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PubMed2006

The effects of different types of goal pursuit on experience and performance during a stressful social task.

Researchers have recently suggested that anxiety research may benefit from the examination of motivational factors, such as the difference between approach and avoidance goals. This suggestion is consistent with the literature on self-regulation, which indicates that affect serves as feedback for goal pursuit, with anxiety primarily providing feedback regarding avoidance. However, no data are available on participant goals for a task that generates social anxiety. Data from 120 speech anxious participants who engaged in a public speaking task were used to test the following hypotheses: (1) avoidance goals would be more specific than approach goals; (2) goals regarding social anxiety would have a negative impact on public speaking experience and performance; and (3) participants would tend to organize approach and avoidance goals not as separate goals, but as opposite poles of the same overarching goal. Hypotheses (1) and (3) were fully supported and hypothesis (2) was partially supported. The results highlight the possibility that approach goals may be particularly important to anxiety reduction.

Adolescent↗

PubMed2001

Goals for the care of frail older adults: do caregivers and clinicians agree?

PURPOSE: Establishing shared treatment goals for patients may improve the quality of care by facilitating achievement of appropriate and desired outcomes. The purpose of this study was to describe types of family caregiver and physician treatment goals for frail elderly patients who had a high prevalence of cognitive impairment, and to ascertain the level of agreement between family caregivers and physicians on principal treatment goals. SUBJECTS AND METHODS: We surveyed family caregivers and physicians for 200 consecutive older adults who were initially evaluated at the outpatient geriatric assessment center of a major teaching hospital. Treatment goals for patients were measured after a comprehensive geriatric assessment. RESULTS: Goals commonly chosen as most important by family caregivers and physicians pertained to day-to-day functioning (61 [31%] family caregivers, 81 [41%] physicians), behavior and emotional health (56 [28%] family caregivers, 50 [25%] physicians), and safety (40 [20%] family caregivers, 29 [15%] physicians). Although a substantial proportion of family caregiver and physician pairs shared at least one goal (157 [79%] of 200), agreement on presence or absence of individual categories of goals was poor (kappas from -0.19 to 0.28), and agreement on the most important goal was also poor (kappa 0.20). CONCLUSIONS: Agreement on treatment goals between family caregivers and physicians for patients at the study site was low. These results suggest that encounters between family caregiver and physician may need improvement. Further research is needed to assess whether lack of agreement is found in other settings, persists over time, and affects achievement of goals and optimal health outcomes.

Activities of Daily Living↗

PubMed2000

Involvement of basal ganglia and orbitofrontal cortex in goal-directed behavior.

