Some characteristics of effective psychiatric treatment programs.

Describes a VA cooperative study seeking to identify the ward milieu characteristics of effective psychiatric programs. It is the largest study undertaken so far in terms of number of programs (79), patients (21,667), characteristics examined (191), and adequacy of outcome measures used to estimate program effectiveness. It was performed as a multivariable, correlational natural history study. Differences in characteristics of patients treated in each program were controlled statistically, and a cross-validation design and multiple outcome measures were used to make spurious findings less likely. Program variables were divided into treatment and setting characteristics, or those characteristics that the staff did and did not have control over. Since the most promising treatment characteristics are to be used in a blind follow-up to this study, this article deals mainly with the setting variables. The major finding reported here is that patients admitted to and treated on wards in which a mixture of acute and chronic patients were being treated had better outcomes than patients treated on wards with a more narrowly defined patient population. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early predictors of job burnout and engagement.

A longitudinal study predicted changes in burnout or engagement a year later by identifying 2 types of early indicators at the initial assessment. Organizational employees (N = 466) completed measures of burnout and 6 areas of worklife at 2 times with a 1-year interval. Those people who showed an inconsistent pattern at Time 1 were more likely to change over the year than were those who did not. Among this group, those who also displayed a workplace incongruity in the area of fairness moved to burnout at Time 2, while those without this incongruity moved toward engagement. The implications of these 2 predictive indicators are discussed in terms of the enhanced ability to customize interventions for targeted groups within the workplace. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptoms reported by older and middle-aged adults after coronary bypass surgery

Knowledge of the most prevalent symptoms after coronary artery bypass surgery (CABS) can be used to assist patients to anticipate recovery. The purposes of this study were to describe the prevalence of symptoms during the first 6 weeks after CABS, to assess changes in the number and types of symptoms, and to compare symptoms in older and middle-aged adults. The most prevalent symptoms during hospitalization (Time 1) were pain, edema, wound drainage, fever, and fatigue. In the third through fifth postoperative weeks (Time 2), the most prevalent symptoms were pain, edema, sleep problems, fatigue, and wound drainage. At 6 weeks (Time 3), sleep problems, edema, pain, fatigue, and shortness of breath were the most common. Number of symptoms decreased significantly between Times 1 and 3. All symptoms were more prevalent at Time 2 than at Time 1 and less prevalent at Time 3, with the exception of sleep problems, which were reported more frequently at Time 3 than at Time 1. The most persistent symptoms were edema, fatigue, sleep problems, pain, and shortness of breath. Significantly more middle-aged adults than older adults reported anxiety at Time 2. No other age-related differences were found. Implications for nursing practice and research are discussed.     

Geriatric patients who improve in token economy and general milieu treatment programs: A multivariate analysis.

Assigned 80 chronic geriatric mental hospital patients, mean age 68.8 yrs, to token economy and general milieu programs. In each program, staff received the same amount of training, and the physical environments were identical. All Ss were rated with the Psychotic Inpatient Profile and the Vigor Intactness Relationship Orientation. Results show significant decreases over 6 mo on both wards in frequency of bizarre and unusual behaviors. Incontinence decreased immediately after transfer to the treatment wards, and there were changes over 6 mo in the amount of staff care given to Ss. Multiple discriminant analyses indicated that in each ward different constellations of pretreatment characteristics discriminated between Ss who improved and those who did not improve in the frequency of bizarre and unusual behaviors. In the token economy, improved Ss were characterized as less "institutionalized," in better physical condition, and actively exhibiting their troubles. In the general milieu, improved Ss were discriminated by less responsiveness to an interviewer. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of an exercise program on musculoskeletal symptoms and physical capacity among nursing staff

