The Birmingham relationship continuity measure:the development and evaluation of a measure of the perceived continuity of spousal relationships in dementia

Background: Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. Methods: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. Results: The questionnaire showed good reliability: Cronbach's α for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's δ was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. Conclusion: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role. © 2012 International Psychogeriatric Association.

The effectiveness of workplace coaching:A meta-analysis of learning and performance outcomes; scale development; theoretical model of individual differences and longitudinal study

The extant literature on workplace coaching is characterised by a lack of theoretical and empirical understanding regarding the effectiveness of coaching as a learning and development tool; the types of outcomes one can expect from coaching; the tools that can be used to measure coaching outcomes; the underlying processes that explain why and how coaching works and the factors that may impact on coaching effectiveness. This thesis sought to address these substantial gaps in the literature with three linked studies. Firstly, a meta-analysis of workplace coaching effectiveness (k = 17), synthesizing the existing research was presented. A framework of coaching outcomes was developed and utilised to code the studies. Analysis indicated that coaching had positive effects on all outcomes. Next, the framework of outcomes was utilised as the deductive start-point to the development of the scale measuring perceived coaching effectiveness. Utilising a multi-stage approach (n = 201), the analysis indicated that perceived coaching effectiveness may be organised into a six factor structure: career clarity; team performance; work well-being; performance; planning and organizing and personal effectiveness and adaptability. The final study was a longitudinal field experiment to test a theoretical model of individual differences and coaching effectiveness developed in this thesis. An organizational sample of 84 employees each participated in a coaching intervention, completed self-report surveys, and had their job performance rated by peers, direct reports and supervisors (a total of 352 employees provided data on participant performance). The results demonstrate that compared to a control group, the coaching intervention generated a number of positive outcomes. The analysis indicated that coachees’ enthusiasm, intellect and orderliness influenced the impact of coaching on outcomes. Mediation analysis suggested that mastery goal orientation, performance goal orientation and approach motivation in the form of behavioural activation system (BAS) drive, were significant mediators between personality and outcomes. Overall, the findings of this thesis make an original contribution to the understanding of the types of outcomes that can be expected from coaching, and the magnitude of impact coaching has on outcomes. The thesis also provides a tool for reliably measuring coaching effectiveness and a theoretical model to understand the influence of coachee individual differences on coaching outcomes.

Az árak észlelése és értékelése(Perception and Evaluation of Prices)

A 2008-ban kezdődött gazdasági válság a korábbiaknál is fontosabbá tette az árakat a vásárlók számára. Azt eddig is mindenki tudta, hogy az árak alapvetően befolyásolják a fogyasztók vásárlási döntését. Arra a kérdésre azonban, hogy miképpen, már nem mindig tudunk pontos választ adni. A közgazdaságtan szerint az árak csökkenése növeli a fogyasztók vásárlási hajlandóságát és fordítva, az árak emelkedése kisebbíti azt. A valóság azonban nem mindig írható le közgazdaságtani fogalmakkal vagy matematikai képletekkel. _______ Since the beginning of the global economic recession prices have become more and more important for sellers and buyers. To study the role of prices in consumer behaviour is a rather new field of marketing research. The paper starts out from the fact that prices can be regarded as a multidimensional stimulus, which influences the purchasing decision of consumers. The study describes the process how, in this multidimensional pricing environment, consumers get from the perception through the evaluation of prices to the purchasing decision. According to the model constructed by the author the perception of prices depends on the presentation of prices and on the willingness and ability of people to numerically perceive and evaluate the different presentations of prices. In the process how consumers get from the perceived prices through the excepted prices to the purchasing decision the perceived value plays the most important role. The perceived value is motivated by the internal and external reference prices and the perceived reference value. The paper comes to the conclusion that in recession and post recession times, companies are compelled to understand these processes better to be able to set their price points according to the changing buyers behaviour.

