Subject(s)
Organizational Culture , Organizational Innovation , Social Work Department, Hospital/organization & administration , Decision Making, Organizational , Hospital Bed Capacity, 500 and over , Humans , Inservice Training , Ontario , Organizational Objectives , Organizational Policy , Psychology, IndustrialABSTRACT
This paper illustrates the importance of giving emotional support and education to patients, families, staff and managers at The Queen Elizabeth Hospital, Toronto during the Spring 1992 downsizing effort. The Queen Elizabeth Hospital is a 601-bed, two-site facility which provides complex specialized rehabilitative and supportive care, teaching and research, as well as specialty programs in rehabilitation, geriatric service, geriatric psychiatry and long-term care. Downsizing at The Queen Elizabeth Hospital meant the consolidation and closure of 82 long-term beds, on one nursing unit at each site, to offset a projected budget deficit of $5.4 million. Internal restraint over the past year and during the budget process reduced this deficit to $2.8 million, thus necessitating further downsizing consideration. Background information includes a review of the recent downsizing literature. This paper describes the informal and formalized support activities that took place during the two-month process and the educational sessions that were provided on a regular basis. It gives specific attention to methodology and rationale. The authors also make recommendations for the successful implementation of a downsizing process which can be beneficial to any health care setting involved in bed closure.
Subject(s)
Employment , Hospital Restructuring/organization & administration , Morale , Personnel Administration, Hospital/methods , Social Support , Hospital Bed Capacity, 500 and over , Hospital-Patient Relations , Humans , Ontario , Personnel, Hospital/psychology , Personnel, Hospital/supply & distribution , Planning Techniques , Vocational GuidanceABSTRACT
This paper reviews the growing literature on the psychology of appearance and outlines prevention principles for working with facially disfigured children, based on 15 years of psychiatric consultation to a major pediatric craniofacial team.
Subject(s)
Abnormalities, Multiple/psychology , Child Development , Child Reactive Disorders/prevention & control , Facial Bones/abnormalities , Referral and Consultation , Skull/abnormalities , Adaptation, Psychological , Child , HumansABSTRACT
Eight males and 12 females (mean age, 12.2 years) with Treacher Collins syndrome were studied longitudinally before and after craniofacial reconstruction. The patients and the parents of the 16 patients who were children were interviewed by a psychosocial team (child psychiatrist, psychologist and social worker) 6 months before and 1, 2, 3 and 4 years after surgery. The patients' facial appearance (Hay's Rating Scale), intellectual ability (Wechsler scales), self-esteem (Piers-Harris Self-Concept Scale for Children) and adaptive functioning (DSM III) were measured. The findings indicate that while their intellectual ability was unchanged, their appearance, self-esteem and adaptive functioning improved, peaking 1 year postoperatively and levelling off at the 2- and 4-year postoperative assessments. The improvement in the patients' facial appearance seems to have a direct, positive influence, creating psychosocial and social benefits for them.
Subject(s)
Adaptation, Psychological , Mandibulofacial Dysostosis/psychology , Surgery, Plastic , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Intelligence , Male , Mandibulofacial Dysostosis/surgery , Psychological Tests , Self Concept , Time FactorsABSTRACT
Twenty-four children with Down syndrome were evaluated to investigate whether appearance, family functioning and intellectual functioning improved after facial reconstruction. Pre- and postoperatively, families were interviewed by a psychosocial team, the children's intellectual functioning was measured and parents were asked to rate their child's facial appearance on the Hay's Scale and to complete the FACES II, a questionnaire determining family functioning. Parents' ratings were compared with the scores of lay raters who viewed randomly presented pre- and postoperative photographs. Measurements of intelligence and family functioning revealed no postoperative improvement and lay raters considered postoperative appearance as slightly less attractive. However, parents rated their children's appearance as noticeably improved and reported happier personal, family and social lives. Thus, positive psychosocial consequences may largely be the result of parents' satisfaction with surgical results, providing them with hope for the future. Presurgical family assessment to clarify surgical limitations and parental expectations is essential.
Subject(s)
Down Syndrome/surgery , Surgery, Plastic , Adolescent , Child , Child, Preschool , Down Syndrome/psychology , Down Syndrome/rehabilitation , Esthetics , Face/surgery , Family , Female , Humans , Intelligence , Male , Postoperative PeriodABSTRACT
Twenty-five children with Apert's syndrome, characterised by craniosynostosis and symmetrical syndactyly of hands and feet, were seen by a psychosocial team. The patients ranged in age from 1 month to 15 years. All had undergone synostosis release in the first year of life and were being assessed for craniofacial reconstructive surgery. Psychosocial adjustment was evaluated using a semistructured interview, psychometric testing. Piers-Harris Self-concept Inventory and Hay's Appearance Rating Scale administered by a team consisting of a child psychiatrist, psychologist and social worker, 6 months before surgery and 1, 2 and 4 years after surgery.
Subject(s)
Acrocephalosyndactylia/psychology , Surgery, Plastic , Acrocephalosyndactylia/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Postoperative Period , Self ConceptABSTRACT
Patients' pre- and postoperative self-reports were compared with reports of non-medical observers to investigate whether improved self-esteem is a direct result of increased social acceptance in maxillo- and craniofacial patients. Twenty-two children and adolescents undergoing reconstructive surgery for a variety of facial deformities were asked to rate their physical appearance on the Hay's Scale and fill out the Piers-Harris Self-Concept Scale. Their ratings were compared with scores given by a panel of lay volunteers on random presentation of pre- and postoperative photographs of the same patients. Patients rated their appearance as noticeably improved after surgery, their self-esteem rose significantly and they reported more social adeptness and acceptance at home and school. Raters observed only relatively subtle changes. Apparently, quality of life improved for the postsurgical facial patient because of increased self-esteem and confidence, which free him to overcome social barriers.