Musculoskeletal disorders are a major health problem, and nursing staff are often seen as a risk group. The purpose of this study was to evaluate the effect of a weekly exercise program among nursing staff on musculoskeletal symptoms and to study the relation to changes in physical capacity. A total of 106 nurses and nursing aides from four geriatric wards were invited to participate; 86 accepted. A cross-over design was used. The staff from two wards were assigned to an exercise period and the staff from the other wards to a control period for the first intervention period. After a wash-out period, the intervention changed. For the exercise periods the staff were invited to participate in an exercise program twice a week for 8 weeks. In total 50 subjects participated more than 8 times regularly during the exercise periods (participants = > or = 8 times regular participation, nonparticipants = < 8). During the control periods 78 subjects attended without intervention. Assessments were made with a standardized questionnaire for analysis of musculoskeletal and psychosomatic symptoms, testing of muscle strength in m. quadriceps with a Cybex dynamometer, and testing of cardiovascular capacity with a Dynavite computerized exercise bicycle before and after the exercise periods. The muscle strength in m. quadriceps increased more during the exercise periods compared with the control periods, explained primarily by the subgroup of nonregular exercisers and those > or = 40 years of age. The number of musculoskeletal symptoms tended to decrease more in the subgroup of nonregular exercisers (those who exercised less than once a week in their spare time) during the exercise periods compared with the nonregular exercisers during the control periods. Comparisons within groups showed a decrease in the number of musculoskeletal symptoms within the exercise periods, explained primarily by a decrease among the participants rather than among the nonparticipants. The decrease within the participants was explained primarily by the subgroup of nonregular exercisers and those > or = 40 years of age. An increase in cardiovascular capacity and a tendency to increase in muscle strength in m. quadriceps were seen among the participants, explained primarily by the effect in the subgroup of nonregular exercisers. The study suggests that a moderate weekly exercise program, performed in a group, among nursing staff affects physical capacity and the number of musculoskeletal symptoms for subjects who are nonregular exercisers and probably subjects > or = 40 years of age.     

A prospective study of the association between obesity and burnout among apparently healthy men and women.

The authors prospectively tested the hypothesis that obesity predicts burnout and the reverse-causation hypothesis that burnout predicts obesity. Respondents were 724 men and 340 women, apparently healthy employees, who underwent routine periodic health examinations at 2 points of time about 18 months apart. Obesity was assessed by body mass index, waist-hip ratio, and waist circumference. In regression analyses, done separately for men and women, the authors controlled for depressive symptomatology, sport activity, and Time 1 levels of the criterion. The hypothesis that burnout predicts obesity was not supported. The authors found that Time 1 measures of obesity predicted reductions rather than the hypothesized elevations of Time 2 burnout levels. The authors also found that for male respondents with relatively higher levels of Time 1 burnout, the higher their level of Time 1 obesity measure, the lower their level of T2 burnout. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived ward climate and treatment outcome.

3 ward climate scales were derived from 2 independent studies linking treatment environments as perceived by patients and staff to treatment outcome as assessed by ward dropout, release, and community tenure rates. Patients and staff from 7 large and 8 small Veterans Administration hospital wards completed the Ward Atmosphere Scales. Patients and staff agreed in perceiving wards with high dropout rates as low in involvement, support, order and organization, and program clarity, whereas wards with high release rates were perceived as strongly emphasizing practical orientation, but as relatively "unexpressive." Wards that kept patients out of the hospital longest were seen as emphasizing autonomy and independence, practical orientation, order and organization, and the open expression of feelings, particularly angry feelings. It is concluded that some relatively consistent findings are emerging from studies in this area. (19 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of work overload and burnout on cholesterol and triglycerides levels: The moderating efffects of emotional reactivity among male and female employees.

The effects of objective and subjective overload, and of physical and emotional burnout, on cholesterol and triglycerides levels were studied in a quasiprospective design. The possible moderating effects of emotional reactivity on these relationships were also investigated. The study's hypotheses were tested separately for male and female employees. Time I (T1) data were collected from 665 healthy employees (30% women) while they were undergoing periodic health examinations in a health-screening center Time 2 (T2) measures of cholesterol and triglycerides were collected 2 to 3 years after T1. The hypotheses were tested by regressing each T2 criterion on its T1 level; the control variables of age, obesity, diet, alcohol consumption, and smoking; and the other predictors. For female employees, the T2-T1 changes in the serum lipids were positively predicted by emotional burnout, as expected, but negatively predicted by physical fatigue. For male employees, both types of T1 burnout were positive predictors of the T2-T1 change in total cholesterol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burnout Prevention Through Personal Growth.

This study evaluated the effects of a burnout prevention program based on insights from transpersonal psychology, notably psychosynthesis. It examined the effects of the program on burnout, happiness, spirituality, emotional intelligence, and relative deprivation with respect to one's career. Thirty-eight individuals, mostly with a background in engineering, participated in a 10-day program over 3 months. A comparison group of similar age and work experience was recruited of colleagues from the same firms and departments. Both groups filled out questionnaires at 3 time points: before the start of the program, immediately after the program (3 months later), and 9 months later. Results showed that a psychosynthesis-based prevention program might be an effective instrument in reducing burnout and enhancing happiness, emotional intelligence, and feelings of spirituality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work characteristics and sickness absence in burnout and nonburnout groups: A study of Swedish health care workers.

