Location of death in Canada. A comparison of 20th-century hospital and nonhospital locations of death and corresponding population trends.

This report compares 20th-century Canadian hospital and nonhospital location-of-death trends and corresponding population mortality trends. One of the chief findings is a hospitalization-of-death trend, with deaths in hospital peaking in 1994 at 80.5% of all deaths. The rise in hospitalization was more pronounced in the years prior to the development of a national health care program (1966). Another key finding is a gradual reduction since 1994 in hospital deaths, with this reduction occurring across all sociodemographic variables. This suggests nonhospital care options are needed to support what may be an ongoing shift away from hospitalized death and dying.

Self-reported risk factors and perceived chance of getting HIV/AIDS in the 1990s in Alberta.

This paper examines self-reported risk factors and perceived chance of getting HIV/AIDS using five representative surveys of adult Albertans obtained in 1990, 1992, 1994, 1995, and 1996. The findings from this trend analysis demonstrate that less than 10% of respondents perceived their chance of getting HIV/AIDS to be medium or high. Persons with multiple sex partners tended to perceive themselves to be at risk. Almost 20% of respondents reported one or more new sex partners in the last two years prior to the survey. Condom use with new sex partners increased substantially. Fifteen percent of respondents reported two or more sex partners in total in the last two years prior to the survey. Fourteen percent reported having two or more sex partners including at least one casual sex partner, and of these 61% reported always using condoms with their casual sex partner(s). Finally, the most striking finding is the perception among health care workers that they are at risk for contracting HIV/AIDS.

Job uncertainty and health status for nurses during restructuring of health care in Alberta.

The Alberta health care system experienced dramatic changes after provincial funding cuts to health care from 1993 to 1996. As a result, stressors for nurses increased. The question of whether job uncertainty, working conditions, cognitive appraisal, and coping strategies influence the health of registered nurses in a context of health care restructuring was examined. Lazarus and Folkman's Transactional Model of Stress was used as the conceptual framework. A total of 271 registered nurses employed in a large, urban, acute-care teaching hospital responded to a self-administered survey questionnaire. Using multiple regression analysis, depression and self-reported physical health were analyzed. The data suggest that the threat of being placed on recall, having a coworker bumped or laid off, and perceived job security were adversely related to physical health. High primary appraisal of threat was associated with high levels of depression and poor physical health. In addition, the findings suggest that various coping strategies had both buffering and exacerbating effects on physical health and depression.

Quality of life of individuals with end stage renal disease: perceptions of patients, nurses, and physicians.

OBJECTIVE: The objectives of this study were to describe the perceptions of physicians, nurses, and patients regarding the quality of life (QOL) of individuals with end stage renal disease (ESRD), to identify differences in ratings of QOL, and to identify predictors of perceptions of QOL for each group. DESIGN: A cross-sectional, descriptive comparative design was used. Three measures of QOL, the Self-Anchoring Striving Scale, Index of Well-Being, and Time Trade-Off were used. SAMPLE/SETTING: The subjects included 215 patients with ESRD (including dialysis and transplant), and 42 nurses and 7 physicians who cared for them. All were from a major tertiary care hospital renal program in western Canada. METHODS: Patients were interviewed and asked to complete questionnaires relating to quality of life, health status, functional status, outlook, support, medical, and demographic characteristics. Three measures of QOL, the Self-Anchoring Striving Scale, Index of Well-Being, and the Time Trade-Off were used. Primary physicians and nurses were asked to complete the same questionnaires within one week of the patients. RESULTS: It was found that there were significant differences in the ratings among the groups. The nurses' ratings of patients' QOL were significantly lower than were patients (T2 = 21.89, df = 5, 377, p < .001). Physicians' mean ratings were higher than patients' ratings (T2 = 14.24, df = 5, 338, p < .05). Correlations among patients', nurses', and physicians' ratings of QOL ranged between .19 and .49. It was also found that different variables explained the perceptions of each group regarding the patients' QOL. CONCLUSIONS: In this study, nurses, physicians, and patients rated the QOL of individual patients differently, and different factors explained the perceptions of QOL of each group. Although findings of the study are not generalizable, it may be advisable for nurses to be aware that patients and physicians may not share their perceptions of patients' QOL.

Quality of life of patients with end stage renal disease: a structural equation model.

In this study, the perceived quality of life (QOL) of 215 patients with and stage renal disease (ESRD) was examined. A LISREL model describing the patients' perceptions of their QOL was tested and, after some revisions, was found to be consistent with the data (chi 2 = 33.76, df = 25, p = 0.113). QOL was measured by: the Self-Anchoring Striving Scale, the Index of Well-Being, and the Time Trade-Off Technique. The model includes the patients medical characteristics, their health status, functional status, support and outlook. Outlook, functional status and treatment modality had significant direct effects on QOL. Support influenced QOL through the mediating variable, outlook. This study suggests that a theoretical reexamination of the measurement structure of QOL is warranted.

Managing occupational HIV exposures: a Canadian study.

