Evaluating reasons for nursing turnover: comparison of exit interview and panel data

Data from a study of nursing turnover are used to compare findings based on two techniques for evaluating the reasons for resignations within the same population of hospital nurses during one year. The techniques are: (1) exit interviews, in which resigning nurses were asked to report in an open-ended format their major reasons for leaving their jobs; and (2) a prospective panel study, in which nurses who resigned are compared with nurses who remained, and actual turnover is predicted. Results show that due to the absence of a comparison group of remaining nurses and of baseline data, causal inferences based on exit interview data alone are overly simplistic and misleading for management purposes. Results of the panel study are more informative, although implications for hospital management are more complex. Use of the prospective panel design is recommended for hospitals concerned with evaluating nursing job conditions during a period of high turnover and staff nurse shortages.

Saving face ? Survey respondents who claim their last week's drinking was atypical

Thirty-one per cent of survey respondents asked about their last week's drinking claimed it was atypical. They are shown, by examining their levels on two blood tests (mean cell volume and gamma-glutamyl transpeptidase) and by a comparison of their consumption on a recent social occasion with that of their companions, to be reporting a trivial difference between their last week and their typical week and appear to be attempting to deny heavy habitual consumption.

Evaluation and training of medication adherence counselors in a clinical trial: application of a skill inventory to video-recorded interviews

This report describes the procedures and feasibility of an integrated evaluation and training program developed at the Baylor-Methodist Lipid Research Clinic to examine the skills used by the clinic's professional staff in conducting medication adherence interviews with participants in the Coronary Primary Prevention Trial (CPPT). The specific aims of this project were to evaluate the staff's interviewing and counseling skills, identify strengths and deficits, provide needed training, and reexamine the staff's skills following this training. Each of five staff members conducted two 20-minute video-recorded interviews with two different simulated CPPT participants. A trained observer reviewed the video-recordings and evaluated, by an Inventory for Interviewing and Counseling Skills for Adherence to Medication (IICS-AM), each staff member's possession and frequency of use of 17 interviewing skills and 10 counseling skills. The 27 skills on the IICS-AM were selected from the literature as being most frequently recommended for effective interviewing and counseling for medication adherence. These rating data were used to design a 14-week training program to acquire and promote the use of these skills. Following training, the video-recorded interview procedure was repeated and the data analyzed to identify the effects of the training program. The integrated evaluation and training procedures used in this project offer a practical, objective method for examining, improving, and monitoring the skills of the adherence counseling staff in a clinic participating in a multicenter clinical trial.

A practical approach to assessing patient learning needs

A practical approach for assessing patient education needs in the ambulatory care setting was developed, tested, and administered to 100 individuals with four non-acute clinical problems. The approach allowed collection, with a single instrument, of a range of information pertinent to the management of a wide mix of disorders. Knowledge about diagnosis, medications, nonmedicinal procedures, emergency situations, and prognosis was collected as well as self-estimation of knowledge and personal information needs.While the assessment can be conducted by a physician, nurse, mid-level practitioner, or health educator in approximately five minutes, it can also be conducted in approximately ten minutes by other appropriately trained personnel. The information gained is useful to clinicians, health educators, and administrators. This practical approach to the assessment of patient learning needs is considered to have applicability for numerous conditions and a variety of clinical settings. The condensed patient learning needs assessment tool is provided (Table 1).

The attribution of personality traits: the stutterer and nonstutterer

Three videotaped recordings were made of an adult male speaking in an interview situation. Tapes differed as a function of the fluency exhibited by the interviewed speaker (i.e., fluent speech, primary stuttering, secondary stuttering). Three audiotapes were recorded from the videotapes yielding six stimulus tapes. Independent groups of college students saw and/or heard one of the stimulus tapes, each described as an interview with a "male who stutters." The fluent audio- and videotapes were replayed to two additional groups but were described only as an interview with a "male." Groups rated the personality of the speaker after tape presentation. Results revealed no difference in personality trait assignment as a function of experimental variables. However, in a second experiment two groups of college students rated a hypothetical normal speaker and hypothetical stutterer as significantly different in personality attributes. Results are discussed with reference to stereotyping behavior.

Consistency of data collected from inmates of a common lodging house

The quality of data obtainable by questionnaire from residents of a common lodging house was explored by comparing the answers received by questioning such men on two or three occasions six months apart. Consistency between the answers obtained on different occasions was good for men who already knew the interviewer well as their medical officer but poor otherwise.

