Staff and patient perceptions of seclusion: Has anything changed?

Background Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. While early research on the topic highlighted significant differences in staff and patient perceptions, there are few recent data to indicate if these differences still exist. Aim This paper reports a study exploring the perceptions of both nursing staff and patients towards the reasons for seclusion; its effects; patients' feelings during seclusion; and possible changes to the practice. Methods Sixty nursing staff and 29 patients who had experienced seclusion at three inpatient units in Queensland, Australia completed Heyman's Attitudes to Seclusion Survey. Results The findings indicate that the two groups differed significantly on a number of the dimensions assessed. Nurses believed seclusion to be very necessary, not very punitive and a highly therapeutic practice that assisted patients to calm down and feel better. Patients, on the other hand, believed that seclusion was used frequently for minor disturbances and as a means of staff exerting power and control. Patients also believed that seclusion resulted in them feeling punished, and had little therapeutic value. Conclusion The disagreement between staff and patients highlights the need for greater dialogue between these groups. While nursing staff require greater understanding of how patients feel about seclusion, patients require information on why and how seclusion is implemented.

Principals' and teachers' perceptions of learning disabilities: A study from Nara Prefecture, Japan

In this study, perceptions of learning disabilities were obtained from 128 principals and 123 teachers in the Nara Prefecture, Japan. A factor analysis indicated that five factors underlie perceptions of learning disabilities: changes in the family and social situation, insufficient knowledge of and support for learning disabilities, teachers' abilities and professional development, teachers' situation and governmental issues. Teachers' situation was perceived to be the main factor, whereas the least important factor was governmental issues. Teachers mainly indicated agreement on the factor of insufficient knowledge of and support for students with learning disabilities. Principals were more aware of governmental issues than teachers.

Parents' and staff's perceptions of parental needs during a child's admission to hospital: an English perspective

The aim of this research was to compare perceptions of parental needs held by parents of hospitalized children and the staff caring for them, so that potential communication breakdown could be avoided. A well-trialled tool was used with a convenience sample in paediatric facilities in a National Health Service trust in north-east England. Some differences were found between parents and staff for scores for perceived importance of the 51 needs that were included in the questionnaire, and whether or not they were being satisfactorily met during the child’s hospital admission, but there were no consistent patterns, so it is difficult to draw conclusions. Parents declared themselves more independent than the staff perceived them to be. Such findings facilitate improvements in communication between parents and staff and can be included in education programmes for both.

Perceptions of organisational subculture and their significance for organisational commitment

This paper investigates the relationship between perceptions of organisational culture, organisational subculture, leadership style, and commitment. The impact of culture and leadership style on commitment has been previously noted, but there is a lack of detail regarding how different types of culture and leadership styles relate to commitment. The paper particularly addresses the notion of organisational subcultures and how the perception of those cultures relates to commitment, subculture being a neglected variable in the commitment literature. These issues were addressed in a survey of 258 nurses drawn from a range of hospital settings and wards within the Sydney metropolitan region. Results indicate that perceived organisational subculture has a strong relationship with commitment. Furthermore, the results identify the relative strength of specific types of leadership style and specific types of subculture with commitment. Both innovative and supportive subcultures have a clear positive relationship, while bureaucratic subcultures have a negative relationship. In terms of leadership style, a consideration style had a stronger relationship with commitment than a structuring style. Regression analysis was used to investigate the possible role of subculture as a mediator for the influence of leadership on commitment. Both direct and indirect effects of leadership on commitment were found. Implications for practice and for further research are discussed.

Community perceptions of adequate levels and reasons for skin protection

In this study the authors addressed whether or not community members use relevant risk factors to determine an appropriate level of skin protection behavior in the prevention of skin cancer. The authors conducted a postal survey with a community sample of 3,600 Queensland residents that they randomly selected from the Commonwealth electoral roll. The predictors of perceptions of doing enough skin protection included intrapersonal, social, and attitudinal influences. People protected themselves from the sun primarily out of a desire for future good health and on other occasions did not protect themselves from the sun because they were not out there long enough to get burnt. The predictors of perceptions of doing enough skin protection indicated that participants were aware of relevant risk factors. The main reasons that people protect themselves from the sun suggest that they are acting on many health promotion messages. However, skin cancer prevention programs need to move beyond increasing awareness and knowledge of the disease to providing a supportive environment and enhancing individual skills. Health promotion campaigns could reinforce appropriate risk assessment and shape an individual's decision about how much sun protection is needed.

Community perceptions of suspicious pigmented skin lesions: are they accurate when compared to general practitioners?

Community responses (n = 925, response rate = 71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners (n = 114, response rate = 77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI = 0.66-0.69]) was higher (p < 0.0001) than that of the comparison general practitioners 0.58 [99% CI = 0.55-0.62]. This reflects a general (but not consistent) inflated propensity to over-diagnose among community members. The average probability that respondents indicated they would seek medical advice for a lesion was 0.71 [99% CI = 0.70-0.73]. As expected, this was strongly associated with their perceptions of the skin lesion. These results suggest that the community can play a valuable role in assessing the need for medical evaluation of pigmented skin lesions. (c) 2004 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved.

Residents' perceptions of walkability attributes in objectively different neighbourhoods: a pilot study

Physical attributes of local environments may influence walking. We used a modified version of the Neighbourhood Environment Walkability Scale to compare residents' perceptions of the attributes of two neighbourhoods that differed on measures derived from Geographic Information System databases. Residents of the high-walkable neighbourhood rated relevant attributes of residential density, land-use mix (access and diversity) and street connectivity, consistently higher than did residents of the low-walkable neighbourhood. Traffic safety and safety from crime attributes did not differ. Perceived neighbourhood environment characteristics had moderate to high test retest reliabilities. Neighbourhood environment attribute ratings may be used in population surveys and other studies. (c) 2004 Elsevier Ltd. All rights reserved.