The aim of this study was to search for constellations of work characteristics that discriminate people who experience burnout from those who do not, and also from those who score high in exhaustion but not in disengagement, and vice versa. The study is based on data from 3,719 employees in a County Council in Sweden. Discriminant analysis revealed that four burnout categories (nonburnout, disengaged, exhausted, and burnout) related in different ways to self-reported work characteristics. The proportions of respondents with overtime, sickness absence, and sickness presence were higher in the burnout and the exhausted groups compared with the nonburnout group. The most common professions in the burnout group were, unexpectedly, dental nurses, secretaries, and service staff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bulimia and interpersonal relationships: A longitudinal study.

We assessed changes in bulimia in female college students and changes in the relation between bulimia and interpersonal relationships with women and men. A measure of bulimia (BULIT) of M. C. Smith and M. H. Thelen (see record 1985-02946-001) was taken at Time 1, after a 7-month interval (Time 2), and again after a 12-month interval (Time 3). Measures of interpersonal relationships with women and men were taken at Time 2 and Time 3. Three groups were constituted on the basis of BULIT scores at Time 1: bulimic, subclinical bulimic (Ss who tested just under the cutoff for bulimia), and normal. Ss who tested bulimic or normal at Time 1 tended to continue to do so. In contrast, the subclinical bulimic group endorsed less bulimic symptomatology over time. There were strong negative correlations between the BULIT and ratings of interpersonal relationships with men. The subclinical bulimics showed the greatest improvement over time in ratings of their relationships with men. Counselors may need to consider severity of bulimia and relationship issues during treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A measure of staff attitudes toward care of physically ill patients.

The development of an instrument for measuring staff attitudes toward patient care in general medical and surgical hospitals, called the Philosophy of Treatment Form (POT), is presented. In this development both a general medical and surgical sample and, for comparative purposes, a psychiatric sample were utilized. The POT measures 7 attitude areas for which reliabilities and intercorrelations are presented. Data from a 3rd sample of 350 general medical and surgical staff members indicate that 3 of these areas reliably differentiated among professional groups and 3 reliably differentiated among wards. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child custody mediation and litigation: Parents' satisfaction and functioning one year after settlement.

A 1-yr follow-up study was conducted on families randomly assigned to settle custody disputes either in mediation or through adversary procedures. Consistent with Time 1 reports, at Time 2 fathers who mediated were substantially more satisfied than were fathers who litigated. Fathers who mediated also complied more with child support orders. Contrary to prediction, the greater satisfaction and compliance of fathers did not lead to increased satisfaction among mothers who mediated. In contrast to Time 1, at follow-up mothers who mediated were significantly less satisfied than were mothers who litigated, but selective attrition may account for these differences. The psychological adjustment of mothers and fathers was not significantly different between settlement groups at Time 2, but mothers in both groups reported less satisfaction with dispute settlement and less dysphoria at Time 2 than they had reported at Time 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment State of Mind, Learning Dispositions, and Academic Performance During the College Transition.

The purpose of this study was to examine the relation among attachment state of mind, students' learning dispositions, and academic performance during the college transition. Sixty-two students were involved in a short-term longitudinal study and were interviewed with the Adult Attachment Interview. Students' learning dispositions were assessed at the end of high school (Time 1) and halfway through their 1st semester in college (Time 2). Academic records were collected at Time 1 as well as at the end of the 1st, 2nd, and 3rd college semesters. Autonomous students showed better learning dispositions throughout the transition and were less likely than dismissing and preoccupied students to experience a decrease in these dispositions between Time 1 and Time 2. In addition, dismissing students obtained the lowest average of grades in college, and this association was mediated by changes in quality of attention during the transition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-evaluative appraisals of coping capability and posttraumatic distress following motor vehicle accidents.

This study tested the importance of coping self-efficacy (CSE) perceptions and change in perceptions of CSE for recovery from motor vehicle accident (MVA) trauma. Data were collected 7 days following the accident (Time 1; n = 163), 1 month after the accident (Time 2; n = 91), and 3 months after the accident (Time 3; n = 70). Early changes in CSE (i.e., from Time 1 to Time 2) predicted posttraumatic distress at 3 months after MVA trauma, even after controlling for Time 1 or Time 2 posttraumatic distress and other trauma-related variables (i.e., accident responsibility, litigation involvement, and peritraumatic dissociation). Early changes in CSE perceptions, however, neither moderated nor mediated the effects of early posttraumatic distress (Time 1) on 3-month posttraumatic distress. Time 2 CSE levels, however, did mediate the relationship between acute posttraumatic distress (Time 1) and 3-month posttraumatic distress (Time 3). These findings highlight the importance of early interventions aimed at strengthening self-efficacy after MVA trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disqualifying family communication as a predictor of changes in offspring competence: A 3-year longitudinal study of sons of psychiatric patients.

