to communicate that only a very small proportion of their colleagues displayed such a lack of team spirit:

“Not pulling their weight in that way not helping out when needed, going off shift doing stuff in the office when they should really be on shift” (Participant Seven).

Coping Strategies Employed by Direct-Care Staff

With regard to coping strategies, the majority of staff reported relying on emotion based coping rather than practical coping (Lazarus, 1999). Direct-Care staff focused on managing emotional distress or relieving tension built up over the course of a shift, rather than actively striving to change the situation. Emotion based coping strategies included healthy outlets with many interviewees naming some form of physical activity as well as unhealthy outlets (such as alcohol, cigarettes and nagging their partner). Furthermore, maintaining a positive approach and attitude in mentally and physically challenging situations is evident within the transcripts as an utilised coping strategy:

“More of a positive approach because you get so wound up and negative about everything and just need to step away and think right now I need to go back in and be a bit more positive about everything” (Participant Seven)

“If you do feel stressed you can just let it all out on the gym” (Participant Nine)

Two of the three participants who employed practical coping used organisational skills in order to better manage the demands placed upon them, for example creating lists to ensure no tasks went forgotten.

Colleague Support

With regard to questions concerning colleague support, analysis revealed three main levels: structured supervision, managerial support, and teamwork. All participants stated that they felt comfortable confiding in their colleagues, finding them helpful and understanding. Some participants saw the ability to converse openly with their colleagues with regard to work related issues as a duty of care, to both service users and other members of the team:

“I am supervising people I need to be able to express things and issues that have been brought up to me. I need to resolve it somehow so I need to be able to talk opening to the issues that are not always comfortable for anyone.” (Participant Eight)

It is clear from the transcripts that participants feel well supported by their on-shift colleagues, but participants are selective when choosing which person to confide in. Factors such as trust, mutual respect and proximity are key. Several interviewees stated they are more likely to confide in staff members with whom they are on shift with more frequently:

“I think because of shifts patterns I’ve built up more stronger relationship with people I work with more frequently” (Participant One)

Despite good working relationships the data suggests that work relationships rarely translate into friendship outside of the work environment. Reasons given for this include: conflicting work schedules, lack of common interests and participants choosing to keep their work and home lives distinct from one another:

“I’ve always been a believer that if something goes wrong in work and them I’m friends with that person outside of work obviously it is going to affect my friendships and I take friendships really really seriously.” (Participant Four)

With regard to managerial support opinion between participants was split. Some Direct-Care staff expressed that they were satisfied with the present level of support they received from their superiors, stating that they felt they could rely on them and ask for help without fear of being viewed as a burden. It was also reported that managerial support was available to resolve within team disputes. However, several interviewees were dissatisfied, feeling instead that there was a lack of pre-emptive support and viewing management as demanding rather than supportive:

“Sometimes upwards it’s more pressure than support because there is a demand to meet a deadline” (Participant Six)

Finally, the general consensus with regard to formal supervision was that it was of a good quality but too infrequent:

“I’m supposed to be supervised monthly but I think my last supervision was probably about December or January so you go figure. Not as often as it should be clearly.” (Participant Four)

Job Satisfaction and Motivation

All participants reported being satisfied with their job to some degree. The area of interaction with service users emerged form the transcripts as a key source of job satisfaction:

“Well young people who display the most difficult, complex behaviours and I feel quite proud of they way I’ve sort of managed to gain some sort of understanding and learned how to work with them in a positive way to aid their continued development and that’s given me enormous pleasure and pride.” (Participant Two)

Other sources of job satisfaction included positive colleague relations, variation of job role and advancement opportunities.

“It is a good team to work with and they are very friendly and you do have a laugh here its not so strict its very laid back and friendly its like a family atmosphere at the moment.” (Participant Ten)

Areas where Direct-Care staff experienced dissatisfaction included: anti-social hours, lack of advancement opportunities and inability to meet demands. By far, the largest source of dissatisfaction for participants was unsatisfactory pay, with all but one seeing it as playing a key role if they were to leave their current job:

“I think a factor would probably be money but also like to move on a bit more.” (Participant Six)

“If I was to leave or I found a job that I wanted to go to it would probably be for more money.” (Participant Four)

Impact of Budget Cuts

With regard to recent budget cuts, participants conversed at length about the impact the cuts had had on the quality and level of service they were able to provide service users. With the Registered Manager stating:

“It hasn’t affected the quality of care I don’t think, but it’s been what we can provide to families has been slightly lessoned but what I’ve had to do as manager is look at it more creatively in how we can provide services.” (Participant Six)

Discourse regarding budget cuts is divided in regards to the level of impact but can be divided into two categories: firstly, the negative impact that the cuts have had on service users and their families, due to increased closure days, cancellation of out-reach programmes and reduced staffing levels:

“The budget cuts have affected us a lot because we now having to close forty-three days a year, which is forty-three days we can no longer give care to the children, which has a knock-on effect with the families” (Participant Ten)