An impressive array of neural processing appears to be dedicated to the extraction of reward-related information from environmental stimuli and use of this information in the generation of goal-directed behaviors. While other structures are certainly involved in these processes, the characteristics of activations seen in mesencephalic dopamine neurons, striatal neurons and neurons of the orbitofrontal cortex provide distinct examples of the different ways in which reward-related information is processed. In addition, the differences in activations seen in these three regions demonstrate the different roles they may play in goal-directed behavior. A principal role played by dopamine neurons is that of a detector of an error in reward prediction. The homogeneity of responsiveness across the population of dopamine neurons indicates that this error signal is widely broadcast to dopamine terminal regions where it could provide a teaching signal for synaptic modifications underlying the learning of goal-directed appetitive behaviors. The responses of these same neurons to conditioned stimuli associated with reward could also serve as a signal of prediction error useful for the learning of sequences of environmental stimuli leading to reward. Dopamine neuron responses to both rewards and conditioned stimuli are not contingent on the behavior executed to obtain the reward and thus appear to reflect a relatively pure signal of a reward prediction error. It is not yet clear whether these activations, and responses to novel stimuli, have an additional function in engaging neural systems involved in the representation and execution of goal-directed behaviors. This representation of goal-directed behaviors may involve the striatal regions studied, where processing of reward-related information appears to be much more heterogeneous. Different subpopulations of striatal neurons are activated at different stages in the course of goal-directed behaviors, with largely separate populations activated following presentation of conditioned stimuli, preceding reinforcers, and following reinforcers. Neurons exhibiting each of these types of activation appear to differentiate between rewarding and non-rewarding outcomes of behavioral acts and, as a population, appear to be biased towards processing reward vs. non-reward. These activations observed in the striatum were often contingent on the behavioral act associated with obtaining reward, reflecting an integration of information not observed in dopamine neurons. Another difference between reward processing in striatal neurons and dopamine neurons is the influence of predictability on neuronal responsiveness. Unlike dopamine neurons, many striatal neurons respond to predicted rewards, although at least some may reflect the relative degree of predictability in the magnitude of the responses to reward. Thus, striatal processing of reward-related information is in some ways more complex than that observed in dopamine neurons, incorporating information on behavior and potentially providing more detailed information regarding predictability. These activations could serve as a component of the neural representation of the goal, and/or the behavioral aspects of goal-directed behaviors. As such they would be of use for the execution of appropriate goal-directed behaviors in response to known environmental stimuli, as well as for generating behaviors in response to novel stimuli that may be associated with desirable goals. Neuronal activations in the orbitofrontal cortex appear to involve less integration of behavioral and reward-related information, but rather incorporate another aspect of reward, the relative motivational significance of different rewards. These activations would serve a function similar to those striatal neurons that encode exclusively reward-related information in situations in which only a single outcome is obtainable. (ABSTRACT TRUNCATED)

Animals↗

PubMed2001

A 2 X 2 achievement goal framework.

A 2 x 2 achievement goal framework comprising mastery-approach, mastery-avoidance, performance-approach, and performance-avoidance goals was proposed and tested in 3 studies. Factor analytic results supported the independence of the 4 achievement goal constructs. The goals were examined with respect to several important antecedents (e.g., motive dispositions, implicit theories, socialization histories) and consequences (e.g., anticipatory test anxiety, exam performance, health center visits), with particular attention allocated to the new mastery-avoidance goal construct. The results revealed distinct empirical profiles for each of the achievement goals; the pattern for mastery-avoidance goals was, as anticipated, more negative than that for mastery-approach goals and more positive than that for performance-avoidance goals. Implications of the present work for future theoretical development in the achievement goal literature are discussed.

Achievement↗

PubMed2004

Images and goals.

We propose that mental images are derived from goals. Goals are represented in a complex hierarchy and form a major part of the "working self". Images reflect the existence of specific goals and also act to maintain goals by facilitating the derivation of beliefs from the content of an image. Images in psychopathology may reflect the operation of dysfunctional goals: goals that are unconstrained and which increase discrepancy (experienced as anxiety) within the goal system. Another feature of the goal system is that it is conservative and avoids change. By this view some aspects of distortions in intrusive images of traumatic experiences might be viewed as a defence against goal change. Conversely generating new images might lead to the formation of new goals. These ideas are applied to the findings of the papers in this special issue of Memory and to several new case studies.

Adaptation, Psychological↗

PubMedDate not supplied

How the gastroenterology nurse can establish and meet career goals.

A career goal promotes professional growth for the gastroenterology nurse. Short-term goals (achievable in less than one year) focus toward attaining a long-term goal (achievable in 5 to 10 years). The steps to achieving a career goal are self-assessment, career goal development, action plan development, implementation of the action plan, evaluation, and the establishment of a new goal. A career goal must be specific, measurable, achievable, realistic, and have a specified time frame. A tailor-made action plan is a list of interventions to promote goal achievement within the specified time frame. A goal posted in a prominent area is less likely to be forgotten and can guide day-to-day activities. A career goal should be reviewed and revised at least annually. A professional resume documents these career achievements.

Career Mobility↗

PubMed2002

Implementing goals for non-cognitive outcomes within a basic science course.

