Mothers' and fathers' perceptions of three year olds' attachment behavior.

This investigation reports on the antecedents and cross-sectional predictors of young children's attachment security based on Q-sort methodology, with particular consideration of the convergence of parental reports. Mothers' and fathers' ratings of child temperament and child behavior problems, as well as each parent's construction of the marital relationship and his/her affective state, were examined in relation to Q-sort assessments of mother-child and father-child attachment security. Generally, a moderate degree of convergence between maternal and paternal perceptions of attachment security was found; this association was stronger than the correlations reported based on studies using the Strange Situation procedure at 12 to 18 months of age. Antecedent relationships between ratings of parental affective symptoms, as well as ratings of marital quality and security of attachment, were stronger for fathers than for mothers. These findings may suggest closer links for fathers than for mothers between parental nurturing responses and psychological state, or they may reveal a stronger subjective bias for fathers inherent in the Q-sort method.

Measuring critical care redesign: impact on satisfaction and quality.

This report describes restructuring on four critical care units at an acute, tertiary care hospital in South-east Pennsylvania. Utilizing a Patient Centered Care conceptual framework that had been successfully applied in the medical-surgical areas, restructuring involved three main areas: revamping of work processes, inclusive of redesigned staff roles; environmental and facility changes; and enhancement of telecommunication and information systems. Preliminary analyses six months post redesign revealed improvements and maintenance in four outcomes areas--satisfaction, quality and efficiency, and costs of care.

Measuring and evaluating hospital restructuring efforts: 18-month follow-up and extension to critical care, Part 2.

Critical care has enjoyed unobstructed growth during the past two decades; however, to remain viable, process and role changes are pivotal to ensuring continued quality, cost-effective, and efficient care. In this article, the second in a two-part series, the authors describe restructuring efforts, inclusive of their measurement and evaluation strategies, within four critical care units at an acute care, tertiary institution. Special emphasis is placed on the process, the authors' observations, and lessons learned to date. Part 1 (September 1998) presented evaluation data of the effects of hospital restructuring on patient and nurse satisfaction, costs of care, and clinical quality in four medical-surgical units.

Measuring and evaluating hospital restructuring efforts. Eighteen-month follow-up and extension to critical care, Part 1.

Increasingly, hospital restructuring is viewed with skepticism because of a lack of systematic and rigorous evaluation of its impact on quality of care. This first article in a two-part series describes comprehensive evaluation of the effects of hospital restructuring on patient satisfaction, nurse satisfaction, costs of care, and clinical quality on four medical-surgical units at a large tertiary hospital. In addition, early application of the model to critical care is described. A quasiexperimental pre- and post-design combined with concurrent control units for selected measures was the overall strategy. The authors conclude that comprehensive restructuring of hospital-based care can take place in a manner that preserves multiple dimensions of quality while decreasing costs. This only can be ascertained, however, through rigorous and systematic measurement and evaluation. Part 2 will detail application and evaluation of the restructuring model in the critical care environment.

Infant temperament and cardiac vagal tone: assessments at twelve weeks of age.

Sixty 12-week-old infants participated in a laboratory study to explore the relations between temperament and cardiac vagal tone. Temperament was evaluated via laboratory observations and maternal ratings. Cardiac vagal tone, measured as the amplitude of respiratory sinus arrhythmia, was quantified from beat-to-beat heart period data collected during a resting baseline period and during the laboratory assessment of temperament. Specific hypotheses were investigated relating temperament to both basal cardiac vagal tone and changes in cardiac vagal tone during social/attention challenges. Infants with higher baseline cardiac vagal tone were rated in the laboratory as showing fewer negative behaviors and were less disrupted by the experimental procedure. Infants who decreased cardiac vagal tone during the laboratory assessment were rated on maternal report temperament scales as having longer attention spans, and being more easily soothed.

The evaluation of hospital restructuring efforts: satisfaction, quality, and costs.

This article reports on study evaluating the effects of hospital restructuring on patient satisfaction, nurse satisfaction, cost of care, and clinical quality. The restructuring involved facility redesign, telecommunications enhancement, and implementation of patient care processes incorporating multiskilled personnel and case facilitation systems. The results indicate improved patient and nurse satisfaction, decreased length of stay and variable cost per patient day, and good clinical outcomes.

A pragmatic approach to measuring and evaluating hospital restructuring efforts.

Organizations have expended enormous resources to restructure care delivery Despite the growing literature describing these organizational innovations there is a paucity of credible data that reflects systematic measurement and evaluation of such changes. This report not only describes a comprehensive research based restructuring effort in a 720 bed acute care hospital, but it also describes an outcomes evaluation strategy and associated findings that may serve as a model and a guide for other healthcare institutions.

Preparing to change from acute to community-based care. Learning needs of hospital-based nurses.

OBJECTIVE: Increasingly, professional nurses will be required to function in practice settings other than acute care, yet little is known about how nurses perceive the skill sets required to practice in these nonacute care settings. This study explores nurses' perceptions and needs concerning the transition from acute to home care and community-based healthcare facilities. BACKGROUND: Because the healthcare reform environment of the 1990s mandates changes in the ways hospitals and hospital nurses care for patients, many nurses in acute care settings anticipate that their roles will include or perhaps shift completely to practice in the home and other community-based settings. How professional nurses perceive the skills required to practice in these nonacute care settings may well influence their willingness to accept work redesign initiatives and voluntary employment transitions that involve working outside the hospital setting. METHODS: Based on focus groups and the literature a three-part 56-item questionnaire was developed as the study instrument to assess skill needs and concerns related to functioning in the acute, home, and community-based setting. A total of 879 nurses representing various specialties in healthcare institutions in the Philadelphia and five-county surrounding areas participated. RESULTS: Test retest for the study instrument was 0.87 for a 2-week period, and alpha coefficients ranged from 0.90 to 0.94. Multivariate analyses revealed that proficiency on certain skill items in the acute care setting predicted feelings of proficiency in home and community-based settings. Based on regression and discriminant function analyses, top predictors and differentiators of proficiency in the nonacute care settings were wound care and dressing, knowledge of community resources, diabetic education, patient and family advocacy, communication with third-party payers, and neonatal care. CONCLUSIONS: Some nurses, such as those working in critical care, perceive themselves as being able to function proficiently in a wide variety of care settings-acute home, and community based. Furthermore, certain acute care skills were identified as top differentiators of proficiency in nonhospital settings, thus providing direction for nursing administrators and academic institutions. In addition, the tool developed for the study can serve as a self-assessment for individual nurses.

Prenatal maternal reactivity to infant cries predicts postnatal perceptions of infant temperament and marriage appraisal.

In a sample of 60 primiparous women, cardiac response and ratings of subjective aversiveness to recordings of unfamiliar infant cries were studied at 32 weeks' gestation. Regression analyses were used to examine relations between cardiac acceleration and subjective aversiveness and 3 groups of postnatal dependent variables: perception of infant temperament, the mother's emotional state, and her appraisal of her marriage. Mothers who prenatally rated the cry recordings as more aversive postnatally described their 3-month-old infants as more fussy/difficult and unpredictable. With statistical control for prenatal variation on the emotional state and marital outcome measures, cardiac acceleration predicted later marital quality. Women who showed greater cardiac acceleration to the cries described their postnatal marital relationships more negatively.