The clinical competency of practicing and nonpracticing faculty of associate degree schools of nursing

This study assesses and describes the perception of clinical competency and the relationship to clinical practice of full-time nursing faculty in the associate degree nursing programs in the state of Florida. The study was developed around one major hypothesis and four research questions. The Hygiene-Motivators Theory proposed by Herzberg, Mausner, and Snyderman (1959) provided the conceptual framework to explain factors that would motivate a person to expand workload and maintain job satisfaction.^ Data were collected from the 244 faculty members teaching full-time at the 15 associate degree schools of nursing accredited by the National League for Nursing in the state of Florida. A total of 186 faculty (76%) responded and 175 (72%) cases were used for data analysis.^ Two instruments were modified and combined for the investigation. The instruments were the Faculty Perception of Practice Questionnaire (Parascenzo, 1983) and a three-part Attributes Deemed Necessary for Faculty to Proclaim Clinical Competency (Smith, 1991) scale. Computer analyses employing descriptive and inferential statistics were performed.^ The findings revealed that faculty were closely divided as to practice activities with more faculty nonpracticing than practicing. Factors identified as impediments to increased clinical practice were identified as teaching load and personal/family responsibilities that lead to a lack of time and lack of opportunity. Those faculty who practice did so as moonlighters in positions that would not require advanced training. Both the practicing and nonpracticing faculty reported a high level of satisfaction with their activities as a means of maintaining clinical practice. While both groups reported a high level of expertise, those practicing faculty perceived themselves to be more clinically competent on the attributes of knowledge, skills, and on the total attribute scale. It was further revealed that perception of competency declined with the length of time spent out of practice. There was no difference in the two groups on the attributes of values/attitude. ^

The relationship between the teacher's experience, the teacher's college major, and the teacher's level of education in predicting classroom attitudes in high school science students

A review of the literature reveals few research has attempted to demonstrate if a relationship exists between the type of teacher training a science teacher has received and the perceived attitudes of his/her students. Some of the teacher preparation factors examined in this study include the college major chosen by the science teacher, the highest degree earned, the number of years of teaching experience, the type of science course taught, and the grade level taught by the teacher. This study examined how the various factors mentioned, could influence the behaviors which are characteristic of the teacher, and how these behaviors could be reflective in the classroom environment experienced by the students.^ The instrument used in the study was the Classroom Environment Scale (CES), Real Form. The measured classroom environment was broken down into three separate dimensions, with three components within each dimension in the CES. Multiple Regression statistical analyses examined how components of the teachers' education influenced the perceived dimensions of the classroom environment from the students.^ The study occurred in Miami-Dade County Florida, with a predominantly urban high school student population. There were 40 secondary science teachers involved, each with an average of 30 students. The total number of students sampled in the study was 1200. The teachers who participated in the study taught the entire range of secondary science courses offered at this large school district. All teachers were selected by the researcher so that a balance would occur in the sample between teachers who were education major versus science major. Additionally, the researcher selected teachers so that a balance occurred in regards to the different levels of college degrees earned among those involved in the study.^ Several research questions sought to determine if there was significant difference between the type of the educational background obtained by secondary science teachers and the students' perception of the classroom environment. Other research questions sought to determine if there were significant differences in the students' perceptions of the classroom environment for secondary science teachers who taught biological content, or non-biological content sciences. An additional research question sought to evaluate if the grade level taught would affect the students' perception of the classroom environment. (Abstract shortened by UMI.) ^

Teachers' perceptions of the usefulness of Individual Education Plans (IEP)

Since 1997 federal special education policy mandated that all classroom teachers take part in planning and implementation of Individualized Education Plans (IEP) for students with disabilities. This legislation has given teachers new responsibilities because it requires greater participation in the IEP process. The purpose of this study was to examine teachers' perceptions of the usefulness of Individualized Education Plans (IEP). ^ Eighty seven certified Miami-Dade County Public School teachers, 60 general education teachers and 27 special education teachers were surveyed using an updated version of Rheams' (1989) The Teacher Perceptions of the Usefulness of IEPs. Subjects completed a survey form containing a demographic cover page, 18 Likert-scale statements and 3 open ended questions. This study looked at differences in perceptions by teacher group affiliation (general and special), grade level taught (elementary and secondary), and years of experience (<=5 and >5 years). The dependent variables were teacher preparedness; feasibility of IEP implementation; relevancy of IP to classroom instruction; and legal, professional and personal accountability with regard to the IEP. ^ Results of the Multivariate Analysis of Variance (MANOVA) revealed that (a) special education teachers held a more positive perception of overall IEP usefulness than general education teachers, (b) special educators held more positive perceptions concerning issues of feasibility and preparedness, (c) elementary level teachers viewed the IEP more positively than secondary level teachers, specifically in the areas of preparedness and feasibility. ^ Findings of this study indicate that general and secondary educators have not embraced the legislation and incorporated it into their planning and instruction. These findings provide policymakers, institutions of higher education, and school administrators with insight as to how to better translate policy into classroom instructional practice. Consideration should be given to implementing (a) honest communication and shared decision making with regard to IEP directed curriculum and instruction, (b) updated pre and in-service IEP development and implementation training, and (c) opportunities for collaboration and increased plan time, especially on the secondary level. ^