OBJECTIVE: An essential principle of competency-based education (CBE) is use of observable outcomes with assessments as judgments of competence based on defined criteria. Faculty are accustomed to using learning objectives as the defining criteria for knowledge, assessing students using written exams. Faculty are less familiar with how the principles of CBE are applied to other competencies. We recently adopted school-wide goals and objectives, modeled after the ACGME Outcomes Project. The present objective was to give faculty first-hand experience in CBE within a basic science course, including both cognitive and non-cognitive outcomes. DESCRIPTION: The format for the learner-centered, first-year Cell and Molecular Biology course was previously described.(1) Course goals were that students: (1) gain an understanding of the principles and concepts of cell and molecular biology, (2) develop an appreciation for how these principles and concepts are important to medicine, (3) demonstrate an ability to think critically using these principles and concepts. Goal 1 was measured by written exams. We assumed goals 2 and 3 were met through small-group problem-solving sessions, and outcomes were not assessed. The revised 2001 course goals were to prepare students for medical knowledge and lifelong learning and communication and professionalism. The goals for medical knowledge and lifelong learning were to: (1) demonstrate ability to use principles and concepts of cell biology, molecular biology, and genetics to analyze medically relevant data, solve problems, make predictions, and determine a course of action; (2) effectively use information technology to search, evaluate, and critically review scientific evidence related to principles and concepts covered in the course; (3) use appropriate techniques to teach peers in a conference setting. The goals for communication and professionalism were to: (1) use appropriate skills and attitudes to collaborate effectively with peers and faculty to accomplish learning goals; (2) maintain a personal learning portfolio to develop habits of reflective learning, broaden understanding of content beyond recall, and enhance communication with faculty; (3) demonstrate personal integrity in meeting course requirements and in interactions with peers and faculty throughout the course. Goals for medical knowledge and lifelong learning were assessed by written exams and by separate tools utilizing four-point Likert scales (novice, advanced beginner, proficient, distinguished) with specific observable criteria for a written research paper and a group PowerPoint presentation. Faculty and student assessments generated a number that was combined with exam grades for a lettered competency grade. A 19-item, five-point Likert scale was used by students to self- and peer-assess goals for communication and professionalism. Small-group faculty facilitators used the tool to give formative feedback midcourse, summative feedback at course conclusion, and competency grades. The tools may be viewed at: . DISCUSSION: Faculty achieved enhanced understanding of students, assisted by descriptive criteria, while suggesting improvements in forms. Better agreement on criteria definitions and consistency in form use is needed. Students developed understanding and improved communication/professionalism skills, based on repeated exposures to criteria and feedback. It remains to be seen whether the skills are used/developed in other courses. A majority of students did not use the learning portfolio as envisioned. Better design and implementation of school-wide rather than course-specific reflective portfolios may increase use and integrate learning in all courses with all six competencies.

Cognition↗

PubMed1992

The use of goal attainment scaling in a geriatric care setting.

OBJECTIVE: Goal attainment scaling (GAS) is a measurement approach used extensively in mental health. It accommodates multiple individual patient goals, yet retains mathematical properties allowing comparisons between patients. This study was carried out to investigate the feasibility and measurement properties of GAS in a geriatric care setting. DESIGN: Prospective descriptive study. SETTING: The geriatric restorative care service and geriatric assessment unit at Camp Hill Hospital, a 350-bed tertiary care facility in Halifax, Canada. PATIENTS: Fifteen patients aged 65 to 94 who were consecutively admitted to the two geriatric services (mean age 79 years, mean length of stay 37 days, 9 females). INTERVENTION: Goal Attainment follow-up guides were developed independently for each patient by two geriatricians after a comprehensive assessment of the patient. These guides were later compared to assess level of agreement in goal setting and scale development. A single goal attainment follow-up guide was then developed for each patient by consensus of the two geriatricians. At the end of the follow-up, the guides were scored independently for each patient by one of the geriatricians and by the patient's primary care nurse. MAIN OUTCOME MEASURES: GAS scores were determined on admission and discharge. Each patient also received admission and discharge ratings on the Barthel Index as well as a global rating of outcome (on a subjective 10-point scale) by a geriatrician who was blinded to the Goal Attainment follow-up score. RESULTS: GAS proved feasible, requiring 15-20 minutes to scale an average of six goals per patient. GAS also appears reliable. Of 87 goals, 71 (82%) were identified independently by two geriatricians, and the remainder were determined by consensus. This is also a measure of content validity. The physician-nurse inter-rater reliability was 0.87 (intraclass correlation). Concurrent validity was assessed by correlation with the Barthel Index (r = 0.86) and the global clinical outcome rating (r = 0.82). Content validity was also assessed by comparing our goal areas with those identified in recent consensus reports on geriatric assessment. Of these 13 assessment areas, 12 appeared to be reasonably well covered while one assessment area (sexual problems) was not identified for any of the 15 patients. CONCLUSIONS: GAS appears to be a feasible method of goal setting and outcome evaluation in geriatric care settings, with promising reliability and validity.

