Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker's stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem.

The purpose of this study was to identify patterns of resource allocation that related to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, casemix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of RN staffing and higher costs. However, comparison groups based on best/worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high and low cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes. Keywords Resident outcomes; Nursing homes; Staffing; Costs Resource Allocation and Resident Outcomes in Nursing Homes: Comparisons between the Best and WorstThere are 23,000 U.S. nursing homes with 1.5 million residents and estimates are that one-half of them provide substandard care (Maraldo, 1991). These conditions exist after more than a decade of efforts to change regulations and provide reimbursement incentives intended to improve quality of care (Cohen & Dubay, 1990). Financial incentives and regulation, however, have done little to improve quality of care. Weissert and Musliner (1992) show, in a review of research on case mix reimbursement systems in six states, that financial incentives have improved access for heavy-care residents, but costs increased with no measurable change in quality. Heavy care residents require more resources and, with reimbursement incentives, nursing homes are willing to care for them. Such increased access with no changes in quality could be interpreted as successful until evidence about the general quality of care in nursing homes is revealed.Regulations also have failed to make appreciable improvements in quality. Lieberman (1995) examined 4 years of Health Care Financing Administration (HCFA) reports finding that "about 40 percent of all facilities certified by the HCFA have repeatedly violated Federal 1 An earlier version of this paper was presented at the Sixth National Nursing Administration Research Conference, Minneapolis, MN, October 27, 1995. We thank the Texas Health Care Association and the Texas Department of Human Services for their assistance in obtaining the data for the study. We also thank Drs. Glenda Joiner-Rogers, Reuben McDaniel, Jr., and Shirin Catterson for their comments on drafts of this paper. Requests for reprints should be made to the first author at The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, Texas 78701. NIH Public Access Author ManuscriptRes Nurs Health. Author manuscript; available in PMC 2007 September 25. Published in final edited form as:Res Nurs Health. 1998 August ; 21(4): 297-313. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript standards over the last f...

The results suggest that acceptance of disability (i) is a useful construct to examine in future studies on psychosocial adaptation to cancer, and (ii) can be integrated into a clinical intervention programme of providing holistic care to patients with colorectal cancer.

Objectives. To (1) describe participation in decision-making as a systems-level property of complex adaptive systems and (2) present empirical evidence of reliability and validity of a corresponding measure. Method. Study 1 was a mail survey of a single respondent (administrators or directors of nursing) in each of 197 nursing homes. Study 2 was a field study using random, proportionally stratified sampling procedure that included 195 organizations with 3,968 respondents. Analysis. In Study 1, we analyzed the data to reduce the number of scale items and establish initial reliability and validity. In Study 2, we strengthened the psychometric test using a large sample. Results. Results demonstrated validity and reliability of the participation in decision-making instrument (PDMI) while measuring participation of workers in two distinct job categories (RNs and CNAs). We established reliability at the organizational level aggregated items scores. We established validity of the multidimensional properties using convergent and discriminant validity and confirmatory factor analysis. Conclusions. Participation in decision making, when modeled as a systems-level property of organization, has multiple dimensions and is more complex than is being traditionally measured. Managers can use this model to form decision teams that maximize the depth and breadth of expertise needed and to foster connection among them.