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PubMed2000

New world views: preparing physicians in training for global health work.

BACKGROUND AND OBJECTIVES: To determine the impact of international health experiences on physicians in training, we studied 60 US medical students who participated in an International Health Fellowship Program (IHFP). METHODS: In 1995 and 1996, US medical students were selected to participate in the IHFP, which included training at three US medical schools and at seven medical schools in developing countries. The program included a 2-week preparatory course at a US school and a 6- to 8-week field experience. Evaluative data were collected prior to the course, after the course, after the field experience, and 1-2 years later. RESULTS: A total of 60 students were selected from 145 applicants. At the end of the fellowship, a majority of participants noted that the exposure affected them in the following ways: changed world views; increased cultural sensitivity; enhanced community, social, and public health awareness; enhanced clinical and communication skills; more appropriate resource utilization; changes in career plans; and a greater understanding of the challenges of working in areas with scarce resources. After the international field experience, students more strongly agreed with the importance of oral rehydration, communication skills, and patient education. According to student self-assessments, the IHFP significantly improved core medical skills. Ninety-six percent of participants recommended international health experiences for other students. CONCLUSIONS: This study of IHFP fellows demonstrates multiple significant impacts of international health experiences on US medical students in training. The knowledge, attitudes, and skills gained through international health experiences are important for medical practice in the United States and abroad. Given the high interest of medical students in international health and the potential for positive educational impacts, medical schools should increase the availability of high-quality international experiences.

Attitude↗
PubMed2004

Breastfeeding practices of health professionals and care workers in Turkey.

Breastfeeding has a significant positive impact on the health of infants and is the best nutrition source. Health professionals/care workers play a considerable role in the promotion of breast-feeding. The knowledge and attitude level of health professionals/care workers and its influence on their own breastfeeding behaviour was investigated. Two hundred sixty three of 345 health care workers (response rate = 76.2%) working in Children and Birth Hospitals and primary health care centres in a rural city (Isparta) in south Turkey participated in this study. A questionnaire was administered. Descriptive statistics and chi2 test have been used (alpha = 0.05) to analyse the data. Seventy four (41.1%) of the respondents with children (n = 180) exclusively nursed their children for less than 4 months; 62 (34.4%) nursed beyond 6 months. Physicians with children (n = 14, 53.8%) were used to exclusively breastfeed less than 4 months (chi2 (4) = 9.76, p = 0.045). This study showed a difference between health professionals/care workers attitudes and knowledge level and their or their spouses breastfeeding behaviour. The reason why knowledge level of health professionals did not translate into their own or their spouses' breastfeeding practices needs to be evaluated in further studies.

Adult↗
PubMed1994

Preventing AIDS: knowledge, attitudes, and practices.

1. Because health care providers are the key professionals in advising patients about prevention and treatment of HIV/AIDS, the degree to which spread can be prevented is at least partially a function of preventive and education measures taken by health care professionals. 2. Nurses surveyed believe that they do not have the right to refuse treatment to patients infected with HIV. 3. Twenty percent of health care professionals indicated they did not have adequate information concerning HIV, with the largest group being nurse executives in long-term care facilities. 4. The survey indicated that more efficient and effective educational methods should be used to increase health care practitioners' knowledge about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The effectiveness of intensive training for residents in interviewing. A randomized, controlled study.