Investigated the effects of family communication on changes in offspring competence. 46 families in which at least 1 of the parents had been diagnosed with a functional psychiatric disorder were studied. Male index offspring's (aged 7 or 10 yrs at initial testing) competence was assessed by peers, teachers, parents, and the Wechsler Intelligence Scale for Children (WISC) at the initial testing (Time 1) and at a 3-yr follow-up (Time 2). The family's communication was observed by means of the Consensus Family Rorschach procedure. During this testing, both parents and all of the children over the age of 4 yrs living at home were present. The results showed that the more disqualifying the communication the index offspring received from his family at Time 1, the less favorable was the development in social competence during the 3 yrs from Time 1 to Time 2. However, changes in cognitive competence from Time 1 to Time 2 were not associated with family communication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problem drinking and depression among DWI offenders: A three-wave longitudinal study.

Longitudinal data collected at 3 occasions of measurement from a convicted driving-while-intoxicated sample (n?=?302) were used to study the interrelations between problem drinking and depressive symptomatology. Time intervals between occasions of measurement were approximately 9 months. Cross-lagged latent variable models indicated that higher levels of depression at Time 1 were significantly associated with lower levels of problem drinking at Time 2. Similarly, higher levels of problem drinking at Time 1 were significantly associated with lower levels of depression at Time 2. However, the direction of effects for the cross-lagged coefficients was reversed for the Time-2–Time-3 relations. Higher levels of depression at Time 2 were significantly associated with higher levels of problem drinking at Time 3, and higher levels of problem drinking at Time 2 were associated with higher levels of depression at Time 3. The results are interpreted to reflect a biphasic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury.

Studied retrospectively changes in behavioral competency ratings of staff, patients, and relatives over the course of an intensive rehabilitation program for 3 groups of 28 seriously brain-damaged patients (aged 19–44 yrs). Group 1 included patients with perspectives similar to those of their social environment. They had more initial emotional distress and showed nonsignificantly less neuropsychological impairment than did Ss in Groups 2 and 3, who greatly underestimated their impairments compared to staff and relative ratings. Ratings of Group 2 Ss became better aligned with staff members and relatives' perspectives at discharge, while Group 3 showed increased divergence from staff and relative ratings. By discharge, Group 1 had reduced emotional distress, while distress increased for Groups 2 and 3. Alignment among perceived behavioral competency ratings was not related to vocational outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family partnership in care: integrating families into the coronary intensive care unit

Since the introduction of Family Partnership in Care in the CICU and other pilot units, many changes have been made. Education sessions are now unit specific rather than in groups with multiple units. This facilitates the discussion of unit-specific educational and implementation needs. In addition, unit-specific sessions allow for some case scenario/role playing activities to facilitate learning and application of the FPCP elements to the unique culture of the unit. Finally, less emphasis is placed on the documentation, while greater emphasis is placed on the philosophy behind the program and the nurses values and attitudes towards families. Overall, the implementation of the FPCP in CICU has had a positive impact on staff and patients. Staff awareness regarding the importance of involving family in the patient's care and the benefits of this has been heightened. Staff who were initially very skeptical have become strong advocates for the program. The successful shift with families in "doing for" to "working with" has enhanced the professional practice of many nursing staff and contributed to the overall unit functioning. Finally, the feedback from patients and their care partners and the independence and informed decision-making fostered by designing a plan of care with staff validates the importance of this program in a critical care area.     

The impact of civility interventions on employee social behavior, distress, and attitudes.

Although incivility has been identified as an important issue in workplaces, little research has focused on reducing incivility and improving employee outcomes. Health care workers (N = 1,173, Time 1; N = 907, Time 2) working in 41 units completed a survey of social relationships, burnout, turnover intention, attitudes, and management trust before and after a 6-month intervention, CREW (Civility, Respect, and Engagement at Work). Most measures significantly improved for the 8 intervention units, and these improvements were significantly greater than changes in the 33 contrast units. Specifically, significant interactions indicating greater improvements in the intervention groups than in the contrast groups were found for coworker civility, supervisor incivility, respect, cynicism, job satisfaction, management trust, and absences. Improvements in civility mediated improvements in attitudes. The results suggest that this employee-based civility intervention can improve collegiality and enhance health care provider outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)