The Impact of Crisis Alleviation Lessons and Methods Program on Injuries in Healthcare

152 Pages·2015·2.02 MB·English

Walden University
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Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
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2015
The Impact of Crisis Alleviation Lessons and
Methods Program on Injuries in Healthcare
Andra Lynn Ferguson
Walden University
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Walden University

College of Social and Behavioral Sciences

This is to certify that the doctoral dissertation by

Andra Ferguson

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Susan Randers, Committee Chairperson, Psychology Faculty
Dr. James Herndon, Committee Member, Psychology Faculty
Dr. Rachel Piferi, University Reviewer, Psychology Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2015
Abstract

The Impact of Crisis Alleviation Lessons and Methods Program on Injuries in Healthcare
by
Andra Lynn Ferguson

Dissertation Submitted in Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Health Psychology

Walden University
December 2015
Abstract
The purpose of this study was to examine whether Crisis Alleviation Lessons and
Methods © (CALM), as a behavioral crisis management program, was effective in
reducing patient and healthcare professional injuries in a long-term residential care
setting. This research was needed due to the lack of peer-reviewed scholarly literature on
the effectiveness of behavioral crisis management programs, especially on programs
using both nonphysical and physical de-escalation techniques, such as CALM. I
conducted an auto-regressive integrated moving average (ARIMA) time series analysis to
examine the effect the implementation of the CALM program (independent variable) had
on the rate of injuries to healthcare providers and patients (dependent variables) using
archival data from a long-term residential care facility. This time-series model was used
to evaluate the relationship between the CALM program and the incidence of injuries to
patients and healthcare providers over time. Collectively, the ARIMA model statistically
accounted for a total of 32% of the trend in reducing healthcare provider injuries. The
findings suggested that the CALM program might be effective in reducing the numbers
of injuries to healthcare providers. However, data on patient injuries were not available,
which was a major limitation of this study. Findings suggest that CALM may be an
effective behavioral crisis management option in other healthcare settings. This study
may lead to social change by contributing to the literature on behavioral crisis
management programs and the reduction of healthcare provider injuries from behavioral
crisis situations. Further research is recommended on the effectiveness of CALM in other
settings and on the effectiveness of CALM in reducing the rate of patient injuries.
The Impact of Crisis Alleviation Lessons and Methods Program on Injuries in Healthcare
by
Andra Lynn Ferguson

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Health Psychology

Walden University
December 2015
Acknowledgments
I would like to acknowledge and thank Dr. Susan Randers and Dr. James Herndon
for their expertise and support in guiding me throughout the dissertation process. I thank
my parents for providing a lifetime of inspiration and encouragement. Also, I thank my
family and friends for their ongoing support.
Table of Contents
List of Tables ..................................................................................................................... iv
List of Figures ......................................................................................................................v
Chapter 1: Introduction to the Study ....................................................................................1
Background ....................................................................................................................5
Problem Statement .........................................................................................................7
Purpose of the Study ......................................................................................................8
Research Questions and Hypotheses .............................................................................9
Theoretical Foundation ................................................................................................10
Nature of the Study ......................................................................................................13
Definitions....................................................................................................................13
Assumptions .................................................................................................................14
Scope and Delimitations ..............................................................................................15
Limitations ...................................................................................................................15
Significance..................................................................................................................16
Summary ......................................................................................................................16
Chapter 2: Literature Review .............................................................................................19
Literature Search Strategy............................................................................................21
Theoretical Foundations...............................................................................................22
Conceptual Framework ................................................................................................29
Literature Review Related to Key Variables and Concepts .........................................34
Behavioral Management Settings ......................................................................... 34
i
Existing Behavioral Crisis Management Programs with No Physical
Component. ............................................................................................... 37
Existing Physical Behavioral Management Programs. ......................................... 44
Existing Physical and Psychological Behavioral Management Programs. ........... 46
Summary ......................................................................................................................61
Chapter 3: Research Method ..............................................................................................63
Research Design and Rationale ...................................................................................63
Methodology ................................................................................................................67
Sampling and Sampling Procedures ............................................................................67
Instrumentation and Operationalization of Constructs ................................................69
Threats to Validity .......................................................................................................74
Ethical Procedures .......................................................................................................76
Summary ......................................................................................................................77
Chapter 4: Results ..............................................................................................................78
Introduction ..................................................................................................................78
Data Collection ............................................................................................................79
Results ………………………………………………………………………80
Moving Average ................................................................................................... 84
Differencing .......................................................................................................... 87
Autoregressive Components ................................................................................. 90
Moving Average Reassessment ............................................................................ 97
Final Model: ARIMA (4, 0, 0) .............................................................................. 98
ii
Summary ....................................................................................................................102
Chapter 5: Discussion, Conclusions, and Recommendations ..........................................104
Introduction ................................................................................................................104
Interpretation and Discussion of the Findings ...........................................................106
Limitations of the Study.............................................................................................110
Recommendations for Further Study .........................................................................112
Implications for Positive Social Change ....................................................................114
Conclusion .................................................................................................................116
References ........................................................................................................................118
Appendix A: CALM Description.....................................................................................132
Appendix B: Site Permission and Data Use Agreement ..................................................138
Appendix C: Copyright ....................................................................................................141

iii
List of Tables
Table 1. Model Fit Statistics for Baseline Model ARIMA (0, 0, 0) ................................. 91
Table 2.Model Fit Statistics for Differenced Model ARIMA (0, 1, 0) ............................. 93
Table 3. Model Details for ARIMA (2, 1, 0) .................................................................... 96
Table 4. Model Fit Statistics for ARIMA (2, 1, 0) ........................................................... 97
Table 5. Model Statistics for ARIMA (4, 1, 0) ................................................................. 97
Table 6. Model Fit Statistics for ARIMA (4, 1, ................................................................ 99
Table 7. Model Fit Statistics for ARIMA (4, 0, 0) ......................................................... 100
Table 8. Model Statistics for ARIMA (4, 0, 0) ............................................................... 101
Table 9. Model Fit Statistics for ARIMA (4, 0, 1) ......................................................... 102
Table 10. Model Statistics for ARIMA (4, 0, 1) ............................................................. 103
Table 11. ARIMA (4, 0, 0) Parameter Estimates for Final Model ................................. 104
Table 12. Model Fit Statistics for Final ARIMA (4, 0, 0) with Implementation of CALM
Included................................................................................................................... 105
Table 13. Model Statistics for ARIMA (4, 0, 0) with Implementation of CALM Included
................................................................................................................................. 105
Table 14. ARIMA (4, 0, 0) Parameter Estimates for Final Model with Implementation of
CALM Included ...................................................................................................... 107

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