The nature of interactions between nursing staff and profoundly multiply handicapped children

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Abstract
Summary The rate and content of naturally-occurring interaction patterns between nursing staff and profoundly multiply handicapped children were observed within a long-stay ward in a large mental handicap hospital. Child behaviours were recorded as appropriate, inappropriate or neutral and responses to the target child's behaviour were coded as positive attention, negative attention and no attention. It was found that for more than half of the time (54%) that the children were observed, they were doing nothing. Staff interacted with them for 16–2% of the total observation period. Most of the attention given by staff was positive, regardless of the appropriateness of the child's behaviour. A social learning framework suggests that given the low rate of interaction, potential therapeutic opportunities are being missed and the style of those interactions which occur may be anti-therapeutic. The implications of these findings for nurse training and hospital management are discussed.