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PubMed2006

A method for implementation of nutritional therapy in hospitals.

BACKGROUND AND AIMS: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening guidelines. METHODS: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Pre-measurement: assessment of quality goals prior to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) INTERVENTION: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning nutrition, elaboration of an action plan and implementation of the plan. (3) Re-measurement: as in (1) based on information from records and patient interviews, and an evaluation based on focus group interview with the staff. Patients who gave informed consent to participate in the study (>14 years) were included consecutively. Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson chi(2) test for nominative data. P values <0.05 were considered significant. The study was performed in accordance with the Research Ethics Committee. RESULTS: In this study 141/122 patients were included before/after the implementation period with a mean weight loss within the last 3 months of 6.2 and 5.2 kg, respectively. Before the study we found that BMI was not measured. More than half of the patients had a weight loss within the last 3 months, and 40% had a weight loss during hospitalization, and this was not documented in the records. About 75% had a food intake less than normal within the last week, and nearly one-third were at a severe nutritional risk, and only 33% of these had a nutrition plan, and 18% a plan for monitoring. Barriers concerning nutrition included low priority, no focus, no routine or established procedures, and insufficient knowledge, lack of quality and choice of menus, and lack of support from general manager of the hospital. The staff introduced individually targeted procedures including assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dieticians and special diets, communication, and educational programs. A great consistency existed between barriers for targeted nutrition effort and ideas for improvement of the quality goals between the different departments. Quality assessment after study showed an overall significant improvement of the selected quality goals. CONCLUSION: The introduction of a new method for implementation of nutritional therapy according to ESPEN screening guidelines seems to improve nutritional therapy in hospitals. The method included assessment of quality goals, identification of barriers and individual targeted plans for each department followed by an evaluation process. The model has to be refined further with relevant clinical endpoints.

Aged↗

PubMed2007

Using enquiry in learning: from vision to reality in higher education.

This paper reports on the contribution of six nurse educators to embed enquiry-led learning in a pre-registration nursing programme. Their focus was to evaluate student and facilitator perspectives of a hybrid model of problem-based learning, a form of enquiry-based learning and to focus on facilitators' perceptions of its longer-term utility with large student groups. Problem-based learning is an established learning strategy in healthcare internationally; however, insufficient evidence of its effectiveness with large groups of pre-registration students exists. Fourth Generation Evaluation was used, applying the Nominal Group Technique and Focus Group interviews, for data collection. In total, four groups representing different branches of pre-registration students (n = 121) and 15 facilitators participated. Students identified seven strengths and six areas for development related to problem-based learning. Equally, analysis of facilitators' discussions revealed several themes related to strengths and challenges. The consensus was that using enquiry aided the development of independent learning and encouraged deeper exploration of nursing and allied subject material. However, problems and frustrations were identified in relation to large numbers of groups, group dynamics, room and library resources and personal development. The implications of these findings for longer-term utility with large student groups are discussed.

Attitude of Health Personnel↗

PubMed2003

Conducting school-based focus groups: lessons learned from the CATS project.

Participation of children in focus groups has received scant attention despite the effectiveness of group interviews in eliciting children's views. Focus groups are a valuable approach for generating qualitative data from children; however, conducting school-based focus groups involves challenges specific to the school milieu and the ages and development of the participants. Lessons learned from conducting school-based focus groups during the Child-Adolescent Teasing Scale (CATS) project are applied to examination of key issues including entry to schools, informed consent and confidentiality, students' cognitive development, safety within the group, and appropriate procedures.

Child↗

PubMed2003

The need for family planning and safe abortion services among women sex workers seeking STI care in Cambodia.

In Cambodia, clinics established for the prevention and management of sexually transmitted infections (STIs) in women sex workers do not address other reproductive health services. The aim of this study was to assess the need for more comprehensive sexual and reproductive health services for women sex workers in Cambodia. In January 2000, relevant documents were reviewed, interviews with key informants carried out and group interviews with women sex workers conducted. Medical records from women sex workers were also reviewed and some data collected prospectively in one government STI clinic. Interviews with the women and data from the government clinic indicated that excluding condoms, a very low proportion of women sex workers were currently using a modern contraceptive method--5% of 38 women and 1.6% of 632 women, respectively. Induced abortion was widely used but was perceived to be risky and costly. Data from a mobile team intervention and the government clinic respectively showed that 25.5% (n = 1744) and 21.9% (n = 588) of women sex workers reported at least one previous induced abortion. These findings reveal the need for accessible contraception and safe abortion services among sex workers in Cambodia, and raise the issue of the reproductive rights and reproductive health needs of women sex workers in general.