A comparative analysis of self-determined evaluations of work performance and support needs by adults with mental retardation in supported work and in sheltered workshop environments

The purpose of this study was to determine if there was a difference in the self-determined evaluations of work performance and support needs by adults with mental retardation in supported employment and in sheltered workshop environments. The instrument, Job Observation and Behavior Scale: Opportunity for Self-Determination (JOBS: OSD; Brady, Rosenberg, & Frain, 2006), was administered to 38 adults with mental retardation from sheltered workshops and 32 adults with mental retardation from supported employment environments. Cross-tabulations with Chi-square tests and independent samples t-tests were conducted to evaluate differences between the two groups, sheltered workshop and supported work. Two Multivariate Analyses of Variance (MANOVAs) were conducted to determine the effect of work environment on Quality of Performance (QP) and Types of Support (TS) test scores and their subscales. ^ This study found that there were significant differences between the groups on the QP Behavior and Job Duties subscales. The sheltered workshop group perceived themselves as performing significantly better on job duties than the supported work group. Conversely, the supported work group perceived themselves to have better behavior than the sheltered workshop group. However, there were no significant differences between groups in their perception of support needs for the three subscales. ^ The findings imply that work environment affects the self-determined evaluations of work performance by adults with mental retardation. Recommendations for further study include (a) detailing the characteristics of supported work and sheltered workshops that support and/or discourage self-determined behaviors, (b) exploring the behavior of adults with mental retardation in sheltered workshops and supported work environments, and (c) analysis of the support needs for and understanding of them by adults with mental retardation in sheltered workshops and in supported work environments. ^

Use of structural equation modeling to examine the association between breast cancer risk perception and repeat screening mammography among United States women

Breast cancer is the second leading cause of cancer death in United States women, estimated to be diagnosed in 1 out of 8 women in their lifetime. Screening mammography detects breast cancer in its pre-clinical stages when treatment strategies have the greatest chance of success, and is currently the only population-wide prevention method proven to reduce the morbidity and mortality associated with breast cancer. Research has shown that the majority of women are not screened annually, with estimates ranging front 6% - 30% of eligible women receiving all available annual mammograms over a 5-year or greater time frame. Health behavior theorists believe that perception of risk/susceptibility to a disease influences preventive health behavior, in this case, screening mammography The purpose of this dissertation is to examine the association between breast cancer risk perception and repeat screening mammography using a structural equation modeling (SEM) framework. A series of SEM multivariate regressions were conducted using self-reported, nationally representative data from the 2005 National Health Interview Survey. Interaction contrasts were tested to measure the potential moderating effects of variables which have been shown to be predictive of mammography use (physician recommendation, economic barriers, structural barriers, race/ethnicity) on the association between breast cancer risk perception and repeat mammography, while controlling for the covariates of age, income, region, nativity, and educational level. Of the variables tested for moderation, results of the SEM analyses identify physician recommendation as the only moderator of the relationship between risk perception and repeat mammography, thus the potentially most effective point of intervention to increase mammography screening, and decrease the morbidity and mortality associated with breast cancer. These findings expand the role of the physician from recommendation to one of attenuating the effect of risk perception and increasing repeat screening. The long range application of the research is the use of the SEM methodology to identify specific points of intervention most likely to increase preventive behavior in population-wide research, allowing for the most effective use of intervention funds.^

Across-scale patterning of plant-soil-water interactions surrounding tree islands in Southern Everglades landscapes