Activities of Daily Living↗

PubMed2002

Goal setting and attainment in Alzheimer's disease patients treated with donepezil.

OBJECTIVES: To understand the treatment goals of Alzheimer's disease (AD) patients, carers, and physicians; to estimate whether clinically important goals are met during treatment with donepezil; and to compare a measure of goal attainment with standard measures used to evaluate AD treatment. METHODS: In a 12 month phase IV trial, 108 patients with mild to moderate AD, their primary carers, and treating physicians set goals assigned to five domains, using Goal Attainment Scaling (GAS) as the primary outcome. Goal attainment was assessed quarterly. GAS scores were correlated with standard outcomes, including the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-cog), and the Clinician's Interview-Based Impression of Change-Plus (CIBIC-plus). RESULTS: Physicians set fewer goals (342, mean (SD) per patient=3 (1)) than patients/carers (855, mean=9 (3)), particularly in leisure (20% by physicians compared with 76% by patients/carers), and social interaction (24% versus 49%). Physicians observed statistically significant improvement in global goal attainment for six months, and patients/carers for nine months. Patients/carers described consistent goal attainment, whereas physicians observed variable effects, such as decline in cognition but improved social interaction and behaviour. Physician global GAS scores correlated highly with the CIBIC-plus at weeks 12 (r= -0.82) and 52 (r=-0.80), but not with the ADAS-cog (r=0.12 and r=-0.45, respectively). Patient/carer global GAS scores correlated moderately with the physician's CIBIC-plus (week 12 r=-0.51; week 52 r=-0.56), and nominally with the ADAS-cog. CONCLUSIONS: Patients/carers and physicians differ in their expectations and impressions of treatment effects. Clinically important changes correlated only modestly with psychometric tests. Attainment of treatment goals does not accord with a simplistic model in which successful AD treatment means that all declines uniformly improve.

Aged↗

PubMed2005

The interplay between goal intentions and implementation intentions.

Two studies tested whether action control by implementation intentions is sensitive to the activation and strength of participants' underlying goal intentions. In Study 1, participants formed implementation intentions (or did not) and their goal intentions were measured. Findings revealed a significant interaction between implementation intentions and the strength of respective goal intentions. Implementation intentions benefited the rate of goal attainment when participants had strong goal intentions but not when goal intentions were weak. Study 2 activated either a task-relevant or a neutral goal outside of participants' conscious awareness and found that implementation intentions affected performance only when the relevant goal had been activated. These findings indicate that the rate of goal attainment engendered by implementation intentions takes account of the state (strength, activation) of people's superordinate goal intentions.

Analysis of Variance↗

PubMed2006

Social achievement goals: the nature and consequences of different orientations toward social competence.

