Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Study of selected factors affecting the communication process employed by general staff nurses in eight… Taylor, Elizabeth Ann 1970

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Notice for Google Chrome users:
If you are having trouble viewing or searching the PDF with Google Chrome, please download it here instead.

Item Metadata

Download

Media
831-UBC_1970_A5_7 T39.pdf [ 3.77MB ]
Metadata
JSON: 831-1.0102005.json
JSON-LD: 831-1.0102005-ld.json
RDF/XML (Pretty): 831-1.0102005-rdf.xml
RDF/JSON: 831-1.0102005-rdf.json
Turtle: 831-1.0102005-turtle.txt
N-Triples: 831-1.0102005-rdf-ntriples.txt
Original Record: 831-1.0102005-source.json
Full Text
831-1.0102005-fulltext.txt
Citation
831-1.0102005.ris

Full Text

A STUDY OF SELECTED FACTORS AFFECTING THE COMMUNICATION PROCESS EMPLOYED BY GENERAL STAFF NURSES IN EIGHT HOSPITALS IN REFERRING PATIENTS WITH A LONG-TERM ILLNESS TO THE COMMUNITY SETTING by ELIZABETH ANN TAYLOR B.Sc.N., University of Western Ontario, 1966 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in the School of Nursing We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA April, 1970 In presenting th i s thes i s in pa r t i a l f u l f i lment of the requirements fo r an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make i t f r ee l y ava i l ab le for reference and study. I fu r ther agree tha permission for extensive copying of th i s thes is fo r scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It i s understood that copying or pub l i ca t ion of th i s thes is fo r f i nanc i a l gain sha l l not be allowed without my wr i t ten permission. Department of The Univers i ty of B r i t i s h Columbia Vancouver 8, Canada ABSTRACT This study was prompted by concern for the method of promoting continuity of care for persons discharged from hospital. Descriptive in design, the purpose of the study was to examine selected factors affecting the communication process employed between general staff nurses In hospitals: and personnel in community agencies with regard to the referral of patients with a long-term illness from the hospital to the community setting. The data were gathered by means of a self-administered questionnaire, designed to seek Information related to each of the study's three hypotheses. It was completed by f i f t y -seven general staff nurses on selected nursing units of eight general hospitals in and near Vancouver, British Columbia. The units were chosen on the basis of the aver-age number of patients with a long-term illness usually present on the unit. From analysis of the data the following conclusions were drawn. Although general staff nurses who participated in this study could recognize needs in patients which Indicate the necessity for referral to community resources, they did not appear to have an adequate knowledge of ava i l -able community agencies. When these nurses made referrals, the lines of communication used were frequently indirect. 69 pages TABLE OF CONTENTS CHAPTER PAGE I. INTRODUCTION . . . . 1 Background of the Study 1 Statement of the problem 1 General aim 2 Specific aims 2 Basic concerns in the development of the study 2 Definition of terms 4 Chronic illness 4 Long-term illness 4 Comprehensive patient care 4 Community agency 5 Community resources 5 Health care needs 5 Self-administered questionnaire . . . . 6 Hypotheses to be tested 6 Limitations of the study 6 Overview of the Remainder of the Study . . . 7 II. REVIEW OF THE LITERATURE 8 Prevalence of Long-Term Illness 8 Comprehensive Care 9 The Role of the General Staff Nurse in the Hospital 11 iv CHAPTER PAGE The Role of the Public Health Nurse 12 The Referral Process 13 Summary 16 III. DESIGN AND METHODOLOGY 17 Selection of the Study Group 17 Sample selection 17 Interviews 18 The Self-Administered Questionnaire 18 Purpose 18 Construction 19 Pre-test 22 Administration 22 Method of Data Analysis . 23 'Summary 23 IV. ANALYSIS OF THE DATA 24 Summary of the Personal Data 24 Analysis in Relation to Hypothesis I . . . . 28 Analysis in Relation to Hypothesis II . . . . 32 Analysis in Relation to Hypothesis III . . . 34 Summary 39 V. SUMMARY, RECOMMENDATIONS, AND AREAS FOR FURTHER INVESTIGATION 42 Summary 42 Recommendations 43 Areas for Further Investigation 44 V CHAPTER PAGE BIBLIOGRAPHY 46 APPENDIX A. Information Relating to the Eight Hospitals Selected for Use in the Study, Expressed in Terms of Bed Capacity, Availability of a Social Worker, and Availability of a Public Health Nurse 50 APPENDIX B. The Questionnaire Employed in the Study 52 APPENDIX C. The Responses of Fifty-Seven General Staff Nurses in Hospitals Related to Specific Items in Six Categories of Patient Needs Expressed in Frequen-cies and Percentages 65 LIST OF TABLES TABLE PAGE I. Age Range of Respondents Expressed i n Total Numbers and Percentages . . . . . . . . 25 II. Level of Nursing Education of Respondents Expressed i n Total Numbers and Percentages . 25 III. Place Where Nursing Education of Respondents was Received Expressed i n Total Numbers and Percentages 26 IV. Length of Time Respondents have Occupied Present Nursing Position Expressed i n Total Numbers and Percentages 26 V. Previous Nursing Experience of Respondents Expressed i n Total Numbers and Percentages . 27 VI. Categories of Needs Ranked i n Order of Importance by Fifty-Two of the Respondents Expressed In Total Numbers and Percentages . 31 VII. Opportunities f o r Respondents to Make Patient Referrals Expressed i n Total Numbers and Percentages 40 VIII. Information on Feedback from Patient Referrals Received or Desired by Respondents Expressed i n Total Numbers and Percentages 40 1X3• Sources from Whom Feedback on Unit Referrals was Received Expressed In Total Number and Percentage of Times Each was Mentioned . . . 41 LIST OF FIGURES FIGURE PAGE 1. Percentage of Heeds Mentioned i n Each Category . 3$ 2. Number of Community Agencies Listed Under Each Category 33 3 . Channels Through Which Referrals Could be Made 35 4 . Methods By Which Referrals Could be Made . . . . 3 8 ACKNOWLEDGEMENTS I wish to express my gratitude to the following persons for making this study possible: the Directors of Nursing, or their Assistants, of the nine hospitals used in this study for their help in arranging for the administration of the questionnaire; the nurses from these hospitals who responded to the questionnaire; Miss Elizabeth Cawston and Miss Maude Dolphin, the members of my committee, for giving so generously of their time, and for their encouragement and constructive suggestions especially in relation to methodology and data analysis, and to Dr. Floris King, my committee chairman, for the many hours she spent reviewing each phase, and for her continued interest and support throughout the duration of the study. CHAPTER I INTRODUCTION Co-ordination or fragmentation of services offered by community agencies i s governed by the effectiveness of the interagency communication system. While employed as a public health nurse, the writer was acutely aware of a lack of continuity in care for per-sons discharged from the hospital to the community. It was evident that many of these persons were in need of follow-up health care. Often the di s t r i c t nurse was not aware of these individuals unless she came In contact with them accidently. If nurses were really concerned about the patient as a total person, functioning within a family and community setting, they should promote a greater under-standing and co-operation among their colleagues working in a variety of health settings. I. BACKGROUND OF THE STUDY Statement of the Problem An effective referral system ,from the hospital to the community i s v i t a l i f the individual patient and his family are to receive the continuing care they deserve, in relation to a variety of health needs. The basis of such a referral system i s the communication process employed 2 between personnel in the hospital and the community. Fac-tors affecting this process may well assist in determining the quality of continuing care the patient and his family w i l l receive. General Aim The general aim of this study was to explore selected factors affecting the communication process em-ployed by general staff nurses in hospitals in referring patients with a long-term illness to the community setting. Specific Aims The effectiveness of the referral system employed between general staff nurses in hospitals and personnel in a variety of community agencies was explored in relation to three areas: (1) the specific needs of the hospitalized patient which indicated the necessity or desirability of referral to another community agency, (2) the specific knowledge general staff nurses in hospitals had in relation to community resources, and (3) the number of referrals actually made by general staff nurses in hospitals to com-munity agencies; through whom they were made, and the kind of feedback they received. Basic Concerns in the Development of the 3tudy A search of the literature pertaining to factors 3 a f f e c t i n g the paucity of r e f e r r a l s from the h o s p i t a l to the public health nurse or other personnel i n community agencies revealed much had been written on home care pro-grams and hospital-based l i a i s o n public health nurses. Unfortunately, up to that time, i t appeared that many hospitals did not have such programs or nurses, yet several patients required continuing care following discharge from h o s p i t a l . There were indica t i o n s that the r e l a t i o n s h i p between a h o s p i t a l and the community was changing. Mo longer was the h o s p i t a l an i s o l a t e d agency apart from the community, but rather one of a number of agencies d e l i v e r i n g health care."