Christer Sandahl

CROSS-CULTURAL EVALUATION OF TWO DRINKING ASSESSMENT INSTRUMENTS: ALCOHOL TIMELINE FOLLOWBACK AND INVENTORY OF DRINKING SITUATIONS

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which assesses daily drinking patterns), and (b) Inventory of Drinking Situations (IDS, which assesses antecedents to “heavy” drinking). Clients (N=308) were outpatient alcohol abusers from four countries (Australia, Canada, Mexico, and Sweden). Generally, the Alcohol TLFB and IDS were shown to be reliable and valid with outpatient alcohol abusers in four countries, and in three languages. These results suggest that the Alcohol TLFB and the IDS can be used in clinical and research settings with Swedish-, Spanish-, and English-speaking alcohol abusers.

Time-Limited Group Psychotherapy for Moderately Alcohol Dependent Patients: A Randomized Controlled Clinical Trial

In recent reviews of treatment of alcohol dependence, psychodynamic group psychotherapy has been evaluated as being comparatively less effective than other methods. Some North American studies have, however, demonstrated differential treatment effects for subgroups of alcohol dependent patients. The focus of the present study was on the evaluation, in a different cultural setting, of psychodynamically oriented time-limited group psychotherapy for a homogeneous subgroup of moderately alcohol dependent male and female patients. After randomization, 49 patients completed either cognitive behavioral or psychodynamically oriented time-limited group treatment. At the 15 months follow-up, patients from both treatment orientations had improved. A majority of the patients in the psychodynamic group treatment, however, seemed to have been able to maintain a more positive drinking pattern during the whole follow-up period compared to the patients in the cognitive behavioral treatment who seemed gradually to deterior...

Systematic simulation-based team training in a Swedish intensive care unit: a diverse response among critical care professions

Background Teamwork—that is, collaboration and communication—is an important factor for safe healthcare, but professions perceive the quality of teamwork differently. Objective To examine the relationship between simulation-based team training (SBTT) and different professions’ self-efficacy, experienced quality of collaboration and communication, perceptions of teamwork and safety, together with staff turnover. Methods All staff (n=151; physicians, nurses and nurse assistants) in an intensive care unit (ICU) at a university hospital were systematically trained over 2 years. Data on individual self-efficacy were measured using the self-efficacy questionnaire; the experienced quality of collaboration and communication, teamwork climate, safety climate and perception of working conditions were sampled using the ICU version of the safety attitudes questionnaire (SAQ). Staff turnover and sick leave was measured using the hospitals staff administration system for the intervention ICU and a control ICU in the same hospital. Results The perception of safety differed between professions before training. Nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived quality of collaboration and communication with physician specialists improved after training. Nurse assistants’ perception of the SAQ factors teamwork climate, safety climate and working conditions were more positive after the project as well as nurses’ perception of safety climate. The number of nurses quitting their job and nurse assistants’ time on sick leave was reduced in comparison to the control ICU during the study period. Limitations Results for SAQ factors must be interpreted with caution given that Cronbachs α and inter-correlations for the SAQ factors showed lower values than benchmarking data. Conclusions All team members benefited from the SBTT in an authentic composed team, but this was expressed differently for the respective professions.

The relationship of treatment preferences and experiences to outcome in generalized anxiety disorder (GAD).

OBJECTIVES The relationship of treatment preferences and experiences to outcome was explored in patients with generalized anxiety disorder (GAD). DESIGN Patients were randomly allocated to either affect-focused body psychotherapy (ABP) (N=26) or standard psychiatric out-patient treatment (N=17). METHOD Initial preferences and subsequent experiences of treatment interventions were measured using a questionnaire focusing on support, inward reflection, concrete and directive problem solving, and affective expression. Outcome was assessed after 1 and 2 years in relation to symptom change. RESULTS ABP patients reported being helped by supportive and reflective treatment interventions to a greater extent than controls. ABP patients also had more positive experiences of supportive and emotionally expressive interventions than they had expected at initial assessment. When patients were divided into two groups on the basis of patterns of preferences and experiences using cluster analysis, it was found that differences in outcome were considerably more marked for clusters than treatment groups. CONCLUSIONS It is concluded that treatment preferences may have considerable interpersonal potential in therapy; how therapists utilize this potential may be important for improving outcome.

Alliance to the Group-as-a-Whole as a Predictor of Outcome in Psychodynamic Group Therapy

Abstract Eighteen patients diagnosed with burnout–related depression and receiving short–term psychodynamic group psychotherapy were included in this study. The participants completed the group version of the California Psychotherapy Alliance Scales (CALPAS) five times during treatment and evaluated the relationship positively. Alliance increased significantly as treatment progressed; however, the amount of change was small. Level of alliance to the group–as–a–whole, averaged over time, was predictive of two out of three outcome measures, whereas growth in alliance during the early phase of therapy was not predictive of outcome. Exploratory examination of the alliance at different time points showed that alliance to the group–as–a–whole at mid–phase of treatment was substantially correlated with outcome. Personality features such as dismissing attachment style and being overly nurturant or exploitable were predictive of early growth in alliance.