Effect of telephone follow-up on medication compliance

This study compared the effectiveness, in improving patient compliance with a 10-14 day course of antibiotic therapy, of the following two strategies: (1) a follow-up telephone call and (2) written instructions and oral consultation by a pharmacist. The 82 study patients were randomly assigned to four groups: 1--control; 2--call-back; 3--written and oral consultation; and 4--written and oral consultation plus a call-back. The follow-up telephone call was made on the fourth or fifth day of the prescription course. The need to take the medication as directed and until completion was explained and reinforced. Any problems with the medication were determined. Compliance was assessed on the ninth or tenth day of therapy by a patient dosage unit count, and the patient's knowledge of the medication regimen was evaluated by a structured interview. The mean compliance was 76.6% for the control group, 86.6% for Group 2, 87.5% for Group 3, and 85.4% for Group 4. The compliance in the control group was significantly less than for each of the study groups (p = 0.0295), but the three study groups were not significantly different (p less than 0.05). Patients receiving written and oral consultation had significantly greater knowledge about side effects and what to do if they missed doses (p less than 0.002). After follow-up telephone call was equal to, but did not enhance, written and oral consultation in improving patient compliance.

New techniques in the construction of patient-management problems

A structured interview was tested as a means of constructing patient management problems (PMPs). Three paediatric cardiologists and three medical students were each interviewed separately to collect information to construct PMPs. Four PMPs--two devised by cardiologists and two by students--were constructed. The PMPs were administered to other doctors and medical students. No difference in performance or user reaction were found between the PMPs authored by doctors or those by students. We believe PMPs can be developed by a time-saving technique of a structured interview, and that senior medical students can provide a reservoir for realistic PMPs.

A randomized trial of librarian educational participation in clinical settings

In order to evaluate the librarian's educational role in patient care settings, an information service was provided for health professionals, patients, and families by two part-time clinical librarians. Eight clinical areas were randomly selected from a pool of settings which met predetermined entry criteria. Four of these settings were randomly allocated to the experimental maneuver (that is, the clinical librarian service), and four were control settings. Results showed that the clinical librarians were accepted by health professionals and that services to all groups were viewed as successful. Significant differences in information-seeking patterns were found between study and control groups of health professionals. In particular, the study group was more likely to use the library for direct patient care and rated the librarian and library resources more highly as sources of information. This time-limited and education-oriented model would be useful for settings in which a full-time librarian program is not feasible.

Teaching interview skills to mentally retarded persons

Five types of behavior found to be predictive of impressions made by mentally retarded persons in interviews were designated as targets of interview skills training: responsiveness to questions, speech intelligibility, eye contact, smiling, and attractiveness. Two training conditions, using an instruction-modeling-rehearsal-feedback format and differing only in type of feedback (video tape and verbal vs. verbal alone), were compared to a placebo condition. Although formal training proved to be little more effective than did the placebo experience, significant improvements in responsiveness and eye contact in the verbal-feedback condition and other trends pointed to the feasibility of improving interview skills with minimal intervention.

Factors associated with family planning acceptance in Bangkok metropolis health clinic areas (MHCs)

To study contraceptive use in Bangkok, 6,809 eligible women were interviewed in a community survey of 5 Metropolis areas. 34.7% were current users of interval contraception and the pill was the most common method. 29.9% were not currently in need of family planning. 18.3% of women were not using contraception, but only 6.2% were in need of family planning (FP) and not currently practising contraception. Non-acceptors who were in need of FP, had a lower educational level; 13.4% did not know about contraception but 52.4% previously used contraception. The most common reason for not currently practising FP was fears about contraceptive safety (37.5%). The prevalence of pregnancy in the community was 10.4%. The fact that only 6.2% of women were not practising FP and were in need of contraception suggests that the services in Bangkok are adequate to meet the needs of most women. However, the subgroup of non-acceptors in need of FP who were from a low socio-economic group require special motivation and services. 1,835 women attending Metropolis Health Centres in the same areas were interviewed to determine their choice of contraception; 57.4% chose the pill.

Maternal and abortion related deaths in Bangladesh, 1978-1979

The incidence and causes of pregnancy-related deaths are unknown for most of Asia; only local area studies have been done for Bangladesh. Between December 1978 and May 1979, we interviewed 118 health workers in 63 hospitals and 732 non-hospital facilities to identify case reports of maternal and abortion-related deaths in Bangladesh. Of 1933 pregnancy-related deaths identified, 498 (25.8%) were due to induced abortion. Abortion mortality rates varied significantly in the 18 administrative districts; the highest were in Dinajpur and Chittagong, the most northern and southern districts, and the lowest in Comilla and Noakhali. We used an earlier study of maternal mortality to estimate that about 21,600 pregnancy-related deaths occur each year in Bangladesh. We estimate that about 7.5% of all pregnancy-related deaths were identified in this survey. We infer from these data that safe and effective fertility control, including abortion performed by adequately trained health workers in both in- and out-patient facilities, might be the most appropriate first step in preventing pregnancy-related deaths in Bangladesh.

Interview or questionnaire? A comparison based on the relationship between caries and dietary habits in preschoolchildren

The aim was to select a method for gaining correct past history data about dietary habits by studying how caries varied in relation to dietary habits. Therefore, an interview was used in one group of preschoolchildren and a questionnaire in another group. Ninety-three 4-year-old children were included and divided by lot into two groups. The groups were comparable concerning dmfs, gingival status and oral hygiene. The parents were either interviewed or filled in a questionnaire about the children's dietary habits. The interview contained the same questions as the questionnaire and was standardized with the instructions for filling in the questionnaire, which concentrated on frequency of eating different foods. An average frequency of cariologically unsuitable eating of food per day was calculated for each child. Each group was distributed over frequency classes: less than 2, greater than or equal to 2 less than 5 and greater than or equal to 5 unsuitable food intakes per day, and the mean caries value was calculated for each class. The amount of caries increased in a logical way with increasing frequency of unsuitable eating in the interview group, but not in the questionnaire group. It might therefore be concluded, for groups of preschooldchildren, that the interview technique gives more relevant information than the questionnaire technique.

