This study focuses on the interpretations and experiences of change recipients, those who carry out organizational interventions initiated by others. Based on the ways nurses experienced a shared governance initiative implemented in their hospital, the authors investigated change recipients’ sensemaking about organizational change through their ascribed meanings, emotional responses, and perceptions of its impacts on them. Survey data demonstrated how nurses subjectively assessed their gains and losses from the change initiative. Participation in the initiative increased the experience of gains, as did membership in a unit where change was implemented more fully. Textual analysis of open-ended responses to the survey indicated that gains were linked with interpretations of the change initiative and pleasant feelings and that there was considerable emotional contagion within work units. Such effects are particularly likely in employee empowerment initiatives as experiences are linked to interpretation and mood among change recipients.
Advances in technology and the expansion of the emergency medical system have made emergency care available to large numbers of people experiencing trauma. Assessing the quality of life experienced by trauma survivors may assist in the development of interventions to optimize the outcomes in this patient population. The purpose of this study was to assess the quality of life experienced by severely injured trauma survivors, and to determine if a relation exists between the severity of the injury and the quality of life, the impact on the family of survivors, and the community resources needed by the survivors. Severely injured survivors of trauma in this study were defined as patients with a severity of injury severity score (ISS) of 25 or more and a trauma injury score (TRISS) of 0.90 or less. In this descriptive study, telephone interviews were conducted to administer the Sickness Impact Profile (SIP), an analog scale, and a demographic data form. All the survivors were interviewed at least 6 months after discharge from the hospital. The data collected on 64 survivors showed that they experienced a significantly poorer quality of life after the trauma incidents, as indicated by both the SIP scores and the analog scores. Although most of the SIP's 12 behavior categories indicated severe disruption, the behavior categories of work, recreation and pastimes, home management, and sleep and rest were the most negatively affected. Patients and families should be prepared for the physical, emotional, and financial disruptions that occur after severe traumatic injury. Support services, including community resources, are needed to optimize outcomes after discharge.
Quality of life (QOL) is recognized as an important indicator of health care and the patient's ability to cope with illness, treatment, and recuperation. Issues that need to be addressed in any proposed QOL research include a clear definition of QOL, a sound rationale for the choice of a measurement instrument, and the value of qualitative data. Measuring QOL in a patient population that has experienced traumatic brain injury (TBI) raises special concerns associated with the physical, behavioral, and cognitive limitations inherent with the specific TBI population. These pertinent issues are discussed with a focus that should be helpful for persons planning QOL projects and those reading and critiquing related literature. A study conducted by the author with patients with severe trauma injury will be used as an example of the impact of these issues on an actual project.
"Slow" codes are not conducted frequently, but even their limited use is controversial from an ethical point of view. Physicians and nurses may view the rationale for a "slow" code differently. A critical care nurse and a physician were interviewed regarding their experiences with and their views about "slow" codes.
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