The proposition that achievement goals are applicable to the social domain was examined in four studies. Study 1 established that different orientations toward developing or demonstrating social competence can be seen in individuals' responses to open-ended questions about their social goals and social competence. Studies 2 through 4 evaluated a new survey measure of social achievement goals. Exploratory and confirmatory factor analyses confirmed the hypothesized model of social achievement goals. Convergent and discriminant validity for the new measure of social achievement goals was established. In line with hypotheses, a social development goal was associated with adjustment and a social demonstration-avoid goal was associated with maladjustment both concurrently and longitudinally. A social development goal also was positively related to instructor ratings of students' social adjustment in small classroom settings. A social demonstration-approach goal was most often unrelated to adjustment. The importance of social achievement goals for a comprehensive understanding of social motivation and adjustment is discussed.

Achievement↗

PubMed2004

A test for children's goal-directed behavior: a pilot study.

A test for children's goal-directed behavior was developed, based on neuropsychological executive function research of Vilkki and Holst and on the framework of Lewin's level-of-aspiration research. 46 12-yr.-old children were participants. Fluid Intelligence was expected to be linked to goal-directed behavior and a commonly used executive function task, the Wisconsin Card-sorting Test. A child was asked to set personal goals in a short-term memory task without prior knowledge about performance. Four different task versions were developed employing both verbal (memorizing series of words) and visuospatial (memorizing block sequences) material. The child set an individual goal for each memory trial. Goal-setting after successful and failed trials was investigated. Usually, the children lowered their goals after failures and set their goals higher or did not change them after successful trials. Compared to goal on a previous trial, Inadequate Responses included setting a goal higher after a failed trial and setting it lower after success. Fluid Intelligence was related to goal-directed behavior, viz., Inadequate Responses. It also correlated with scores on the Wisconsin Card-sorting Test. The results are in concordance with previous research. In addition to experimental executive function research, the novel test might be useful in research concerning children's motivation, self-efficacy, and self-regulated learning.

Child↗

PubMedDate not supplied

Goal-setting in physical therapy practice.

Goal-setting is traditionally used by physical therapists; however, factors identified in the literature as increasing goal achievement are often not considered. The purpose of this paper is to describe the potential use of goal-setting in improving and measuring effectiveness in physical therapy practice. Factors identified in the literature for effective goal-setting include setting specific and measurable goals, degree of goal difficulty, goal acceptance, and feedback. Active participation by the client in the goal-setting process is of primary importance. In order to maximize the use of goal-setting in physical therapy practice, reliable, valid, and sensitive clinical measures need to be identified and developed. There appears to be a potential for further use of goal-setting in physical therapy practice both as a means of improving treatment effectiveness and as a method for measuring effectiveness of treatment programs.

Canada↗

PubMedDate not supplied

Empirically identified goals for the management of unexplained symptoms.

BACKGROUND AND OBJECTIVES: Effective management of patients with medically unexplained symptoms may be influenced by physicians' goals. This study's objective was to identify physicians' goals for managing primary care patients with unexplained symptoms. METHODS: This was a qualitative study of patients and clinicians from primary care clinics in Iowa and Illinois. Interviews were conducted with 47 patients who had unexplained symptoms and the 36 primary care clinicians who managed them. The interviews were transcribed and coded independently by two investigators. Categories for coding responses were derived from the data and the literature. RESULTS: Eleven goals were identified and grouped into four classes based on whether they were disease centered, patient centered, society centered, or clinician centered. The three goals most commonly held by patients were patient centered: clinician support (62%), functional improvement (45%), and patient coping (43%). The most common clinician goals were symptom alleviation (38%), patient coping (32%), and functional improvement (30%). Only one clinician (2%) cited making the patient feel supported as a goal. CONCLUSIONS: The goals of clinician support and patient coping appear to have value to patients beyond being means for achieving symptom alleviation. Although receiving physician support is an important goal for patients, it was not a commonly recognized goal by physicians. Clearly identified management goals may improve the care of patients with medically unexplained symptoms and help clinicians achieve greater satisfaction with the management of these patients.

Adaptation, Psychological↗

PubMed1999

Social Predictors of Changes in Students' Achievement Goal Orientations.