** The patient was seen as both an i n d i v i d u a l and a member of several groups, the most important of which was the family unit. He was not alone i n h i s s u f f e r i n g , but t i e d to other i n d i v i d u a l s through some kind of r e l a t i o n -2 ship. These others could have a s i g n i f i c a n t bearing on h i s attitude and adjustment to h i s i l l n e s s . To o f f e r the i n d i v i d u a l and h i s family the wide range of services available to them, communication between Edwin L. Crosby, "Co-ordination or Fragmentation?" Nursing Outlook, XI (January, 1 9 6 3 ) , p. 42. 2 Minna F i e l d , Patients Are People (New York: Colum-bia University Press, 1967), p. 201. 4 the h o s p i t a l and other community agencies was required. It was t h i s communication process which was studied i n t h i s t h e s i s . D e f i n i t i o n of Terms For an understanding of the terms used i n t h i s study, they were defined as follows: Chronic i l l n e s s . An i l l n e s s " persisting f o r long periods of time without change or with only extremely 3 slow pr o g r e s s i o n . M > Long-term i l l n e s s . The term encompasses: a l l impairments or deviations from normal which have one or more of the following c h a r a c t e r i s t i c s : are permanent; leave residual d i s a b i l i t y ; are caused by non-reversible pathogenic a l t e r a t i o n s ; require s p e c i a l t r a i n i n g of the patient f o r r e h a b i l i t a t i o n ; may be expected to require a long period of supervision, observation or care.^ In t h i s study the terms long-term I l l n e s s and chronic i l l n e s s were used interchangeably although i t was recognized that i n many instances a long-term i l l n e s s i s not necessarily a chronic one. Comprehensive patient care. This i s defined as: ^Dorland's Pocket Medical Dictionary (Philadelphia: W.B. Saunders Company, 1959), p. c-30. ^Frank Reynolds and Paul Barsam, Adult Health: Ser- vices f o r the Chronically 111 and Aged (New York: The Macmillan Company, 1967), p. 1. 5 the exercise of s k i l l and judgement in the integration of the various services required to meet the needs of individual patients. It demands attention to emotional and social as well as physical factors and continuing supervision of the patient in c l i n i c , hospital or home during each episode of illness for sufficient time to bring him through convalescence and rehabilitation, i f such i s possible, to an optimal state of health and productivity and to maintain him In it.5 Throughout the literature the terms comprehensive patient care, continuing patient care, and total patient care were used interchangeably. For the purposes of this study the three terms were considered to be similar in meaning, although i t was recognized they are not necessar-i l y synonymous. Community agency. An organization that has as one of i t s purposes the offering of specialized service or services to the surrounding community. Community resources. The wide variety of agencies which offer services to the residents of a community. Health care needs. Needs arising from a patient's condition which indicate the necessity of medical, nursing, economic, or counselling services offered by community agencies, in order that he may function at his optimum ^George G. Reader and Mary Goss (ed.), Comprehensive  Medical Care and Teaching (Ithaca, New York: Kingsport Press, Inc., 1967), p. 2. 6 level in his home environment. Self-administered questionnaire. A questionnaire which is completed by the respondent in the presence of the researcher. Hypotheses Tested Three hypotheses were tested in the study: 1. General staff nurses in hospitals can recognize needs of patients which indicate the necessity for referral to community resources. 2. General staff nurses in hospitals lack knowledge of community resources which can be a contribut-ing factor in the lack of referrals Initiated by hospital staff nurses to community resources. 3. General staff nurses in hospitals, in making refer-rals, use lines of communication which are fre -quently Indirect. Limitations of the Study There were recognized limitations to the study: 1. There was l i t t l e background literature directly related to the study's purpose, and no studies could be located that were concerned specifically with the problem under investigation here. 2. The study was conducted In eight hospitals located 7 in or near one large city and i t would be d i f f i -cult to generalize from the results. 3. The data were collected using an open-ended ques-tionnaire. Parts of the analysis were necessarily subjective. II. OVERVIEW OF THE REMAINDER OF THE STUDY Chapter I I contains a review of literature; Chapter III discusses the design and methodology used in the study; Chapter IV presents the results obtained from the data, and Chapter V contains the summary, recommendations, and areas for further investigation. CHAPTER II REVIEW OF THE LITERATURE There was a lack of literature directly related to the communication process employed in referring patients from hospitals to other community agencies. However there appeared to be an awareness of the increasing number of persons in the community suffering from some kind of long-term i l l n e s s , and the need for effective interagency communication to u t i l i z e more f u l l y the variety of services offered to these people. The review of the literature was discussed under the following headings: prevalence of long-term illn e s s ; com-prehensive care; the role of the general staff nurse in the hospital; the role of the public health nurse; and aspects of the referral process. Prevalence of long-term il l n e s s . In 1956, a study conducted by the World Health Organization found that three-quarters of the people suffering from chronic illness were between the ages of sixteen and sixty-five, with more than half of these under the age of forty-five. Typically they James M. MacKintosh, "Matching F a c i l i t i e s to Needs of Long-Term Patients," Hospitals, XL (April 16, 1966), p. 85. 9 were patients who because of age, I l l n e s s , injury or mental or physical d i s a b i l i t y required medical, nursing, or sup-2 portlve care f o r a prolonged period of time. At the same time, i n the United States, the Committee on Chronic I l l -ness concluded 3.5 per cent of the t o t a l population suf-fered from some type of chronic i l l n e s s . Of these 61 per 3 cent were under s i x t y - f i v e years of age. These figures were based on the 1950 United States population census, and were the l a t e s t a v a i l a b l e f i g u r e s . Unfortunately there were no accurate figures available on the prevalence of chronic i l l n e s s i n Canada. Comprehensive care. Behind the concern of the need f o r better patient r e f e r r a l l a y the concept of comprehen-sive care f o r a l l c i t i z e n s of a community, with any kind of health need. To think of the h o s p i t a l as only one of several supportive agencies concerned with providing contin-u i t y of care, rather than considering i t as being apart from the surrounding environment, helped to put i t i n a more r e a l i s t i c perspective. In 1963, Crosby wrote: Developing P o l i c i e s and Procedures f p r Long-Term  Care I n s t i t u t i o n s (Chicago: American Hospital Association, 1958), p. 5. 3 ^Commission on Chronic I l l n e s s , Care of the Long-Term Patient (Vol. II of Chronic I l l n e s s i n the United  States. 4 vols.; Cambridge: Harvard' University Press, 1956), pp. 6-7. 10 the h o s p i t a l has long since ceased to be an i s l a n d . It has become an i n t e g r a l part of the t o t a l community health, and, I believe, we s h a l l see other health services and agencies . . . integrated into t h i s pat-tern, each bearing i t s own share of r e s p o n s i b i l i t y f o r provision of care.4 At the same time, nursing was adopting a new and broader outlook. The Canadian Nurses' Association stated that nursing care: Is concerned with a person's past and future as well as the present, and reaches out to co-operate with other groups i n the community which contribute to health and well-being. . . . Hospital, home and com-munity can complement each other i n a comprehensive health programme provided there i s a set plan f o r continuity of care to co-ordinate t h e i r e f f o r t s . * In an a r t i c l e dealing with comprehensive care as a r e a l i s t i c nursing goal, Brackett and Fogt outlined s i x guiding statements i n r e l a t i o n to defining the term compre-hensive nursing care. One of them was p a r t i c u l a r l y p e r t i -nent to t h i s study: The patient and h i s family are informed of the nursing needs he w i l l have a f t e r discharge from the h o s p i t a l , and either are given i n s t r u c t i o n necessary to provide safe and e f f e c t i v e nursing care or are assisted i n receiving continuing nursing through the proper health agency." ^Edwin L. Crosby, "Co-ordination or Fragmentation?" Nursing Outlook, XI (January, 1963), p. 42. 