Using work sampling to investigate staff time allocation in community mental health centers.
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Biomedical subjects
Publications and source records attributed to S Caverly.
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OBJECTIVE: The study attempted to develop a brief and integrated set of reliable and valid outcome measures that could be used by both consumers and providers to assess the quality of public mental health care. METHODS: A model of outcomes in four domains-consumer satisfaction, functioning, quality of life, and clinical status-was developed from the literature and from the priorities expressed by members of an advisory group of stakeholders. Based largely on extant measures, a consumer survey and a case manager survey were then created to assess these domains. A total of 236 adult consumers of mental health services from six community mental health centers in Washington State were surveyed. The four-item case manager survey to rate consumers' clinical status was completed by 163 of the participants' case managers. Scores and ratings on the survey were analyzed using correlational analysis and principal components analysis to determine whether the data provided empirical support for the four-domain model. RESULTS: Principal components analysis demonstrated support for the four-domain model. Internal consistency of the outcome indicators was adequate, and their concurrent validity was partly supported. CONCLUSIONS: The described outcome measures provide a practical, empirically supported structure for monitoring and improving public mental health services.
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A criticism sometimes made of nurse practitioners is that they want to be or think they are doctors. Who has not heard a nurse administrator accused of having lost her nursing identity, or of a faculty person who no longer knows nursing? Before BSN degrees were common, there were stories of 4-year nurses who believed they were above providing direct care and identified only with the administrative roles on the unit. These criticisms have been made by nurses. It is only recently that nurses are recognizing that fragmentation of the profession along these and other lines disempowers us and may result in non-nurses delineating what our practice will be. Perhaps stimulated by the nursing shortage and an increased awareness of our collective power, nurses are more vocal and we are owning our identity as nurses. Psychosocial nurses, perhaps because of conflicts related to professional territory with psychiatry, psychology, and social work, or because of the ramifications of third party payments, are less likely to assume the generic title of "therapist" than in the past. More often, there seems to be a coming together of psychosocial nurses with each other and with the nursing community as a whole. This coming together enhances the potential for nurse-to-nurse communication and sets the stage to allow nursing to become the bridge needed by consumers of mental health services. I am hopeful that psychosocial nursing will meet this challenge.
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