门诊病人满意度的影响因素分析

目的分析门诊病人满意度的影响因素。方法自行设计问卷对门诊病人进行满意度调查,采用多元线性逐步回归进行影响因素分析。结果554名病人综合满意率为95.31%;性别、年龄、居住地等8项人口学特征对综合满意度没有影响;医疗技术水平、医生服务态度、治疗费用、健康知识宣传、取药排队等候时间、检查时舒适性与就医环境方便等7项指标,对综合满意度的影响具有统计学意义(P<0.01或P<0.05)。结论采用多元线性逐步回归分析门诊病人满意度,能使测量与分析更具科学性。     

The job satisfaction of physical therapists

Ten statements were created for the purpose of measuring job satisfaction in the practise of physiotherapy. The subjects consisted of 96 of the 106 (90%) of the physical therapists licensed with the Texas State Board of Physical Therapy Examiners, and listed as residing in El Paso, Texas, USA. To indicate their job satisfaction, subjects indicated on a seven-point scale their level of agreement or disagreement with each statement. They then indicated on a different seven-point scale how important they thought each statement was to their job satisfaction. The results indicated that subjects thought that their jobs were challenging in a positive sense; enabled them to use their abilities; and were interesting. They also thought that they had sufficient independence in decision-making; were learning and improving in their work; and were given significant autonomy. The most dissatisfying aspect of their work was the amount of paperwork. In addition, the results suggest that some subjects may feel overworked, and think their jobs may be too physically demanding and mentally stressful. The subjects felt that all the statements had validity and measured important aspects of job satisfaction in physical therapy. Copyright © 1996 Whurr Publishers Ltd.     

Determinants of patient satisfaction with migraine therapy

Determinants of patient satisfaction with migraine treatment are not well understood. The objective of this study was to evaluate which treatment outcomes influence patient satisfaction with treatment. Analyses were performed on data from 1506 migraineurs from two clinical trials of rizatriptan for treatment of migraine. Satisfaction with treatment was assessed 2 h after initial treatment and prior to use of rescue therapy. Over 90% of patients who were pain-free at 2 h were at least somewhat satisfied with treatment compared with <10% of patients with moderate or severe pain. Only 60-70% of patients with mild pain at 2 h experienced some level of satisfaction with treatment. For patients with mild pain at 2 h, results showed subjects who reported severe pain at baseline, absence of associated symptoms at 2 h and pain relief within the first 90 min had at least a 76% probability of being at least somewhat satisfied. This probability decreased with the presence of associated symptoms, slower pain relief and moderate baseline pain intensity. Fast, complete pain relief is one important factor in determining short-term patient satisfaction with treatment.     

Job satisfaction traits of Nigerian physical therapists

In recent years emigration of highly trained health personnel has caused manpower shortages that were of real concern to the developing countries. This study was designed to (1) determine whether physical therapists (PTs) in Nigeria were satisfied with their jobs, and (2) assess whether Nigerian PTs practicing in the United States (U.S.) were more satisfied with their jobs than the PTs in Nigeria. A questionnaire was administered to PTs in Nigeria ( N = 110) and Nigerian PTs based in the US ( N = 31). The questionnaire consisted of two parts: Part 1 sought demographic information and Part 2 consisted of ten statements relating to paperwork, job challenge, physical demand, job autonomy, fulfillment, and stress. Overall, these cohorts of PTs were satisfied with the clinical practice aspects of their jobs. The two groups were comparable except in areas relating to stress, paperwork, and physical demand. Nigerian PTs practicing in the U.S. were not more satisfied than their counterparts in Nigeria. The study suggests that factors other than those related to clinical practice aspects of physical therapy were responsible for the wave of emigration of PTs from Nigeria in the past decade.     