5 ^Continuing Care: The Nurse and Community Resources (Ottawa: The Canadian Nurses' Association, 1962), p. 4. ^Mary E. Brackett and Joan R, Fogt, "Is Comprehensive Nursing Care a R e a l i s t i c Goal?" Issues i n Nursing, B. Bullock and V. Bullock, editors (New York: Springer Publish-ing Company, Inc., i960), p. 133. 11 Authors like the ones cited above obviously were concerned with meeting a l l of a person's health needs, regardless of whether he was in an institution or his own home. As Smith observed: Citizens in a democracy have a right to expect that every effort that can contribute to their progress in illness and their satisfaction in being kept alive w i l l be part of their health services.' The role of the general staff nurse in the hospital. Within the hospital someone must assume the responsibility for seeing that patients received the continuous care they deserved. In this regard the general staff nurse in the hospital appeared to be a key person. It was she who was with the patient daily, and therefore should be in a good position to recognize his many health needs during hospital-ization, and ones that would continue after his discharge to the community setting. Smith examined the process of continuity of nursing service for chronically i l l patients. She recognized the need for hospital nurses to project their thoughts and planning beyond the patient's discharge. She stated: I believe the hospital nurse has a distinctive oppor-tunity and important responsibility in giving conscious *Mary Straub and Kitty Parker (eds.), Continuity of  Patient Care: The Role of Nursing (Washington: The Catholic University of America Press, I960), p. 68. 12 consideration to what patients may need in discharge and follow-up care. 8 Unfortunately i t i s very often questionable i f nurses realize they have this responsibility to heed the patient's and family's concern and apprehension about his care after discharge, and to participate in planning for his care once Q he has l e f t the hospital. The role of the public health nurse. Because the public health nurse i s in a unique position to be aware of the various community agencies and their functions, she appeared to be an ideal person to bridge the apparent gap between the hospital and other community agencies. Support for this idea was found in current nursing literature. According to.an a r t i c l e by Whalstrom: the responsibility of helping the patient back into the community as a participating member belongs to many persons. Nevertheless, the key professional , Q person in the community i s the public health nurse. A similar viewpoint was expressed by Wolff: A function of the public health nurse, always empha-sized, seldom challenged, i s that of liaison between the helping professions of a community. She i s in an ideal position to f i l l this role. At the forefront ^Ibid., p. 69. ^Byrdice Tarns, "Continuity of Patient Care," Blueprint  for Action in Hospital Nursing (New York: National League for Nursing, 1964), p. W* ^°E. Dorothy Whalstrom, "Initiating Referrals: A Hospital Based System," American Journal of Nursing, LXVII (February, 1967), p. 335. 13 of human r e l a t i o n s , she reaches into homes, schools, c l i n i c s , and ind u s t r i e s . She i s well equipped to carry messages about services available i n the com-munity and to steer people through the maze and net-work of complex, i n t e r r e l a t e d , and sometimes un-related s o c i a l organizatIons.il In t h i s same regard Dahlin wrote: i t i s frequently the public health nurse working i n the community who can e a s i l y recognize health devia-tions and t h e i r implications, who can f i n d out the patient's medical status, and who has knowledge of the health supporting services that are needed and , 2 how they may be mobilized to the patient's benefit. The r e f e r r a l process. The transfer of information, e s s e n t i a l to the concept of continuity of eare, i s made possible by the process of communication, which may be defined as: the transfer of information from one person to another . . . i t i s the means by which organized a c t i v i t y i s u n i f i e d . . . behavior i s modified, change i s effected and goals are achieved. 1-* The communication system i s the v i t a l l i n k between a l l of the agencies and services existing i n a community. Both h o s p i t a l and public health nurses must be com-mitted to the goal of achieving continuing care f o r persons 1 : L I l s e S. Wolff, " R e f e r r a l — A Process and a S k i l l , " Nursing Outlook, X ( A p r i l , 1962), p. 253. 12 Bernice Dahlin, "Rehabilitation and the Assessment of Patient Need," The Nursing C l i n i c s of North America, I (1964), p. 385. 13 •^Harold Koontz and C y r i l 0'Donne 11, P r i n c i p l e s of Management: An Analysis of Managerial Function (New YorkT McGraw-Hill Book Company, 1968), p. 590". 14 with a variety of needs. As Lewis stated: nursing staffs must honestly believe that continuity of care for patients i s in the patient's best inter-est and that nursing has a responsibility to work in achieving it. 1**-In describing a referral program set up in a veteran's hospital, with a public health nurse as co-ordinator, Whalstrom reported: increased contact between hospital and public health nurses demonstrates this common aim: to promote health and assist each patient to the maximal use of his mental and physical a b i l i t i e s so he can live as a happy person as long as possible.15 The relationship between these two types of nurses can be a viable one, as pointed out by Beghtel and Akins in their report of a home care program in Indiana. As a result of improved interagency communication: a closer relationship between the public health and the hospital nurse has been realized. The public health nurse i s more aware of current nursing proce-dures, changing hospital techniques, and therapeutic measures; the hospital nurse broadens her knowledge of improvisation and modification necessary for nurs-ing a patient at home, and deepens her respect for those social and economic handicaps which confront the public health nurse daily.1« Sfergaret D. Lewis, "Providing Continuity of Patient Care," Blueprint for Action in Hospital Nursing (New York: National League for Nursing,~T964), p. 64". 15 ^Whalstrom, op. c i t . , p. 335. "^Genevieve Beghtel and Charlotte Akins, "Hospital Nursing Service Co-ordinates Home Nursing Program," American Journal of Nursing, LXIV (May, 1964), p. 99. / 15 To speak of a r e f e r r a l r e a l l y means the act of pass-ing information, usually written, about a patient from one agency to another. Without the use of the r e f e r r a l system interagency communication would at best be sporadic and patients may not receive the continuous care they deserve. Wensley outlined a philosophy encompassing three basic b e l i e f s or p r i n c i p l e s upon which the success of good ho s p i t a l to community r e f e r r a l s r e s t s : 1. F i r s t i s the b e l i e f that focus must always be on the p a t i e n t — h i s needs and h i s well-being—whether he i s i n the hos p i t a l or i n his own natural environ-ment. For some patients care at home may precede, follow, or be Interspersed with care i n the h o s p i t a l . But i t i s a l l care f o r the patient. He i s the centre. 2. The second p r i n c i p l e i s rel a t e d to good nursing. Many nurses believe that the assessment of a patient's complete nursing n e e d s — i n h o s p i t a l and out of h o s p i t a l — i s an i n t e g r a l , h i g h - p r i o r i t y part of nursing. They emphasize that any oversight i n seeing that a patient receives needed post h o s p i t a l care i s as serious as an oversight i n medication and treatment. 3. The t h i r d basic p r i n c i p l e i s that whole hearted "pulling together" i s e s s e n t i a l a l l along the way. "Continuity of nursing care" i s r e a l l y only another way of saying we need better co-operation among community organizations, professional personnel, and other c i t i z e n s . There appeared to be a growing awareness of the need f o r e f f e c t i v e communication between the ho s p i t a l and other 'Edith Wensley, Nursing Service Without Walls (New York: National League f o r Nursing, 1963), pp. 15-16. 