Search

Poor adherence to drug therapy decreases the effectiveness of antihypertensive treatment. Patients must take more than 80% of their antihypertensive drugs to maintain adequate blood pressure control. To understand the incidence of noncompliance and contributing factors, a pilot study was conducted in which a questionnaire was devised and administered to a random sample of 243 hypertensive patients of the adult ambulatory care clinic at Methodist Hospital of Indiana. Ninety-eight patients completed the telephone survey. Demographic data were obtained through chart reviews. The results indicated that 30-46% of the patients were noncompliant with their antihypertensive drug regimens. Factors found to be associated with noncompliance were; employment (P = .0077), use of home remedies (P = .0043), age (P = .0165), experience of side effects (P = .0051), level of concern with missed doses (P = .0043), and cost (P = .014). The incidence of noncompliance in this pilot sample is lower than the estimated 50% noncompliance rate of published data. More research is needed to understand the determinants of noncompliance in order to design interventions to improve compliance.

A model of organizational stress in the hospital was developed and tested. The model utilized measures of organizational climate, supervisory practices, and work group relations as predictors of the amount of role conflict and ambiguity that nurses perceived in providing patient care. Role conflict and ambiguity were treated as variables that intervene between organizational variables and the level of stress that the nursing staff experienced. Nursing stress was viewed as a direct cause of job dissatisfaction and as an indirect cause of absenteeism among the nursing staff. Data from 158 registered nurses, licensed practical nurses, and nursing assistants on seven nursing units in a 1,160-bed private teaching hospital were used to estimate the parameters of a structural equation model. The model was used to predict the results of a survey feedback project designed to change the supervisory style used on the units. Pre- and posttest data from four surgical units were used to validate the model. The findings suggest that, as predicted, supervisory practices that led to more open expression of views and joint problem solving resulted in reduced role conflict, ambiguity, and stress; increased job satisfaction; and lower levels of absenteeism among the nursing staff.

The literature indicates that nurses on special care units experience stress resulting from the role conflict and ambiguity to which they are exposed. Role theory predicts that such individuals will become dissatisfied with their work and will decrease their confidence in supervisors and co-workers. Consequently, it was hypothesized that a staff support program designed to assist nurses to cope with role conflict and ambiguity would result in reduced stress; increased satisfaction with work, supervision, and co-workers; and decreased staff turnover. A nine week staff support program was implemented on a hospice unit in a large, private, general hospital. The program utilized an insight-oriented approach focused on specific sources of stress combined with structured exercises designed to facilitate nurses' ability to cope with stress resulting from a role conflict and ambiguity. Data were collected from two groups to hospice nurses using a Nursing Stress Scale developed for this study, the Job Description Index, and personnel records. A quasi-experimental research design was used to assess the validity and generalizability of the results of the program. Data were analyzed in four stages: (i) pre-program levels of stress and job satisfaction were analyzed using a multivariate profile analysis; (ii) correlated t-tests were used to test for significant differences between pre- and post-program levels of stress; (iii) a repeated measures ANOVA was used to examine the effect of the program on job satisfaction; (iv) turnover among the nursing staff on four other hospital units was compared to the hospice unit. Results of the evaluation indicated that the support program was effective in reducing nursing stress, increasing job satisfaction, and decreasing staff turnover. The implications of the study for the design and evaluation of hospital staff support programs are discussed.