The freshwater Everglades is a complex system containing thousands of tree islands embedded within a marsh-grassland matrix. The tree island-marsh mosaic is shaped and maintained by hydrologic, edaphic and biological mechanisms that interact across multiple scales. Preserving tree islands requires a more integrated understanding of how scale-dependent phenomena interact in the larger freshwater system. The hierarchical patch dynamics paradigm provides a conceptual framework for exploring multi-scale interactions within complex systems. We used a three-tiered approach to examine the spatial variability and patterning of nutrients in relation to site parameters within and between two hydrologically defined Everglades landscapes: the freshwater Marl Prairie and the Ridge and Slough. Results were scale-dependent and complexly interrelated. Total carbon and nitrogen patterning were correlated with organic matter accumulation, driven by hydrologic conditions at the system scale. Total and bioavailable phosphorus were most strongly related to woody plant patterning within landscapes, and were found to be 3 to 11 times more concentrated in tree island soils compared to surrounding marshes. Below canopy resource islands in the slough were elongated in a downstream direction, indicating soil resource directional drift. Combined multi-scale results suggest that hydrology plays a significant role in landscape patterning and also the development and maintenance of tree islands. Once developed, tree islands appear to exert influence over the spatial distribution of nutrients, which can reciprocally affect other ecological processes.

Historical analysis of two contemporary issues at the International Community School of Abidjan, Cote d'Ivoire: Local -hired and overseas -hired teacher relationships. Community perceptions of the U.S. Embassy at ICSA

This study was a qualitative investigation to ascertain and describe two of the current issues at the International Community School of Abidjan, examine their historical bases, and analyze their impact on the school environment.^ Two issues emerged during the inquiry phase of this study: (1) the relationship between local-hired and overseas-hired teachers in light of the January 1994 devaluation which polarized the staff by negating a four-year salary scale that established equity, (2) the school community's wide variance in the perceived power that the U.S. Embassy has on school operations based on its role as ICSA's founding sponsor.^ A multiple studies approach was used in gathering data. An extensive examination of the school's archives was used to reconstruct an historical overview of ICSA. An initial questionnaire was distributed to teachers and administrators at an educational conference to determine the scope of the 1994 devaluation of the West and Central African CFA and its impact on school personnel in West African American-sponsored overseas schools (ASOS). Personal interviews were conducted with the school staff, administration, school board members, and relevant historical participants to determine the principal issues at ICSA at that time. The researcher, an overseas-hired teacher, also used participant observations to collect data. Findings based on these sources were used to analyze the two issues from an historical perspective and to form conclusions.^ Findings in this study pertaining to the events induced by the French and African governments' decision to implement a currency devaluation in January 1994 were presented in ex post-facto chronological narrative form to describe the events which transpired, describe the perception of school personnel involved in these events, examine the final resolution and interpret these events within a historical framework for analysis.^ The topic of the U.S. Embassy and its role at ICSA emerged inductively from open-ended personal interviews conducted over the course of a year. Contradictory perspectives were examined and researched for accuracy and cause. The results of this inquiry presented the U.S. Embassy role at ICSA from a two-sided perspective, examined the historical role of the Embassy, and presented means by which the role and responsibility of the U.S. Embassy could best be communicated to the school community.^ The final chapter provides specific actions for mediation of problems stemming from these issues, implications for administrators and teachers currently involved in overseas schools or considering the possibility, and suggestions for future inquiries.^ Examination of a two-tier salary scale for local-hired and overseas-hired teachers generated the following recommendations: movement towards a single salary scale when feasible, clearly stated personnel policies and full disclosure of benefits, a uniform certification standard, professional development programs and awareness of the impact of this issue on staff morale.^ Divergent perceptions and attitudes toward the role of the U.S. Embassy produced these recommendations: a view towards limiting the number of Americans on ASOS school boards, open school board meetings, selection of Embassy Administrative Officers who can educate school communities on the exact role of the Embassy, educating parents through the outreach activities that communicate American educational philosophy and involve all segments of the international community, and a firm effort on the part of the ASOS to establish the school's autonomy from special interests. ^

The effects of cross -age peer tutoring on writing and reading comprehension skills and attitudes and self -perceptions as writers of third and fourth grade students