Assessment of nonverbal communication in the patient-physician interview

The interview portion of 34 patient-physician visits at a family medical center was videotaped. Videotapes were screened by two judges in two major nonverbal categories, immediacy and relaxation. Physician and patient were scored separately at 40-second intervals for 11 component parameters of the two major categories. These scores were correlated with patient satisfaction and understanding, ascertained by post-interview questionnaire. For analytical purposes, patients were assigned to low or high satisfaction groups and low or high understanding groups. Statistically significant (P less than or equal to 05) differences between low and high satisfaction groups were demonstrated with respect to overall physician immediacy; five individual physician nonverbal parameters; and two individual patient nonverbal parameters. Similar statistical results were obtained for understanding groups. This preliminary investigation suggests that nonverbal behavior of the physician in the patient-physician interview is important in determining patient satisfaction and understanding.

Climacteric symptoms in an African community

Climacteric symptoms were studied in a rural community in Zimbabwe. The incidence of symptoms was found to be similar to that described among westernized societies. A positive correlation was observed between various "metabolic" type symptoms and the number of years that had elapsed since the menopause.

Climacteric symptoms: a study in the Indian context

The climacteric is a universal phenomenon which has received relatively little attention from psychiatrists, psychologists, sociologists, anthropologists and social workers all over the world, but almost no research on this subject has been carried out in the Third-World countries. This study, carried out in India, has been conducted for the purpose of unravelling the difficulties that Indian women have to face during the climacteric. 405 married women between 40 and 55 yr of age from the general population were contacted and interviewed. The results, obtained with the menopausal symptom checklist prepared by the authors, indicate (as do other recent surveys) that hot flushes, night sweats and insomnia seem to be clearly associated with the menopause. Also the incidence of other symptoms is described. Despite embarrassment or discomfort experienced from these symptoms by a majority of women, only 10% had apparently sought medical treatment. This study underlines the necessity of a multidisciplinary approach to the problems of menopause and ageing.

A teachers' guide to teaching medical interviewing

Success in teaching a course in medical interviewing requires competence on the part of instructors, who also need training, and have to provide a structured approach. Problems encountered by course coordinators at the Department of Family Medicine, University of Miami School of Medicine, Miami, Florida have been: (1) a shortage of skilled teachers; (2) inadequate motivation of instructors for teaching the course; (3) differences in content, teacher's style, and outcomes from small groups; and (4) ambiguities in structure or guidelines provided for teachers. The development of a teacher's guide, giving specific objectives and step-by-step methods for teaching significantly improved teacher satisfaction and commitment to the course, as well as student learning.

A new approach to gonorrhea control. The asymptomatic man and incidence reduction

Reduction of gonorrhea incidence in the United States continues to resist public health intervention. Control strategies currently in use are associated with containment of the disease; about 1 million cases have been reported annually since 1975. Control efforts emphasize treatment of symptomatic men and the detection of asymptomatic women. Asymptomatic gonorrhea in men is well known clinically, but its epidemiologic significance has not been detailed. More than 60% of the infected partners of certain selected women are asymptomatic. By focusing control resources on these women and removing their asymptomatic partners from the disease reservoir, a substantial reduction in gonorrhea incidence can be expected.

Fictitious data in drug abuse research

The production of fictitious interviews in field studies of drug abuse has been suspected on any number of occasions, and many researchers in the drug field have caught their interviewers constructing such fraudulent data. In the current experiment, several sets of fictitious and real data were compared and statistical differences were observed. While the technique cannot detect individual fictitious interview schedules, it does have promise for detecting fraudulent data on a mass basis.

Factors influencing pediatric interns' relationships with dying children and their parents

Events and feelings immediately surrounding the deaths of children in the hospital were investigated in order to identify factors that might influence a house officer's ability to relate in a personally satisfying way to dying children and their parents. Open-ended interviews with the involved interns and their supervising residents were conducted within 36 hours of the deaths of 31 hospitalized children to gain insight into the reactions and responses of new physicians managing terminally ill patients. Interns' relationships with children who were fatally ill appeared to be influenced by two factors: the child's age and the child's neurologic status. The interns' relationships with parents reflected their attitudes toward the children but were also affected by the duration of the illness, especially in instances when the patients were comatose or severely impaired. Senior medical staff awareness of the age and responsiveness of dying patients and the duration of their illness can help to provide case-specific guidance and support to the interns. Such support may help prevent that excessive distancing or over involvement that can impair the interns' abilities to provide optimal emotional support to patients, the families, or themselves.