Reproducibility and accuracy of pulmonary artery pressure measurement in supine and lateral positions.

The reproducibility and accuracy of pulmonary artery (PA) pressures in supine versus side-lying positions were compared in two groups of intensive care unit (ICU) patients. Side-lying measurements were reproducible, accurate, and clinically acceptable for surgical ICU patients, but not for medical ICU patients. The inconsistency was partly explained by the reference points used for transducer releveling in lateral positions. Surgical ICU used the fourth intercostal space and dependent midaxillary line; medical ICU used the fourth intercostal space and sternum. Reversing the leveling procedure in each ICU reduced surgical unit accuracy to an unacceptable level; medical unit accuracy was increased but was still too low for clinical acceptance. Further research is needed to identify appropriate anatomic reference points for transducer releveling in the side-lying position and to clarify which patient groups may be safely monitored by using this position.

A seminar on working with families.

Teaching family practice residents how to work with families is an important part of their training. An eight week seminar given to family practice residents during their rotation in a pediatric hospital is presented. The learning objectives and the teaching strategies are described. Informal assessment indicates the experience was a stimulus for attitudinal change and some degree of skill development among the residents despite its relatively short duration.

The head nurse: perceptions of stress and ways of coping.

Head nurses occupy an important position in hospitals, but there have been few studies of the stress experienced by these first line managers. The purpose of this research was to investigate patterns and sources of workplace stress and how head nurses coped with it. Twenty-one head nurses from four teaching hospitals were interviewed. Major sources of stress were lack of resources including nursing staff, work load and powerlessness. Events were seen as stressful because the head nurse lacked control or did not feel competent. Length of time in position affected perceptions of stress. Coping with stress was generally through problem-focused strategies. The findings may reflect the impact of role changes on head nurses.

Perceptions of care and services by the clients and families: a personal experience.

This study was initiated in response to a provincial mental health policy emphasizing the primacy of the person and the hospital's decision to adopt total quality management. The objective of the project was to learn more about how clients and families viewed the care and services received during a psychiatric admission. Their perceptions were elicited through seven focus groups including multiple admission (3) clients and families of single and multiple admission clients (2 each). Group sessions were tape-recorded, transcribed and analysed for themes. Three major themes were identified: quantity and quality of care, individuality and partnership. Both positive and negative comments were made within each of these themes, but two major areas for improvement were continuity of care and the environment. The findings are being used to change practices within the Department of Psychiatry.

Increasing the effectiveness of clinical supervision.

Effective use of preceptors in the clinical training and supervision of residents involves four essential steps: careful screening of the preceptor's practice to ensure it reflects the goals of the residency program and teaching the preceptor about the goals; setting a realistic contract for learning between resident and preceptor; teaching the preceptor to use constructive feedback techniques in the day-to-day supervision of residents; and developing the preceptor's skills in the reliable and valid evaluation of the resident's performance. Clinical preceptors must be trained to become effective teachers and evaluators in residency programs.