No abstract

Life crises and transitions forge our identities by initiating changes that challenge our basic values, placing new demands on us, and disrupting significant relationships and established roles. Although much of the research on adaptation to life crises emphasizes the painful emotions and psychological symptoms they generate, these events often are an impetus for personal growth (Tedeschi & Calhoun, 1995;Tedeschi, Park, & Calhoun, 199813). A wide variety of crises-natural disasters, war and combat, physical illness, divorce, and bereavement-can be catalysts for personal transformation. It is quite common for people to emerge from these crises with enhanced social and personal resources and new coping skills (Schaefer & Moos, 1998).Of all life's crises, the death of someone we love is one of the most emotionally wrenching. For many individuals and their families, adjustment to bereavement is a lengthy process that is a result, in part, of the This work was supported by the Department of Veterans Affairs Office of Research and Development (Health Services Research and Development Service) and by NIAAA Grant AA06699. Shira Luft provided valuable assistance with the literature review for this chapter; she identified, retrieved, and organized a large number of articles.

Relationships between work stressors and work climate, and job morale and functioning were examined. Initial and 8-month follow-up data were obtained from 405 staff in 14 long-term care facilities. Relationship and workload stressors were related to less job satisfaction and intent to stay in the job, and more job-related distress, depression, and physical symptoms. Patient care task stressors were associated with better outcomes. More positive work climates were linked to higher job morale. Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up.

The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.

After offering a systems perspective that considers a diversity of job-related and personal factors, we discuss the determinants and impacts of health care work climates and how staff morale and performance can influence the treatment milieu and quality of patient care. We also describe the physical features, organizational structure and policies, and suprapersonal and task factors that help to shape health care work climates. We then review research on the connections between work climate and staff morale and performance, the interplay of work climate factors, and the role of personal factors in these relationships. Finally, we orovide some ideas about how to improve health care work settings and focus on some promising new research directions.