The purpose of this study was to test research instruments to measure social and therapeutic rules, role incompetence and violence in hospitalized psychiatric patients. Instruments were tested to measure the specific concepts of: the Discrepant Interpretation of the Therapeutic Rules (GTRS and PTRSI), the Inconsistent Enforcement of the Social Rules (SRSI), the patients' Inability to Adhere to the Therapeutic Rules (PTRSII), the patients' Inability to Adhere to the Social Rules (SRSII) and Violence (VS). The study used a descriptive correlational design. The nursing staff sample consisted of 57 nursing staff working in nine clinical psychiatric units of four local hospitals. The nursing staff sample completed research ratings on 162 patient subjects hospitalized on the units. The data were analyzed for estimations of the psychometric properties of the research instruments. The theory was estimated using correlational and multiple regression techniques. The results indicated that with the exception of the General Therapeutic Rule Scale, the instruments had strong evidence of reliability and validity. The General Therapeutic Rule Scale had limited evidence of reliability and validity. The theoretical model testing indicated that three of the predicted theoretical relationships were supported. The expanded empirical model testing indicated three additional relationships. The amount of variance in violence explained by the expanded empirical model was R² = 18%. The major findings of this study were: (a) the social rules were more important than the therapeutic rules in predicting violence, (b) contrary to the literature, personal patient variables such as, age, sex, and diagnosis did not contribute to violence in the hospital setting, (c) a patient history of violence outside the hospital contributed to the patients' inability to adhere to the rules, (d) a direct relationship existed between the therapeutic and social rules, (e) the subdimensions of violence against self, others and property may be theoretically distinct dimensions of violence, and (f) the relationship of violence and other variables may be curvilinear.

The purpose of this research was the development of an instrument to measure the complexity of nursing care requirements in ambulatory care settings. Charles Perrow's sociological theory of organizations was adapted to nursng in order to define the complexity concept. Four research questions were investigated in this study. These questions related first, to the construct validity of the instrument's activity category system; second, to the criterion validity of the complexity weighting system; third, to the equivalent reliability to the instrument and fourth, to the instrument's clinical generalizability. Construct validity was evaluated through the regression of subjective estimations of complexity on the individual categories which make up the 154 ratings that contained measurement error, 641 independent client ratings remained for analysis. This data indicated that the classification instrument accounted for 52 percent of the total nursing care complexity in the ambulatory setting. An 18 variable equation was as statistically effective in explaining complexity as was the original 44 variable equation. Criterion validity was examined by comparing empirical complexity weights established through the regression of subjective complexity estimations on activity categories with theoretical weights determined by nurse experts in a Delphi exercise. Kendall's tau, a measure of rank association, was used for analysis. This examination revealed no statistically significant direct association between empirical and theoretical sets of complexity weights. Equivalent reliability was investigated by looking at the percent agreement among six trained raters using the classification instrument. The data indicated agreement on ratings was above 90 percent which met the criterion pre-established for interrater reliability. Finally, by a graphical analysis of residuals from regression equations, instrument generalizability across clinical services was examined. The Ambulatory Care Client Classification Instrument was not found to be generalizable in explaining the complexity of nursing care requirements across the clinical services used in this research.

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No description available.

The purpose of this study was two-fold. First, it was designed to determine what factors physicians consider most important when choosing a hospital to use for patient referrals. The second portion of the study sought to determine what means of communication were most effective in reaching physicians. A review of the available literature showed that some studies had been conducted on the physician-tophysician referral process. However, nothing had been done on the physician-to-hospital relationship. No communication studies were found regarding what form(s) of communication is/are the most effective in reaching the physicians.A survey was sent to all members of the medical communities in Madision County/Anderson, Indiana, and Allen County/Fort Wayne, Indiana. All results of the survey were tested by statistics with all results found to be non-significant. Only percentages were reported in the study.The study showed that physicians were mostly concerned with care-related factors when referring patients to a hospital. These factors include quality of patient management, patient results, availability of specialists and reputation of specialists. Of least importance to the physicians were patient-related factors such as cost, convenience, and preference of hospital.The survey also showed that the physicians' age and area of specialty made no difference in how receptive they were to communications. When asked about mass media, the physicians said they noticed newspapers the most, followed by television and radio. When asked how they preferred to receive information from or about a hospital, doctors listed, from most preferred to least preferred, direct mail, medical staff newsletters, medical society publications, hospital publications, and educational meetings.The researcher feels that an in-depth interview approach with the physicians would better determine the more complex reasons for referral decisions. A readability study would also determine to what extent the physicians read, heard, or saw the messages sent to them, and how design, layout and writing style would assist the hospitals and other health professions in reaching the physicians more effectively.