Abortion, Legal↗

PubMed2001

Description of an expert teacher's constructivist-oriented teaching: engaging students' critical thinking in learning creative dance.

The focus of this study was to investigate how an expert teacher implemented constructivist-oriented teaching strategies to engage students'critical thinking skills in learning creative dance. The data were collected through videotaping 16 creative dance lessons taught by an expert teacher to 2 kindergarten, 2 first-grade, and 4 third-grade classes and conducting two formal interviews and several informal interviews with the teacher. In addition, one group interview was conducted with 4 kindergarten students, 4 first-grade students, and 8 third-grade students. The three salient themes were: (a) relating students' knowledge and ideas to lessons to spark dispositions, (b) encouraging and facilitating students' inquiries and creative products, and (c) engaging students' metacognition in refining the quality of dance movement.

Child↗

PubMed2005

Quality of working life indicators in Canadian health care organizations: a tool for healthy, health care workplaces?

BACKGROUND: Quality-of-work-life (QWL) includes broad aspects of the work environment that affect employee learning and health. Canadian health care organizations (HCOs) are being encouraged to monitor QWL, expanding existing occupational health surveillance capacities. AIM: To investigate the understanding, collection, diffusion and use of QWL indicators in Canadian HCOs. METHODS: We obtained cooperation from six diverse public HCOs managing 41 sites. We reviewed documentation relevant to QWL and conducted 58 focus groups/team interviews with strategic, support and programme teams. Group interviews were taped, reviewed and analysed for themes using qualitative data techniques. Indicators were classified by purpose and HCO level. RESULTS: QWL indicators, as such, were relatively new to most HCOs yet the data managed by human resource and occupational health and safety support teams were highly relevant to monitoring of employee well-being (119 of 209 mentioned indicators), e.g. sickness absence. Monitoring of working conditions (62/209) was also important, e.g. indicators of employee workload. Uncommon were indicators of biomechanical and psychosocial hazards at work, despite their being important causes of morbidity among HCO employees. Although imprecision in the definition of QWL indicators, limited links with other HCO performance measures and inadequate HCO resources for implementation were common, most HCOs cited ways in which QWL indicators had influenced planning and evaluation of prevention efforts. CONCLUSIONS: Increase in targeted HCO resources, inclusion of other QWL indicators and greater integration with HCO management systems could all improve HCO decision-makers' access to information relevant to employee health.

Canada↗

PubMed1992

Febrile infections and malignant melanoma: results of a case-control study.

Several reports have described an inverse relationship between the frequency of infections and various malignancies. In this paper results of a hospital-based case control study on 139 melanoma patients and 271 suitable selected controls are presented, addressing the question of whether this relationship exists with respect to malignant melanoma while simultaneously controlling for the effects of other risk factors. Data on childhood diseases (group I), febrile diseases of adulthood (group II) and common febrile infections within a 5-year period prior to the diagnosis of melanoma (group III) were collected using a standardized interview. Group I diseases did not show a marked influence on the risk of malignant melanoma. Considering group II diseases, a significant protective effect was determined for chronic infectious diseases (OR = 0.32) and also for wound infections, abscesses and furunculosis (OR = 0.21). In group III, herpes simplex infections (OR = 0.45) and influenza/common cold (OR = 0.32) substantially reduced the melanoma risk. This effect was less pronounced for gastroenteritis (OR = 0.52). Analysis of the cumulative influence of infections pointed to a strong dose-response relationship between the frequency of febrile infections in adulthood and malignant melanoma. In particular, the risk reduction was striking when two or more febrile infections were compared to no febrile infections in group II (OR = 0.09) and group III (OR = 0.20). The study confirms the hypothesis that an inverse relationship exists between febrile infections and malignant melanoma, but these results have to be interpreted cautiously due to the inherent limitations of the case-control design.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2005

Exploring the relationship between nursing protocols and nursing practice in an Irish intensive care unit.

Nursing practice no longer relies on tradition or ritual; instead, it is based on research and empirical evidence. The emphasis on evidence-based nursing, as well as standardization of nursing practice, has resulted in the production of policies, protocols and guidelines aimed at directing numerous aspects of nursing care. The aim of this study was to explore the relationship between these documents and actual nursing practice. To this end, this descriptive study employed a case study approach to examine the experiences of nurses in an Irish intensive care unit with a protocol on endotracheal tube suctioning. Focus group interviews of 17 nurses in six focus groups provided a significant insight into the experiences of these nurses in relation to policies, protocols and guidelines. Analysis of the data afforded some highly relevant findings, including the fact that nurses adapt clinical protocols as they see fit, thus demonstrating the importance that they place on their own professional judgement and autonomy.

