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PubMed2004

Culture and communication in Thai nursing: a report of an ethnographic study.

Most nurses live and work in multicultural settings. Given the need for all nurses and health-care workers to communicate--with patients, with families and with other health-care professionals--the study of the relationship between culture and communication can help to inform practice. This paper offers the findings from an ethnographic study of culture and communication, carried out in Thailand. The aim of the study was to address the question: 'in what, if any, ways do Thai cultural issues influence interpersonal communication patterns in Thai nursing and Thai nursing education?'. Data were collected from a variety of sources, including direct and indirect observation, interviews and discussions and the literature on the topic. For the interviews, the sample was a convenience and purposive one made up of clinical nurses and nurse educators (n = 14). Those data were analysed with the aid of a computerised, qualitative data analysis program. Findings reported in this paper include those relating to 'Thainess', Buddhism, the nursing profession and nurse--patient/doctor--patient relationships. The report ends with a 'portrait' of Thai nursing communication. It is suggested that understanding the cultural aspects of nursing in various contexts can help nurses, internationally.

Altruism↗
PubMed2002

A comparison of four computer-based telephone interviewing methods: getting answers to sensitive questions.

Interactive voice response (IVR) technology presents a new and promising approach by which to collect accurate data on sensitive topics by telephone interviews. In a national survey of 2,880 households of alcohol and drug consumption, we compared computer-assisted telephone interviewing (CATT) and IVR with two hybrid methods that combine IVR with CATI. The principal hypothesis was that the self-report rates of sensitive behaviors would be higher for the hybrid and IVR methods owing to greater perceived confidentiality than with CATI. All the methods obtained similar sample demographic compositions. Response rates did not differ significantly between the CATI and the hybrid methods; however, the response rate with IVR was significantly lower. The hybrid and IVR methods obtained significantly higher self-report consumption rates for alcohol and marijuana and significantly higher hazardous drinking scores, as measured by the Alcohol Use Disorders Identification Test (AUDIT).

Humans↗
PubMed2002

How do U.S. and Canadian dental schools teach interpersonal communication skills?

The status of instruction in interpersonal communication was surveyed in forty U.S and Canadian dental schools. Key faculty members were identified, and syllabi and course descriptions were collected and content-analyzed. The following findings were obtained for responding schools: 1) only one-third of schools had courses specifically focusing on interpersonal communication; 2) more than half of the schools offered these types of courses only during the first two years; 3) the most common topics were communication skills, patient interviewing, and patient education/consultation; 4) the most frequently used method of teaching was lectures; active practice was used less often; 5) written examination was the primary instructional evaluation tool, whereas more sophisticated performance-oriented assessments were used less often; and 6) about half of the teachers did not have a D.D.S. degree; those not dentists were primarily psychologists. At least eight of the forty dental schools surveyed do not appear to meet the accreditation guidelines for predoctoral programs in this area of instruction. Some could not identify a faculty member responsible for such instruction. Schools offering more extensive instruction were more likely to offer active rather than passive teaching and use more sophisticated student evaluation strategies. This research suggests a need for reevaluation of teaching in this subject area.

Canada↗
PubMedDate not supplied

Communication deficits: assessment of subjects with frontal lobe damage in an interview setting.

This paper is about communication deficits in an interview setting among adolescents with frontal lobe damage. One of the predominant characteristics of these patients is difficulty taking the context into account. Pragmatic theories, which attempt to clarify the link between the formal structure of language and the extra-linguistic context (such as the interlocutor's characteristics or strategies), may help provide insight into the difficulties of these patients. An interview setting, viewed here as a communication situation, is governed by an interaction format based on specific cooperative principles. In this study, the results of subjects with frontal lobe damage (in the role of interviewee) were first compared with those of normal subjects in an interview situation. Three pragmatic indexes were considered: the number of utterances per speaking turn (speech quantity), amount of digression (keeping to the topic or predefined subject of conversation shared by the interlocutors) and prevalence of within-subject contingency speaking turns without an intervening remark by the interviewer (topic development). Secondly, we attempted to determine whether the patients' discourse was dependent upon the interviewer's conversational strategy (structured, non-structured, or alternating). The results clearly point out the extent of the difficulty frontal lobe patients have conforming to the rules of the interview situation, whether regarding the amount of speech they produce or their ability to keep within and/or development of the topic of conversation. The data also indicated that the patients' linguistic productions varied with the interviewer's strategy. The structured strategy did not always give rise to the best performance: while the unstructured and alternating strategies allowed patients to produce more utterances per speaking turn, the alternating strategy enabled better development of the interview topic. These results suggest that such variations could be put to fruitful use in remedial techniques.

