Individual Wards Research Articles

A comparison of care in private nursing homes, geriatric and psychogeriatric hospitals

AbstractThere is considerable debate about who should provide long‐term institutional care for the elderly.We describe and compare care in three private nursing homes, 12 long‐term geriatric and 10 psychogeriatric hospital wards which service a Scottish city using measures of patient dependency, patient morale, regime, environment and staff morale.There was overlap of phsyical dependency between geriatric and psychogeriatric wards but lower dependency in nursing homes. There was a high prevalence of cognitive impairment in all sectors (<80%) limiting the use of patient self‐report measures, but nursing home patients were more satisfied with staff than geriatric patients (p < 0.05).Nursing home staff had greater job satisfaction than geriatric (p <0.01) or psychogeriatric (p < 0.05) staff.There were large variations between homes and between wards in measures of regime and environment, with overlap of most measures between the three settings, suggesting that where care is provided is less important than how it is shaped at the level of individual homes and wards.

Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures.

The strain of methicillin-resistant Staphylococcus aureus (MRSA) prevalent in south-east England produced in one acute hospital in a year 40 infections (bacteraemia, pneumonia and surgical wound, skin and urinary tract infections) with three attributable deaths. Rigorous measures succeeded in controlling the outbreak despite its extent, but our results suggest that less stringent measures could fail to control outbreaks of this scale. Several subsequent localized outbreaks within the hospital, probably caused by separate re-introductions of MRSA from other hospitals, were controlled by re-instigation of control measures on individual wards. The overall success of the intervention was shown by the decline in the incidence of MRSA infections from 27 in the 6 months beforehand to 2 in the most recent 6 months, and by the decline in the prevalence of colonization among patients 10 or more days in hospital from 52% immediately before the intervention to 3% 7 months after it. The incidence of attributable morbidity and death without control measures warrants a concerted effort to tackle the epidemic in all affected hospitals in Britain.

Nosocomial infections on nursing units with floors cleaned with a disinfectant compared with detergent

Nosocomial infections on eight acute care nursing units in a tertiary care hospital was compared between two 3-month periods in which floors were cleaned with either disinfectant or detergent. Personnel performing infection surveillance were unaware of the cleaning product used. Surface cultures from selected floor sites were obtained at 3 and 6 months to assess microbial contamination. The combined nosocomial infection rate for the eight wards did not differ between disinfectant ( 8·0 100 patient discharges) and detergent ( 7·1 100 ). For individual wards, a significant difference in nosocomial infection rate between the two periods was observed in only one ward, favouring the detergent. No differences in floor contamination were observed.

The Evolution of a Public Guardianship Program

The available literature on guardianship suggests that this legal device has a poor benefit/burden ratio for individual wards, yet there are 11,147 persons allegedly in need of a guardian in Florida. Florida has begun to test a public guardianship response to this need. Florida's comparison of volunteer and professional models of public guardianship suggests that volunteers are no panacea to guardianship problems. Public guardianship programs risk the self-aggrandizing position of both petitioning for adjudication of incompetency and serving as guardian, the conflict-of-interest position of being part of a social service agency, inadequate staffing and funding, and vague guardianship criteria and lax procedures.

Determining differential costs of psychiatric care in a VA hospital.

This study reports the methodology developed to obtain more meaningful cost data in a VA psychiatric hospital. The VA cost-accounting system provides specific cost data for two major groups of patients: the psychiatric medically infirm (chronic long-term patients with significant physical disabilities who primarily need medical rather than psychiatric care) and all other psychiatric patients. A method was developed to redistribute costs more realistically to individual wards, and to relate them meaningfully to classification of patients and treatment programs. Differential costs are discussed as they relate to evaluation of programs for the delivery of mental health care.