The findings reported in this paper are part of a larger study that explored how nurses cope with the risk of acquiring HIV infection while caring for persons with AIDS (PWAs). The data were collected through in-depth interviews with 13 nurses who cared for PWAs in a large Western Canadian hospital. Seven of these nurses perceived that they had been exposed to HIV-infected blood or body fluids. This paper describes how these seven nurses coped with actual exposures to HIV-infected blood or body fluids. Data were analyzed using the methodology of grounded theory. Nurses' coping efforts after exposure were grouped into four categories: minimizing the effect of exposures, reducing a sense of vulnerability, selective disclosure to others, and assigning meaning. Nurses minimized the physical effects of exposure through measures such as 'bleeding' the needlestick injury and immersing the affected area in bleach solution. Nurses reduced their sense of vulnerability by assessing the possibility of harm, avoiding situations that aroused fear, and confronting the decision for HIV testing. Nurses limited their disclosures to co-workers to avoid rejection and to preserve professional self-esteem. Disclousre to significant others was influenced primarily by the support nurses perceived they would receive. Finally, nurses attempted to assign meaning to the exposure by determining why the event occurred and by evaluating the implications it has had on their lives. The article concludes with implications for nursing practice.

Making risk meaningful: developing caring relationships with AIDS patients.

A qualitative study was conducted in order to understand how nurses cope with the risk of contagion while providing care to persons with AIDS (PWAs). Data were collected through in-depth interviews with 13 nurses who had cared for PWAs in an acute-care hospital in a western Canadian city. The data were analysed using the constant comparative methodology of grounded theory. The analysis revealed that caring for PWAs involved achieving a sense of control over uncertainty. One aspect of this process, making risk meaningful, centred on efforts to justify caring for PWAs in the face of risk. The purpose of this paper is to describe how nurses make risk meaningful. A sense of meaning was found to be related to three major factors: accepting the patient as a person who needs and deserves care, finding work enjoyable and worthwhile, and professional commitment to care for all patients. Attaining a sense of meaning led to a reappraisal of the risk situation as worthy of investment and provided the motivation to care for patients in spite of risk. The paper concludes with implications for practice and suggestions for further research.

Concurrent utilization of chiropractic, prescription medicines, nonprescription medicines and alternative health care.

This study examines the use of chiropractic, prescription medicines, nonprescription medicines and alternative health care for two independent samples representative of the population of Edmonton, Alberta, Canada in 1979 (n = 439) and again in 1988 (n = 464). While the usage of prescription medicines was unchanged from 1979 to 1988, utilization of nonprescription medicines, chiropractic and alternative health care increased. Users of chiropractic tended to be concurrent users of the conventional health care system, although they were also more likely to utilize alternative health care. This study shows that Edmontonians tend to select their health care concurrently from various health care modalities including both prescription and nonprescription medicines and conventional and alternative health care.

Public opinion regarding AIDS policy: fear of contagion and attitude toward homosexual relationships.

This study examines public attitudes toward AIDS issues and tests the extent to which fear of contracting AIDS and attitude toward homosexuality influence opinions regarding the screening of potentially infected persons and the isolation of those already identified as infected. The data for this study are drawn from a 1989 survey of a representative sample of the adult residents of Edmonton, Alberta (n = 443). Stepwise regression analysis reveals that fear of contracting AIDS and attitude toward homosexual relationships independently predict support for AIDS screening and isolation policies. The implications for public health education are discussed.

Hospital administrators as professionals: a study of occupational role identity.

This study set out to examine how hospital administrators see themselves in relation to their occupational role, that is, do they see themselves primarily as professionals, as organizational men and women, or as some combination of both. The determinants of their perceptions of occupational role identity were also examined. Canadian hospital CEOs numbering 361 were surveyed with a 72 percent response rate showing wide variation in education and length of work experience. Findings indicate these CEOs manifest a combination of professional and organizational role identities with no apparent conflict between these identities and no systematic differences in role identity by type of education or by length of work experience. The structure of this integrated model of professionalism and its potential impact on the leadership role of the CEO is examined in this article.

The social bases of discrepancies in health/illness perceptions.

Health care professionals generally assume that their perceptions and assessments of their patients' health status are accurate and are congruent with those of the patient and other health care providers. However, despite the patient education process, there is evidence that discrepancies in perceptions persist. These discrepancies are of particular concern to nurses because they may interfere with the provision of quality patient care. Poor communication, non-compliance with the treatment regimen, inadequate or unnecessary treatment, and ethical problems could be outcomes of discrepancies in perceptions. In this paper, the literature pertaining to discrepancies in health/illness perceptions is reviewed. As well, several social factors that may affect perceptions are described. These include cultural background, gender, socioeconomic status, experience and role. The effect of occupational role on health/illness perceptions has not been examined systematically. Regarding differences in perceptions of physicians, nurses and patients, further research is required to clarify and explain the nature of discrepancies in health/illness perceptions.

Religion and differences in morbidity and mortality.

Religion and its effects on morbidity and mortality (with particular emphasis on mortality) are reviewed as are special issues which have in the past made the study of religion and death difficult. The morbidity and mortality experience of various religious groups is portrayed, including Protestants, Catholics, Jews, Muslims, the clergy, Seventh-day Adventists, Latter-day Saints, Parsis, Jehovah's Witnesses and Hutterites. Studies of religious effects on morbidity and mortality have broadened in focus from the study of specific health practices, or health-related behaviors, to include the study of social support, religious participation and health-related attitudes. Gaps in the literature are identified and a preliminary model of religion's effect on morbidity and mortality is discussed.

Factors in the utilization of the small non-metropolitan hospital in Alberta, Canada.

This paper examines factors which determine the utilization of the small (100 beds or less) non-metropolitan acute care hospital. Explanatory variables represent both demand and supply dimensions. Measures of utilization include average length of stay and per capita patient days, separations, surgical visits, mothers delivered and emergency outpatient visits. The analysis used multiple regression and explained from 62 to 93% of the variation in the utilization measures. Both supply and demand variables showed considerable predictive power. Key explanatory variables include bed supply, patient flow, population characteristics (especially age) and physician manpower.