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Methodological issues in developing a scale to measure social support.

In recent years there has been considerable research and clinical interest in developing instruments to assess social supports available to individuals. There is, however, a notable deficiency of attempts to evaluate the psychometric properties of these questionnaires. The present article describes efforts made to evaluate the properties of a Social Relationship Scale (SRS) that was developed as part of a prospective study of the psychosocial influences on the health status of a population. Some descriptive scale statistics are also presented.

Female↗

Beyond therapy: bringing social work back to human services reform.

Based on field interviews in a Chicago community development corporation and settlement houses in New York City and St. Louis, as well as interviews with leading social services innovators and social work educators, this article explores the intersection of current social work practice and human services innovation. The article offers a rationale and a blueprint for a reorientation of social work's "helping relationship," reviews a number of promising innovations and strategies that may help the profession make this reorientation operational, and explores forces restraining as well as driving such change.

Community-Institutional Relations↗

FAMILY CAREGIVERS: caring for older adults, working with their families.

As the U.S. population ages and health care costs soar, family and friends are called upon increasingly to provide care. While the typical caregiver is a 46-year-old woman with at least some college education, anyone in the infirm person's circle may be called upon to provide care. The kind of care provided varies greatly--from managing treatment and medication regimens to driving in from out of town to help with shopping--as does each caregiver's reaction to providing such care. While some find caregiving terribly stressful, others find it rewarding. Nurses need to know how to identify the primary caregiver, discern the level of strain caused by caregiving, and create a partnership with the caregiver to help ease the burden. Accompanying text explores one caregiver's experience.

Adaptation, Psychological↗

The customer is always right: patients' perceptions of psychiatric nursing actions.

In this age of consumerism, consideration should be given to patients' perceptions of interactions with the health care provider as a factor in assessing the quality of care provided. This article describes a study of 100 psychiatric inpatients in a large urban medical center who evaluated 50 commonly used psychiatric nursing actions. Significant differences were found between the general psychiatric patient population and the substance abuse population in perception of helpfulness and frequency of performance with 7 of the 50 nursing actions. As the consumer's perception of the effectiveness of nursing actions is determined, emphasis can be given to those interventions when planning patient care.

Adult↗

Determining intensity of need of high-risk maternal and infant clients.

Sound funding decisions by policymakers require data that relate health care services to both client need and client outcome. However, client need for care is not easy to express quantitatively, particularly in the realm of preventive and health promotion services. Application of the Community Health Intensity Rating Scale (CHIRS) with high-risk infants and prenatal clients revealed that differences in intensity of need, particularly in contextual and behavioral domains, helped to explain variation in amount of care received. The CHIRS holds promise of providing the language and measurement with which to articulate client need as the basis for cost-effective multidisciplinary care.

Child Health Services↗

Are patients in Western Turkey contented with healthcare services?: a quality assessment study.

The purpose of this study was to describe service quality as perceived by 1200 patients who had inpatient treatment at 3 hospitals in Istanbul: university, social security administration, and government. Patients were most satisfied with the helpful attitudes of personnel during check-in procedures, promptness and skill of nurses, overall service provided by physicians, speedy and skilled work of personnel in laboratories and X-ray rooms, and hospitals in general.

Attitude of Health Personnel↗

Application of the case study design: nursing interventions for discharge readiness.

A single case study design was used to explore the nursing process and intervention related to discharge preparation of one family with a child requiring complex care at home. Helping methods described by Orem were used to categorize identified nursing interventions. Discharge readiness was assessed to verify consideration of conditions for discharge. The major study question was "How is discharge preparation conducted?" Collected data provided evidence to support each of three case study propositions: (1) patients and their home caregivers are involved in discharge preparation as planners and as learners, (2) nursing interventions occur in five major helping areas as outlined by Orem, (3) discharge preparation addresses each component of discharge readiness. The case study design was effective as an approach to explore nursing interventions, verify considerations of discharge conditions, and refine the concept of discharge readiness. A decision trail is presented for nurses to replicate the process with questions related to their practice.

Helping Behavior↗

Risk taking by health care workers.

HEALTH CARE WORKERS (HCWs) are at risk for acquiring infections such as human immunodeficiency virus, hepatitis B virus, hepatitis C, and tuberculosis from blood and body fluids. The Centers for Disease Control established guidelines known as universal precautions (UPs) to prevent transmission of blood-borne pathogens in hospital settings, but UPs are not universally followed. CNSs are in a unique position to enhance the practice of UPs and decrease the HCW's risk-taking behavior. CNSs need to identify risk-taking behaviors and help HCWs make the right decision in risky situations. Reasons cited for noncompliance with UPs were habit, forgetfulness, influence of the nurse manager, and perceptions that barrier precautions hinder the ability to perform procedures successfully. Suggestions for improving compliance with UPs were better enforcement of guidelines, a policy mandating compliance, easy and available access to supplies, replacement of hazardous devices with safer ones, and discussion with HCWs on decision making in risky situations. CNSs possess the credibility in the clinical arena to effect change through clinical expertise, role modeling, and collaboration with HCWs.

Health Knowledge, Attitudes, Practice↗

Adolescents with cancer: experience of life and how it could be made easier.

This study is about what adolescents with cancer think about their life situation, the support they get, and the information they receive about their illness. The data for this qualitative and descriptive study were collected in 3 focus group interviews with 20 adolescents aged 13 to 18 years attending a cancer adjustment camp. Interpretation was based on the method of inductive content analysis. The adolescents' experiences of their current situation were analyzed into 5 categories: views on life here and now, negative experiences of self because of the illness, resources recognized in self, difficulties caused by the illness in relation to life around them, and resources identified in the world around. They made very little, if any, conscious effort to plan ahead for the future. The information received by the adolescents concerned their illness and its treatment here and now, various practical matters, as well as the future impacts of the illness and its treatments. Most of this information focused on the here and now, whereas the adolescents' information needs were mainly oriented to the future. As for the adolescents' chances to take part in making decisions about their care and life, the analysis yielded 6 categories: joint decision making, inadequate chances for decision making, independent decision making, illusion of decision making, reluctant to make decisions, and excluded from decision making. Finally, the adolescents' hopes for improvement were focused on staff activities, physical care facilities, chances to discuss and work through their experiences of the illness, and the support received from society.

Adaptation, Psychological↗

The intimacy of dying: a personal reflection.

Nurses are often involved in patient care at the patient's end of life. The author describes how a nurse's actions can make a positive difference in one person's life, and in one person's death. Using all of the skills and gifts that nurses have to preserve life is a privilege and a challenge; using all of the skills and gifts nurses have to provide a respectful, dignified, peaceful, and even intimate death, is an equal privilege and challenge.

Attitude of Health Personnel↗