Nurses' behavioural intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables.

BACKGROUND: The incidence of self-poisoning is on the increase. Most patients who self-poison are dealt with initially in the general hospital. Therefore, the type and quality of care self-poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self-poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals' attitudes towards people who self-poison. Usually, however, these have not focused specifically on nurses' attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice. AIMS: The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses' own attitudes, and the social pressures represented by other people's attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self-poisoning patients. DESIGN/METHODS: The study adopts a questionnaire-based approach incorporating two specially designed vignettes. RESULTS: The results show that nurses' own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self-poisoning patients. The study also shows that nurses with a more positive orientation towards self-poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation. CONCLUSIONS: The implications for future attempts to explore the relationship between nurses' attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.

A comparison of the WHOQOL-100 and the WHOQOL-BREF in detecting change in quality of life following liver transplantation.

The World Health Organization has recently produced a generic quality of life measure--the WHOQOL-100, together with an abbreviated version, the WHOQOL-BREF. Preliminary data suggest that the WHOQOL BREF provides a valid and reliable alternative to the lengthier WHOQOL-100. In the present study, the sensitivity to change of both versions was tested pre- and 3 months post liver transplantation in fifty patients and also in twenty-one non-transplanted liver disease controls. Quality of Life domains on both measures were highly correlated, and were sensitive to change following transplant and remained stable on repeat assessment in non-transplanted control patients. However, the sensitivity to change was significantly reduced for the Social domain in the WHOQOL BREF. It is concluded that the WHO-QOL-BREF is a useful alternative to the WHOQOL-100 in evaluating quality of life improvement following major therapeutic interventions for Physical, Psychological and Environmental domains of life quality. However, researchers interested in measuring the Social aspects of life quality may be best advised to use the lengthier WHOQOL-100.

Sensitivity to Change Following Liver Transplantation: A Comparison of Three Instruments that Measure Quality of Life.

There is an increasing focus on the importance of quality-of-life (QOL) factors in evaluating the efficacy of medical and surgical interventions. There are a wide number of instruments currently available, and the aim of the present study was to evaluate the relative sensitivity to change of three widely used QOL measures, the WHOQOL-100, the SF-36 and the Rotterdam Symptom Checklist, focusing on psychological and physical components of life quality. Fifty patients were assessed pre- and 3 months post-liver transplantation. In addition, 21 patients with liver disease but who were not transplanted were assessed twice, separated by a 3-month interval, in order to serve as a comparison group. All QOL measures showed significant improvement following liver transplantation, whereas the control group showed no significant within-subject change on any measure. We employed the Standardised Response Mean (SRM) effect size as our index of clinically meaningful change in QOL measures. Large SRM effect sizes were obtained following liver transplantation for WHOQOL-100 and SF-36 summary measures, and for the Rotterdam physical subscale. In contrast, the traditional SF-36 scale scores and Rotterdam psychological subscale exhibited only moderate sensitivity to change.

Variceal haemorrhage and post-traumatic stress disorder.

OBJECTIVE: Post-traumatic Stress Disorder (PTSD) is thought to be relatively common following extremely distressing life-threatening events. Patients with liver cirrhosis can experience severe brisk variceal haemorrhage during which they vomit litres of blood and may exsanguinate. We predicted that a significant proportion of survivors would suffer from PTSD. DESIGN: PTSD assessment of 30 patients who had a haematemesis of more than four units of blood secondary to variceal bleeding and were fully conscious at the time of the bleed. METHOD: Structured Clinical Diagnostic Interview (SCID-DSM-III-R) and self-report measures. RESULTS: Most found the experience distressing, but only 1 out of 30 patients fulfilled DSM-III-R diagnostic criteria for PTSD. CONCLUSIONS: PTSD in a sample of patients who survived life-threatening variceal haemorrhage is much rarer than might reasonably have been anticipated. Possible reasons for this low prevalence of PTSD are discussed.