SUMMARYThe methodology and part of the results of an in-depth observational study of four psychogeriatric hospitals are described, focusing on the quality of care received by patients and how this was affected by the level of job satisfaction among nurses. In all four hospitals two wards were selected for intensive study over a period of 4 5 months each. Quality of care was studied through standardized recording of staff's feeding, toileting and bathing of a stratified sample of patients. The findings point to a very strong relationship between job satisfaction and quality of patient care. Staff and patients in high-satisfaction (HS\ wards proved more likely to initiate a conversation or other interaction. HS staff also offered patients more choice, independence, personal attention, supervision, information and privacy, and were more likely to converse with patients during feeding, toileting and bathing. Toileting and bathing appeared especially sensitive to these effects. Despite these differences, HS staff took no longer to feed, toilet or bathe their patients. These relationships are suggested to be mainly attributable to management practices, particularly at ward level, which influence both job satisfaction and quality of patient care.

This paper discusses the way in which quality of care has been measured and in particular draws attention to the vagueness of concepts such as autonomy, individuality and dignity. In our research we have put forward a number of indicators for the quality of care received by patients and, in addition, we have constructed a method by which they can be measured, through the use of standardized observation schedules. This paper therefore describes our indicators and the data collection process followed. This aspect of our work is part of a larger study into work satisfaction and quality of care in psychogeriatric wards in Scotland. Ultimately, the data will allow us to identify factors affecting high and low levels of job satisfaction as well as factors influencing good and bad quality of care. Further, we will be able to examine any association between work satisfaction and the quality of care delivered to patients. The results of this research are due to be published shortly.

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.

This paper begins by reviewing the small number of studies of staff nurses' work satisfaction. Subsequently, an examination is made of the differences in work satisfaction between staff nurses and other grades of nursing staff in psychogeriatric wards in National Health Service hospitals in Scotland. These data are part of a larger study into work satisfaction and the quality of care in these settings. Significant differences in satisfaction at work are identified between the staff nurse group and the other grades taken as a whole. Analysis of the components of job satisfaction suggests that these differences arise from: first, the experience of the work itself; second, the quality of the supervision which takes place; and third, the assessment of hospital policies, such as the transfer of staff to other wards.

In this paper the impact of gender differences within nursing is examined. Previous work has highlighted the disproportionate number of men in senior managerial positions in nursing and the perceived benefits which more males entering the profession may bring, for example increased status and higher pay. The present work addresses two domains where the impact of gender differences may importantly affect both policy and practice; first in the realm of care delivery and second in the area of supervisory relationships. The care received by male and female patients is studied, with particular attention being given to mixed wards. Differences between the care delivery of male and female ward staff are also discussed. Finally, differences in the supervisory roles of male and female charge nurses are examined. The research concludes that the inter-relationships between male and female ward staff and the way in which these impact upon the care received by patients is, as yet, little understood. However, as increasing numbers of males enter traditional female preserves within nursing, the need for a debate regarding the impact of gender differences is now essential.