Mental Illness and Chronic Disease in a Random Sample of Newly-Arrived Refugees and Immigrants to the U.S.

The goal of this research is to examine the prevalence of chronic diseases [Hypertension, Heart diseases, Asthma and Diabetes] among newly arrived refugees and immigrants to U.S., to predict the risk factors for each of the four chronic diseases studied, and to discuss whether self-reported mental illnesses [Depression and PTSD] have an impact on the occurrence of chronic diseases

Unemployment in Iraqi Refugees: The Interaction of Pre and Post-Displacement Trauma

Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2 years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee\u27s country of origin

Specific Trauma Subtypes Improve the Predictive Validity of the Harvard Trauma Questionnaire in Iraqi Refugees

Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12 and 10 %, respectively) than did the cumulative trauma index (7 and 3 %, respectively). Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations

Kidnapping and Mental Health in Iraqi Refugees: The Role of Resilience

Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms

Violence towards health care personnel : prevalence, risk factors, prevention and relation to quality of care

This thesis investigates the prevalence and nature of violence towards health care personnel and its implications for quality of care. The research presented here is based on a comprehensive perspective of violence as an occupational issue that may have negative consequences for health care personnel, health care organizations, and for the quality of care that they provide. Data from a total of eleven different studies were used in the analyses. The first study was based on a representative national sample of registered nurses, the largest group of health care personnel in Sweden. The Örebro Regional Hospital (RSÖ) was the site of four surveys of the work environment of hospital staff, and three surveys of patients' views of the quality of care. A controlled, longitudinal intervention study concerning workplace violence was carried out at 47 health care work sites in the greater Stockholm area and was the source of three data sets. Two instruments have been developed within the framework of this thesis. The first is the Violent Incident Form (VIF), a practical instrument for the registration of violent incidents in health care environments. The second instrument is the Quality of Care Patient Questionnaire, which measures quality of care from the patient perspective, including patient's views of the staff s work environment. This thesis uses a broad definition of violence that includes verbal threats and aggression in addition to physical violence. Standard epidemiological methods of measurement were used to identify risk factors and risk groups for violence. Approximately 30% of nurses in the representative national sample had been victims of violence at some time in their nursing career. Those nurses working with psychiatric or geriatric patients were at increased risks for violence at work. Compared to this national sample, standardized prevalence ratios for violence were significantly higher for general hospital nursing personnel and physicians. Standardized incidence rates were highest for practical nurses. Experience with violence at work was significantly associated with lower staff ratings for mental energy, work efficiency, participation in work processes and decisions, and with higher work load/stress ratings. Staff experience with violence was also an important (inverse) predictor of a positive overall quality grade from patients. Results from the longitudinal, structured intervention project for dealing with violence indicate that regular registration and review of violent events may be an effective method for increasing understanding of violence in health care settings. Violence towards health care personnel may have significant implications for the quality of care that health care organizations provide. Improving the work environment of health care personnel and their influence over work processes may have an attenuating effect on violence, and a favorable impact on patient ratings of the quality of care

Violence towards health care staff and possible effects on the quality of patient care

Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.Violence Health care workers Quality of care Patient satisfaction

The impact of an educational intervention on nursing staff ratings of quality of older people care: A prospective, controlled intervention study

Background: Low competence levels among nursing staff have been associated with lower quality of older people care. However, interventions to improve staff competence have not always been evaluated for their impact on the quality of older people care. An educational intervention in the form of a workplace "toolbox" was shown to have positive effects oil nursing staff competence and work satisfaction, but had no effects on care recipients' or their family members' ratings of quality of care. It was therefore of interest to investigate whether the intervention had any effect on nursing staff ratings of quality of care. Objectives: The aim of the Study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of quality of care. Design: A prospective, non-randomized, controlled intervention. Participants and settings: Nursing staff in two municipal older people care organizations in Sweden. Methods: Practical instruments and educational materials for improving staff competence and work practices were collated in a workplace "toolbox" and introduced in the intervention organization in February of 2003. Nursing staff ratings of quality of care were measured pre- and post-intervention by questionnaire and compared to nurses' quality ratings in a reference organization, where no toolbox was introduced. Results: Nursing staff ratings of quality of care improved significantly over time in the intervention organization. No improvements were found in the reference organization. Conclusions: Compared to a reference municipality, nursing staff ratings of quality of care improved in the organization where the toolbox was introduced. Competence development Measures may have a positive impact on nursing staff's ratings of quality, but not on the quality ratings of care recipients and their family members. Further research is needed to understand the differences in these stakeholders' perceptions. (C) 2008 Elsevier Ltd. All rights reserved

Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes

Aims. The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home-based care; and (2) to examine determinants of work satisfaction in both care settings. Background. The shift in older people care from hospitals to community-based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home-based care. Design. A cross-sectional questionnaire survey. Methods. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. Results. In general, staff in home-based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work-related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work-related exhaustion was the strongest (inverse) predictor of work satisfaction. Conclusions. Future interventions should focus on counteracting work-related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work-related exhaustion and lack of competence development may have significant negative implications for work satisfaction among older people care nursing staff in both home care and nursing homes

A comparative study of nursing staff, care recipients and their relatives’ perceptions of quality of older people care

Background. Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement. Aim. The aim was to compare staff, older care recipients' and their relatives' quality of care ratings. Design. Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level. Methods. Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups. Results. Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff. Conclusions. Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations. Relevance to clinical practice. Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care