16 community agencies. Increased co-operation and communica-tion between nurses in hospitals and professional personnel in other community agencies would be a positive step to-ward this goal. Summary. The review of the literature outlined factors which affect comprehensive care for patients dis-charged from hospital to the community. Long-term illness was seen as a condition affecting individuals in a variety of age groups. Several authors emphasized the need for co-operation between hospitals and other community agencies in relation to continuing care for these patients and their families. General staff nurses in hospitals and public health nurses were perceived to have key roles in relation to promoting comprehensive care through interagency re-ferrals. Effective communication was considered essential to the success of any referral system. C H A P T E R III D E S I G N AND METHODOLOGY The d e s c r i p t i v e s u r v e y m e t h o d o f r e s e a r c h w a s u s e d f o r t h i s s t u d y w h i c h w a s c o n d u c t e d i n e i g h t g e n e r a l h o s p i -t a l s l o c a t e d i n o r n e a r t h e c i t y o f V a n c o u v e r , B r i t i s h C o l u m b i a . T h e b e d c a p a c i t y o f t h e h o s p i t a l s r a n g e d i n s i z e f r o m 15B t o 1,634. T h e d a t a w e r e g a t h e r e d b y m e a n s o f a s e l f - a d m i n i s t e r e d q u e s t i o n n a i r e , u s i n g g e n e r a l s t a f f n u r s e s f r o m s e l e c t e d u n i t s i n t h e s e h o s p i t a l s a s t h e r e s p o n d e n t s . I. S E L E C T I O N OF T H E STUDY GROUP S a m p l e s e l e c t i o n . E i g h t g e n e r a l h o s p i t a l s w e r e s e l e c t e d f o r t h e p u r p o s e o f c o l l e c t i n g d a t a , b a s e d o n t w o c r i t e r i a : t h a t t h e y b e g e n e r a l a s o p p o s e d t o s p e c i a l i z e d h o s p i t a l s ; a n d o n b e d c a p a c i t y . T h e e i g h t c h o s e n h a d t h e l a r g e s t b e d c a p a c i t y i n t h e s e l e c t e d a r e a . A p p e n d i x A , p a g e 5 0 , c o n t a i n s d a t a w i t h r e g a r d t o e a c h h o s p i t a l . T h e s t u d y w a s c o n d u c t e d o n t w o n u r s i n g u n i t s i n e a c h o f t h e h o s p i t a l s . The u n i t s w e r e c h o s e n o n t h e b a s i s o f t h e a v e r a g e n u m b e r o f p a t i e n t s w i t h a l o n g - t e r m i l l n e s s u s u a l l y p r e s e n t o n t h e m . T h e s a m p l e c o n s i s t e d o f a l l g e n e r a l s t a f f n u r s e s o n d u t y d u r i n g t h e d a y s h i f t h o u r s , o n t h e d a y c h o s e n t o administer the questionnaire in each hospital. The day and time the questionnaires were to be administered were selected at the convenience of the units involved. Interviews. A letter was sent to the Director of Nursing of each hospital explaining the purpose of the study, and the anticipated participation requested. Each letter was followed by a personal interview with the Director of Nursing and, in some cases, the head nurses of the selected units were involved. During each interview the background of the study was explained, the method of data collection discussed, and arrangements for adminis-tration of the questionnaire were made. In each instance the researcher received excellent co-operation from the Director of Nursing or her Assistant. II. THE SELF*-ADMINISTERED QUESTIONNAIRE Purpose. The purpose of the questionnaire was to seek information from persons who, in the opinion of the researcher, were directly concerned with providing continu-ing care for patients with a long-term il l n e s s . The desired information was in relation to the study's three hypotheses. A copy of the questionnaire i s contained in Appendix B, page 52. 19 C o n s t r u c t i o n . T h e q u e s t i o n n a i r e w a s c o n c e i v e d a s h a v i n g f o u r s e c t i o n s , c o n s i s t i n g o f : (1) b a c k g r o u n d i n f o r -m a t i o n t (2) q u e s t i o n s r e l a t e d t o a b i l i t y t o r e c o g n i z e p a t i e n t n e e d s ; (3) q u e s t i o n s r e l a t e d t o k n o w l e d g e o f c o m -m u n i t y r e s o u r c e s , a n d (4) q u e s t i o n s r e l a t e d t o t h e r e f e r r a l s y s t e m . T h e d e s i r e d b a c k g r o u n d i n f o r m a t i o n r e l a t e d t o t h e r e s p o n d e n t ' s a g e , g e n e r a l e d u c a t i o n a l p r e p a r a t i o n , p l a c e i n w h i c h n u r s i n g e d u c a t i o n w a s r e c e i v e d , t h e l e n g t h o f t i m e e a c h h a d h e l d h e r p r e s e n t n u r s i n g p o s i t i o n , a n d t h e t y p e o f p r e v i o u s n u r s i n g e x p e r i e n c e s h e h a d h a d . I t w a s t h o u g h t t h a t t h i s i n f o r m a t i o n w o u l d h e l p t o p u t t h e s a m p l e i n t o p e r s p e c t i v e . A l a r g e g r o u p i n a n y o n e c a t e g o r y c o u l d i n f l u e n c e t h e d a t a . T h i s w o u l d b e e s p e c i a l l y t r u e w i t h r e g a r d t o t h e l e n g t h o f t i m e i n t h e p r e s e n t p o s i -t i o n , a n d t h e k i n d o f p r e v i o u s e x p e r i e n c e t h e n u r s e h a d h a d . B o t h o f t h e s e f a c t o r s c o u l d a f f e c t h e r k n o w l e d g e o f t h e s u r r o u n d i n g c o m m u n i t y a n d r e f e r r a l p r o c e d u r e s u s e d i n h e r h o s p i t a l . W i t h r e g a r d t o t h e a b i l i t y t o r e c o g n i z e n e e d s i n p a t i e n t s w h i c h m i g h t i n d i c a t e t h e n e c e s s i t y f o r r e f e r r a l t o c o m m u n i t y r e s o u r c e s , i t w a s n e c e s s a r y t o c a t e g o r i z e t h e w i d e v a r i e t y o f p o s s i b l e n e e d s . I f t a l l i e d i n d i v i d u a l l y , t h e r e a r e a m u l t i t u d e o f h e a l t h c a r e n e e d s . S e v e r a l g u i d e s w e r e r e v i e w e d b e f o r e t h e 20 one which appeared to suit most adequately the purposes of this study was selected as the frame of reference. It was the guide outlined by Dahlin in a discussion of assessment of patient needs. She put forth nine categories or general areas: (1) principal impairment(s) which affect a b i l i t y to function independently (2 (3 (4 (5 (6 (7 (8 (9 physical health mental health housing and living arrangements patient's occupation finance recreational a c t i v i t i e s and interests interpersonal relationships , general adjustment and morale. For the purposes of the questionnaire, these nine cate-gories were reduced to the following six to prevent am-biguity : 1. physical care 2. physical limitations 3. mental health 4. home environment 5. occupational environment 6. social environment. Having selected the main categories, each was then broken down into several observations and a c t i v i t i e s that ^"Bernice Dahlin, "Rehabilitation and the Assessment of Patient Need," The Nursing Clinics of North America. I (1964), p. 385. 21 were indicative of the presence of a need. The respondents were required to check appropriate statements under each category. The observations and act i v i t i e s were l i s t e d , rather than having the respondents write them, in order to derive some consistency in the way they were expressed for purposes of analysing the data. In relation to knowledge of community resources pos-sessed by general staff nurses in hospitals, the six cate-gories were again used. In this instance i t was decided to have the respondents name appropriate agencies under each category. The a b i l i t y to name an agency correctly would indicate an awareness of i t s existence, and test with more validity the knowledge they had of community resources. The last section dealt with the channel used for referrals and the avai l a b i l i t y of feedback on referred patients. This part was designed to e l i c i t the actual practice in each hospital with regard to channel and method used in making referrals, and then, in the opinion of the respondent, what would be the ideal channel, and method. There were also questions regarding referrals that the respondents had actually made, and from whom feedback on patients referred from the unit was received. The questionnaire was open-ended. The respondents were told there were no right or xvrong answers and that blanks could be l e f t i f none of the alternatives offered 22 seemed appropriate. Using this kind of design appeared to be the best way to e l i c i t the desired information. Pre-test. The questionnaire was pre-tested in a large military hospital not included in the study. The purpose of the pre-test was to examine the wording of the questions and to insure that the specific questions or 2 observations were relevant and precise. For the pre-test, the sample consisted of four head nurses as they were readily available, and validity and r e l i a b i l i t y were being 3 tested, rather than the respondents' knowledge. The results of the pre-test revealed an understand-ing of the concepts involved and no changes in the question-naire were indicated. Administration. The questionnaire was administered by the researcher to the selected sample. Groups of three or four respondents were seen at one time. In each case i t was possible to arrange for the use of empty offices or classrooms to ensure some degree of privacy. By having the questionnaire self-administered, the researcher was able to c l a r i f y any questions that might have arisen. 2 Faye G. Abdellah and Eugene Levine, Better Patient  Care Through Nursing Research (New York: The Macmillan Company, 1965), p. 70o~I 3 I b i d . . p. 321. 