Time allocation patterns of occupational therapists in Israel: implications for job satisfaction

This study analyzes the time allocation patterns at work of a sample group of Israeli occupational therapists who function in different roles and specialty areas. The sample consisted of 89 female occupational therapists working in the areas of physical impairment, rehabilitation, psychiatry, and pediatrics. Subjects recorded all of their activities during one work week and rated 23 previously identified occupational therapy activities according to perceived levels of importance. The results indicated that, on the whole, occupational therapists in all areas devoted at least two-thirds of their time to treatment-related activities (direct and indirect treatment). The results led us to conclude that the time allocation patterns used may have been conducive to "burnout." Therefore, to facilitate professional growth, we recommend that priorities be set and followed and also that role definitions be adhered to more strictly.     

Job satisfaction in relation to change to all-RN staffing

BACKGROUND: A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost. AIM: The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff. METHODS: Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years. RESULT: The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.     

Determinants of satisfaction with community reintegration in older adults with chronic stroke: role of balance self-efficacy

BACKGROUND AND PURPOSE: Many people with stroke have a low level of satisfaction with community reintegration. Although previous studies focused on the effect of physical factors on community reintegration, the effect of psychological factors, such as balance self-efficacy, has been ignored. The purpose of this study was to determine the contribution of balance self-efficacy to satisfaction with community reintegration in older adults with chronic stroke. SUBJECTS: A sample of 63 community-dwelling older adults (50 years of age or older) with chronic stroke (onset of 1 year or more) participated in this study. METHODS: This study involved a secondary analysis of data collected from a stroke exercise clinical trial. Satisfaction with community reintegration was measured with the Reintegration to Normal Living (RNL) Index, and balance self-efficacy was measured with the Activities-specific Balance Confidence (ABC) Scale. RESULTS: Bivariate correlation analyses showed that the RNL Index scores were moderately correlated with the ABC Scale scores. In a multiple regression analysis, after adjusting for age, sex, depression, and other impairments after stroke, balance self-efficacy remained independently associated with the RNL Index scores, accounting for 6.5% of the variance in the RNL Index scores. DISCUSSION AND CONCLUSION: Balance self-efficacy is an independent predictor of satisfaction with community reintegration in older adults with chronic stroke. Improving balance self-efficacy may be instrumental in enhancing community reintegration in this population.     

High and low job satisfaction: some characteristics of two groups of occupational therapists.

From a sample of 1400 occupational therapy respondents, the characteristics of two groups, those scoring high on the Minnesota Satisfaction Questionnaire (N = 280) and those scoring low (N = 280) on this measure of job satisfaction, are compared on age, position, educational levels and the value and salience scales of the Life Roles Inventory. The implications of these findings for occupational therapy unit management and supervision are discussed and recommendations for continuing professional education are made.     

The satisfaction of patients with multiple sclerosis regarding services received from physical and occupational therapists

The purpose of this study was to describe the satisfaction of patients with multiple sclerosis regarding the services they received from their physical and occupational therapists. Eighty-one patients volunteered for the study in response to advertisements and completed the Therapist Evaluation Form (TEF). Subjects had to have been a physical or occupational therapy patient within the last year and also had to have seen the same therapist for a minimum of four treatment visits. Total score and item analysis of the results demonstrated a high degree of satisfaction among the patients surveyed. The content of two open-ended questions on the TEF also showed that patients value therapist characteristics of being friendly and caring. Patients reported less satisfaction with the therapists' technical skills as opposed to rapport issues. These results reinforce the literature, which cites the importance of interpersonal aspects of patient/professional relationships for persons with disabilities. In addition, the initial reliability and validity data on the TEF obtained in this study support its further development as an instrument to measure patient satisfaction in physical and occupational therapy.     

