A study on the nature of interactions between direct-care staff and persons with developmental disabilities in institutional care

This study aimed to explore the nature of the interactions between health care assistants (HCAs) and long-stay residents with profound to severe developmental disabilities, in an institutional setting. The daily interaction between HCAs and residents under their care was observed by using the Interaction Recording System (IRS) developed by Veit (1973). Analysis of the observational data showed that the staff-resident interaction rate was relatively low. Staff-resident interactions were predominantly found in the context of 'nursing care' activities, which mainly comprised feeding, nappy changing, oral cleansing, toileting and recording of vital signs, e.g. taking resident's body temperature, pulse and bloof pressure and applying ointment when requested. Most staff-resident interaction was initiated by the HCAs and their affect expressed in the interactions was largely neutral. Factors affecting the frequency and content of interactions were identified to include residents' physical dependence, interaction barriers and hospital culture. It was proposed that to enhance staff-resident interaction, the non-resident care duties of the HCAs should be minimised during residents' waking time. A clear delineation of job assignments should be established and the therapeutic purposes of assigned task to the direct-care staff have to be explicitly explained.