Attitude of Health Personnel↗

PubMed2004

Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.

OBJECTIVE: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. DESIGN: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. MEASUREMENTS: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. RESULTS: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. CONCLUSION: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them.

Attitude of Health Personnel↗

PubMed2006

Strategies to improve the performance of learners in a nursing college. Part II: Issues pertaining to management, attitudes and values.

UNLABELLED: This article forms part two of a bigger study that was conducted in a nursing college to explore and describe the reasons for the poor performance of learners. Part one of the study dealt with the issues pertaining to education, while this article (part two) seeks to describe issues pertaining to management, attitudes and values that lead to the poor performance of learners in the nursing college under study. A qualitative, exploratory and descriptive design that was contextual in nature was employed, and three focus groups interviews were conducted. Seven tutors formed one group while other two groups were formed by fourth-year learners following a comprehensive diploma course. All participants voluntarily participated in the study. Data was analyzed using the descriptive method of open coding in accordance with Tesch's protocol (in Creswell, 1994:154-156). Trustworthiness was ensured using the following principles: credibility, conformability, transferability and dependability (Lincoln & Guba 1985:290-326). Findings were categorized into issues pertaining to management, attitudes and values that had an influence on the poor performance of learners as follows: MANAGEMENT: Inadequate resources and study facilities; policies that change frequently; tutors' dissatisfaction with regard to staff development, the lack of involvement by management and lack of management support, staff shortage and maldistribution of staff members; ineffective selection process of learners; inconsistent regulations, and too many of them; policies and procedures resulting in confusion and poor discipline. Attitudes and values: Tutors' lack of motivation and interest, lack of respect by learners and no team work among tutors. Through a conceptualization process and the recommendations by participants, strategies to improve the learners' performance were described. It is recommended that these strategies be submitted to the staff development committee for implementation and future follow-up research be undertaken to determine the effectiveness of the strategies. It is also recommended that other nursing colleges replicate the study within their context.

Attitude↗

PubMed2001

Communication about prostate cancer between men and their wives.

OBJECTIVES: Metastatic prostate cancer is a serious disease that affects both men and their intimate partners. We explored the perceptions of men who have been treated for metastatic prostate cancer and the views of their wives regarding the changes that were caused by prostate cancer and its treatment. STUDY DESIGN: We conducted retrospective focus group interviews with married men and separate focus groups with their wives. POPULATION: Twenty married men (11 white and 9 African American) with an average age of 69 years (range=60-82 years) and 7 of the wives (5 white and 2 African American) participated in our study. Thirteen of the men were treated with orchiectomy, and 7 received monthly hormone ablation therapy. OUTCOMES MEASURED: We compared the accounts of husbands and wives concerning the diagnosis and treatment of prostate cancer. RESULTS: The participants' accounts indicate little spousal communication about the implications of prostate cancer on their lives. In particular, couples appear to talk little about their emotions, worries, and fears. CONCLUSIONS: Although wives have a profound interest in their husbands' prostate cancer, actual communication about the disease, its treatment, and the feelings it evokes may be less than we believe. Noncommunication in marriages might indicate that these couples are at increased risk for poor adjustment to prostrate cancer.

Adaptation, Psychological↗

PubMedDate not supplied

The influence of social support on cardiovascular health in families.

The purpose of this qualitative study was to identify how social support in families can influence the health behaviors of multigenerational families already at risk for cardiovascular disease (CVD). Using a case study method, semistructured individual and family group interviews were conducted of 3 members of 10 families (N = 30) with known cardiovascular risk. Each family member represented a different generation. The index member was a senior or middle family member who had undergone coronary bypass surgery. A convenience sample was recruited from individuals having had coronary bypass surgery at a regional hospital in a rural area. Prior to group family interviews, each participant completed a behavior risk questionnaire to determine high or low risk of CVD. A subsample of 6 participants received individual interviews. A participant with high CVD risk and one with low CVD risk represented each generation. Themes generated from the family interviews formed the basis for the individual interview questions. All interviews were audiotaped and transcribed, and interviewer reflections were documented. Analysis consisted of coding, naming, and categorizing data according to conceptual patterns. The findings revealed examples of family social support that influenced cardiovascular health behaviors. Opportunities are identified as to when healthcare professionals can encourage positive social support and sustained changes in health behaviors in families already at risk for CVD.

Adolescent↗

PubMed2003

The social organization of commercial sex work in Moscow, Russia.