Determinants of job satisfaction among nurses in Kuwait

OBJECTIVE: Job satisfaction among nurses working in five general hospitals in Kuwait was analysed using a global scale based on the McClosky Mueller Satisfaction Scale (MMSS) in relation to selected background characteristics (eg age, gender, nationality, educational qualification, monthly salary and the departments in which they worked. DESIGN: The questionnaire was distributed to 500 nurses using a stratified random sample. The response rate was 87.2%. RESULTS: Age, nationality and the department worked in had a positive significant relationship with job satisfaction. However, a higher level of educational qualification and previous work experience in other countries showed an inverse relationship with job satisfaction. CONCLUSION: Based on our findings, we recommend that expatriate staff should be provided with an understanding of cultural differences and how to cope with them. Special attention should be paid to the norms regarding interaction among males and females and social interaction among professionals from the opposite gender. Intensive courses in the languages to be used in the care provision process should be provided to impart requisite language competency.     

Determinants of priorities and satisfaction in pediatric care

AIMS: To investigate determinants of parents' priorities and satisfaction in relation to pediatric inpatient care and to examine the relationship between fulfillment of expectations and satisfaction. METHODS: The study took place in a pediatric acute care inpatient department with 300 parents of children admitted consecutively. Data were collected by means of two self-administered questionnaires. Parents completed one questionnaire immediately after their child's admission and the second after hospital discharge. RESULTS: Having confidence in the doctors, getting answers to questions about care and treatment, and being satisfied with the nurses' and doctors' behavior, were found to be determinants of having a satisfaction score above average. Waiting time was a relatively weak determinant of being satisfied in general, although a short waiting time was one of the items given the highest priority score.     

Determinants of self-report outcome measures in people with knee osteoarthritis

OBJECTIVES: To identify the determinants of self-report mobility measures in people with knee osteoarthritis (OA) and to compare self-report measures with physical performance. DESIGN: Cross-sectional, prospective. SETTING: Motor performance laboratory and human mobility research center. PARTICIPANTS: A convenient sample of 54 participants with medial compartment knee OA (32 women, 22 men; age 68.3+/-8.7y; range, 50-87y). Three participants were excluded because of the presence of lateral knee OA on radiographs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reports were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Performance measures included the six-minute walk test (6MWT), Timed Up & Go (TUG) test, and a standardized stair-climbing task (STR). RESULTS: Stepwise linear regression analysis identified models that included pain, quadriceps and hamstrings strength, and depression to explain 62% to 73% of the variance in scores on the physical functioning subscale of the WOMAC and the SF-36. These self-report measures had a moderate relation (r range, .46-.64) with performance measures (6MWT, TUG, STR). CONCLUSIONS: Self-report measures were strongly related to pain; physical performance measures were strongly related to self-efficacy. Regression models showed that self-report scores reflect pain, knee strength, and depression. The relation between self-report and performance measures was moderate, suggesting that these examine different aspects of mobility.     

Testing a new theory of patient satisfaction with treatment outcome

OBJECTIVES: Theories of patient satisfaction with treatment outcome have not been developed and tested in healthcare settings. The objectives of this study were to test a new theory linking patient satisfaction and embodiment (body--self unity) and examine it in relation to other competing theories. DESIGN: We conducted a prospective cohort study. SETTING: This study was conducted at a tertiary care hospital. PATIENTS: We studied 122 individuals undergoing elective hand surgery. METHODS: Satisfaction with treatment outcome approximately 4 months after surgery was examined against the following factors (representing 7 theories of satisfaction): 1) overall clinical outcome, 2) patients' a priori self-selected important clinical outcomes, 3) foresight expectations, 4) hindsight expectations, 5) psychologic state, 6) psychologic state in those with poor outcomes, and 7) embodiment. ANALYSIS: Seven hypotheses were tested first using univariate analyses and then multivariable regression analysis. RESULTS: Satisfaction with treatment outcome was significantly associated with embodiment. Three confounders--the extent to which surgery successfully addressed patients' most important reason for surgery, hindsight expectations, and workers' compensation--were also significant. The final model explained 84% of the variance in a multidimensional measure of satisfaction with treatment outcome. CONCLUSION: This research suggests that satisfaction with treatment outcome could be facilitated by developing strategies to improve body--self unity, and eliciting and addressing the patient's most important reason for undergoing treatment.     

