Page 93 - Reduction of coercive measures

other cognitions such as caregivers’ self-efficacy play in determining responses to challenging behavior.
Limitations and implications
All data reflected, in one way or another, the perspective of care staff, including decisions to record coercive measures. Schippers et al. (2018; Chapter 2 this dissertation) found reasonable reliability for some but not all coercive measures and also reported that implementation of the registration system did not result in complete recording of coercive measures. For the purpose of the current study, registration of support staff and professionals was checked and updated. This led to the inclusion of an additional 22 coercive measures to the study. However, because reliability of reports was not tested, results of present study must be interpreted with caution. Furthermore, the subsets of coercive measures are yet to be validated, and different subdivisions may be considered (Dörenberg et al., 2018; Matson & Boisjoli, 2009; Williams, 2010). Another limitation is that some of the factors at the level of residents and staff reflect these factors at one point in time whereas coercive measures were counted over a one year period, attenuating predictive associations. Although overall sample size was adequate, missing values on several factors studied limited statistical power in the multivariate analyses, preventing the detection of possibly weak effects. Furthermore, staff factors were studied at the team level rather than at the level of individual caregivers. While this was done because coercive measures are decided upon at team level, group dynamics may play a role that are not captured by averaging individual caregiver cognitions. Finally, the cross-sectional design of the study limits any causal conclusions to be drawn.
Implications
The association between challenging behavior and coercive measures against direct risk of harm underlines the importance of ongoing efforts to test and implement alternative interventions to prevent and control challenging behavior. The association between social adaptive functioning and coercive measures irrespective of type underlines the important role of communication. Learning how best
Associate factors of coercive measures
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