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Emotional exhaustion and distress among nurses: how important are AIDS-care specific factors?

This study describes distress symptomatology and levels of job-related exhaustion in a sample of 153 hospital nurses currently caring for AIDS patients. While the level of emotional exhaustion in the sample was not alarmingly high, these nurses did report symptoms of distress. Levels of emotional exhaustion were related to a variety of personal demographic, AIDS-specific, and job-related factors. These factors included: age, income, years of practice on the unit, recent change in shift, type of unit, discomfort caring for AIDS patients, willingness to continue caring for AIDS patients, number of AIDS patients cared for, job tension, job influence, and enthusiasm about returning to work. Regression analysis indicated, however, that six general job-related factors accounted for about 46% of the variation in emotional exhaustion. These results suggest that general job-related factors such as 8-hour shifts, changing shifts, level of job tension, and other factors characterizing all hospital care are particularly worthy of future study.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Primary care physicians' satisfaction with quality of care in California capitated medical groups.

CONTEXT: Managed care and capitation have placed new responsibilities on primary care physicians, including formally acting as "gatekeepers" for specialty services and tests. Previous studies have not examined whether primary care physicians who provide services to patients under many coverage arrangements feel differently about caring for patients covered under capitation vs those covered through more traditional forms of insurance. An understanding of whether California primary care physicians feel that they deliver a different level of quality to capitated patients could help signal whether variations in care for patients with different coverage forms are evolving. OBJECTIVE: To evaluate whether primary care physicians in California capitated groups report different satisfaction levels with quality of care for patients in their overall practice than for patients covered by capitated contracts and to examine whether physicians' satisfaction with capitated care quality is influenced by the characteristics of the practice setting. DESIGN: Cross-sectional questionnaire. SETTING: A total of 89 California physician groups with capitated contracts. PARTICIPANTS: A total of 910 primary care physicians (80% response rate). MAIN OUTCOME MEASURE: Satisfaction with 4 aspects of quality of care provided to patients covered by capitated contracts vs patients overall. RESULTS: Physicians reported lower satisfaction with all 4 aspects of care for patients covered by capitated contracts than for patients in their overall practice: 71% were very or somewhat satisfied with relationships with capitated patients (compared with 88% for overall practice), 64% were very or somewhat satisfied with the quality of care they provided to capitated patients (compared with 88% for overall practice), 51% were very or somewhat satisfied with their ability to treat capitated patients according to their own best judgment (compared with 79% for overall practice), and 50% were very or somewhat satisfied with their ability to obtain specialty referrals (compared with 59% for overall practice) (P< or =.001 for all comparisons). Being in a medical group practice (vs an independent practice association) and having a larger percentage of capitated patients were independently associated by multivariate analysis with higher levels of satisfaction with capitated quality of care (P< or =.005). CONCLUSION: These California primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than with the quality of care they deliver to patients covered by other payment sources. However, those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated care. National expansion of capitation should be accompanied by efforts to ensure that the satisfaction of practicing physicians with the care they deliver does not decline.

Attitude of Health Personnel↗