Declines in students' achievement motivation across the transition to middle school may be explained by characteristics of both the academic and social environment of the new school. This study proposes that students' sense of belonging in middle school and their endorsement of social responsibility, relationship, and status goals in that setting should explain, in part, changes in their achievement goal orientations between 5th and 6th grades. Longitudinal survey data from 660 students indicated that, on average, endorsement of personal task goals declined, whereas endorsement of ability goals increased across the transition. Increases in task goal orientation were associated with perceiving both a task and an ability goal structure in 6th grade classes, along with sense of school belonging, and endorsing responsibility goals. Increases in ability goal orientation were associated positively with perceiving an ability goal structure in classes, with relationship and status goals, and negatively with school belonging. Copyright 1999 Academic Press.

Journal Article↗

PubMed2000

What Is It That I'm Trying to Achieve? Classroom Goals from a Content Perspective.

In this article, goals are discussed with respect to content, that is, as cognitive representations of what it is that an individual is trying to achieve in a given situation. In support of this perspective, I argue that a focus on the content of students' goals can provide unique and valuable insights into ways in which students' multiple social and academic goals might influence their academic accomplishments. Several models of relations between multiple goals are described. First, from a developmental perspective, relations among social and academic goals might be one-directional, with fundamental orientations toward the self and the social environment guiding efforts to be academically competent. Second, relations between goals also can be complementary, with social and task-related goal pursuit independently contributing to academic achievement. Finally, relations between social and academic goal pursuit can be reciprocal and hierarchical in nature, reflecting students' beliefs about how to achieve academic success. The significance of a goal content perspective in relation to other goal-related constructs also is discussed. Copyright 2000 Academic Press.

Journal Article↗

PubMed2003

Implementation of provincial/territorial health goals in Canada.

During the past two decades, policy makers in most of Canada's provinces and territories developed broad population-level goal statements about desired health or health and social outcomes. The health goals development process used in each province/territory has been described in government documents and studied by a small number of researchers. However, there is a lack of published research examining the implementation and use of the health goals since they were developed. To begin to fill this gap, we conducted a study between 1998 and 2000 that examined the implementation of provincial/territorial health goals in Canada. Our findings indicate that as the 1990s drew to a close, provincial/territorial health goals were not being used explicitly by policy makers at either provincial/territorial or regional levels in most provinces in Canada to guide health policy and program development, implementation, or evaluation. Instead, the majority of health ministry and regional policy makers were employing strategic/business plans that, at best, reflected or were similar to the original provincial/territorial health goals. Moreover, even though all provinces and the NWT/Nunavut had health goals associated with broad social, economic, and physical environment health determinants, regional-level policy makers were giving priority to health care system goals over all other types of goals. We discuss our findings in relation to studies about health goals in other countries, and we suggest implications that our findings have for both future research and health policy.

Canada↗

PubMed2003

Improving communication in the ICU using daily goals.

BACKGROUND: Clear communication is imperative if teams in any industry expect to make improvements. An estimated 85% of errors across industries result from communication failures. PURPOSE: The purpose of this study was to evaluate and improve the effectiveness of communication during patient care rounds in the intensive care unit (ICU) using a daily goals form. DESIGN: We conducted a prospective cohort study in collaboration with the Volunteer Hospital Association (VHA), Institute for Healthcare Improvement (IHI), and Johns Hopkins Hospital's (JHH) 16-bed surgical oncology ICU. All patients admitted to the ICU were eligible. Main outcome variables were ICU length of stay (LOS) and percent of ICU residents and nurses who understood the goals of care for patients in the ICU. Baseline measurements were compared with measurements of understanding after implementation of a daily goals form. RESULTS: At baseline, less than 10% of residents and nurses understood the goals of care for the day. After implementing the daily goals form, greater than 95% of nurses and residents understood the goals of care for the day. After implementation of the daily goals form, ICU LOS decreased from a mean of 2.2 days to 1.1 days. CONCLUSION: Implementing the daily goals form resulted in a significant improvement in the percent of residents and nurses who understood the goals of care for the day and a reduction in ICU LOS. The use of the daily goals form has broad applicability in acute care medicine.

Cohort Studies↗