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This qualitative phenomenological study examined the experiences of patients, their family members, and the nurses in the intensive care unit during critical illness. Five participants from each category participated in two interviews over a period of five months. Content analysis of the interview transcripts revealed five integrating common themes, each reflecting concepts from the Roy Adaptation Model (RAM). The ICU experience among all participants is interdependence. Adaptation in the ICU integrated family as a unit, physical care/comfort, physiological care and psychosocial support, resulting in transformation.

Examines the effects of hospital restructuring and downsizing on components of psychological burnout experienced by a predominantly female sample of hospital‐based nursing staff. Collects data from 1,362 staff nurses using anonymous questionnaires Considers three components of psychological burn‐out: emotional exhaustion, cynicism and prfessional efficacy. Includes three blocks of predictors: personal demographics, work situation characteristics, and three different measures of demands resulting from a restructuring experience. Concludes the experience of hospital restructuring and downsizing was consistently related to a high level of emotional exhaustion and cynicism, controlling for personal demographic and work situation characteristics.

Over 3 million intermittently employed and socially disadvantaged workers receive low wages and limited benefits in diverse long-term care settings and employment arrangements as they try to become a positively valued unified occupation: “direct care workers.” Before this occurs, these workers must overcome negative definitions imposed by three powerful institutions: professional guilds, employers, and states. Care workers’ legitimacy is challenged as nursing labels them “unlicensed, assistive personnel,” defining them in terms of their task relationship to nurses rather than their social relationship to clients. Care workers’ identity is obscured as corporate rationalization nullifies their unique contributions with task unbundling, part-time work, short staffing, and turnover undermining bonding with colleagues and clients. State regulation impedes care workers’ integration, segmenting similar workers under different regulatory regimes, defining workers negatively rather than by their educational attainments and competencies. Overcoming this triple negation will require not just cultural change, but also real structural changes, and can occur only through concerted actions involving coalitions. Labor market intermediaries, public authorities, labor unions, workforce investment boards, philanthropic organizations, and government interagency groups are among those supporting direct care workers’ advancement by strategically coordinating licensing, purchasing, and developing the workforce. Recent federal policy changes and health reform legislation have enhanced recognition of this occupation and are providing new resources for its development.