Police officers' knowledge of, and attitudes towards, mental illness in southwest Scotland.

Questionnaires were sent to all operational officers in a regional police service regarding their level of knowledge about and attitudes towards, mental illness. It was widely accepted by police officers that mental illness occurred commonly, can be effectively treated in the community and that the main risk of harm is to patients themselves. There was a good knowledge of relevant legislation, but most officers felt they did not have sufficient training in mental illness, and were keen for more. Improved liaison between sector psychiatrists and local police may be of value in the earlier identification and treatment of the mentally ill.

Immediate psychiatric discharge letters by fax.

Much psychiatric care is provided outside the hospital setting. It is important for general practitioners (GPs) to have available information of good quality, provided promptly, after patients' discharges from in-patient psychiatric care to enable them to provide a high standard of follow-up care. In order to assess the value of hand-written Immediate Discharge Letters sent by fax we undertook a postal questionnaire survey of GPs, and examined a proportion of the clinical notes relating to 160 patients who between January and March 1998 had been discharged from in-patient care in the psychiatry admission wards at Crichton Royal Hospital, Dumfries. We found that structured letters, hand-written on a patient's discharge from in-patient status were generally valued by GPs as was their transmission by fax. Though certain deficiencies were confirmed in their completion, they are of value pending the arrival of a more definitive final discharge summary. We conclude that the continued use of such immediate discharge letters in psychiatry and their continued transmission by fax is justified.

Improving pain management in an acute care setting. The Crawford Long Hospital of Emory University experience.

PURPOSE: To identify which of three pain intensity measurement scales is most appropriate for use with patients admitted to the inpatient units of the study hospital. The following questions were addressed: Is one of the scales easier for most patients? Is the choice of scales influenced by nursing unit, age, education, race, SES, diagnosis, or type of pain experienced? Do patients perceive that a rating scale helps them describe their pain more effectively? SAMPLE: 267 patients admitted over a 3-week period completed a four-page questionnaire and demographic form distributed on admission. The primary admitting diagnosis for 39.5% of the sample reflected acute pain, 40.3% chronic pain, and 20.2 no pain. METHODS: Three pain rating scales were presented: two visual analogues (one contained a 100 mm line; the other contained six faces depicting graduated levels of distress); and a cognitive number rating scale. Each scale used a 0 (no pain) to 10 (worst pain possible) rating format. Patients completed the questionnaire by rating the intensity of pain experienced using each of the three scales once over the next 24 hours. The last page contained questions related to which of the scales was easiest to use, whether the scale was helpful or needed further explanation, and work and education information. The demographic form was completed from information contained in the patient record. FINDINGS: The scale selected most frequently was the visual analogue containing faces (48.6%), followed by the number (35.3%) and line scales (16.1%). None of the demographic information was found to significantly influence choice of preferred scale. A majority (85.8%) indicated a rating scale as helpful; only 13.6% indicated a need for further explanation. The means for pain intensity ranged from 5.09 to 5.75. The interval between pain ratings for the majority (> 71%) was less than 2 hours. Patients tended to tell the nurse about their pain when the intensity exceeded the midpoint on the scales. A reliability coefficient for the three scales was computed at alpha = 0.88. CONCLUSION: The use of rating scales for pain assessment in adult inpatient units was viewed positively by patients. Recommendations for incorporating self-ratings of pain intensity are set forth. Involving both patients and providers in the process is essential to improving both our processes and the outcomes achieved.

Work role inventory: a guide to job satisfaction.

The Miller-Carey Work Role Expectations model helps the nurse executive understand the dynamics which motivate managerial teams. The application of this model emphasizes the importance of assessing nurse manager's functions and responsibilities and suggests specific ways to enhance work motivation.

A collaborative case management program: the Crawford Long Hospital of Emory University model.

At Crawford Long Hospital of Emory University, a new system of patient care delivery, defined as collaborative case management, was developed as the organization struggled with implementation of the Deming management method. At the onset of the change process, an evaluation system was established to measure and document specific outcomes for patients, families, providers of care, and the organization. This article traces the development and implementation of the collaborative case management program and describes the evaluation system. Findings highlighting improved patient care outcomes, changes in patient and provider perceptions of care, and benefits to the organization are summarized.

Preceptor, mentor, and sponsor roles. Creative strategies for nurse retention.

As nurse executives and managers struggle to decrease the costs of providing direct care to patients, the hidden expense related to staff turnover should be examined. The authors present a framework for identifying the needs of staff nurses related to preceptors, mentors, and sponsors, and suggest that meeting these needs may enhance retention and reduce the high costs of nurse turnover.