Jeanne A. Schaefer

Effects of work stressors and work climate on long-term care staff's job morale and functioning

Relationships between work stressors and work climate, and job morale and functioning were examined. Initial and 8-month follow-up data were obtained from 405 staff in 14 long-term care facilities. Relationship and workload stressors were related to less job satisfaction and intent to stay in the job, and more job-related distress, depression, and physical symptoms. Patient care task stressors were associated with better outcomes. More positive work climates were linked to higher job morale. Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up.

The Crisis of Physical Illness

An acute health crisis is often a key turning point in an individual’s life. The vivid confrontation with a severe physical illness or injury, prolonged treatment and uncertainty, and intense personal strains can have a profound and lasting impact. Most patients cope reasonably well with such a crisis and are able to recover and resume their prior level of functioning. Some individuals, however, are utterly demoralized and suffer serious psychological consequences, whereas others emerge with a more mature outlook and a richer appreciation of life. What factors affect the ultimate psychosocial outcome of a health crisis? Why do some patients continue to struggle under the most harrowing circumstances? What are the major adaptive tasks seriously ill patients encounter? What types of coping skills do they use to promote recovery? Are there common phases or stages through which individuals progress as they negotiate a health crisis? What stressors are encountered by health care professionals and how can they nourish the psychological healing process among patients and their families? We deal with these issues here by considering physical illness as a life crisis and by describing how patients and staff cope with the stress of illness and of treatment.

Evaluating health care work settings: A holistic conceptual framework

Abstract After offering a systems perspective that considers a diversity of job-related and personal factors, we discuss the determinants and impacts of health care work climates and how staff morale and performance can influence the treatment milieu and quality of patient care. We also describe the physical features, organizational structure and policies, and suprapersonal and task factors that help to shape health care work climates. We then review research on the connections between work climate and staff morale and performance, the interplay of work climate factors, and the role of personal factors in these relationships. Finally, we orovide some ideas about how to improve health care work settings and focus on some promising new research directions.

Life Transitions and Crises

While awaiting an ambulance after sustaining a grave injury in a sudden, terrifying automobile accident, Jon Krapfl mentally prepared for death. The ambulance attendants wanted him to remain hopeful and hesitated to tell him that his neck was broken. By sharing his intense fear of imminent death, Jon managed to obtain the information he sought. During his lengthy rehabilitation, Jon experienced sharp, insistent pain, felt he was losing his mind due to intrusive hallucinations, found it hard to accept his injury and physical limitations, and ruminated about how his wife and children would confront his disability. Jon faced these issues effectively and eventually returned to his job as a professor of psychology at the University of West Virginia. He later construed the forced review of his life as a “freeing experience” and came to see his ordeal as having “enriched my life.”12

Continuity of care practices and substance use disorder patients' engagement in continuing care.

Background:Substance use disorder (SUD) patients who engage in more continuing care have better outcomes, but information on practices associated with greater patient engagement and retention in continuing care remains elusive. Objectives:The objectives of this study were to determine if staffs continuity of care practices predict patients’ engagement in continuing care in the 6 months after discharge from intensive SUD treatment and to determine if the impact of continuity of care practices on patients’ engagement in continuing care differs for patients treated in inpatient/residential versus outpatient programs. Research Design:Staff in 28 Veterans Affairs (VA) intensive SUD treatment programs with varying continuity of care practices provided data on 878 patients’ alcohol and drug problems at treatment entry. At discharge, staff provided data on patients’ motivation, treatment intensity, and on the continuity of care practices they used with each patient. VA administrative databases supplied data on patients’ subsequent engagement in continuing care. Mixed-effects modeling was used to examine predictors of patients’ engagement in care. Results:Patients in outpatient programs who received more continuity of care engaged in continuing care significantly longer. More highly motivated outpatients, those with fewer alcohol problems at treatment entry, and patients who used VA services in the year before treatment also remained in continuing care longer. These findings did not hold for patients treated in inpatient/residential programs. Conclusions:Continuity of care practices predicted engagement in continuing care only for patients treated in outpatient SUD programs. More research is needed to identify effective continuity of care practices for patients treated in inpatient/residential programs.

VA nursing home residents with substance use disorders: Mental health comorbidities, functioning, and problem behaviors.

Objectives: This research addresses whether residents with substance use disorders (SUDs) in VA nursing homes (VANHs) are distinctive in terms of their demographic characteristics, medical and mental health comorbidities, functioning, and problem behaviors. Methods: Residents over age 55 admitted to VANHs (n = 27,002) were identified in VA administrative files, and SUD and non-SUD residents were compared. Results: Compared with other residents, the residents with SUDs (18% of admissions over age 55) were more likely to be younger, male, African-American, unmarried, have low income and a tobacco use disorder. Controlling for demographic factors and smoking, SUD residents were more likely to have mental health comorbidities (dementia, serious mental illness, depressive disorders, and post-traumatic stress disorder), as well as AIDS/hepatitis, pulmonary disease, gastro-intestinal disorders, and injuries. SUD residents were less likely to have cancer, diabetes, neurological disorders, heart failure, and renal failure. SUD residents were more independent in activities of daily living, such as mobility and toileting. They were more likely to engage in verbal disruption but not in other problem behaviors such as aggression. With demographic factors and comorbidities controlled, the functioning differences were diminished, and SUD and non-SUD residents did not differ in the levels of problem behaviors. Discussion: VANH residents with SUDs have distinctive patterns of comorbidities and functioning. SUD appears to represent a separate risk factor for VANH admission. Residents with SUDs present challenges but may have good potential for positive discharge outcomes if their substance use problems and limited resources can be addressed.