Role stress among first‐line nurse managers and registered nurses – a comparative study

BACKGROUND Studies show that first-line nurse managers (F-LNMs) experience high psychological job demands and inadequate managerial guidance. The purpose of this study was to investigate whether F-LNMs have higher stress levels and show more signs of stress-related ill health than registered nurses (RNs). AIM The aim of this study was to examine possible differences in self-rated health between F-LNMs and RNs on various psychosocial factors (e.g. job demand, job control and managerial support). METHODS Data were collected at a university hospital in Sweden. Sixty-four F-LNMs and 908 RNs filled in a web-based questionnaire. RESULTS Both F-LNMs and RNs reported having good health. Approximately 10-15% of the F-LNMs and RNs showed signs of being at risk for stress-related ill health. Statistically significant differences (Mann-Whitney U-test) were found in the distribution between the F-LNMs and the RNs on three indices of job control, job demand and managerial support. CONCLUSION Our findings suggest that F-LNMs were able to cope with high-demand job situations because of relatively high control over work. IMPLICATION FOR NURSING MANAGEMENT The implication for nursing management shows the needs for a work environment for both F-LNMs and RNs that includes high job control and good managerial support.

Simulation team training for improved teamwork in an intensive care unit

PURPOSE This study aims to describe implementation of simulator-based medical team training and the effect of this programme on inter-professional working in an intensive care unit (ICU). DESIGN/METHODOLOGY/APPROACH Over a period of two years, 90 percent (n = 152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter-professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme. FINDINGS In interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians. ORIGINALITY/VALUE The present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.

Drinking-Related Assessment Instruments: Cross-Cultural Studies

In recent years a number of drinking-related assessment instruments have undergone extensive developmental work and are in widespread use. These include measures that are designed to assess: 1) patterns of alcohol consumption. Timeline Followback Method (TLFB); and 2) antecedents to alcohol use, Inventory of Drinking Situations (IDS)-two constructs that would be expected to be sensitive to cross-cultural variability in drinking practices. These assessment tools present opportunities for the study of cross-cultural differences in drinking patterns and the circumstances under which drinking occurs. A World Health Organization project utilizing these assessment tools is currently underway in five countries (Australia, Canada, Mexico, Poland, and Sweden). This project focuses on the identification of profile differ.

Effects of dialogue groups on physicians' work environment

PURPOSE The purpose of this study is to evaluate whether dialogue groups for physicians can improve their psychosocial work environment. DESIGN/METHODOLOGY/APPROACH The study assessed the impact of eight dialogue groups, which involved 60 physicians at a childrens clinic in one of the main hospitals in Stockholm. Psychosocial work environment measures were collected through a validated instrument sent to all physicians (n = 68) in 1999, 2001 and 2003. Follow-up data were collected after the termination of the groups. FINDINGS The overall score of organizational and staff wellbeing, as assessed by the physicians at the clinic, deteriorated from 1999 until 2003 and then improved 2004. This shift in the trend coincided with the intervention. No other factors which might explain this shift could be identified. RESEARCH LIMITATIONS/IMPLICATIONS In a naturalistic study of this kind it is not possible to prove any causal relationships. A controlled survey of management programmes concerning the work environment among physicians would be of interest for further research. PRACTICAL IMPLICATIONS The results suggest that dialogue groups may be one way to improve the psychosocial work environment for physicians. ORIGINALITY/VALUE There is a lack of intervention studies regarding the efficacy of management programmes directed toward physicians, concerning the effects on professional and personal wellbeing. This is the first time dialogue groups have been studied within a health care setting.

Teaching group dynamics - do we know what we are doing?: An approach to evaluation

Background: Research into the efficacy of programs of leadership and group dynamics in undergraduate medical education is sparse. Aims: The aim of this study was to apply and test a pre- post evaluation design of a one-week experiential learning based course of group dynamics. Methods: Two questionnaires were sent to 160 medical students, before and after the course. The response rate was acceptable (73%). Results: While there was a small change in attitudes towards openness in their professional role and group dynamics, there was a major change in two subgroups of students to these topics. The students who were least interested in collaborative constructivist learning and those students who mainly looked for practical value were the students who changed their attitudes most towards openness in their professional role. Conclusions: It appears that those students who would be least likely to voluntarily attend such a course were the ones who learned the most. This study does not allow for any generalizations regarding the outcome of experiential learning of group dynamics, but it is an argument for the use of systematic evaluations in order to identify students who can benefit from courses aimed at improving profound knowledge.