23 II I . METHOD OF DATA ANALYSIS The analysis of the data was descriptive. Once collected, i t was transferred to a large work sheet. From this tables and graphs il l u s t r a t i n g figures and drawing comparisons were made. This analysis i s discussed in de-t a i l in Chapter IV. IV. SUMMARY Details of the design and methodology were dis-cussed. This included the construction, pre-test, and administration of the data-gathering tool, and an overview of the method used to analyse the data. C H A P T E R 1 7 A N A L Y S I S OF T H E DATA T h e a n a l y s i s o f t h e d a t a c e n t e r e d a r o u n d a n s w e r i n g t h e s t u d y ' s t h r e e h y p o t h e s e s . I t was c o n d u c t e d i n f o u r p a r t s ; a summary o f t h e p e r s o n a l d a t a , f o l l o w e d b y a n a l y s i s i n r e l a t i o n t o e a c h o f t h e h y p o t h e s e s . I . SUMMARY OF THE P E R S O N A L DATA D e t a i l s w i t h r e g a r d t o t h e b a c k g r o u n d o f t h e r e s p o n -d e n t s i n t h e s t u d y a r e c o n t a i n e d i n t a b l e s I t o V , p a g e s 2 5 - 2 7 . A t o t a l o f f i f t y - s e v e n g e n e r a l s t a f f n u r s e s i n h o s p i t a l s p a r t i c i p a t e d . O f t h e s e , 59.6 p e r c e n t w e r e b e -t w e e n t w e n t y a n d t w e n t y - n i n e y e a r s o f a g e . T h u s , m o r e t h a n 50 p e r c e n t o f t h e r e s p o n d e n t s h a d c o m p l e t e d t h e i r n u r s i n g t r a i n i n g d u r i n g t h e l a s t t e n y e a r s . W i t h r e g a r d t o e d u c a -t i o n a l p r e p a r a t i o n , 84.7 p e r c e n t h a d h a d n o p r e p a r a t i o n b e y o n d t h e r e g i s t e r e d n u r s e l e v e l . T h e r e m a i n i n g 15.3 p e r c e n t h a d d i p l o m a s i n v a r i o u s f i e l d s . None h a d a n a c a d e m i c d e g r e e i n n u r s i n g . I n 74 .1 p e r c e n t o f t h e c a s e s , t h i s n u r s i n g e d u c a t i o n h a d b e e n r e c e i v e d i n C a n a d a . O f t h e s e , 44.7 p e r c e n t h a d b e e n e d u c a t e d i n t h e P r o v i n c e o f B r i t i s h C o l u m b i a . C o n c e r n i n g t h e c u r r e n t n u r s i n g p o s i t i o n , 29.8 p e r c e n t o f t h e r e s p o n d e n t s h a d b e e n i n t h e . p r e s e n t j o b s i x 2 5 TABLE I AGE RANGE OF RESPONDENTS EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Age Number Percentage 20-29 years 34 59.6 30-39 years 12 21.1 40-49 years 3 5.3 50-andyoyer 8 14.0 Total 57 100.0 TABLE II LEVEL OF NURSING EDUCATION OF RESPONDENTS EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Level of Nursing Education Number Percentage R.N. 50 #4.7 R.N. plus University diploma 2 3.4 B. Sc.N. 0 0.0 Other 7 11.9 Total 59 100.0 26 TABLE III PLACE WHERE NURSING EDUCATION OF RESPONDENTS WAS RECEIVED EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Place Where Nursing Education Received Number Percentage Vancouver 14 24.1 Another Part of B.C. 7 12.1 Another Canadian Province 26 37.9 Outside Canada 15 25.9 Total 62 100.0 TABLE IV LENGTH OF TIME RESPONDENTS HAVE OCCUPIED PRESENT NURSING POSITION EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Length of time i n Present Nursing Position Number Percentage 0 - 6 months'" 17 29.6* 7 months - 1 year 14 24.6 1 - 5 years 20 35.1 5 - 1 0 years 4 7.0 Over 10 years 2 3.5 Total 57 100.0 27 TABLE V PREVIOUS NURSING EXPERIENCE OF RESPONDENTS EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Previous Nursing Experience Number Percentage None 7 10.8 Another ward or ho s p i t a l 47 72.3 V.O.N. 1 1.5 Public Health Nursing 1 1.5 Occupational Health 0 0.0 Other 9 13.9 Total 65 100.0 28 months or less, and an additional 24.6 per cent seven months to one year. The rest had held their current position for a year or longer. For 72.3 per cent previous experiences were confined to nursing in another ward or hospital, while 10.8 per cent had had no previous experience. Only 3 per cent had participated in any community nursing. In general the data revealed a sample of many f a i r l y young nurses educated in Canada at the registered nurse level, with very l i t t l e experience outside of the hospital setting. II. ANALYSIS IN RELATION TO HYPOTHESIS I General staff nurses in hospitals can recognize needs of patients which indicate the necessity for referral to community resources. Support for the f i r s t hypothesis was indicated by the data. The respondents were asked to identify needs with regard to patients they had nursed during the week prior to f i l l i n g out the questionnaire. The fifty-seven respondents were able to identify a total of 896 health care needs. These are outlined in Appendix C, page 65. With regard to the six main categories, 25.3 per cent of the needs were related to physical care; 14.2 per cent to physical limitations; 18.1 per cent were associated with mental health; 13.3 per cent with the home 29 environment; 7.3 per cent with the occupational environ-ment, and 21.B per cent with the s o c i a l environment. These percentages are i l l u s t r a t e d i n Figure 1. At the same time, the respondents were asked to rate the s i x categories i n order of p r i o r i t y . Of the f i f t y -seven respondents, fift y - t w o responded to t h i s section of the questionnaire. As Table VI shows, physical care and mental health were seen as the two most important cate-gories, followed c l o s e l y by physical l i m i t a t i o n s and the home environment. It i s Interesting to note that i n actual recognition of various needs, those i n the s o c i a l environment category were noted more frequently than needs i n any of the other categories except physical care. However, i n the ranking, they were considered to have the lowest o v e r a l l p r i o r i t y and i n fact were placed l a s t 46.2 per cent of the time. From these data, i t was concluded that the general s t a f f nurses i n hospitals who participated i n the study could recognize needs i n patients which indicated the necessity f o r follow-up care i f the patient was to be d i s -charged from the h o s p i t a l . Percentage of t o t a l no. of needs o o O o"<! > o O > 1-3 W O O 03 CO CD O 03 M tr1 3 cr H-^ <; Ct CO 33 03 H* O ct O M H" 03 O M •-3 3 > CO a w 3 CD CD o 03 3 1^ M <+ M C+ 03 Q 3" M w w w a M a> w oa 3 3 3 < 3 w (D H' O 3 1 3 •-9 C+ O CD M 3 O 1 2 a W ct O 3 3 F> O M CD < o o H- 3 C c+ 1 0 ) ^ ) O M 03 3 I W 03 3 3 O CD <; O 3 H* H-ct -J 03 O t—' 3 31 TABLE VI CATEGORIES OF NEEDS RANKED IN ORDER OF IMPORTANCE BY FIFTY-TWO OF THE RESPONDENTS EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES CATEGORY OF NEEDS Times F i r s t No. % Times Second No. % Times Third No. % Times Fourth No. % Times F i f t h No. % Times Sixth No. % Physical Care 15 22.8 12 23.1 11 21.2 6 11.5 7 13.5 1 1.9 Physical Limitations 9 17.3 11 21.2 7 13-5 13 25.0 4 7.7 8 15.4 Mental Health 13 25.0 20 38.5 10 19.2 8 15.4 0 0.0 1 1.9 Home Environment 12 23.1 8 15.4 16 30.8 10 19.2 5 9.6 1 1.9 Occupational Environment 1 1.9 1 1.9 4 7.7 10 19.2 19 36.5 17 32.7 Social Environment 2 3.8 0 0.0 4 7.7 5 9.6 17 32.7 24 46.2 32 III. ANALYSIS IN RELATION TO HYPOTHESIS II General s t a f f nurses i n hospitals lack knowledge of community resources which can be a contributing factor i n the lack of r e f e r r a l s I n i t i a t e d by hos p i t a l s t a f f nurses to community resources. Support f o r the second hypothesis was indicated by the data. Using the s i x categories of needs, the respon-dents were asked to l i s t community agencies which would be he l p f u l i n regard to s a t i s f y i n g patient needs related to each category. The same agency could be repeated under more than one heading i f i t was applicable. As may be seen i n Figure 2, the majority of respondents were able to name only one agency within each category. Several could not name any, esp e c i a l l y i n r e l a -t i o n to the occupational environment. The previous discus-sion showed needs rel a t e d to mental health were frequently recognized and that category was given top p r i o r i t y . Yet 78.9 per cent of the respondents could name one or no agencies which could be h e l p f u l i n s a t i s f y i n g t h i s kind of need. There are a great variety of community resources concerned d i r e c t l y or i n d i r e c t l y with health care. In the Vancouver area over 400 agencies exist which could o f f e r some kind of assistance i n meeting a wide variety of health 30 None One Two Three Four Five Over Five Number of Agencies Listed FIGURE 2 NUMBER OF COMMUNITY AGENCIES LISTED UNDER EACH CATEGORY Physical Health Home Environment — Physical Limitations Occupational Environment w Mental Health Social Environment 34 needs. Yet the majority of the respondents in this study could not name more than one agency related to each category. From these results i t was concluded that the general staff nurses in hospitals who participated In the study lacked knowledge of community resources. This could be a contributing factor In the lack of referrals initiated by general staff nurses in hospitals to community resources. IV. ANALYSIS IN RELATION TO HYPOTHESIS III General staff nurses in hospitals, in making refer-rals, use lines of communication which are frequently indirect. Support for the third hypothesis was indicated by the