Peripheral vascular resistance in septic shock: its relation to outcome

To support the concept that patients who die of septic shock have a persistent defect in peripheral vascular tone irrespective of cardiac index (CI), a retrospective study was undertaken of 42 patients with documented septic shock. From the patient records, the single lowest CI (t=2) measured after initial values (t=1) with concomitantly obtained haemodynamic and metabolic variables was taken. Group 1 consisted of 21 survivors and group 2 of 21 patients, who had died in shock. Initial haemodynamic and metabolic variables were comparable between the groups, reflecting shock with a hyperdynamic circulation and lactic acidemia. At t=2, median CI measured 3.21·min^-1·m^-2 in both groups, but mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) were higher in group 1 than 2 (p<0.0005). Changes in arterial blood lactate levels also differed significantly. The rankcorrelation between CI and SVRI at t=2 was significant in group 1 (r _s=-0.69, p<0.005) but not in group 2 (r _s=-0.34). Our data suggest that when CI decreases in septic shock, patients with a fatal outcome have less capability to augment vascular resistance than survivors. Hence, peripheral vascular failure, even if complicated by inability to maintain an elevated CI, may be a major haemodynamic determinant of mortality in septic shock.     

Determinants of outcome for patients admitted to a long-term ventilator unit

BACKGROUND: This prospective cohort study was done to identify determinants of successful weaning from mechanical ventilation among patients admitted to the 10-bed long-term ventilator unit (LTVU) of a teaching hospital. METHODS: Prospective patient surveillance and data collection were done on 472 patients admitted to the LTVU over a 4-year period (January 1996 to December 1999). RESULTS: Multiple logistic regression analysis showed that the absence of home mechanical ventilation at the time of hospital admission, absence of intensive care unit (ICU) readmission, and admission to the LTVU from a nonmedical service were independently associated with successful weaning. No statistical difference between hospital survivors and nonsurvivors was associated with length of stay in the LTVU and length of stay in the hospital. CONCLUSIONS: Patients admitted to an LTVU require prolonged hospitalizations and intensive resource utilization. These data suggest that improved methods for identifying patients who are unlikely to benefit from prolonged mechanical ventilation may assist physicians in their discussions with patients and family members as they consider various treatment options.     