The purpose of this study was to investigate the effects of cross-age peer writing response groups on the writing and reading achievement of third and fourth grade students. Students' attitudes about writing and their perceptions of themselves as writers were also measured at the end of the study. ^ One hundred and twenty-two third and fourth grade students enrolled in a public school in a middle-class, multi-cultural neighborhood participated in the study. Four existing classes of students were randomly assigned to either the experimental condition (EC) or the control condition (CC). Both groups were pretested and posttested for writing and reading achievement. The intervention, cross-age peer writing groups, met for eleven weeks. ^ Three hypotheses were examined in this study: (a) writing improvement score, (b) reading comprehension improvement score, and (c) students' attitudes toward writing and their perception of themselves as writers based on the five scales measured on the Writer Self-Perception Scale. ^ ANOVAs were done on the pretests and posttests for writing and the Stanford Achievement Test reading comprehension subtest scores for the year of the study and the previous year. ANOVAs were also done for the five areas of the Writer Self-Perception Scale. Cross-tabulations were also used to compare improvement level verses treatment group, and grade level. ^ Analysis of the data revealed that there was no evidence that the tutoring (EC) groups made more progress than the non-tutoring (CC) groups in writing and reading. There was evidence of growth in writing, especially by the fourth graders. Most importantly, the fourth grade tutors, the experimental group, had the most positive feelings about writing and themselves as writers. ^

Managing small-scale commercial fisheries for adaptive capacity: Insights from dynamic social-ecological drivers of change in Monterey Bay

Globally, small-scale fisheries (SSFs) are driven by climate, governance, and market factors of social-ecological change, presenting both challenges and opportunities. The ability of small-scale fishermen and buyers to adapt to changing conditions allows participants to survive economic or environmental disturbances and to benefit from optimal conditions. This study presented here identifies key large-scale factors that drive SSFs in California to shift focus among targets and that dictate long-term trends in landings. We use Elinor Ostrom’s Social-Ecological System (SES) framework to apply an interdisciplinary approach when identifying potential factors and when understanding the complex dynamics of these fisheries. We analyzed the interactions among Monterey Bay SSFs over the past four decades since the passage of the Magnuson Stevens Fisheries Conservation and Management Act of 1976. In this region, the Pacific sardine (Sardinops sagax), northern anchovy (Engraulis mordax), and market squid (Loligo opalescens) fisheries comprise a tightly linked system where shifting focus among fisheries is a key element to adaptive capacity and reduced social and ecological vulnerability. Using a cluster analysis of landings, we identified four modes from 1974 to 2012 that were dominated by squid, sardine, anchovy, or lacked any dominance, enabling us to identify external drivers attributed to a change in fishery dominance during seven distinct transition points. Overall, we show that market and climate factors drive the transitions among dominance modes. Governance phases most dictated long-term trends in landings and are best viewed as a response to changes in perceived biomass and thus a proxy for biomass. Our findings suggest that globally, small-scale fishery managers should consider enabling shifts in effort among fisheries and retaining existing flexibility, as adaptive capacity is a critical determinant for social and ecological resilience.

The role of group activity participation in depression among institutionalized elderly

The role of group activity participation in depression among a group of residents (N=65), age 80 and older, in a nursing home was examined using the framework of Roy's Adaptation Theory and Nolen-Hoeksema's Response Style Theory of Depression. Roy views depression as a maladaptation. Nolen-Hoeksema views group activity participation as a therapeutic distraction to break depressed moods and thus allow for positive adaptation. This study utilized data from medical records, group activity attendance, and self-report questionnaires. Demographic distributions were computed and correlational statistics were performed between subjects' participation and their degree of depression, pain experience, functional status, presence of social support, and perception of benefits. Results show a negative correlation between frequency of participation and Geriatric Depression Scale score (GDS). The wide range of measured frequencies among low GDS-scored subjects suggests that less depressed individuals exercise more freedom of choice to participate than those who are more depressed. Significant finding show a positive correlation of group activity participation with functional status in terms of ambulation. Data shows that the experience of pain was not a significant deterrent to participation. The presence of social support from the staff and family did not increase participation. However there is a lesser GDS score among subjects who had recent family/friends visit suggesting a positive role of family in decreasing depression. These results are significant not only for optimizing group therapeutic effects but also for understanding basic human and environmental correlates of depression. Study limitations are pointed out and recommendations are presented.