Secondly, the negative impact that the cuts have on staff, due to increased closure days, reduction in use of agency and bank staff, and loss of overtime. Participants report that such measures have led to job and financial insecurity, as well as increased pressure and demands placed onto remaining staff members:

“I’ve noticed bank workers aren’t being used as much and I think there is a slight knock-on effect that the core workers are sort of slightly working with more children than what we used to” (Participant Three)

Discussion

The present study aims to:

Investigate working conditions and job demands of individuals currently employed in Direct-Care roles.
Investigate how physically demanding a Direct-Care role is and sources of stress for care workers.
Identify self-reported sources of support and coping strategies for Direct-Care staff.
Explore the levels of job satisfaction and motivation.

The results presented here indicate that Direct-Care Staff experience pressurised working conditions and have excessive job demands placed upon them. Job demands predominantly refer to the psychological demands placed on staff working in Direct Care. These include mental workload, organizational constraints on task completion and conflicting demands (Pelfrenet, 2001). One issue that emerges from the transcripts is that participants have varied and conflicting responsibilities and duties (including the compilation of care plans, personal care tasks and administering medication). Furthermore, these duties and responsibilities are subject to change due to the reorganisation of service users care packages (Emerson & Hatton, 1994). Participants struggle to prioritise time for both direct and indirect-care duties, complaining that the daily routine is too intensive and fast-paced. The quantity of domestic chores and administrative duties decreases the time available for staff to positively interact with their service users.

It is clear from the present findings that recent budget cuts have served to further increase demands and pressure placed on Direct-Care staff. More specifically, staff reported a reduction of staff-client ratios as a major source of added strain. What is more, previous research suggests that low staff-client ratios are reliably associated with high staff turnover (Braddock & Mitchell, 1992; Larson & Lakin, 1992).

Results show that Direct-Care Staff experience a stressful work environment as a result of striving to meet all the physical and mental demands placed upon them by service users and management alike. Stress refers to the perception of an imbalance between the demands made of an individual and the resources available to that individual to meet them. If such an imbalance is persistent over time, it may result in the individual suffering psychological and/or physical ill health (Bonn, & Bonn, 2000). Scores obtained from the GHQ 12 revealed that in the present sample of Direct-Care Staff, working in respite centres for individuals with developmental disabilities, there is a great variability with regard to self-reported levels of psychological well being. The majority of staff did not produce scores of psychological distress that are indicative of mental health problems. These results somewhat jar with previous research that suggests up to a third of Direct-Care Staff experience stress levels indicative of mental health problems (Hatton el al, 1999; 2004). However, the GHQ 12 measure only assesses respondent’s current state of psychological well-being, asking if that differs from their usual state. It is therefore only sensitive to short-term psychiatric disorders, not long-standing attributes of the participant. It is however possible that participants may be suffering from persistent low levels of psychological well-being, but were not identified as such by the GHQ 12. Prolonged psychological distress is evident within the interview data, with one of the interviewees reporting that she has been diagnosed with depression as a result of work related stress, requiring her to take six months leave from work.

The sources of stress reported by participants in this study fall into three main categories: working conditions, the nature of the job, and lack of teamwork. These categories reflect those established in previous qualitative research, considering staff moral in day care centres for adults with intellectual disabilities (Mascha, 2006). More specifically, staff reported the long and anti-social working hours were a major source of stress in the job. Although, descriptive statistics produced from survey data demonstrated an average working week for permanent full-time staff of 37 hours, interview data suggests that a single working week experienced by Direct-Care Staff can be lengthy, with participants reporting working over and above 50-hour weeks. These findings are expected given that previous research has linked social hindrance with psychological distress, somatic complaints and emotional exhaustion (Akerboom & Maes, 2006). Challenging behaviour and inability to make a difference were also identified from the transcripts as important stressors, with participants reporting injuries sustained through work related violence and difficulty with moving and handling tasks. The experience of stress when faced with challenging behaviour and moving and handling of service users was linked to Direct-Care staff feeling they lacked sufficient knowledge and skill. This finding is supported by published research (Akerboom and Maes 2006).

The literature suggests that in order to meet demands, staff will employ a range of physical, psychological, social and organisational resources. Drawing on these resources enables workers to get the job done by reducing demands and stimulating development (Dermouti et al., 2001; Lazarus, 1999). In terms of organisational resources the majority of participants either did not have access to or were un-aware of the existence of an occupational health service. Coping has previously been defined as the: “cognitive and behavioural efforts a person makes to manage demands that tax or exceed his or her personal resources” (Lazarus, 1995, p.6). Participants generally relied on emotion-based coping, where efforts are made to manage the emotional distress, rather than attempting to change the situation (practical-based coping) (Lazarus, 1999).