data. Information in relation to the referral process was concerned with the channel through which the referral passed, the method used, and the amount of feedback received on referred patients. Figure 3 shows a comparison of the channels for referral in use on the selected units at the time of the study with channels for referral which, In the opinion of the respondents, would be the most effective ones to use. United Community Services of Greater Vancouver, Directory of Services (Vancouver: Community Information Service, l9o"8), pp. 97-109. Percentage of times mentioned o ro o O O o > 2 2 M Ir1 CO O i-3 O W tr< O a c: o Gd re w as re i—i o re S > a 33 w 33 33 > co M P-O CD CD 03 Hj |—i 3 (0 H 3 o <<J CD Ct-CO < Ct CD rr CD 3 o CO ct M o a 33 w o rr H" 03 rs 3 3 £ CD CO r-> CD CO T3 CD CO CD 3. ct 1—' K3 • a o cr CD c •<; o ct s rc C CD 1 03 co a CD < co CO T3 O CD I a o o ct o 2 CO CD rn ^ 3 o CD C CO 03 a"r> I—1 I—' H« Ct H- Ct rr o 03 I—1 re si co o 0 O CO 1 n t i VK H- H-CD 03 Ct 4 M 03 t- 1 03 03 3 ct M CD ^ 3 ct CO O ct 3 o 3J 03 CD CD 3 1 i a c t 03 3 WWWWWN \\\\\\\\\\\SI 3$ Data on the channels were concerned with the directness of the r e f e r r a l , whether i t was made by the general s t a f f nurse i n the h o s p i t a l to the agency or agencies involved, or v i a other persons within the ho s p i t a l before i t reached the agency. It was apparent that i n most instances the r e f e r r a l must pass through at least one other person, be-tween the source and the receiver. At the time of the study, on the selected u n i t s , r e f e r r a l s were channelled through the doctor or head nurse 51.2 per cent of the time, with the h o s p i t a l s o c i a l worker the next most frequently used channel. The h o s p i t a l public health nurse was used 10.1 per cent of the time* Other channels, such as the nursing supervisor and the patient's family, were seldom used. In in d i c a t i n g which, i n t h e i r opinion, would be the most e f f e c t i v e channel, the respondents were asked to select only one, however several r e p l i e s included a combina-t i o n of two. Here the h o s p i t a l s o c i a l worker was seen as the most e f f e c t i v e channel In 30.5 per cent of the r e p l i e s , followed by the head nurse at 22 per cent. The doctor and ho s p i t a l public health nurse followed at 18.3 and 17.1 per cent respectively. Other channels were not regarded as s i g n i f i c a n t . This presented two i n t e r e s t i n g r e s u l t s . F i r s t , i n practice and i d e a l l y , d i r e c t r e f e r r a l s from the nurse 37 Involved with the daily care of the patient to an agency, were made very infrequently. Secondly, the respondents selected the hospital social worker as the most effective channel for referral almost twice as frequently as they selected the hospital public health nurse. Yet, of the eight hospitals involved in the study, two had no kind of social worker and of the remaining six, only three had full-time qualified social workers. In seachi of these same eight hospitals, public health nurses visited at least once a week. Appendix A, page 50, contains details with regard to each of the hospitals. Figure 4 presents a comparison of the method of referral In use on the selected units at the time of the study with methods chosen by the respondents as being the most effective. In actual practice specific referral forms were used as the method of referral 3 4 . 4 per cent of the time, followed by the telephone 2 7 . 8 per cent of the time, and interviews 16.7 per cent of the time. In choosing the most effective method, this order was modified slightly. Specific forms were s t i l l the most frequent choice, being selected 4 4 . 2 per cent of the time, followed by Interviews and the telephone at 2 3 . 3 per cent and 2 0 . 9 per cent respectively. Letters were mentioned by 9 . 3 per cent of the respondents. As Table VII illu s t r a t e s , the opportunity to make a 45 xi o •H •P c £ to CD S •H •P CH O CD b f l CO •P C CD O ^ 40 35 30 25 20 15 10 5 0 1 2 E L T e l e -phone S p e c i f i c R e f e r r a l Form L e t t e r Inter-view U n c e r t a i n and Other FIGURE 8 METHODS BY WHICH REFERRALS COULD BE MADE Methods p r e s e n t l y i n use I d e a l l y , the most e f f e c t i v e channels • CO-39 r e f e r r a l had been given to 66.6 per cent of the respondents. Data contained i n Table VIII indicates a s i m i l a r number had received some kind of feedback on patients referred from t h e i r unit. Details regarding the sources from whom t h i s feed-back was received are outlined i n Table IX. The doctor was the most frequent source of information, followed by the h o s p i t a l s o c i a l worker and the head nurse. Analysis of data regarding the channel indicated that r e f e r r a l s made by participants i n the study passed through channels which were frequently i n d i r e c t , the message going through one or more persons between the source and the receiver. V. SUMMARY Data with regard to the background information of the respondents and each of the three hypotheses were analysed and conclusions r e l a t i n g to the hypotheses were drawn. In each instance, the data supported the hypothesis being tested. 40 TABLE VII OPPORTUNITIES FOR RESPONDENTS TO MAKE PATIENT REFERRAL EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Yes No Number Percentage Number Percentage Opportunity to i g ^.1 38 66.6 refer a patient TABLE VIII INFORMATION ON FEEDBACK FROM PATIENT REFERRALS RECEIVED OR DESIRED BY RESPONDENTS EXPRESSED IN TOTAL NUMBERS AND PERCENTAGES Yes No Number Percentage Number Percentage Feedback received on unit referrals 19 33.3 38 66.6 Feedback desired on unit referrals 37 97.4 1 2.6 TABLE IX SOURCES FROM WHOM FEEDBACK ON UNIT REFERRALS WAS RECEIVED EXPRESSED IN TOTAL NUMBER AND PERCENTAGE OF TIMES EACH WAS MENTIONED Source of Feedback Number of times mentioned Percentage of times mentioned Head Nurse 7 17.9 Supervisor 1 2.6 Doctor 11 28.2 Hospital Public Health Nurse 5 12.8 Hospital Social Worker 9 23.1 Pat i e nt 1s family 4 10.3 Community agency involved 2 5.1 Other 0 0 Total 39 100.0 CHAPTER V SUMMARY, RECOMMENDATIONS, AND AREAS FOR FURTHER INVESTIGATION I. SUMMARY The purpose of t h i s descriptive study was to examine selected factors a f f e c t i n g the communication process em-ployed between general s t a f f nurses i n hospitals and person-nel i n community agencies with regard to the r e f e r r a l of patients with a long-term i l l n e s s . A review of the l i t e r a t u r e was conducted i n r e l a t i o n to the prevalence of long-term i l l n e s s ; the concept of comprehensive patient care; the rol e of the general s t a f f nurse i n a ho s p i t a l and a public health nurse i n r e l a t i o n to promoting comprehensive patient care, and aspects of the r e f e r r a l process. The data were gathered by means of a self-administered questionnaire designed to seek information related to the study's three hypotheses. It consisted of four parts: (1) questions related to the background of the participants; (2) questions re l a t e d to the a b i l i t y to recognize patient needs; (3) questions related to knowledge of community resources, and (4) questions related to the channels and methods used i n making r e f e r r a l s . 43 T h e q u e s t i o n n a i r e w a s c o m p l e t e d b y f i f t y - s e v e n g e n e r a l s t a f f n u r s e s f r o m s e l e c t e d u n i t s i n e i g h t g e n e r a l h o s p i t a l s i n o r n e a r t h e c i t y o f V a n c o u v e r , B r i t i s h C o l u m b i a . T h e u n i t s w e r e c h o s e n o n t h e b a s i s o f t h e a v e r -a g e n u m b e r o f p a t i e n t s w i t h a l o n g - t e r m i l l n e s s u s u a l l y p r e s e n t o n t h e m . F r o m t h e a n a l y s i s o f t h e d a t a t h e f o l l o w i n g c o n c l u -s i o n s w e r e d r a w n . A l t h o u g h g e n e r a l s t a f f n u r s e s i n h o s p i -t a l s , who p a r t i c i p a t e d i n t h e s t u d y , c o u l d r e c o g n i z e n e e d s i n p a t i e n t s w h i c h i n d i c a t e t h e n e c e s s i t y f o r r e f e r r a l t o c o m m u n i t y a g e n c i e s , t h e y d i d n o t h a v e a n a d e q u a t e k n o w l e d g e o f c o m m u n i t y r e s o u r c e s . When t h e s e n u r s e s made r e f e r r a l s , t h e l i n e s o f c o m m u n i c a t i o n u s e d w e r e f r e q u e n t l y i n d i r e c t . I I . R E C O M M E N D A T I O N S F r o m t h e r e s u l t s o f t h e s t u d y t h e f o l l o w i n g r e c o m -m e n d a t i o n s w e r e m a d e : 1. T h a t g r e a t e r a t t e m p t s b e made t o e n c o u r a g e g e n e r a l s t a f f n u r s e s I n h o s p i t a l s t o t r a n s f e r i n f o r m a t i o n r e g a r d i n g p a t i e n t n e e d s t o n u r s i n g c a r e p l a n s , u s i n g t h e s e a s a v e h i c l e i n p r o m o t i n g c o n t i n u i t y o f c a r e . 2. T h a t i n - s e r v i c e e d u c a t i o n p r o g r a m s f o r g e n e r a l s t a f f n u r s e s i n h o s p i t a l s i n c l u d e i n f o r m a t i o n o n s e r v i c e s o f f e r e d b y t h e w i d e v a r i e t y o f a g e n c i e s 44 in the community in which the hospital i s located. 