The relationship between the teacher's experience, the teacher's college major, and the teacher's level of education in predicting classroom attitudes in high school science students

A review of the literature reveals few research has attempted to demonstrate if a relationship exists between the type of teacher training a science teacher has received and the perceived attitudes of his/her students. Considering that a great deal of time and energy has been devoted by university colleges, school districts, and educators towards refining the teacher education process, it would be more efficient for all parties involved, if research were available that could discern if certain pathways in achieving that education, would promote the tendency towards certain teacher behaviors occurring in the classroom, while other pathways would lead towards different behaviors. Some of the teacher preparation factors examined in this study include the college major chosen by the science teacher, the highest degree earned, the number of years of teaching experience, the type of science course taught, and the grade level taught by the teacher. This study examined how the various factors mentioned, could influence the behaviors which are characteristic of the teacher, and how these behaviors could be reflective in the classroom environment experienced by the students. The instrument used in the study was the Classroom Environment Scale (CES), Real Form. The measured classroom environment was broken down into three separate dimensions, with three components within each dimension in the CES. Multiple Regression statistical analyses examined how components of the teachers' education influenced the perceived dimensions of the classroom environment from the students. The study occurred in Miami-Dade County Florida, with a predominantly urban high school student population. There were 40 secondary science teachers involved, each with an average of 30 students. The total number of students sampled in the study was 1200. The teachers who participated in the study taught the entire range of secondary science courses offered at this large school district. All teachers were selected by the researcher so that a balance would occur in the sample between teachers who were education major versus science major. Additionally, the researcher selected teachers so that a balance occurred in regards to the different levels of college degrees earned among those involved in the study. Several research questions sought to determine if there was significant difference between the type of the educational background obtained by secondary science teachers and the students' perception of the classroom environment. Other research questions sought to determine if there were significant differences in the students' perceptions of the classroom environment for secondary science teachers who taught biological content, or non-biological content sciences. An additional research question sought to evaluate if the grade level taught would affect the students' perception of the classroom environment. Analysis of the multiple regression were run for each of four scores from the CES, Real Form. For score 1, involvement of students, the results showed that teachers with the highest number of years of experience, with masters or masters plus degrees, who were education majors, and who taught twelfth grade students, had greater amounts of students being attentive and interested in class activities, participating in discussions, and doing additional work on their own, as compared with teachers who had lower experience, a bachelors degree, were science majors, and who taught a grade lower than twelfth. For score 2, task orientation, which emphasized completing the required activities and staying on-task, the results showed that teachers with the highest and intermediate experience, a science major, and with the highest college degree, showed higher scores as compared with the teachers indicating lower experiences, education major and a bachelors degree. For Score 3, competition, which indicated how difficult it was to achieve high grades in the class, the results showed that teachers who taught non-biology content subjects had the greatest effect on the regression. Teachers with a masters degree, low levels of experience, and who taught twelfth grade students were also factored into the regression equation. For Score 4, innovation, which indicated the extent in which the teachers used new and innovative techniques to encourage diverse and creative thinking included teachers with an education major as the first entry into the regression equation. Teachers with the least experience (0 to 3 years), and teachers who taught twelfth and eleventh grade students were also included into the regression equation.

Perceptions of collaboration between emergency nurses and paramedics

Collaboration between emergency room (ER) nurses and paramedics is vital due to the increasing number of critically ill patients entering the hospital via the "911" system. This descriptive study examined the perception of the collaborative relationship using the Revised Pehl Collaboration Scale (RPCS) and by qualitative data from four free response questions. The results of this study indicated that the overall relationship between the ER nurses and paramedics was friendly but not fully trusting. The content analysis of the free response questions identified that the "report" of patient information was the origin the most conflict. The nurses felt that paramedic patient assessment, patient priorities, and by-pass protocol were problems. Whereas, the paramedics identified the nurses condescending manner and mistrust, not being "listened" to, and overcrowded emergency rooms as the source of conflict. Data was not statistically significant with regards to personal attributes or social demographics from the RPCS.