This thesis tests and explores the impact of increasing competition (marketisation) on the leaders of NHS hospitals in England. The research was prompted by the researcher’s observations in practice that language and behaviours were changing to reflect an increasing sense of competition between NHS hospitals. Whilst published opinions are not difficult to find in relation to changing NHS policy, this unique academic investigation provides a new contribution to knowledge through evidence generated from a mixed methodological research process. A qualitative case-study involving telephone interviews with leaders at a single hospital site were conducted in late 2009. The findings were tested for generalisability across 20 NHS hospital sites as a larger cohort of comparable NHS leaders were targeted using a multi-site, on-line questionnaire in 2010. This thesis concludes that hospital leaders believe that competition exists between NHS hospitals. A significant proportion also believes that the sense of competition is increasing. This is evidenced through culturally significant research findings related to changes in leadership behaviour, language and actions as a consequence of increasing marketisation. Furthermore, hospital leaders are divided and clearly unconvinced that increased competition would be a good thing for the NHS. This has numerous implications for policy, leadership in practice, leadership and market theory and specifically, the NHS leadership development model - the NHS ‘Leadership Qualities Framework’ (LQF).

The purposes of this study were (1) to explore the possibility that sociometry can be a valuable prognostic method in milieu therapy, and (2) to investigate the validity of the "Draw-a-Group" (DAG) projective technique for measuring interpersonal responsiveness.

The role of marketing and marketing communication in hospitals has grown in the last decade. The need for hospitals to make careful decisions about their marketing communication efforts is mandated, given the changes taking place in the hospital industry. The purpose of this dissertation was to conduct empirical research to determine whether for-profit and non-profit hospitals perceive and utilize promotion as a marketing strategy element. The two steps taken included: identifying important factors considered by hospital administrators and marketing staff in the development of communication messages designed for patients, hospital staff and medical staff; and testing the factors developed and studying the attitudes of hospital personnel toward promotion using a national sample of hospitals. In phase 1, focus group interviews were conducted in a surrogate for-profit hospital and a surrogate non-profit hospital. In phase 2, an original mail questionnaire was used to collect data from a sample of 80 hospitals. A total of 38 hospitals participated, providing 114 usable responses. Test statistics included content analysis, Chi-Square, Pearson correlation coefficient and Analysis of Variance. The results of the focus group study indicated the practice of marketing in hospitals is in its early growth stages and marketing is viewed as nothing more than advertising and public relations. The results of the mail survey indicated that respondents in small for-profit hospitals with 20 to 30 years of experience as professionals, with key decision making authority, are favorably disposed to marketing and marketing communication. It was also found that respondents in large non-profit hospitals are very positive towards marketing. In contrast, respondents in medium and large for-profit hospitals, who are not directly involved in decision making, tend to be less positive towards marketing. The study serves as a basis for future research which may involve, (1) a larger sample frame, (2) hospitals in inner-city and rural areas, (3) investigation of the association between hospital ownership and hospital efficiency, and (4) development of a profile of respondents by title held, in hospitals.

This study explores women's experiences of critical illness in Jordanian intensive care units. A narrative approach was employed to access Jordanian women's stories of their critical illness and to study how these accounts changed during the period following their discharge from intensive care. The study was conducted in two hospitals in a major Jordanian city. A purposive sample of 16 women who had spent at least 48 hours in intensive care was recruited over a period of six months, with each woman taking part in between one and three interviews during the six month period. Two focus group discussions were also conducted with 13 ICU nurses drawn from the hospitals in which the women had been patients. These had the aim of encouraging discussion about the development of new supportive care strategies for critically ill women in Jordanian intensive care units. The study findings revealed three main areas: the women's experiences of suffering and pain; their experience of body care; and the impact of the ICU experiences on their lives after discharge home. Experiences of suffering were pervaded with physical, emotional, social and temporal dimensions, interlinked with pain that was often severe, overwhelming, and disturbing to their sleep. The notion of 'nafsi' suffering was employed to describe emotional and social losses, such as loss of family support, which the women experienced. The notion of 'vicarious death' was used to explain the mortal fear women experienced in witnessing the death of others. Loss of body control, the unfamiliar ICU environment, and the sudden onset of illness made it difficult for the women to make sense of their experiences. This study shows that cultural norms and religious beliefs shape the ways in which these Muslim women made sense of their bodies. An analysis of the concept of 'bodywork' is presented: the 'dependent body' captures the women's experiences of changes of their physical status, which meant that from being care providers, they became those in need of care. This involved the experience of a sense of paralysis or disablement, and a complete dependence on their family or nurses. The 'social body' describes the women's feelings and emotions toward their family members. The latter assisted in the care of the women's bodies, but distress, frustration and a sense of loneliness were experienced by the women as a result of the loss of verbal communication with their relatives. The 'cultural body' describes the effect of cultural norms and Islamic religious beliefs on the women's interpretation of their experiences, and the interpretation of male nursing care in the ICU. The 'mechanical body' describes the women's experiences of the ICU machines as extensions of their bodies, and the senses of limbo and ambiguity they encountered during their ICU stay. The recovery period raised many physical, emotional, social, and spiritual issues, which in turn impacted on the women's experiences of their everyday lives. Weakness and tiredness accompanied with difficulties in eating and sleeping made some women feel frustrated and uncertain about their health. Some felt they were a burden upon their families. The meaning of the critical illness experiences were interpreted by some women as an opportunity to value family unity and neighbours' support. For other women, the illness experiences gave them lessons which strengthened their role as mothers and helped them to think positively about their future. This study highlights the importance of considering the cultural and religious preferences among Muslim women in critical care settings. The study recommendations focus on the need to base nursing care on an understanding of the physical, emotional, social, and religious elements of suffering, by exploring the potential of a palliative care approach for nursing critically ill people.

No description available.