BACKGROUND: Interviewing and the physician-patient relationship are crucial elements of medical care, but residencies provide little formal instruction in these areas. OBJECTIVE: To determine the effects of a training program in interviewing on 1) residents' attitudes toward and skills in interviewing and 2) patients' physical and psychosocial well-being and satisfaction with care. DESIGN: Randomized, controlled study. SETTING: Two university-based primary care residencies. PARTICIPANTS: 63 primary care residents in postgraduate year 1. INTERVENTION: A 1-month, full-time rotation in interviewing and related psychosocial topics. MEASUREMENTS: Residents and their patients were assessed before and after the 1-month rotation. Questionnaires were used to assess residents' commitment to interviewing and psychosocial medicine, estimate of the importance of such care, and confidence in their ability to provide such care. Knowledge of interviewing and psychosocial medicine was assessed with a multiple-choice test. Audiotaped interviews with real patients and videotaped interviews with simulated patients were rated for specific interviewing behaviors. Patients' anxiety, depression, and social dysfunction; role limitations; somatic symptom status; and levels of satisfaction with medical visits were assessed by questionnaires and telephone interviews. RESULTS: Trained residents were superior to untrained residents in knowledge (difference in adjusted post-test mean scores, 15.7% [95% CI, 11% to 20%]); attitudes, such as confidence in psychological sensitivity (difference, 0.61 points on a 7-point scale [CI, 0.32 to 0.91 points]); somatization management (difference, 0.99 points [CI, 0.64 to 1.35 points]); interviewing of real patients (difference, 1.39 points on an 11-point scale [CI, 0.32 to 2.45 points]); and interviewing (data gathering) of simulated patients (difference, 2.67 points [CI, 1.77 to 3.56 points]). Mean differences between the study groups were consistently in the appropriate direction for patient satisfaction and patient well-being, but effect sizes were too small to be considered meaningful. CONCLUSION: An intensive 1-month training rotation in interviewing improved residents' knowledge about, attitudes toward, and skills in interviewing.

Attitude of Health Personnel↗
PubMed2003

The acceptability of chronic disease management programmes to patients, general practitioners and practice nurses.

AIM: To evaluate the perceived effectiveness and acceptability of a disease management programme for patients with congestive heart failure (CHF) in South Auckland. METHODS: Focus groups were held with patients, and practice nurses (PNs) and general practitioners (GPs) interviewed to develop the questionnaires. Questionnaires were posted to the 150 patients, 14 GPs and 6 PNs involved in the programme. RESULTS: The programme was reported as changing patient lifestyle behaviours and patient understanding of medications and CHF. GP management was also seen as having improved. All aspects of the programme were seen as important: clinical review with a GP, educational sessions with a PN, patient-held care plan and educational material. The main issues were lack of time for practice staff to be involved, and payment for their time. CONCLUSIONS: Disease management programmes such as this are of value and are acceptable to both patients and providers.

Attitude of Health Personnel↗
PubMed1997

The psychosexual needs of stoma patients.

An awareness of sexual issues is an integral part of nursing care. Nurses often perceive the concept of sexuality as not their responsibility. In this study 11% of SCNs routinely incorporate a sexual history in nursing practice.

Adult↗
PubMed1997

Pressure ulcers in adults: family physicians' knowledge, attitudes, practice preferences, and awareness of AHCPR guidelines.

BACKGROUND: Little is known about physicians' knowledge, attitudes, and practice preferences with regard to pressure ulcers. Clinical practice guidelines on pressure ulcers from the Agency for Health Care Policy and Research (AHCPR) have been publicized, but their impact on family physicians has not been assessed. METHODS: A questionnaire was sent to a random sample of active members of the Minnesota Academy of Family Physicians. Information was collected on respondent demographics practice characteristics, training, and awareness of AHCPR guidelines. Knowledge about pressure ulcers was assessed with a 43-item test. Attitudes about pressure ulcer treatment were measured on a Likert-type scale. Four case scenarios were used to explore preferences. RESULTS: Of 292 potential respondents after exclusion, 155 (53.1%) returned questionnaires. Regression analysis revealed that taking care of more elderly patients, completing a residency, being board-certified, and being aware of the AHCPR guidelines were independently associated with higher knowledge scores. Virtually all (99%) the respondents felt that it was the family physician's role to provide pressure ulcer care, whereas 70% felt that they had not been adequately trained to do so. There was a wide variety of practice preferences. Approximately 70% of physicians were not aware of the AHCPR guidelines. CONCLUSIONS: Most family physicians fell ill-prepared to manage pressure ulcers, suggesting a need to increase educational efforts for this important problem. Knowledge about pressure ulcers could possibly be enhanced by more clinical exposure to older patients, rigorous residency training, and review of AHCPR guidelines.

Adult↗
PubMedDate not supplied

Matching a graduate curriculum in public/community health nursing to practice competencies: the Rush University experience.

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing.

Attitude of Health Personnel↗
PubMed2006

Identity and resistance: why spiritual care needs 'enemies'.

