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Biomedical subjects

S A Ritter

Publications and source records attributed to S A Ritter.

4 recordsLinked to original sources
PubMed2000

Detection of psychological distress by practice nurses in general practice.

BACKGROUND: The general practitioner (GP) has traditionally been the first port of call for people with psychiatric morbidity but increasingly other members of the primary care team see the patients first, particularly practice nurses. The numbers and roles of practice nurses have expanded greatly over the past decade and it is important that practice nurses are able to recognize patients with psychiatric morbidity. This paper reports a study to determine the abilities of 24 practice nurses to detect psychiatric morbidity in patients attending their clinics. METHODS: Twenty-four practices were randomly selected from 41 practices recruited from South London and Kent. One nurse per practice took part in the study. Patients were asked to complete a 12-item General Health Questionnaire (GHQ-12) while waiting for their appointment with the practice nurse. Following their consultation, the practice nurse rated the patients' level of psychological distress on a five-point rating scale. RESULTS: The response rate of patients was 97% (N= 1710). The GHQ case rate was 36%. The mean detection rate by practice nurses when identifying significant distress was 16% (between nurse variation, 0% to 61%). The mean specificity was 96% (variation 77% to 100%). A second analysis, changing the nurse criterion to recognition of distress increased the mean sensitivity rate to 58% (variation 31% to 84%) but the mean specificity rate decreased to 66% (variation 26% to 95%). CONCLUSIONS: These results demonstrate that practice nurses' caseloads include a high proportion of patients with psychiatric morbidity and that agreement with the GHQ classification of psychiatric morbidity is modest. Therefore, training in detection will be crucial for the nurses.

Adolescent↗
PubMed1997

A controlled comparison of the ability of practice nurses to detect psychological distress in patients who attend their clinics.

This study aimed to compare the ability of practice nurses in two groups of general practices to detect psychological distress in patients attending their clinics. Practice nurses in Britain are employed directly by general practitioners (GPs) and carry out their duties mainly in treatment rooms in GP's practices. The number of practice nurses has increased rapidly since the mid-1970s; recent estimates put the total between about 15000 and 18000. Most psychiatric disorders that come to medical attention do so initially within a primary care setting. In Britain, 98% of the population is registered with a GP and 70% of these people will consult their doctor in a given year. In the early 1990s the WHO found a 24% prevalence of current mental disorder in users of general health care. A further 9% of patients had significant and/or disabling symptoms but did not reach the threshold criteria for a confirmed diagnosis of mental disorder. Although published reports of surveys of practice nurses have shown varying degrees of involvement in mental health care, it is thought to be important that they become agents of detection of mental health problems because these nurses are in contact with a wide range of vulnerable people. Armstrong (1994) found that informants in a survey thought that practice nurses needed additional training in three main areas of mental health care: recognition followed by appropriate referral and on-going care of people with depression and anxiety; primary prevention of depression; and care in the community for people with serious long-term mental illness. The study briefly reported here measured practice nurses' detection of mental health problems. Results showed that practice nurses detect about 23% of those identified as cases using the General Health Questionnaire (GHQ). Testing of agreement between nurses and patients using Cohen's (1960) kappa showed a low level of agreement between nurses and patients concerning psychological distress.

Attitude of Health Personnel↗
PubMed1994

Occupational stress amongst care staff working in nursing homes: an empirical investigation.

A questionnaire survey of care staff in nursing homes examined staff stress. Staff completed questionnaires covering Type A behaviour, job satisfaction, psychological well-being, relaxation behaviour, coping skills and demographic details. A specific measure of nursing home stress was developed following a pilot study. From a total sample of 375, 112 (30%) responses were obtained. On the stress questionnaire the major stressors were found to be 'unsatisfactory wages', 'shortage of essential resources', 'not enough staff per shift', 'feeling undervalued by management', 'lifting heavy patients' and 'working with colleagues who are happy to let others do the work'. Factor analysis of stress questionnaire responses identified five major stress groupings. These were, 'differing expectations about patient care', 'management factors', 'lack of support from other staff', 'feeling inadequately trained to deal with job demands' and 'home-work conflicts'. Examination of stress outcomes showed that many staff were under pressure, with high levels of smoking and alcohol intake. Given the increasing importance of nursing home care for the elderly the present study is timely. The implications of the findings for further research, and for the training of staff in nursing homes are considered.

Adult↗