No abstract

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.

Objective To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results. Design Randomised controlled trial. Setting A large teaching hospital. Subjects Two thousand two hundred and eighty‐nine pregnancies defined as being at risk by referral for Doppler or fetal monitoring. Interventions Continuous wave Doppler studies of umbilical artery. Results immediately available to clinicians. Main outcome measures Fetal outcome: perinatal mortality, Apgar score and admission to the neonatal unit. Obstetric intervention: admission to hospital, induction of labour and caesarean section. Use of tests of fetal well being: cardiotocography, biophysical profile and ultrasound biometry. Results The treatment and control groups were comparable in age, parity, gestation at point of entry and risk features. There were no overall differences in perinatal outcome, obstetric intervention or use of fetal monitoring. Examination of a subset recruited only because of hypertension or suspected intrauterine growth retardation (n = 754) similarly showed no difference attributable to group randomisation. Comparison of only those pregnancies retrospectively defined as low risk and high risk showed more use of cardiotocography in the high risk group with access to Doppler (P= 0.007) but no difference in the low risk group. Conclusion Doppler umbilical artery recording has been shown to perform well in prediction power of antenatal fetal compromise. What has been examined in this study is the response of clinicians to the test. The results suggest that obstetricians do not use the test to modify their risk assessment, and, therefore, the need for fetal monitoring in particular pregnancies. There is a real need for accumulation of information from very large data sets, particularly in the prediction power of Doppler for antenatal fetal compromise from apparently chronic utero‐placental cause to guide use of monitoring resources. If simply added to existing fetal monitoring techniques in a hospital where these are widely used, then umbilical artery Doppler recordings may at present simply involve extra resources of staff and expenses, without benefit.

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.

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.