Roadblocks encountered in recruiting patients for a study of sleep disruption in Alzheimer's disease.

Recruitment strategies and the roadblocks encountered in a clinical trial are described. A four-group, repeated measures design was used to test the effects of three sleep-related behavioral interventions on sleep disruption and related variables in Alzheimer's disease patients and their primary caregivers. Despite extensive recruitment efforts, enrollment did not meet expectations. Data analysis revealed three types of roadblocks to recruitment: caregiver resistance, provider resistance, and a mismatch of the disease characteristics with protocol requirements. Recommendations are made to help others solve recruitment problems.

Coping amid uncertainty: an illness trajectory perspective.

This paper offers an alternative to the conventional social/psychological definition of "coping." Using a theoretical framework of "illness trajectory," the authors examine the uncertainty of temporality, body, and identity inherent in coping with cancer. Analysis then turns to the interaction among these uncertain conditions and the complex work processes described by people with cancer, as they tolerate, i.e., "cope with," the disease. Although presented separately for purposes of clarity, these processes and their related activities are experienced in varying combinations and with varying and fluctuating importance by each individual. Viewed comprehensively, however, they constitute the larger process of coping with cancer, with implications for other diseases as well.

Factors contributing to the hospitalization of nursing home residents.

This anthropological study describes and analyzes the clinical and social-structural factors contributing to the hospitalization of nursing home residents. In 48.2% of the cases, hospitalization could have been avoided. Factors such as an insufficient number of adequately trained nursing staff, the inability of nursing staff to administer and monitor intravenous therapy, lack of diagnostic services, and pressure for transfer from the staff and family contributed to hospitalization. In the United States each year, an estimated 216,000 nursing home residents who are hospitalized might be treated in the nursing home, for a cost savings of $942,763,530.

Defensive work in nursing homes: accountability gone amok.

This paper contrasts conditions in intensive care nurseries and skilled nursing facilities in order to bring out certain features of organizational functioning in nursing homes. Data stem from a study of three American nursing homes which focused on the circumstances influencing decision-making in the evaluation and treatment of acute illness. DEFENSIVE WORK--work that is institution-protective and/or self-protective-emerged as a dominant process. It is demonstrated that the avoidance strategies which constitute defensive work lead to a progression of counterstrategies and foster skewed priorities. Consequences are: an acceptance of substandard care and a diversion of attention from therapeutic work. The relationship of defensive work to the larger question of how the nation handles its sick elderly is examined in the conclusion of the paper. Recommendations are offered for organizational steps that would re-channel the wasted energy that is spent on defensive work toward more productive therapeutic work.