Physician attitudes toward cost containment. The missing piece of the puzzle.

A survey of 720 physicians practicing in central and western Massachusetts was undertaken to examine their attitudes toward cost-containment measures. The majority of physicians felt that major techniques (58%), major procedures (57%), inappropriate ordering of diagnostic tests (48%), and malpractice concerns (47%) were very important contributors to increasing health care costs. Physician age, practice affiliation, and specialty area were related to the perceived importance of these factors. In addition, while there was a uniform lack of prior training in cost-containment measures, 48% of all physicians felt that courses in cost-containment techniques would be worthwhile. These results suggest a variety of concerns and issues that need to be considered when attempting to modify the cost-containment attitudes and practices of physicians.

Job stress and satisfaction among the staff members at a cancer center.

Although it is evident that working with cancer patients can be stressful, explanations have differed as to why this is so and little attention has been paid to the rewards of this work. One hundred ninety clinical staff members at a comprehensive cancer center representing 91% of eight disciplines studied were interviewed using a semistructured format about the factors influencing their job satisfaction. The fact that the staff members almost uniformly rated their satisfaction as high (8.2 on a scale of 1 to 10) precluded the detection of discriminating variables. Satisfaction with the way they met their goals also was high; most identified potentially achievable goals, relied heavily on the interdisciplinary team, and experienced changes in their attitudes and approach during their first 2 years in the field, primarily increased realism. A major discomfort for physicians was the inability to provide optimal care. Ethical issues were a major discomfort for nurses. Death itself and staff conflict were less important sources of discomfort than in previous reports.

Barriers to influenza vaccine acceptance. A survey of physicians and nurses.

The Immunization Practices Advisory Committee (ACIP) recommends that health care providers who contact high-risk patients receive influenza immunization annually. There are few available data on hospital employees' acceptance of these recommendations or their attitudes about influenza immunization. In a hospital where no formal influenza immunization program was in place, a survey of 193 nursing personnel and physicians showed that only 2.1% received the 1986-1987 trivalent influenza vaccine and 3.2% the monovalent A/Taiwan/1/86 vaccine before the 1986-1987 influenza season. An influenza-like illness developed in a total of 35.3% of hospital employees during the influenza season, and 76.6% of them cared for patients while ill. Fear of adverse reactions, avoidance of medications, and the inconvenience of vaccine administration were frequently cited reasons for declining immunization. Hospital employees would be more inclined to receive future influenza immunization if vaccine administration were more accessible and if they were informed that immunization were a national health care policy. During the influenza season, nurses and physicians should be considered a uniformly susceptible reservoir of infection capable of transmitting influenza to patients. Moreover, ACIP guidelines alone probably will not lead to acceptable immunization rates among health care providers; organized institutional efforts to promote immunization of health care providers may be required.

Radiologists and endoscopy: a survey of the attitudes and intentions of radiologists in training.

A postal survey of senior registrars in radiology in this country was carried out to assess attitudes towards radiologists taking part in endoscopy services. One hundred and ninety-six senior registrars from 37 training centres recognised by the Royal College of Radiologists completed the questionnaire (a response of 74%). Thirty-nine per cent of respondents had some practical experience of endoscopy before commencing training in radiology. Twenty-eight per cent of respondents declared a major interest in gastrointestinal radiology. Sixty four per cent felt that radiologists should perform endoscopy (87% in the case of those with a major interest in gastrointestinal radiology). Thirty-seven per cent were interested in providing, or participating in, an endoscopy service after obtaining a consultant post. Despite this level of interest, only 18% of respondents felt that they had adequate access to endoscopy training and only 3% were aware of the training recommendations of the British Society, of Gastroenterology.

Provider assumptions about long-term care in American Indian communities.

A brief survey of 208 Indian Health Service (IHS) providers and allied personnel revealed the extent to which they subscribed to a number of myths about long-term care. With some exceptions, long-term care is equated with the nursing home, perceived as involving essentially health care professionals, and service objectives are assumed to be primarily rehabilitative and protective in nature. Underscored is the importance of past recommendations of geriatric training for IHS and tribal human service providers.

Understanding of elderly patients' resuscitation preferences by physicians and nurses.