Adolescent↗
PubMed2000

Subjective pain experience of people with chronic back pain.

BACKGROUND AND PURPOSE: Studies into the effect of pain experience on those who have it have largely focused on the views and interpretations of researchers gained by the use of assessment tools aimed at measuring pain. The purpose of this study was to explore and describe pain, as experienced by those with chronic back pain, and to document 'insider' accounts of how pain is perceived and understood by those who have it. METHOD: Unstructured interviews using the framework approach. Subjects were sampled for age, sex, ethnicity and occupation, from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 M; 6 F) agreed to be interviewed. Interviews were unstructured, but followed a topic guide. Subjects were interviewed in English (nine) or their preferred language (two). Tape-recordings of interviews were transcribed verbatim and read in depth twice to identify the topics or concepts. Data were extracted in the form of words and phrases by use of thematic content analysis. The themes were pain description and amount of pain. An independent researcher reviewed the data and confirmed or contended the analysis. RESULTS: All subjects, except one, provided descriptors of the quality of their pain. The use of simile was common to emphasize both what the pain was, and what it was not. Five subjects expressed a loss of words in trying to describe their pain. Only 13 of 29 different pain descriptors used were commensurate with those in the McGill Pain Questionnaire (Melzack, 1983). Subjects had great difficulty quantifying their pain intensity. Several explained how the pain fluctuated, thus, quantifying pain at one point in time was problematic. Only one subject offered a numerical description of pain intensity. CONCLUSIONS: Subjects provided graphic and in-depth descriptions of their pain experience, but these bore little resemblance to commonly used assessment tools. The findings challenge the appropriateness of such formal instruments.

Adaptation, Physiological↗
PubMed2002

[Knowledge concerning illness, expectations and perceptions of treatment of elderly stroke patients and family caregivers--a prospective study during inpatient treatment].

Forty-five stroke patients and their 45 proxies were interviewed after the patients' hospital admission and before discharge. The topics of the interviews were disease knowledge, expectations in and judgement about therapy, estimation of functional health status (CCOP/WONCA Charts), and prognosis. The patients and proxies were also asked to name the patient's actual three most important health problems. The depressive symptomatology in the patients (geriatric depression scale) and their ADL status (Barthel Index) were evaluated on admission and before hospital discharge. The proxies' general knowledge of disease was superior compared to that of the patients. There were knowledge deficits regarding individual risk factors and secondary prevention, in particular. Information was predominantly obtained from physicians. However, an additional need for information on prognosis and prevention, in particular, was expressed by patients and proxies before hospital discharge. There was a high agreement between the patients and their proxies in mentioning the patients' actual three most important health problems, apart from psychological problems. These were mentioned only by the proxies but not by the patients themselves. Depressive symptomatology in the patients increased significantly. There were associations of depression with the level of the Barthel Index score and the patients' self-estimation of functional health status before and after the stroke. Full recovery was expected by one half of the patients, on admission. The patients' primary therapeutic goal was the ability to walk again. Their ADL status improved significantly, as measured by a mean increase in the Barthel Index score by 22 points. The patients and their proxies, as well, judged the result of treatment equally high. The proxies' total satisfaction with patient care was significantly related to their ratings of separate parts of patient care regarding nurses, therapists, and physicians, to their expectations in therapy, and the satisfaction of their own personal needs. The results of the study revealed a particular need for information on prognosis and secondary prevention of stroke. Furthermore, depression and coping with consequences of the disease should be important issues in counselling of stroke patients and their proxies. The results regarding patient and proxy satisfaction with care were of importance for internal discussion in the clinic.

