For several months, nurses completed ratings of the degree to which certain events relevant to absence were present during each of their scheduled workdays. The event ratings for days when the nurses decided to be absent were then compared with those for days when the nurses attended. As expected, certain events, such as ill health and tiredness, tended to covary and proved to be consistently related to absenteeism across nurses. Also as expected, some events that were not especially relevant for the nurses as a whole, like having a sick family member or friend and concerns about previous poor attendance, nonetheless emerged as being relevant to the absence behavior of certain individuals. Finally, some events were consistently related to the nurses' expressed desire to be absent but not to actual absences. We discuss these differences from two perspectives, one emphasizing the role of attribution bias and the other, a two-stage process in which such bias has no major role.
BACKGROUND: Stress, strain, and fatigue at the workplace have previously not been studied in relation to acoustic conditions. AIMS: To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU). METHOD: Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed. RESULTS: Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain. CONCLUSIONS: Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors.
Little is known about the conditions that must be in place to help adolescent patients and their families gain the confidence needed to continue recovery at home, following the adolescents' hospitalization for anorexia nervosa.
Beliefs about discharge readiness were obtained through an open-ended questionnaire following the patients' first weekend pass home from an in-patient unit. The perceptions of patients, parents, and registered nurses were obtained using parallel versions of a questionnaire.
An examination of the responses revealed four themes; medical stability, education, psychological changes, and community resource planning, that were common to all respondents, as well as themes specific to adolescents and to nurses.
The findings suggest that each group of respondents has unique discharge readiness needs and that registered nurses have an important role to play in helping patients and families make the transition home as successful as possible. Implications for nursing practice are highlighted.
The purpose of this field study was to measure the influence of three factors on the adoption of information technology in a health care setting--namely, attitudes toward using the technology, subjective norms or beliefs about others' expectations, and perceived voluntariness. Approximately 77 percent of the variance of intent to use the technology was explained by three attitude variables (beliefs related to perceived relative advantage and compatibility with previous work patterns as well as result demonstrability), and one variable associated with subjective norms (influence of a senior policymaker, the director of nursing). Use of this model may provide insights for administrators managing the process of information technology implementation in health care.
This study examined the views and experiences of 20 physicians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care.
The participants were purposively drawn from four clinical specialties: family and community medicine, oncology, intensive care and geriatrics. Detailed interviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitative techniques.
Thirty-nine of the 40 participants favoured the use of advance directives in clinical care; physicians had somewhat less positive attitudes than nurses toward such directives. Advance directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment options; in making patients more comfortable, both physically and psychologically, during the process of dying; and in opening up communication and trust among patients, their families and health care professionals. Concerns about the use of advance directives focused on the lack of clarity in some patients' instructions, the absence of legal status for directives, the possible interference with a practitioner's clinical judgement, the adequacy and appropriateness of patients' information about their circumstances, and the type of intervention (passive or active) requested by patients.
New regulations and legislation are making the use of advance directives more widespread. Health care professionals should participate in the development and implementation of these directives. Continuing professional education is essential in this regard.
BACKGROUND/LITERATURE REVIEW: The prevalence of agitated behaviors in different populations with dementia is between 24% and 98%. Although agitated behaviors are potentially disruptive, little research attention has been focused on the effects of these behaviors upon nursing staff. The objectives of this study of demented patients in long-term-care beds at an acute care community hospital were to determine the frequency and disruptiveness of agitated behaviors; to investigate the associations of patient characteristics and interventions with the level of agitation; and to explore the burden of these agitated behaviors on nursing staff.
The study sample comprised 56 demented patients in the long-term-care unit during the study period. Twenty-seven staff who cared for these patients during three shifts over a 2-week period were interviewed to rate the frequency and disruptiveness of agitated behaviors using the Cohen-Mansfield Agitation Inventory, and the burden of care using a modified version of the Zarit Burden Interview. Data on patient characteristics and interventions extracted from the hospital chart included scores on the Barthel Index and Mini-Mental State Examination, the use of psychotropic medication, and the use of physical restraints.
Ninety-five percent of the patients with dementia were reported to have at least one agitated behavior; 75% had at least one moderately disruptive behavior. A small group of six patients (11%) had 17 or more disruptive behaviors. The frequency of most behaviors did not vary significantly by shift. Length of stay on long-term care, Barthel Index score, and the use of psychotropic medications were significantly associated with the number of agitated behaviors. The number of behaviors, their mean frequency, and their mean disruptiveness were all significantly correlated with staff burden.
The prevalence of agitated behaviors in patients with dementia in long-term-care beds at an acute care hospital is similar to that reported in long-term-care facilities. These behaviors are associated with staff burden.