BACKGROUND: Increased poverty, unemployment, and migration place the Russian population at high risk for sexually transmitted infections (STIs). A qualitative study was undertaken to clarify the organization of sex work and describe the likely contributions of different types of sex work to disease transmission. GOAL: The goal of the study was to describe the social-organizational patterns of sex work in Moscow, Russia. STUDY DESIGN: Four qualitative data collection methods were used: semistructured telephone interviews, semistructured face-to-face individual and group interviews with key informants, systematic and unobtrusive naturalistic observations, and geomapping. RESULTS: Intermittent, truck stop, and railway station sex workers may be the most important groups in the dissemination of STIs. Sex work is widely disseminated throughout the city. Identifiable positions in the social organization of street sex work include pimps, assistant female pimps, guards, drivers, "indicators," the sex workers themselves, and recruitment "pluckers." CONCLUSION: The Moscow sex market may be an adjustive response of the social system to the economic pressures in Russia. Sex work in Moscow has great potential for disseminating STIs throughout Russia and beyond. Understanding of these issues may enhance the impact of STI prevention programs.

Female↗

PubMed2006

Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study.

BACKGROUND: The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales. AIMS: The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture. METHODS: This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture. RESULTS: The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made. CONCLUSION: There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.

Adult↗

PubMed2006

[Interprofessional communication and cooperation training in ward rounds for medical and nursing students: a pilot project].

This study reports on a pilot study of the effect of an inter-professional course for medical and nursing students in how to collaborate in the conduct of a ward round. A mixed group of 13 medical and 12 nursing students attended a one-day course. They worked together in small groups training in communication and collaborative skills using a framework for ward rounds in a simulated clinical ward environment. The course was evaluated on standard evaluation forms and through focus group interviews. The programme was highly rated by both of the groups and considered most relevant, well situated and efficient. Next term the training course will be extended to include twice as many students.

Cooperative Behavior↗

PubMedDate not supplied

Death and dying in four Asian American cultures: a descriptive study.

Among ethnic minorities, the Asian and Pacific Islander (API) American group is the fastest growing, and, as a whole, is quite longevous. Although there is a significant literature on the history and religious traditions of API cultures, little has been published on death rituals and beliefs of the American descendants of these groups. The purpose of this study was to begin to explore cultural variations in response to the process of dying and grieving among four Asian American populations--Chinese, Japanese, Vietnamese, and Filipino. To this end, key informants and focus group interviews were conducted with members of these ethnic groups, and significant differences among, and within, groups were found. The small size and Hawaiian base of the sample preclude generalization of findings to the United States as a whole. However, this study provides health care workers with information that can increase their awareness of and sensitivity to Asian American approaches to death and dying.

Adult↗

PubMed1994

Attitudes about autopsy: implications for educational interventions.

Although the role of autopsy in confirming diagnoses and advancing research is well documented, family members are inadequately informed about the procedure. The present study examined attitudes about autopsy among older adults. Focus group interviews were conducted with members of three caregiver support groups and two senior centers. Predominant themes included: benefits, barriers, religious views, and concerns about procedures. Results suggest the need to design educational interventions to: (a) involve family members in advance planning; (b) provide counseling regarding the purpose, process, and procedures of autopsy; and (c) facilitate communication skills and awareness of local autopsy services and policies among physicians.

Autopsy↗

PubMed2006

Preschoolers' dietary behaviours: parents' perspectives.

PURPOSE: Preschoolers' dietary intake behaviours are described from the perspective of their parents. METHODS: A maximum variation sample of 71 parents of preschoolers participated in this qualitative study. Ten semi-structured focus group interviews were conducted. Two experienced moderators facilitated all focus groups, which were audio-recorded and transcribed verbatim. Strategies to ensure trustworthiness of the data were employed throughout the study. Two team members independently performed inductive content analysis. NVivo software was used to code the emerging themes. RESULTS: Parents identified food and food issues as key health-related behaviours among preschoolers. Parents discussed challenges to healthy eating, including time limitations and societal pressures, as well as methods for facilitating healthy food choices, including bribery, education, and being creative with food. CONCLUSIONS: Dietary intake is on the minds of preschoolers' parents. Unfortunately, some methods that parents currently use to promote healthy food choices may be more detrimental than beneficial for children in the long term. Parents' keen interest in their preschoolers' eating habits may make them particularly receptive to learning about and facilitating healthy choices in more behaviourally appropriate ways. Widespread educational messages about the benefits and detriments of various strategies to facilitate healthy eating among preschoolers therefore seem warranted.

Adult↗