Activities of Daily Living↗
PubMed2001

Revealing moments: formulating understandings of adverse experiences in a health appraisal interview.

Analysis of a health appraisal interview reveals how an interviewer employs formulations to organize talk about a patient's medical history. When selected reportings by patient are paraphrased, a three-part formulations cycle is initiated: (1) interviewer's formulated understandings, (2) patient's confirmation, and (3) topic shift by interviewer. The reenactment of this interactional pattern promotes increasing attention to patient's adverse experiences as "root problems" underlying adult health status (e.g. molestation, obesity, depression). Creating an environment for patient's emergent disclosures is facilitated by displaying non-judgmental sensitivity to patient's stated concerns, soliciting alignment to particular reconstructions and avoidance of moving the interview forward prematurely and to issues not grounded in patient's illness circumstances. The identification and utilization of communication techniques for attending to patient's bio-psycho-social history is critical for refining understandings of empathic interviewing, enhancing diagnosis and treatment (e.g. referrals), decreasing patients' utilization of health care systems, and ultimately reducing costs for quality medical care.

Adult↗
PubMed2001

Frontline talk: teachers' linguistic resources when talking about mental health and illness.

Talk about mental health and mental illness was examined using Potter and Wetherell's system of discourse analysis. Participants were 8 health coordinators (teachers) from a range of New Zealand secondary schools. They were interviewed on the topics of mental health and mental illness. Verbatim transcripts from the interviews were analyzed, and three mental health and illness linguistic resources were identified: a mental health as illness resource, a mental well-being resource, and a mental illness resource. Each resource was examined, and the practical consequences of this language use was discussed in relation to the role of teachers as frontline mental health professionals.

Communication↗
PubMed2003

Pilot study on the factors that influence learning by general practice registrars in central Australia.

INTRODUCTION: To counter a medical workforce shortage in rural and remote areas of Australia an increasing number of general practitioners are being trained in rural and remote areas. General practice (GP) registrars train in general practice as working apprentices alongside GP supervisors. GP registrars are allocated a training advisor to oversee their progress throughout their training. Central Australian GP registrars expressed concern to their training advisor regarding certain work partnerships with their GP supervisors. The study was carried out in response to these concerns, which were raised during a shortage of GPs in the area. The aim of the study was to explore factors in the interaction between GP registrars and GP supervisors in the context of their practices that impact on the quality of GP registrar learning in Central Australia. METHOD: A qualitative research method was used to explore the subtleties and issues in relationships between GP registrars, their GP supervisors and their practices. The interview schedule comprised pairs of polarised, provocative statements to generate discussion. Topics for the interview schedule were derived from the data from training advisor visits and the literature. GP registrars in Central Australia who had completed at least one six-month term in general practice were eligible for the study. Five female GP registrars participated in the study. Interviews were recorded, transcribed and checked by the participants before the interview material became the research record. RESULTS: The interview schedule generated considerable discussion as planned. The structures that determine GP income were seen as a barrier to GP registrar learning in Central Australia. The registrars reported that the fee-for-service model prevented them capitalising on learning opportunities both inside and outside their designated general practice. The GP registrars considered their training was compromised by the need to provide clinical service during a time of workforce shortage. Adaptation to a practice was seen as an important skill for GP registrars to learn, providing this did not compromise a registrar's own ethical and professional values. Learning was optimised by agreement between GP registrars and GP supervisors on the teaching subjects, and a mix of opportunistic and planned teaching sessions. Geographical isolation was perceived to have had a significant negative impact on GP registrar learning but one GP registrar discussed how this could be turned into a positive factor. CONCLUSION: GP registrars reported learning best by providing a clinical service with ready access to a supportive GP supervisor. Workforce pressures in Central Australia at the time of this pilot study reduced the GP supervisors' ability to support GP registrars, especially in a fee-for-service model of health care. GP registrars should be placed in practices where they will receive experience, training and education rather than be allocated to areas of workforce shortage. Changes to the remuneration system for GP registrars and GP supervisors could be considered to enable GP registrars to capitalise on the learning opportunities in remote clinical practice.