One issue that emerges throughout the course of the interviews is the importance of colleagues as a source of support, with participants highlighting lack of teamwork as a source of stress. Participants reported feeling as though they could rely on and trust their colleagues to support them in challenging situations. The majority of participants were comfortable confiding in their team members with regard to work related issues, communication of issues was viewed as a duty of care to both other team members and to young people accessing the respite service by some participants. These findings contradict previous research conducted by Harris and Thomson (1993). In a study investigating issues of social support in both residential and respite settings, they found high levels of stress and low levels of staff support, particularly in respite settings. However, the data from the present study and previous research does serve to highlight the importance of communication and teamwork in care settings, where Direct-Care staff usually work in small teams. Studies have indicated this factor as being essential for the development of better quality of work within the services (Collins & Bruce, 1984; Rose, 1993; Schulz et al., 1995).

Support provided by management was related as an important source of support, enabling less senior staff members to develop their skills and grow in confidence. Formal supervision was also indicated as an important source of staff support, while problems with supervisors created discontent among several of the participants. The vast majority of participants were happy with the quality of supervision they received and felt confident that their concerns would be dealt with quickly and efficiently by their supervisors. Management was however also flagged as a source of pressure and participants complained about a lack of pre-emptive support.

Previous studies have identified formal supervision as a means to develop trust and competence through reflection on performance (Severinsson, 2001; Gustafsson, 2004). Although policies and procedures are in place enforcing mandatory monthly formal supervision, these are often not adhered to. The infrequency of supervision is a prominent source of discontent amongst the Direct-Care staff. Reasons given for the infrequent supervisions were conflicting shift patterns and excess demands. In spite of this, participants did divulge that they were able to access their supervisors for informal conversations as and when required, but did not feel this was substitute enough for structured supervision.

Finally, results revealed that the present sample experienced relatively high levels of job satisfaction and intrinsic job motivation. More specifically, contact with co-workers, variation of job role, career development opportunities and contact time with service users were four areas that produced the most satisfaction. Findings support previous quantitative research, which suggests communication as well as training opportunities show significant association with job satisfaction. Furthermore, salary, anti-social shift patterns, lack of development opportunities and inability to make a difference were the most frequently mentioned sources of dissatisfaction. The relatively stable workforce is most likely a reflection of the positive levels of job satisfaction and informal culture (Schien, 1990) reported by participants. Unlike multiple studies indicating that Direct-Care work is associated with high turnover rates (Hatton & Emerson, 1995), participants surveyed had remained in their current job role for over four years (Mean = 4.1).

Limitations

The studied relied on self-report data from four participating care homes recruited from a large range within the local area, facilities were selected based on proximity to the researcher. Participants that were interviewed were all sourced from one facility due to funding and time constraints. A respite care unit for children and young people employed all interviewees. This type of facility was selected as it has received the least amount of attention within the available literature. The participants interviewed were all volunteers who were perhaps more likely to converse at length than those who had a more positive view of their experiences working in Direct Care. Therefore, researchers make no claims that these findings can be generalised more widely. Further research requires a larger sample in order to establish cross-validation and allow the results to be generalizable to the care population as a whole.

Greater emphasis was placed on data collected from study 2 due a lack of qualitative data available in published literature as well as the labour intensive transcription and analysis involved. However, like any self-report method, the interview approach relies upon respondent’s retrospective abilities and willingness to provide accurate and complete answers to the questions posed. Steps were taken to reduce researcher effects; they can never be eliminated completely.

Furthermore, all interviewees were female. Two male staff were employed on the bank team of the respite facility at during the period of time in which the interviews took however. However due to the casual nature of their employment and the restrictive time frame for data collection neither were available to partake in Study 2 and therefore any gender differences cannot be accounted for. An all female sample may have obscured the findings, as according to Karasek et al. (1998, p. 346); the enduring gender differences evident in studies employing the JDCS model reflect ‘a deficit of good psychosocial conditions for women’. The high levels of worksite social support indicated in the transcripts of the current Direct-Care staff sample may not be enduring across genders.

Finally, although this study did take into consideration members of Direct-Care staff employed on a part-time or casual basis, a group overlooked by research, it did not recruit participants based on this attribute. Therefore true statistical comparison between employment statuses is limited, despite differences being observed. Future research should statistically consider the interaction between employment status and levels of psychological distress in Direct-Care staff, by recruiting participant based on this attribute.

Conclusion

The present study underscores the need for the further investigation of experiences of Direct-Care staff working in residential and respite facilities for individuals with intellectual disabilities. Direct-Care staff working within these services experience exposure to multiple stressors on a daily basis within the working environment, such as lack of teamwork, challenging behaviour, under-staffing, excessive workload and infrequent supervision. Although self-reported job satisfaction is relatively high, the vast majority of staff would consider leaving their position, highlighting the existence of work-related issues.

It is clear that Direct-Care Staff have a difficult task to meet all of the demands and expectations placed upon them. Direct-Care staff are constantly challenged to provide the highest quality service within the constraints of the funding they receive. A task made even harder by further recent budget cuts.

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