A preliminary investigation into quality of life, psychological distress and social competence in children with cloacal exstrophy.

PURPOSE: Cloacal exstrophy is a complex multisystem anomaly. Due to ambiguous genitalia gender assignment or reassignment is common. The psychological, emotional and behavioral impact of this condition has rarely been investigated. MATERIALS AND METHODS: We recruited 8 children with cloacal exstrophy born with genital ambiguity and a control group of 12 with cloacal anomalies born without genital ambiguity were recruited via urology-endocrine clinics at Great Ormond Street Hospital for Children. Patient age was 5 to 18 years (average 11.3). The child behavior checklist, child health related quality of life and social cognition questionnaire were administered to assess perceived levels of social competence and adjustment, emotional and behavioral distress, and perceived quality of life. RESULTS: Social and behavioral competence as well as psychological problems were comparable with normative data for the 2 groups. There were no statistically significant differences in the 2 groups on any competence, problem or social adjustment scale. A quality of life measure again revealed no significant differences in the groups. The scores obtained were comparable with those reported for other chronic illnesses. CONCLUSIONS: Results suggest that being born with cloacal exstrophy or anomaly and gender assignment or reassignment does not necessarily result in childhood psychological, emotional or behavioral distress and/or problems, lower levels of social competence or subjective reports of poor quality of life. It is suggested that longitudinal and larger studies are required to assess the long-term implications of this condition.

Staff morale in the merger of mental health and social care organizations in England.

Following the closure of the last Victorian asylum in Somerset, the health authority and county council undertook a review of mental health services. A major outcome of this review was the creation of an integrated mental health and social care provider. The current paper explores the impact of this integration on the morale of staff members involved, using a conceptual model derived from the literature on organizational behaviour. During the year immediately following integration, the average ratings on all measures of role clarity and job satisfaction reduced. For staff members involved in the integration, by far the largest group of whom were mental health nurses, job satisfaction was related to team role clarity, team identification, emotional exhaustion and gender. These effects of the integration on staff morale are discussed in light of the wider research into the determinants of job satisfaction and the conditions for success in merging organizations. The study has significant implications for managerial and professional leadership during organizational change.

The meanings of 'culture' in health and social care: a case study of the combined Trust in Somerset.

On the 1st of April 1999 Somerset Health Authority and Somerset County Council established a Joint Commissioning Board (JCB) to commission mental health services. Simultaneously, the Somerset Partnerships Health and Social Care NHS Trust was set-up as a combined health and social care services provider; for the first time in England, the majority of social services mental health staff transferred their employment to this Trust. The JCB commissioned an evaluation of the impact of these innovations on users and carers, staff and senior officers and members in the organisations concerned. In the course of the research, one concept frequently recurred as a source of both optimism and concern: 'culture'. However, the meanings attributed to this term varied significantly between stakeholders. After summarising the methodology and the results to date of the evaluation, this paper briefly reviews the conceptions of culture in the literature on organisations, and introduces a taxonomy for discussing culture. That taxonomy is then deployed to explore the ways in which the notion of 'culture' is being applied to and within the combined Trust in Somerset, and the implications of those applications for local practice and national policy around partnership.

Compliance and outcome in treatment-resistant anorexia and bulimia: a retrospective study.

OBJECTIVES: To investigate the extent to which compliance with treatment is related to outcome, and factors associated with compliance in a group of treatment-resistant eating-disordered in-patients. DESIGN: A retrospective case study design was employed where clinic staff made expert ratings of eating behaviours, attitudes and outcome of former in-patients. METHOD: Ten health-care staff at a specialist eating disorders clinic rated overall success of treatment outcome at discharge, as well as compliance, severity of disordered eating behaviours and body-image disturbance at both admission and discharge for 46 anorexic and 14 bulimic patients. RESULTS: For all participants, high compliance at admission was associated with lower levels of body image disturbance, less disordered eating behaviours and higher ratings of overall treatment success at discharge. Compliance at admission predicted the body mass index (BMI) at discharge for anorexic participants and predicted higher ratings of overall treatment success at discharge for all participants. In all participants, compliance at admission was related to the extent of eating-disordered behaviours at admission. CONCLUSIONS: Results suggest the importance of compliance in facilitating recovery and treatment success among treatment-resistant eating-disordered in-patients. The promotion of strategies to improve compliance in this population should be considered. A role for motivational interviewing is discussed.

Over the rainbow.

What is required to renew purposeful and socially relevant leadership in Britain? In the fifth and final article of his 'Travelling Light' series, David Towell draws on the experience gained during his travels to consider how we can all contribute

Developing effective management for the general nursing service.

Directors of nursing services and their colleagues in the new units created by NHS restructuring face major challenges in developing effective management for the general nursing service. Emerging ideas within the profession on the organization of nursing work, severe pressures arising from financial constraints at a time of growing health care needs, and restructuring itself each demand a carefully planned response. Beginning from the basic management cycle involved in implementing the nursing process, this paper offers a redefinition of the main functions of nursing management as a whole in meeting these challenges and provides a check-list for reviewing existing management practice. The use of this check-list is then illustrated by a case study in one health district. In this example, managers sought external assistance in planning a programme of action to strengthen nursing leadership. Similar efforts elsewhere are likely to rely mainly on a range of self-help methods. This paper is intended to provide a tool for designing and implementing these local strategies of management development.

Towards professional autonomy: a commentary on "Expectations and disappointments' in development of the Royal College of Nursing.

The Royal College of Nursing of the United Kingdom has been engaged over recent years in a unique process of organizational change. Since 1973 sustained efforts have been made to mobilise widespread membership participation in shaping a new college structure which enables the Rcn to function effectively in representing the profession and in developing expertise on all aspects of nursing. A critical element has been creation of a network of "Rcn Centres' to provide a professional forum in each locality. A recent study by Bridget Ramsay has followed up this process. Its title, Expectations and Disappointments, reflects the mixed views of those involved on the progress which has been made. This article provides a commentary on Ramsay's analysis against the background of the complex situation of the Rcn in the early 1970s and the considerations which led the College to adopt an innovative approach to change. Particular attention is given to the influences which have made the growth of an active and integrated "Rcn at local level' quite problematic. It is suggested that the course Rcn development has taken in part reflects important elements in the nursing culture which members learn from their work in hospitals. Accordingly the Rcn experience has wider implications for the profession, not least for contemporary efforts, to achieve the greater professional autonomy necessary for nurses to implement more individualized patient care.