Journal Article↗
PubMed2005

Women's narratives of long-term urinary incontinence.

PURPOSE: The purpose of this study was to use narrative analysis as a method for examining the lived experience and meaning of long-term, female urinary incontinence (UI). METHOD: Cognitive anthropology and critical medical anthropology provided the overall framework for this study. Theoretical saturation (Strauss, 1987) was achieved after 17 community-dwelling women with long-term (greater than 5 year's duration) UI were interviewed. Informants participated in two face-to-face, audiotaped, interviews and a semi-structured, topical outline for each interview was used. A field journal was used to supplement and validate other data. Informant's narratives were analyzed to emphasize the overall plot type of their stories. FINDINGS: In this study, three dominant plot types emerged from women's narratives: the UI Quest Narrative, UI Restitution and Redemption Narratives, and the UI Victim Narrative. These plot types provide a beginning understanding of the lived experience and meaning of long-term female UI. CONCLUSIONS: Study findings suggest (a) long-term female UI is primarily conceptualized as a condition integrated into a larger life story, (b) women with long-term UI relate stories that follow a narrative format, and (c) long-term, female UI is heterogeneous. Findings go beyond existing literature by suggesting that women's UI narratives serve an important function in understanding the lived experience and the meaning of UI.

Activities of Daily Living↗
PubMed2000

Volunteer bias in nonrandomized evaluations of the efficacy of needle-exchange programs.

OBJECTIVE: Nonrandomized comparisons of the incidence of HIV and hepatitis B and C between injection drug users (IDUs) who do and do not attend voluntary needle-exchange programs may be subject to bias. To explore possible sources of bias, we examined characteristics associated with voluntarily beginning or ceasing to participate in the Seattle needle exchange. METHODS: In a cohort of 2,879 IDUs, a standardized questionnaire measured characteristics present at enrollment. We examined the relation of these characteristics to the proportion of IDUs who began to use the program during the ensuing 12-month follow-up period and to the proportion of current exchangers who dropped out during that period of time. RESULTS: Of the 494 never-exchangers at baseline, 32% attended the exchange program during follow-up; those who reported sharing syringes or who were homeless at enrollment were more likely to become new exchange users (adjusted risk ratio [ARR] for becoming an exchange user = 1.8 for those who shared syringes, and ARR = 2.2 for those who were homeless). Of 1,274 current exchangers, 16% stopped using the exchange during followup, with daily injectors (ARR = 0.6) and those who reported backloading (ARR = 0.6) being relatively less likely to drop out of the exchange. CONCLUSIONS: The analysis suggests that IDUs participating in needle-exchange programs at a given point in time may include a particularly high proportion of those injectors whose pattern of drug use puts them at elevated risk of blood-borne viral infections.

Adult↗
PubMed1994

Comparative advantage of 3-day food records over 24-hour recall and 5-day food frequency validated by observation of 9- and 10-year-old girls.

OBJECTIVE: The validity of the 24-hour recall, 3-day food record, and 5-day food frequency was assessed to decide on a dietary assessment method for the National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study. DESIGN: All subjects were assigned to one of three dietary assessment methods. Unobtrusive observers recorded types and amounts of foods eaten during lunch, and these were compared with the foods reported by the girls in the study. SETTING: School lunchrooms in California and Ohio. SUBJECTS: 58 girls, aged 9 and 10 years. MAIN OUTCOME MEASURES: Reporting errors for dietary assessment methods. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, matched pair t tests, and Spearman correlation coefficients. RESULTS: Comparison of the intakes of energy and selected macronutrients showed different ranges of, and median percentage absolute errors for, each dietary assessment method. Percentage absolute errors ranged between 20 and 33 for the 5-day food frequency method; 19 and 39 for the 24-hour recall; and 12 and 22 for the 3-day food record. The proportion of missing foods (ie, observed food items not reported) and phantom foods (ie, reported food items not observed) by each method were 46% and 40%, respectively, for the 5-day food frequency; 30% and 33%, respectively, for the 24-hour recall; and 25% and 10%, respectively, for the 3-day food record. APPLICATIONS/CONCLUSIONS: Errors in food reporting and quantification can vary with the type of dietary methodology. Agreement between observed and reported intakes from 3-day food records made it the best overall choice. On this basis, it was selected as the method of assessment for the NHLBI Growth and Health Study.