We compared the understanding by family physicians and nurses of their elderly outpatients' preferences for cardiopulmonary resuscitation and mechanical ventilation under 3 scenarios reflecting varying qualities of life. Physicians and nurses correctly predicted patients' treatment preferences in from 59% to 84% and 53% to 78% of cases, respectively, for the various decisions. For most decisions, neither physicians nor nurses were significantly more accurate in their predictions than expected by chance alone. Moreover, nurses and physicians did not significantly agree with one another in their predictions of patients' preferences for any of these decisions. These results suggest that while nurses' and physicians' perceptions of patients' preferences for life-sustaining treatment are not necessarily similar, neither nurses nor physicians systematically understand their elderly patients' resuscitation preferences.

Physicians' attitudes toward the legalization of marijuana use.

We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.

Preparing students to be moral agents in clinical nursing practice. Report of a national study.

Various types of teaching and learning strategies can be effectively employed to assist students' professional development in ethical decision-making skills. To be prepared to act as a moral agent in clinical practice, a terminal goal upon completion of the baccalaureate program is the student's ability to develop and consistently use a systematic approach/framework when confronted by an ethical dilemma. Eleven skill steps not necessarily exclusive or in sequence were outlined as selected activities that can be considered for the ethical decision process. Specific ethical issues that are germane and applicable to many patient care situations were investigated and identified as frequently occurring in clinical practice. Course work about these issues prior to completion of their nursing programs may be beneficial in preparing students with basic knowledge and skill about them as they enter or return to clinical practice.

Dual degree. Future preparation for nurse executives?

What is the best educational preparation for top-level nurse executives? Which educational degrees will improve marketability? These questions were asked of nurse executives and their chief executive officers in a national market survey. The authors discuss the results of the survey which provides information that may be useful in selecting educational programs and in planning and revising graduate curriculum.

Getting to the heart of rural EMS.

The Rural EMS Task Force was formed by the National Rural Health Association to investigate critical issues in the rural EMS response system. The task force felt that many issues were at play and should be investigated in the form of a survey to determine nationwide needs. The EMS Today Working Conference in March became a forum to address potential solutions to those needs. Much work remains to better conditions for volunteer personnel who are expected to meet greater and greater expectations with fewer and fewer resources.

Absenteeism among hospital nurses: an idiographic-longitudinal analysis.

For several months, nurses completed ratings of the degree to which certain events relevant to absence were present during each of their scheduled workdays. The event ratings for days when the nurses decided to be absent were then compared with those for days when the nurses attended. As expected, certain events, such as ill health and tiredness, tended to covary and proved to be consistently related to absenteeism across nurses. Also as expected, some events that were not especially relevant for the nurses as a whole, like having a sick family member or friend and concerns about previous poor attendance, nonetheless emerged as being relevant to the absence behavior of certain individuals. Finally, some events were consistently related to the nurses' expressed desire to be absent but not to actual absences. We discuss these differences from two perspectives, one emphasizing the role of attribution bias and the other, a two-stage process in which such bias has no major role.

The developmentally disabled elderly: concerns of service providers.

We examined the availability of services for the developmentally disabled elderly and the concerns expressed by the service provider. We compared agencies which traditionally served individuals with developmental disabilities versus those serving the elderly populations. Although both types of agencies recognized the need for services, concern was raised as to who would provide them and how the two groups would blend.

Physician perspectives on the role of religion in the physician-older patient relationship.

A study of 160 family physicians and general practitioners found that the majority of physicians believed that religion has a positive effect on the mental health of older patients, and many believed that religion has a positive effect on physical health. While more than one half reported that patients only rarely, if ever, mentioned religious issues during a medical visit, a significant proportion of the physicians felt they should address religious issues when an older person indicates religion's importance and that religious issues should not be reserved completely for the clergy. Nearly two thirds of the physicians felt that prayer with patients was appropriate under certain circumstances, and over one third reported having prayed with older patients during extreme physical or emotional distress. Older physicians were less likely than younger to have positive attitudes toward addressing religious issues. The strongest predictors of physicians' belief in the appropriateness of addressing religious concerns were two attitudinal variables that indicated an understanding of the importance of religion in the lives of older adults and an awareness that patients might desire to engage in prayer with them. Hence, the beliefs and attitudes of the physician appear to be important factors in determining their receptivity to discussion of religious issues, which in turn may influence whether patients mention such issues in the context of the medical visit.