AIMS: This paper explores certain key critiques of spirituality-in-nursing as they have been offered by people outside of the discipline. It argues that nurses have not taken seriously enough the recent criticism of the nature and role of spirituality in nursing. Not to listen to the 'enemies' of spirituality-in-nursing is to risk stagnation and a drift into obscurity. BACKGROUND: The area of spirituality has become a growing field of interest for nurses and has produced a burgeoning body of research literature. Yet, whilst much has been written about the positive aspects of spirituality, nurses have offered almost no critique of the ways in which spirituality and spiritual care are understood, despite the fact that there are clearly certain key issues that require robust critique and thoughtful reflection. Almost all of the major criticisms of spirituality-in-nursing have come from people outside of the discipline of nursing. The paper argues that nurses need to listen carefully to the criticisms of spirituality and spiritual care offered by the 'enemies' of spiritual care in nursing. When listened to constructively, they highlight issues that are vital for the development and forward movement of this important area of nursing practice. METHODS: Literature review and critical reflection on current critiques of spirituality in nursing practice. CONCLUSIONS: The paper concludes that nurses need to begin to develop spirituality as a specific field of enquiry with its own bodies of knowledge, methodologies, assumptions and core disciplines. RELEVANCE TO CLINICAL PRACTICE: In listening to and taking seriously its 'enemies', nursing has the opportunity to establish spirituality as an important, creative and vibrant aspect of nursing practice that has the capacity to grow and respond constructively to its 'enemies', in ways that make whole-person-care a real possibility.

Attitude of Health Personnel↗
PubMed2006

Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia.

OBJECTIVE: To assess an important part of Australia's National Mental Health Strategy by examining the collaboration and referral practices between general practitioners and community mental health workers in rural and remote areas. DESIGN: Semistructured interviews. SETTING: Rural and remote health service region in Australia. PARTICIPANTS: In total, 31 general practitioners and 14 mental health workers. RESULTS: Meaningful collaboration and referral practices between general practitioners and mental health workers are prevented by contradictory and ambiguous definitions involving professional roles and mental health. A pattern of negative collaboration was further magnified by the rural and remote context. CONCLUSION: The implementation of Australia's National Mental Health Strategy faces serious problems in rural and remote area due to the negative collaboration and referral practices between general practitioners and mental health workers.

Attitude of Health Personnel↗
PubMedDate not supplied

Knowledge, behavior, and fears concerning breast and cervical cancer among older low-income Mexican-American women.

INTRODUCTION: Although recent studies have documented the low participation level of Hispanic women in cancer screening, few have examined their predisposing knowledge and attitudes concerning cancer. We documented the knowledge and fears concerning cancer of an older population of Mexican-American women and how these factors relate to screening behavior and sociodemographic characteristics. METHODS: The data are from baseline surveys conducted before the start of a community cancer awareness and prevention program. Nine hundred twenty-three Mexican-American women were interviewed in-person about their knowledge, attitudes, and Pap smear and mammogram screening practices. RESULTS: Knowledge and attitude about cancer varied with age, education, type of health insurance, ability to speak English, and place of birth. Women 65 years of age and older were least knowledgeable of cancer-detection methods and screening guidelines. Those with only Medicare or Medicaid knew far less even compared to uninsured women. Women who did not speak English well were more likely not to know the cancer signs and symptoms, risk factors, and screening guidelines. Women who had knowledge of guidelines and detection methods were more likely to have had a recent screening. Older Mexican-American women with more fatalistic and fearful attitudes toward cancer were less likely to have had a recent Pap smear. CONCLUSIONS: The low screening participation among Mexican-American women may be due to their limited awareness and knowledge about breast and cervical cancer screening examinations. Our study highlights the need for wide-scale cancer screening interventions consistent with Mexican-American beliefs.

Adult↗
PubMed2006

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue.

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.

Attitude of Health Personnel↗
PubMed2006

End-of-life practices at a Lebanese hospital: courage or knowledge?

End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

Adult↗
PubMedDate not supplied

Critical thinking and evidence-based practice.

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.

Attitude of Health Personnel↗