ABSTRACT
T h e exten sive literature on stress and caregiving in
d em en tia focu sed , until the m id -1 9 9 0 s , on the exp eri-
en ces o f fam ily carers. S in ce th en , stud ies in N o r th
A m er ic a h ave s u g g e s te d th a t th e fa c to rs th a t
con tribu te to stress and b u rn ou t in staff w orking in
residentia l and day care settin gs in clu d e the shift
(N o v a k & C h a p p e ll , 1 9 9 6 ) , w ork in g c o n d it io n s
(W ilber & S p ech t, 1 9 9 4 ) , socia l sup p ort (C hap p ell &
N ovak , 1 9 9 2 ) , staff appraisal (N ovak & C hap p ell,
1994 ) and uncooperative or d ifficult behaviour (C hap -
p ell & N ovak , 1 9 9 4 ). In the U K , staff stress and/or
b u rn ou t have b een linked w ith resident aggression
(M acP h erson et al., 1 9 9 4 ) , organisational aspects o f
the w ork settin g (B aillon et a l., 1 9 96 ) and the quality
o f staff in teraction s w ith the residents that th ey care
for (Jenkins & A llen , 1 9 9 8 ) . T h e con tr ib u tion o f
d iff ic u lt , u n c o o p e r a t iv e or a g g re ss iv e r e s id e n t
b e h a v io u r to sta ff d is tr e ss p a ra lle ls th e fa m ily
ca r eg iv in g litera tu re , w h ere so m e s tu d ie s argue
strongly that beh aviou r d isturban ce or ‘n o n -cogn itive
featu res’, w hich w e refer to as ‘ch allen gin g b eh aviou r,’
p red ict carer stress (see , for exam p le , D o n a ld so n et al., 1 9 9 8 ). H ow ever, the relationship b etw een resident
beh aviou r and staff d istress is com p lex , sin ce the
m ajority o f d ifficult and u ncooperative b eh aviou r is
p red ic tab le , n o t n ecessarily in trinsic to the resident,
appears to occur during a self-care activity such as
dressing or b athin g (B eck et al., 1990; B urgen er et al.,
1 9 92 ) and can be m in im ised if the caregiver rem ains
relaxed and sm iling (Burgener et al., 1 9 9 2 ). O f perhaps
m ore in terest is the ob servation that p rob lem atic
b ehaviour in a g iven resident is o ften perceived differ-
ently by d ifferent staff and its im p act on d ifferent
staff can also d iffer w idely (E veritt et al., 1 9 9 1 ). T h e
em ergin g o p in ion is that the training o f care staff is
im p ortan t (B a illon et al., 1996 ) and shou ld be aim ed at h elp in g th em work w ith residents (C h ap p ell &
N o v a k , 1 9 94 ) or at altering th eir appraisal o f the
r e s id e n ts ’ b eh av iou r (N o v a k & C h a p p e ll, 1 9 9 4 ) .