3. That hospitals and public health agencies examine together the services offered and role played by a public health nurse in relation to patient referrals. 4. That more attention be directed to the channels of communication employed by general staff nurses in hospitals in relaying information to personnel who could aid in satisfying the needs of patients. 5. That information on the progress of patients refer-red from the nursing unit to another community agency, when known, be included in daily ward reports. III. AREAS FOR FURTHER INVESTIGATION From the results of the study, the following areas outlined as worthy of further investigation: 1. An exploration of reasons why social needs are readily recognized yet given such low priority by general staff nurses in hospitals. 2. A study of the curriculum content within a diploma school of nursing in regard to the community, i t s resources, and i t s relation to the hospital. 3. The rationale behind the lack of desire, on the part of general staff nurses in hospitals, to 45 make direct patient referrals. 4. The rationale behind general staff nurses in hospi-tals selecting the hospital social worker more often than the hospital public health nurse, as the most effective channel for patient referral. BIBLIOGRAPHY BIBLIOGRAPHY A. BOOKS Abdellah, Faye G., and Eugene Levine. Better Patient Care  Through Nursing Research. New York: The Macmillan Company, 1965. Brackett, Mary E., and Joan R. Fogt. "Is Comprehensive Nursing Care a R e a l i s t i c Goal?" Issues i n Nursing. Bonnie Bullock and Vern Bullock, editors. New York: Springer Publishing Company, Inc., 1966. Pp. 133-139. Commission on Chronic I l l n e s s . Care of the Long-Term  Patient. Vol II of Chronic i l l n e s s i n the United  States. 4 vols. Cambridge: HarvardHJniversity Press, 1956. Continuing Care: The Nurse and Community Resources. Ottawa: Canadian Nurses' Association, 1962. Dahlin, Bernice. "Rehabilitation and the Assessment of Patient Need," Nursing C l i n i c s of North America. Philadelphia: W.B. Saunders Company, 1964. Pp. 375-386. Developing P o l i c i e s and Procedures f o r Long-Term Care " I n s t i t u t i o n s . Chicago: American Hospital Association, 1968. Dorland's Pocket Medical Dictionary. Philadelphia: W.B. Saunders Company, 1959. F i e l d , Minna. Patients Are People. New York: Columbia University Press, 1967. Freeman, Ruth B. Public Health Nursing Practice. P h i l a -delphia: W.B. Saunders Company, 1963. Hanser, Johanne, Frank Oechsli, and Edith Pross. Continuity  o f Nursing Care from Hospital to Home: A Study i n a Voluntary General Hospital. New York: NationalTeigue for Nursing, 1966. Koontz, Harold, and C y r i l O'Donnell. P r i n c i p l e s of Manage- ment : An Analysis of Managerial Functions. New York: McGraw-Hill Book Company, 1968. 4a Lewis, Margaret D. "Providing Continuity of Patient Care," Blueprint for Action in Hospital Nursing, New York: National League for Nursing, 1964. Pp. 6I-64. Reader, George G., and Mary E.W. Goss (eds.). Comprehensive  Medical Care and Teaching. Ithaca, New York: Kingsport Press, Inc., 1967. Reynolds, Frank, and Paul Barsam. Adult Health: Services  for the Chronically 111 and Aged. New York: The Macmillan Company, 1967. Straub, Mary, and Kitty Parker (eds.). Continuity of  Patient Care: The Role of Nursing. Washington: The Catholic University of America Press, 1966. Tarns, Byrdlce. "Continuity of Patient Care," Blueprint for  Action in Hospital Nursing. New York: National League for Nursing, 1964. Pp. 65-66. United Community Services of Greater Vancouver. Directory of Services. Vancouver: Community Information Service, I^6B: Wensley, Edith. Nursing Service Without Walls. New York: National League for Nursing, 1963. B. PERIODICALS Anderson, Eleanor M. "A Continuity of Care Plan for Long-Term Patients," American Journal of Public Health. LIV (February, 1964), pp. 308-312. . , and Jane Irving. "Uninterrupted Care for Long-Term Patients," Public Health Reports. LXXX (March, 1965), pp. 271-275T Beghtal, Genevieve, and Charlotte Aklns. "Hospital Nursing Service Co-ordinates Home Nursing Program," American  Journal of Nursing. LXIV (May, I964), pp. 97-99. Crosby, Edwin L. "Co-ordination or Fragmentation?" Nursing  Outlook, XI (January, 1963), pp. 42-43. Geld, Solomon. "Who Is the Long-Term Patient?" XXXIX (January 1, 1965), pp. 44-45, 88. 49 Gray, June W. "Liaison Nurses Bridge the Gap," Nursing Outlook, XV (May, 1 9 6 7 ) , pp. 28-31. Greene, Marian S., and Myrtle B. Singleton. "A County Health Information and Referral Service," Nursing  Outlook. XIV (December, 1966), pp. 40-43. MacKintosh, James M. "Matching F a c i l i t i e s to Needs of Long-Term Patients," Hospitals, XL (Ap r i l 1 6 , 1 9 6 6 ) , pp. 8 5 - 8 9 . MacLeod, Isabel. "The Patient Returns to the Community," Canadian Nurse. LVI (December, I 9 6 0 ) , pp. 1079-1082. Mitch, Anna D., and Sophie Kaczola. "The Public Health Nurse Coordinator i n a General Hospital," Nursing  Outlook, XVI (February, 1 9 6 8 ) , pp. 3 4 - 3 6 . Mussallem, Helen K. "The Changing Role of the Nurse," American Journal of Nursing, LXIX (March, 1 9 6 9 ) , pp. 5 1 4 - 5 1 7 . Rogatz, Peter, and Guida M. C r o c e t t i . "Home Care Program-mes—Their Impact on the Hospital's Role i n Medical Care," American Journal of Public Health, XLVIII (September, 1 9 5 8 ) , pp. 1 1 2 5 - 1 1 3 3 . Schwartz, Doris R. "Communication Between Hospital S t a f f and Community Agencies: A Study of Referrals to the Public Health Nurse," American Journal of Public Health, L (August, I 9 6 0 ) , pp. 1 1 2 2 - 1 1 2 5 . "That the Needs of the Sick at Home Sha l l Be Met . . .," Nursing Outlook, X (May, 1 9 6 2 ) , p. 301. Whalstrom, E. Dorothy. " I n i t i a t i n g Referrals: A Hospital-Based System," American Journal of Nursing, LXVII (February, 1967), pp. W^JW. Wolff, U s e S. " R e f e r r a l — A Process and a S k i l l , " Nursing  Outlook. X ( A p r i l , 1 9 6 2 ) , pp. 2 5 3 - 2 5 6 . Young, Marjorie A.C. "Review of Research and Studies Related to Health Education Communication: Methods and Materials," Health Education Monographs, XXV ( I 9 6 7 ) , pp. 1 - 1 5 . APPENDIX A INFORMATION RELATING TO T H E EIGHT HOSPITALS SELECTED FOR USE IN THE STUDY, EXPRESSED IN TERMS OF BED CAPACITY, A V A I L A B I L I T Y OF A SOCIAL WORKER, AND A V A I L A B I L I T Y OF A PUBLIC HEALTH NURSE 51 APPESDIX A INFORMATION RELATING TO THE EIGHT HOSPITALS SELECTED FOR USE IN THE STUDY, EXPRESSED IN TERMS OF BED CAPACITY, AVAILABILITY OF A SOCIAL WORKER, AND AVAILABILITY OF A PUBLIC HEALTH NURSE NAME OF HOSPITAL Number of Beds Availability of a Social Worker Availability of a Public Health Nurse Mount St. Joseph Vancouver, B.C. 158 None Twice weekly Peace Arch District White Rock, B.C. 225 None (some duties done by one head nurse) Twice weekly Burnaby General Eurnaby, B.C. 244 Half day -Every day Twice weekly St. Mary's New Westminster, B.C. 256 None Once weekly Royal Columbian New Westminster, B.C. 434 None (some duties done by a nurse) Once weekly Lions Gate North Vancouver, B.C. 484 Full time D a i l y St. Paul's Vancouver, B.C. 619 Full time Once weekly Vancouver General Vancouver, B.C. 1634 F u l l time Daily APPENDIX B THE QUESTIONNAIRE EMPLOYED IN THE STUDY 53 This questionnaire i s a t o o l t o f a c i l i t a t e a study of f a c t o r s a f f e c t i n g the communication process employed by general s t a f f nurses i n h o s p i t a l s i n r e f e r r i n g p a t i e n t s w i t h a long-term i l l n e s s to the community setting'. I t i s intended to gather i n f o r m a t i o n of a general nature, and i s not designed to r e f l e c t p a r t i c u l a r aspects of any one h o s p i t a l or any p a r t i c i p a n t i n the study. A l l p a r t i c i p a n t s remain anonymous. Except f o r questions r e q u i r i n g a simple yes or n£ answer, each one may be answered by one or s e v e r a l r e p l i e s . There i s no r i g h t or wrong response to any question. When answering please place an "x" i n the box to the r i g h t of the appropriate l i n e . Thank you very much f o r t a k i n g the time to answer t h i s q u e s t i o n n a i r e . Your co-operation i s g r e a t l y appreciated. I f you wish a r e p o r t of the r e s u l t s of t h i s study, please put your name and ward number below, t e a r paper at dotted l i n e , and give t o researcher. 54-1 • n B i o g r a p h i c a l d a t a c o n c e r n i n g r e s p o n d e n t . 