No description available.

Research and anecdote suggest that . the morale of doctors is low. Consequences of this in medicine include poor communication, faulty decision making, and poor interpersonal relationships. This works assesses the morale of pre-registration house officers (PRHOs), using the proxy measures of job satisfaction and mental and physical ill-health manifestations of stress, and follows one group over a period of eighteen months to determine whether morale improves over this time. Data collections was by modified postal questionnaire and consisted of self reported job satisfaction and mental and physical ill-health, life style data and career information. Data was obtained in three separate studies, comprising : 234 eligible PRHOs working within the West Midlands in 1993 (response rate of 83.6%) : A follow up study of the respondents to the original west Midlands survey (response rate 80.4%) : 828 eligible PRHOs working in the West Midlands, Bristol, Nottingham, Oxford and Sheffield (response rate of 58.9%) PRHOs and SHOs had significantly lower scores for job satisfaction and significantly higher scores for mental and physical ill-health than comparative groups. Female PRHOs and SHOs had significantly higher scores for ill-health than male PRHOs. Some improvement in job satisfaction was seen in the 18 month period from PRHO to SHO, but there was no significant change in well being during this time. As a result of this work, a stress counselling and management service has been made available in the West Midlands, an "Introduction to being a House Officer" course begun in the final year at Birmingham Medical School, and a "Stress Survival Guide" book published.

No description available.

No description available.

No description available.

No description available.

The increased emergence of bacterial resistance to antibiotics means that primary prevention of all hospital-acquired infections is essential, but ensuring that infection control practice is evidence-based requires reliable measurement of endemic hospital-acquired infections. The research sought to develop a comprehensive method for combining surveillance of infection with improved infection control by incorporating a problem solving approach within nursing process documentation. Prior to the research there was little evidence of nursing documentation of infection risk assessment, evaluation or outcomes monitoring. Development of the documentation matched the aspirations for a clear, objective complete system to support infection control care planning and audit. The documentation was designed to collect and collate only routine items of clinical information that the nurse at the bedside on an ICU would already know or be able to access in a very short time. The data items were successfully incorporated within the audit documentation for measuring incidence of each of the four site-specific infections. The system provided a framework for case-mix identification, case definitions, data collection and identification of indicators for measurement of ICU-acquired infection. It was shown to be feasible to incorporate the audit tool within routine documentation of clinical care. The method has potential application for surveillance of endemic hospital-acquired infections in a wide range of clinical specialities and could be adapted by others facing similar difficulties in determining priorities for monitoring and controlling endemic hospital-acquired infections within limited resources.

This thesis gives an account of research into management changes in the English NHS following the implementation of the Griffiths' Report (1983). The research had three aims: 1. To describe and consider the effects of new management philosophies plans and practices by conducting a case study of one particular unit of health care. 2. To study theories of nursing and health care organisation. 3. To assess the relationship, if any, between experience and theory, suggesting ways to bring theory and practice closer together. The academic perspective is multidisciplinary, drawing on literature from nursing, organisational 'theory and behaviour, health service management, social science, philosophy, history, economics and policy studies. The thesis commences with a discussion of research methodology, arguing the appropriateness of an interpretive stance. An account of the development of the NHS and nursing's place within it is followed by a detailed case study of one unit, which lasted nine months and involved more than a hundred interviews. Particular characteristics of the case study are:- Data analysis utilising grounded theory methodology Inclusion of members of the organisational context A system for participants to validate data pertaining to themselves. The style is naturalistic, qualitative and processual. Presentation of the results recognises the existence of multiple interpretations of organisational reality; a metaphor likens the development of the Unit to the weaving of a tapestry, where the backing is the structure of the unit, and the pattern the perceptions, values and aspirations of its staff, patients and context members. Emerging themes in the thesis are:- the complexity of the NHS professional philosophies and their relationship to management organising as a process growth of a distinctive unit culture. A deliberate choice is made to expose the conflicts and difficulties of naturalistic inquiry, by reflecting on research method throughout the thesis, which is written in the first person.

This thesis explores some theoretical, conceptual, empirical and methodological issues concerning psychological research into unemployment. A review of the literature revealed some important limitations in the approach which has hitherto been taken to examine this phenomenon. Specific weaknesses included an undervaluation of the role of theory, a dearth of empirical research on intervention programmes or other responses to unemployment, as well as oversimplification, overgeneralisation, imprecision and unfalsifiability in the theoretical contributions which have been offered. Moreover, it was noted that there had been a lack of attention to dispositional factors in empirical research or theory, and inadequate (particularly undifferentiated) conceptualisation and operationalisation of mental health variables. The empirical part of the study, therefore, was developed as an initial exploration of (a) Individual differences in the mental health of unemployed adults, and (b) the experience of participation on Community Programme (CP), a UK government intervention for long-term unemployed adults. A multi-method, multivariate design was used adopting a theoretically grounded, guiding conceptual framework. Qualitative in-depth interviews (N = 60) were conducted with CP participants from two CP managing agencies. In addition, a large scale cross-sectional quantitative survey (N=484) was undertaken incorporating individuals who were: (a) Participating on CP (b) Employed (c) Unemployed. The findings of the stud demonstrated a number of relationships between personal characteristics (i. e. demographic and personality related variables), intervening variables and dimensions of mental health. Some theoretical and empirical implications of these findings were discussed and directions for future empirical research and theoretical development were suggested. With respect to the experience of Community Programme, the findings suggested that within these two managing agencies, the content of the scheme (i. e. the nature of the work) was evaluated positively by the respondents, but that the context of the scheme and its temporary nature were perceived in a negative light. Some suggestions are made as to how these different aspects of the scheme impacted upon the mental health of the participants.

The main aim of the research was to develop a preference-based measure of health from the Short Form-36 (SF-36) Health Survey for valuing health-related quality of life on a 0 to 1 scale in order to calculate Quality adjusted life years (QALYs). Before undertaking the empirical work, reviews were undertaken of the justification for the QALY approach, existing preference-based measures for deriving QALYs and the rationale for looking at the SF-36. The methods of the research were as follows. The SF-36 was reduced and simplified to form a six dimensional health state classification (SF-6D) amenable to valuation. One hundred and sixty five patients, health professionals, managers, and students valued a sample of health states defined by the SF-6D using the visual analogue scale (VAS) and standard gamble (SG) techniques to elicit preferences. There were 1,357 VAS and 1,037 SG health state valuations after adjustment and exclusions for major inconsistencies. Models for predicting median and mean VAS and SG health state values from the SF-6D were estimated from these data by multivariate techniques. A set of additive models were selected on the basis of goodness of fit and parsimony. More complex specifications did not improve the models. Initial applications of algorithms based on these models to five data sets suggested this new preference-based measure retained much of sensitivity of the SF-36 at the milder end of the of the illness spectrum. The preference-based algorithms can be used to transform SF-36 data collected in a clinical trial (with costs) into information suitable for assessing the cost-effectiveness of health care interventions. The adoption of these algorithms has the potential to considerably extend the application of economic evaluation in health care.