The nutritional energy to clinical outcome relation revisited

In the previous issue of Critical Care, Dr Bellomo and colleagues reported an observational study of the relationship between nutritional intake and survival in the RENAL randomized controlled trial. In summary, the total energy intake in a very large and severely ill patient population was low. Higher average daily caloric energy intake was not associated with improved survival. The study illustrates the complexity of the interaction between disease and nutrition.The observational study by Bellomo and colleagues [1] is valuable for clinicians and investigators involved in ICU nutrition for two reasons. First, it provides an unbiased snapshot of nutrition therapy in severe critical illness during 2005 to 2008 in Australia and New Zealand. Indeed, the risk for selection bias in this nutritional dataset is very low. In the RENAL (Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy) randomized controlled trial (RCT), 89% (n = 1,508) of eligible patients were effectively randomized [2]. In 97% of these RENAL patients, prospectively collected nutrition energy data were complete. The administered energy (including non-nutritional energy) was low (mean 11 kcal/kg/day) despite 30% of patients receiving (total or supplemental) parenteral nutrition. Moreover, 1 week was needed to achieve full feeding in this real-life ICU situation.Second, this observational study of the relation between nutritional intake and 90-day survival may contribute to generating new hypotheses and to designing new nutrition RCTs in the ICU. Indeed, the optimistic expectations for improved outcome by enhanced (enteral or parenteral) nutrition in the ICU have been dismissed by recent RCTs [3-7]. The duration of ICU dependency, survival and functional outcome were unaffected or even worsened by different early feeding interventions. This finding has inspired investigation of nutritional data available from previous non-nutritional RCTs (Figure 1). Multicenter surveys of nutrition practices predict an impressive mortality reduction of more than 30% per additional 1,000 kcal mean daily caloric intake (DCI) achieved [8,9]. RENAL nutrition data [1] and Glucontrol nutrition data [10], on the contrary, suggest a neutral relation between DCI and survival or even increased mortality with more nutrition (Figure 1). The VISEP (Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis) trial also showed that patients receiving only enteral nutrition experienced a better survival despite much less nutritional energy administered [11]. Likewise, the lowest energy intake interval was associated with the fastest recovery in an observational analysis of enteral plus parenteral energy in the EPaNIC (Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients) trial, even in the “late” arm where patients did not receive any parenteral nutrition during the first week in the ICU [12]. Open in a separate windowFigure 1Schematic conceptual graph depicting the energy to clinical outcome relationship as suggested by different observational analyses. For analyses, see [1,8-10,12]. EPaNIC, Impact of Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients; INS + PEP uP, International Nutrition Survey (INS) Enhanced Protein-Energy Provision via the Enteral Route in Critically Ill Patients (PEP uP); RENAL, Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy.Dr Bellomo and coauthors avoided several common problems with observational studies of nutrition in the ICU. First, as explained above, the analyses were performed in a large unselected group of severely ill patients, reducing the risk of nutritional selection bias. Time bias is a second problem with analyses of the association between clinical outcome and average energy intake, as the provision of nutrition improves during ICU stay [13]. The authors therefore provided a separate analysis restricted to patients staying longer than 3 days in the ICU to tackle this problem. In this substudy, Kaplan–Meier analysis revealed a higher mortality in patients with higher DCI [1]! A third, often unrecognized error is informative censoring in time-to-event analyses [13]. Informative censoring occurs, for example, when patients leaving the ICU earlier are censored in ICU survival analyses on the ICU discharge day. This statistical flaw artificially inflates the observed mortality in patient groups experiencing a shorter ICU stay [13]. Bellomo and colleagues avoided this problem by using landmark 90-day-survival independent of ICU or hospital discharge status [1]. With this undisputable mortality endpoint, moreover, assessment bias is very unlikely. Nevertheless, this endpoint is also a limitation, because long-term functional outcome – perhaps more likely to be affected by nutrition – was not reported.Finally, it is impossible to distinguish in an observational study whether less severely ill patients are easier to feed or whether better feeding improves outcome. Indeed, at baseline the patients in the lower DCI group had more organ failure and were older. However, the results of unadjusted and the multiple adjusted analyses all point robustly in the same direction, even if two (mean and median) energy variables together in one multivariable model might be too much. Ultimately, a RCT allocating patients to different energy intake levels remains the only definite solution to distinguish between cause and consequence [3].If future RCTs confirm the impossibility to improve survival or functional outcome through enhanced feeding early in critical illness [3-7], the mechanisms behind this failure need to be unraveled to improve therapy. In the past, hyperglycemia might have been an explanation for the complications with early feeding – particularly parenteral feeding – in critical illness. Today, hyperglycemia is less likely to be an issue because almost all ICUs (87.2%) implement a glycemic control protocol (see additional online material with [9]). Alternatively, suppression of autophagy might nullify potential benefits of early and enhanced nutrition [14,15]. Autophagy is an intracellular mechanism eliminating damaged organelles and toxic protein aggregates. Autophagy is crucial in maintaining tissue integrity, it is activated by starvation and cellular stress signals and is inhibited by feeding.In conclusion, observational studies of prospectively collected nutritional data are valuable to designing new RCTs aimed at establishing safe and effective feeding strategies in the ICU. Such RCTs should preferably assess impact on 90-day landmark survival, acute cellular metabolism and long-term functional outcome.     

儿童康复治疗师的人格特质与职业满意度影响因素调查

目的 调查江苏省儿童康复治疗师人格特质与职业满意度现状,探究两者之间的关联及职业满意度的影响因素。