1. Age b r a c k e t 20-29 30-39 40-49 • 50 or over U 2. L e v e l of n u r s i n g e d u c a t i o n R.N. R.N. p l u s u n i v e r s i t y d i p l o m a B.Sc.N. Other - p l e a s e s p e c i f y / | Hi 3 - Where n u r s i n g e d u c a t i o n was r e c e i v e d Vancouver • Another p a r t o f B r i t i s h Columbia D Another p r o v i n c e i n Canada f~~l O u t s i d e of Canada | i 4- Length of time employed in p r e s e n t p o s i t i o n 0 - 6 months 6 months-1 y e a r 1- 5 y e a r s i I 1— i 5-10 y e a r s Over 10 y e a r s • • 55-2 5. Other n u r s i n g experience ' p r i o r to present employment None I I H o s p i t a l n u r s i n g i n another ward or h o s p i t a l L~Z3 V.O.N. D P u b l i c h e a l t h n u r s i n g O c c u p a t i o n a l h e a l t h n u r s i n g Other - please s p e c i f y • J j I I . The Work S e t t i n g When c o n s i d e r i n g p a t i e n t s with a long-term i l l n e s s some w i l l r e q u i r e more follo w - u p care a f t e r d i s c h a r g e than o t h e r s . The f o l l o w i n g i s a l i s t of o b s e r v a t i o n s and a c t i v -i t i e s t h a t are i n d i c a t i v e of h e a l t h care needs. Please i n d i c a t e the ones which were d i s p l a y e d by p a t i e n t s you nursed during the past week which w i l l r e q u i r e f o l l o w up care i f the p a t i e n t i s t o be dis c h a r g e d . A. Re P h y s i c a l Care 1. D a i l y baths D 2. D r e s s i n g changes • 3. Colostomy i r r i g a t i o n n 4. I n j e c t i o n s (e.g. i n s u l i n , d i u r e t i c s , etc)! 1 5. C a t h e t e r i r r i g a t i o n s and changes • 6. Enemas • 56 -3 7. Drug s u p e r v i s i o n J I 8. Graduated e x e r c i s e s f 1 9. Physiotherapy • 10. Other - please s p e c i f y | } B. Re P h y s i c a l L i m i t a t i o n s 1. C o n f i n e d t o bed 1 .! 2. C o n f i n e d t o w h e e l c h a i r 1 I 3. Dependent on c r u t c h e s I I 4. Dependent on w a l k e r I , | 5. Dependent on p r o s t h e s e s 1 | 6. L i m i t e d m o b i l i t y (e.g. s e v e r e a r t h r i t i c c o n d i t i o n ) I ,J 7. Other - p l e a s e s p e c i f y | ) C Re M e n t a l H e a l t h 1. D i f f i c u l t y i n a c c e p t i n g l o n g - t e r m illnessL_J 2. Depressed L, J 3. O v e r a c t i v e 1 I 4. Overanxious ! 1 5. Quarrelsome i I 6. E x t r e m e l y d o c i l e 1 I 7. F e a r f u l j I 8 . S u s p i c i o u s i J 5 7 - L 9. Other - please s p e c i f y D. Re Home Environment 1. W i l l r e q u i r e housekeeper or p r a c t i c a l nurse 2. May r e t u r n t o former r e s i d e n c e i f p h y s i c a l f a c i l i t i e s a d j u s t e d (e.g. f o r use of w h e e l c h a i r , t o i l e t , e t c .) 3. Needs more a p p r o p r i a t e home 4. Has f i n a n c i a l w o r r i e s about s e l f and/or f a m i l y 5. Other - please s p e c i f y ^ E. Re O c c u p a t i o n a l Environment 1. Has l i m i t a t i o n s imposed on a c t i v i t i e s i n present p o s i t i o n (e.g. w i l l need frequent r e s t p e r i o d s ) 2 . Needs f u r t h e r education f o r o l d job 3. Needs a s s i s t a n c e i n f i n d i n g a new job 4« Needs r e - t r a i n i n g f o r new job 5- Other - pl e a s e s p e c i f y F. Re S o c i a l Environment 1. Needs more companionship 58-5 2. Needs a s s i s t a n c e i n pursuing new hobbies [~ I 3. Needs t o develop new areas of i n t e r e s t o u t s i d e of home s e t t i n g j i 4. Family needs e x p l a n a t i o n and encourage-,ment re p a t i e n t ' s c o n d i t i o n { I 5. Family needs d i r e c t t e a c h i n g re p a t i e n t ' s c o n d i t i o n j j 6. Needs c o u n s e l l i n g i n f a m i l y r e l a t i o n -s h i p s — 7. Needs encouragement i n g e n e r a l adjustment to l i m i t a t i o n s imposed by i l l n e s s 8. Other - please s p e c i f y | j G. Category Placement In c o n s i d e r i n g the s i x main c a t e g o r i e s o u t l i n e d above, without r e f e r e n c e t o s p e c i f i c p a t i e n t s , please i n d i c a t e how you would rank them i n order of importance (use the number 1 through 6, with 1 being the top p r i o r i t y ) P h y s i c a l Care P h y s i c a l L i m i t a t i o n s Mental Health Home Environment [ f O c c u p a t i o n a l Environment S o c i a l Environment J I 59-6 I I I . The Community C o n s i d e r i n g p a t i e n t s you have n u r s e d , p l e a s e l i s t under t h e f o l l o w i n g h e a d i n g s , which community a g e n c i e s would have been u s e f u l i n order.to give adequate f o l l o w - u p s e r v i c e t o t h e s e p a t i e n t s a t home. A. Re P h y s i c a l H e a l t h B. Re P h y s i c a l L i m i t a t i o n s C. Re M e n t a l H e a l t h 60- 7 D. Re Home Environment E. ReOccupational Environment F. Re S o c i a l Environment 61-The Process A. In r e f e r r i n g p a t i e n t s f o r follow-up n u r s i n g care from your ward t o the community, please i n d i c a t e the f o l l o w i n g 1. The Channel How i s the r e f e r r a l made to the agency (a (b (c (d (e (f (g (h ( i d i r e c t l y by you through head nurse " s u p e r v i s o r " doctor " h o s p i t a l p u b l i c h e a l t h nurse " h o s p i t a l s o c i a l worker " p a t i e n t ' s f a m i l y u n c e r t a i n Other - please s p e c i f y 2 . The Method The method by which a r e f e r r a l i s made (a) telephone (b) s p e c i f i c r e f e r r a l form (c) l e t t e r (d) Interview (e) u n c e r t a i n (f) Other - please s p e c i f y Feedback (a) Have you, i n f a c t , ever had an o p p o r t u n i t y to make such a r e f e r r a l w h ile i n your present job s i t u a t i o n ? Yes No (b) Do you r e c e i v e any i n f o r m a t i o n on the progress of r e f e r r e d p a t i e n t s ? Yes No (c) I f yes to (b) from whom do you r e c e i v e t h i s i n f o r m a t i o n ? ( i ) head nurse ( i i ) s u p e r v i s o r ( i i i ) d octor ( i v ) h o s p i t a l p u b l i c h e a l t h nurse (v) h o s p i t a l s o c i a l worker (v i ) p a t i e n t ' s f a m i l y ( v i i ) community agency i n v o l v e d ( v i i i ) Other - please s p e c i f y 6 3 - 1 0 (d) I f no t o ( b ) , would you l i k e t o r e c e i v e i n f o r m a t i o n on t h e p r o g r e s s of p a t i e n t s you have r e f e r r e d t o a community agency? Yes No B. I n t h i n k i n g f u r t h e r abour such r e f e r r a l s , p l e a s e i n d i c a t e w h i c h , i n your o p i n i o n , would be t h e s i n g l e most e f f e c t i v e c h a n n e l and method. 1 . The Channel A r e f e r r a l may e f f e c t i v e l y be made (a (b (c (d (e ( f (g (h ( i d i r e c t l y by you th r o u g h head n u r s e " s u p e r v i s o r ?I d o c t o r " h o s p i t a l p u b l i c h e a l t h n u r s e " h o s p i t a l s o c i a l worker p a t i e n t ' s f a m i l y u n c e r t a i n Other - p l e a s e s p e c i f y • a a • • • • The Method The method by which a r e f e r r a l i s made may e f f e c t i v e l y be (a) t e l e p h o n e • (b) s p e c i f i c r e f e r r a l form D (c) l e t t e r I f (d) i n t e r v i e w (e) u n c e r t a i n 64 - n (f) Other - please specify j j APPENDIX C THE RESPONSES OF FIFTY-SEYEN GENERAL STAFF NURSES IN HOSPITALS RELATED TO SPECIFIC ITEMS IN SIX CATEGORIES OF PATIENT NEEDS EXPRESSED IN FREQUENCIES AND PERCENTAGES 66 APPENDIX C THE RESPONSES OF FIFTY-SEVEN GENERAL STAFF NURSES IN HOSPITALS RELATED TO SPECIFIC ITEMS IN SIX CATEGORIES OF PATIENT NEEDS EXPRESSED IN FREQUENCIES AND PERCENTAGES A. ITEMS IN PHYSICAL CARE CATEGORY OF NEEDS Physical Care Frequency Percentage 1. Daily baths 26 11.5 2. Dressing changes 26 11.5 3. Colostomy irrigations 8 3.5 4. Injections 25 11.0 5. Catheter irrigations and changes 30 13.2 6. Enemas 26 11.5 7. Drug supervision 17 7.5 a. Graduated exercises 19 8.4 9. Physiotherapy 45 19.8 10. Other 5 2.2 Total 227 100.1 67 B. ITEMS IK PHYSICAL LIMITATIONS CATEGORY OP NEEDS Physical Limitations Frequency Percentage 1. Confined to bed 14 11.0 2. Confined to wheelchair 31 24.4 3. Dependent on crutches 16 12.6 4. Dependent on walker 25 19.7 5. Dependent on prostheses 4 3.1 6. Limited mobility 31 24.4 7. Other 6 4.7 Total 127 99.9 C. ITEMS IN MENTAL HEALT R CATEGORY OF NEEDS Mental Health Frequency Percentage 1. Difficulty in accepting long-term illness 24 14.8 2. Depressed 44 27.2 3. Overactive 11 6.8 4* Overanxious 25 15.4 5. Quarrelsome 12 7.4 6. Extremely docile 7 4.3 7. Fearful 25 15.4 8. Suspicious 6 3.7 9. Other 8 4.9 Total 162 99.9 68 D. ITEMS IN HOME ENVIRONMENT CATEGORY OP NEEDS Home Environment Frequency Percentage 1. Will require house-keeper or practi-cal nurse 29 24.4 2. May return to former residence i f physical 28 f a c i l i t i e s adjusted 23.5 3. Needs more appropriate home 29 24.4 4. Has financial worries about self and/or family 27 22.7 5. Other 6 5.0 Total 119 100.0 E. ITEMS IN OCCUPATIONAL ENVIRONMENT CATEGORY OF NEEDS Occupational Environment Frequency Percentage 1. Has limitations imposed on a c t i v i t i e s i n present position 38 57.6 2. Needs further education for old job 1 1.5 3. Needs assistance in finding new job 14 21.2 4. Needs re-training for new job 7 10.6 5. Other 6 9.1 Total 66 100.0 69 F. ITEMS IN SOCIAL ENVIRONMENT CATEGORY OF NEEDS Social Environment Frequency Percentage 1. Needs more companion-16.9 ship 33 2. Needs assistance in pursuing new hobbies 20 10.3 3. Needs to develop new areas of interest outside of home setting 15 7.7 Family needs explanation and encouragement re patient's condition 41 21.0 5. Family needs direct teaching re patient's condition 33 16.9 6. Needs counselling in family relationships 12 6.2 7. Needs encouragement in general adjustment to limitations imposed by illness 39 20.0 a. Other 2 1.0 Total 195 100.0 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            data-media="{[{embed.selectedMedia}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/dsp.831.1-0102005/manifest

Comment

Related Items