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Biomedical subjects

D Mansell

Publications and source records attributed to D Mansell.

7 recordsLinked to original sources
PubMed2000

Clinical factors that influence patients' desire for participation in decisions about illness.

BACKGROUND: Clinical practice often fails to optimize patient participation in decisions about serious illness. Prior studies are unclear about whether the type of decision and prior illness experience affect the patient's preferences for participation in decision making. Most studies of patient decision making have not addressed decisions about serious illness. OBJECTIVE: To determine whether the type of illness and nature of the decision predict the patient's preferences for involvement in making decisions. DESIGN: Study of randomly selected patients' responses to vignettes about cancer, acute myocardial infarction, and diabetes coupled with cross-sectional survey and chart review. SETTING: Outpatient Veterans Affairs medical clinic. PATIENTS: A total of 255 patients with a mean age of 63.2 years (95.2% male; 61.9% married). MAIN RESULTS: Patients wanted to share hypothesized major decisions with their physicians (mean score, 2.9; 1 = only physician, 5 = only patient) but wanted less involvement in hypothesized minor decisions (mean score, 2.5). Patients with recent severe heart disease (myocardial infarction, bypass surgery, angioplasty) wanted more involvement in decisions about acute myocardial infarction than did patients with stable angina or no heart disease; prior experience with diabetes did not affect decisions about diabetes. Factor analysis of the vignette items yielded 3 types of decisions that we consider to reflect major, minor, and patient behavior decisions. Mean scores were 2.9 for major decisions, 2.1 for minor decisions, and 2.7 for patient behavior decisions. CONCLUSIONS: Patients want to share in major decisions with their physicians but prefer to be less involved in minor decisions. For some illnesses, such as myocardial infarction, prior experience with the illness increases the patients' desire for participation in decision making. Arch Intern Med. 2000;160:2991-2996

Critical Care↗
PubMed1999

Roles of physicians, attorneys, and illness experience in advance directives.

BACKGROUND: Age, illness severity, functional status, and education are associated with advance directive completion. We examined these patient characteristics and discussions with attorneys and physicians in a predictive model for advance directive completion. METHODS: We did a cross-sectional survey of 255 randomly selected patients in a VA outpatient clinic. RESULTS: Patients were predominantly men (95.2%), married (61.9%), with a mean age of 63.2 years; 17.7% of the patients had an advance directive; 5.0% had only a living will, 6.0% had only a durable power of attorney for health care, and 6.7% had both. Age, marital status, illness severity, previous serious illness in spouse, and physician discussion were all associated with advance directive completion in a multiple logistic regression. Eighty-two patients were asked about discussions with attorneys--15 had advance directives; of these, 13 had talked to an attorney, but only 7 had talked to a physician. CONCLUSIONS: Previous serious spousal illness, marital status, age, illness severity, and patient-physician discussions all predicted completions of an advance directive. Attorney discussions were strongly associated with advance directive completion. Better communication between physicians, patients, and attorneys may increase the usefulness of advance directives.

Adult↗
PubMed1998

"We picked the wrong one to sterilise": the role of nursing in the eugenics movement in Alberta, 1920-1940.

The opening decades of the twentieth century were years in which the Canadian government actively recruited immigrants from the United Kingdom, Europe and the United States to assist in the settlement of western Canada. The immigration waves that followed contained large numbers of non-English speaking people of eastern European heritage. As these numbers increased, the white Anglo-Saxon minority feared a "multiplication of the inferior". Alberta's solution was the passage of the Sterilization Act in 1928 and the creation of the Eugenics Board. The Act remained law until 1972 and its repercussions are facing Alberta courts today. The Act was supported by many prominent first-wave feminists such as Nellie McClung and Emily Murphy. Nurses too supported the Act and the philosophical ideology on which the need for sterilization was based- "an available means for racial improvement." The role nurses played in promoting eugenics in Alberta through referrals to the Eugenics Board and the promotion of birth control material will be explored in the presentation. Contributions made by public health nurses will be included since much of their work was devoted to the socialization of new immigrants to Canada. Class, gender and ethnicity are central themes to this discussion because the majority of individuals who were sterilized were unemployed, female immigrants from eastern Europe. These two decades represent a time in nursing history when the nurse's duty to care was complicated by the attitudes and values of the society in which she existed. Primary sources used include the personal collection of one of Alberta's early birth control nurses, Canadian Journal of Public Health, Canadian Nurse, and Alberta newspapers.

Canada↗
PubMedDate not supplied

Profile of a leader. Mary Agnes Snively: realistic optimist.

This paper examines the leadership Mary Agnes Snively gave to Canadian nursing during the late-nineteenth and early-twentieth century with a particular focus on her practical views regarding nursing education. Although surrounded by the Victorian values of her day, Snively developed a vision of nursing education that was both optimistic and realistic. This investigation of Snively's ideas as they were articulated in papers she presented to the American Society of Superintendents of Training Schools for Nurses in 1895 and 1898, is further testament to the validity of the accolade, "Mother of Nurses in Canada," given her in 1924 by her biographer.

Canada↗