Structural Variations in Iron Meteorites

SEVERAL authors1–4 have drawn attention to the possibility that slight variations of composition and structure may be present within the original meteoroid mass which produced the Barringer crater and the Canon Diablo iron meteorites. Transition between regions rich and poor in cohenite, (FeNi)3C, is not uncommon in large sections of this meteorite, but we now draw attention to a transition of structure from a well developed Widmanstatten to a granular pattern in a 1,235 g individual (Wards Natural Science Establishment No. 34,4,678) which does not contain macroscopically visible inclusions of cohenite.

FROM CUSTODIAL CARE TO INTENSIVE TREATMENT OF THE GERIATRIC PATIENT*

AbstractThe Mental Health Institute at Independence, Iowa, as part of a progressive State mental health program, made substantial gains in treatment of the mentally ill, with a marked reduction in the average daily census even though the admission rate had increased. Because of limited funds, however, the treatment of geriatric patients did not approach the progress made in other areas of the hospital. In 1966, with the aid of a grant from the National Institute of Mental Health, the intensive treatment of geriatric patients became a reality. The staff was strengthened in all disciplines and a fully equipped physiotherapy department was added to the geriatric unit. Whereas previously all patients over 65 were admitted to psychiatric units, under the new plan these patients were admitted directly to the geriatric unit. There they received a complete medical and psychiatric review before being assigned to one of two areas within the unit. In one area were the patients who had potential for making substantial gains with intensive psychiatric treatment (group and individual therapy, ward government, remotivation techniques, occupational therapy and other activity therapies such as music, recreation, adult education and homemaking services, as well as intensive case work by experienced social workers). In the second area were the patients who were markedly regressed and organically deteriorated; even some of these showed enough improvement to be transferred to the more intensive unit. Patients unable to benefit from intensive treatment were transferred to nursing homes. Under the new regimen, the discharge rate for geriatric patients increased from 36 per cent to 59 per cent, and the discharge rate to their homes from 28 per cent to 47 per cent. The average length of stay in the hospital was markedly reduced from 112 days to 65 days.

Evaluating Nursing Care in a Mental Hospital

Dorothy V. Wheeler, director of the Veterans Administration Nursing Service during the turbulent postwar period, had to say about the measurability of quality nursing In keeping with this philosophy, an attempt was made-as part of the annual review and appraisal of the Brockton VA Hospital nursing service-to ascertain the quality of nursing care being given on the individual wards of this 950-bed mental hospital. The guiding philosophy of this ward evaluation, carried out in 1960, was: Insofar as a ward meets the standard of nursing care as defined by nursing service administration, it will be considered to have a comparable rating of quality nursing care. The authors are aware that this is an a priori approach but, in the absence of established functions and standards for psychiatric nursing, decided to get on with finding how it can be measured.

The detection of cholera vibrios in Calcutta waters: the River Hooghly and canals.

1. Before undertaking a bacteriological survey of the waters of the Hooghly River and the associated canals a detailed epidemiological study over the past 20 years of cholera, as it affected the individual administrative wards of Calcutta, was undertaken. Sampling points were selected in accordance with the results of this study. Samples of water from the various points were collected at intervals extending from December 1958 to August 1959 in 2½–5 l. amounts. The whole sample in each case was filtered through special filter pads. The pads were first cultured in an enrichment medium from which plate cultures were subsequently made for colony isolation, serological and biochemical examination.2. The sampling points on the canals were all adjacent to areas where the local endemicity was judged to be high; other points were by bathing ghats, etc. A total of eighty-nine samples covering all the sampling points were examined and Vibrio cholerae were isolated from twelve of these samples, eight of which came from twenty-six samples collected from two sampling points on the Chetla and Circular Canals, respectively.3. The positive isolations were spread fairly evenly over the whole period of the study which covered both epidemic and non-epidemic periods including the monsoon. Although the incidence of cholera in Calcutta may fall to a low level during non-epidemic periods cases continue to occur throughout the year and the relationship of the maintenance of the infection in the city to the continuous potential infectivity of the open natural waters of Calcutta is discussed.