Bias↗
PubMed1988

Menarche, menstruation, sexual relations and contraception of adolescent females with Down syndrome.

Fifteen female adolescents with Down syndrome (DS) and 33 female controls without this syndrome were surveyed on age of menarche, menstruation, sexual relations and contraception. All probands and controls were born between 1 January 1965 and 31 December 1970. The day of census was December 31, 1985. All probands and controls were living permanently in the Danish county of Aarhus on this day. Persons close to the DS patients (parents/foster-parents/permanent staff) were interviewed on the above-mentioned topics. All controls were interviewed themselves. The average age of menarche was 13.6 years for probands and 13.5 years for controls. The average duration of the bleeding was 5.5 days for probands and 5.4 days for controls. The average length of the cycle was 28.3 days for probands and 28.6 days for controls. Thirteen DS patients had not had sexual intercourse (no information was available for 2 probands). Twenty-four controls had and 9 had not had sexual intercourse. There is a significant difference between probands and controls concerning use of oral and other contraceptives.

Adolescent↗
PubMed1988

The effectiveness of cervical screening: a population-based case-control study.

The cervical smear histories of 36 women with invasive cervical cancer were compared to those of 120 age-matched controls, drawn from local registrar's offices. Of the cases 47% were screened at least once, while for the controls this figure was 68%. The relative risk of getting invasive cervical cancer for women screened at least once compared to women who were never screened was 0.32. The most important confounding factor was age at first intercourse. Contrary to other studies however, it was found that women who were younger when having first intercourse were screened more often. After correcting the relative risk of screened vs unscreened for age at first intercourse, the relative risk became 0.22. When the length of the interval since the last smear was considered, the relative risk was 0.18 when the smear was made between 2 and 5 years earlier and 0.30 when this smear was made more than 5 years earlier. These results support the assumption that screening is effective in the prevention of invasive cancer of the uterine cervix. Even a screening interval of more than 5 years provides considerable protection.

Adult↗
PubMed2005

An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report.

BACKGROUND: Nine DSM-IV-TR criterion symptom domains are evaluated to diagnose major depressive disorder (MDD). The Quick Inventory of Depressive Symptomatology (QIDS) provides an efficient assessment of these domains and is available as a clinician rating (QIDS-C16), a self-report (QIDS-SR16), and in an automated, interactive voice response (IVR) (QIDS-IVR16) telephone system. This report compares the performance of these three versions of the QIDS and the 17-item Hamilton Rating Scale for Depression (HRSD17). METHODS: Data were acquired at baseline and exit from the first treatment step (citalopram) in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Outpatients with nonpsychotic MDD who completed all four ratings within +/-2 days were identified from the first 1500 STAR*D subjects. Both item response theory and classical test theory analyses were conducted. RESULTS: The three methods for obtaining QIDS data produced consistent findings regarding relationships between the nine symptom domains and overall depression, demonstrating interchangeability among the three methods. The HRSD17, while generally satisfactory, rarely utilized the full range of item scores, and evidence suggested multidimensional measurement properties. CONCLUSIONS: In nonpsychotic MDD outpatients without overt cognitive impairment, clinician assessment of depression severity using either the QIDS-C16 or HRSD17 may be successfully replaced by either the self-report or IVR version of the QIDS.

Adult↗