The impact of clinical practice guidelines should not be overestimated.
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Attitude of Health Personnel↗
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Reflecting on research.
Reflecting on my first 4 months as a part time academic general practice registrar demonstrates the highs and lows of pursing the challenges of research - particularly after being involved in full time clinical practice. Exploring research in general practice has proved an interesting and rewarding experience.
Academic Medical Centers↗
Complementary medicine: knowledge, use and attitudes of doctors.
The recent growth in interest in the use of complementary medicine by the general public has been well reported. Health professionals, particularly nurses and midwives, are incorporating the use of complementary therapies into their practice. The medical profession is involved in the political processes affecting legislation governing complementary medicine and it is therefore important to determine the views of doctors when considering the use of complementary therapies by nurses within the health-care system. A critical review of published research studies which consider the knowledge, use and attitudes of doctors to complementary medicine is presented. These studies suggest doctors' interest in complementary medicine but they also raise a number of concerns including lack of evidence to demonstrate effectiveness, possible harmful effects, inadequate knowledge of doctors and lack of statutory regulation for most therapies. Recommendations of recent reports are outlined which attempt to address these and other issues.
Attitude of Health Personnel↗
Assumptions about disease treatment challenged in a family health clerkship: views of first clinical year medical students.
CONTEXT: During a family health clerkship at the University of The West Indies, students are expected to acquire individual and community diagnosis skills and the ability to relate the two, as well as acquire knowledge of other community agencies involved in health care. OBJECTIVE: To determine the main assumptions related to disease treatment, which students have had to re-think after engaging in this clerkship. METHODS: End of clerkship assessments were carried out from two successive groups of third year medical students (n=64) at the University of West Indies, Jamaica. Students were asked to "list two assumptions regarding treating disease that have been challenged by your experience". A subsequent content analysis was done. RESULTS: Fifty-five students (86%) completed the assessment. All assumptions were listed (n=99) and similar issues were linked into emerging themes. Twenty-five groups of assumptions produced seven main themes: "Issues related to compliance" (27.3%),"Patient's treatment is mainly physical" (17.2%), " Superiority of western medicine over alternative" (15.2%), "Patients' health seeking behavior and attitudes" (12.1%), " The extent of the contribution of social factors on health" (12.1%) and "Patients' knowledge and understanding of health" (7.0%). CONCLUSION: The majority of students examined felt challenged on three themes: relating to issues of compliance, treating the "whole" patient not just the physical, and the superiority of western medicine over alternative. The three most popular individual assumptions were; patients have a mindset that favours compliance, medication affordability does not affect compliance and treatment is independent of social and environmental conditions.
Attitude of Health Personnel↗
Use of alternative folk medicine by Mexican American women.
Nontraditional health care resources available to Mexican Americans are many. The Mexican culture is rich with alternative health and illness beliefs and remedies which have their origins in ancient Mestizo/Indian folklore which viewed the causes of illness to include social, spiritual, and physical forces. This perception calls for culturally relevant folk practitioners who can treat all aspects of the perceived illness. This study of 70-Mexican American women explored their knowledge of and use of alternative Mexican folk medical practitioners in their own health maintenance. Results provided some evidence that, even among highly assimilated Mexican American women, there persist traditional, indigenous beliefs, and practices.
Adult↗
Testing a theory of political development by comparing the political action of nurses and nonnurses.
BACKGROUND: Some nursing theories are available to guide the conceptualization, planning, and conduct of political action. Little initial or ongoing testing of these theories has taken place. PURPOSE: The purpose of this descriptive-comparative investigation was to test the theory of Cohen et al (Cohen SS, Mason DJ, Kovner C, Leavitt JK, Pulcini J, Sochalski J. Stages of nursing's political development: where we've been and where we ought to go. Nurs Outlook 1996;44:259-66) of political development stages through describing and comparing a specific example of political action by nurses and nonnurses. METHOD: Semistructured interviews of persons who spoke to a standing legislative committee about a proposed bill took place after the health care issues raised by this private bill were later addressed in a government act. Qualitative inquiry was used to gain an understanding of the subjects' perspectives. DISCUSSION: The political action undertaken by both nurses and nonnurses substantiated the first 2 of 4 theorized political stages. However, most nonnurses engaged in political action for self-interest purposes, whereas nurses were oriented to the public good. This finding provides partial support for the third stage of Cohen et al, political sophistication. CONCLUSIONS: Nurses have consistently viewed themselves as patient advocates. It is not surprising then to see "other oriented" political activism by nurses at the community and societal level, because this is in keeping with the caring nature of nursing practice.
Alberta↗
Cultural safety--what does it mean for our work practice?
Culturally safe service delivery is critical in enhancing personal empowerment and, as a result, should promote more effective and meaningful pathways to self determination for Indigenous people. Little has been said about encouraging people from Indigenous groups into the health and education discipline(s) to help provide a safe environment which includes cultural safety. This is a phrase originally coined by Maori nurses which means that there is no assault on a person's identity. The people most able or equipped to provide a culturally safe atmosphere are people from the same culture. We need to move on from the 'short term, cost effective, quick fix' approach to Indigenous issues, driven by economic imperatives, the clamouring of industry and conservative, hegemonic practices. To genuinely address the challenges of Indigenous health and education, the issue of cultural safety cannot be avoided. Critical reflection on experiential knowledge and defining or framing a debate on cultural safety is essential. This paper briefly examines some considerations for work practice.
Cultural Characteristics↗
Female genital mutilation in the Sudan: survey of the attitude of Khartoum university students towards this practice.
BACKGROUND: Female genital mutilation (FGM) or female circumcision is the removal of variable amounts of tissue from the female external genitalia. It is practised all over the world on very young girls. This study was conducted in Sudan where FGM is a criminal offence and not a religious dictate. We assessed the knowledge, attitudes, and perceptions of this practice among Khartoum university students and compared the differences between male and female student responses. METHODS: An anonymised detailed questionnaire was distributed among the university students. In addition to the participant's age, marital status, course studying, details regarding their attitude, knowledge of the practice of FGM, and their own experiences were collected. RESULTS: Of the 500 questionnaires distributed, 414 (82.8%) were returned from 192 (46%) females and 222 (54%) males. 109 (56.8%) of the female respondents were themselves circumcised.18.8% of the male students and 9.4% of the female students thought FGM was recommended by their religion. Only 90 (46.9%) female students compared with 133 (59.9%) male students thought FGM was illegal. Though 16 (8.3%) female respondents thought FGM would increase their chances of marriage, the majority, 166 (74.8%), of the male students would prefer a non-circumcised female. CONCLUSIONS: This study shows that 109 (56.8%) female university students who responded were circumcised. Confusing religious messages and ambiguous laws seem to be responsible for the continuation of this practice. The study highlights the partnership that needs to be established between religious leaders and educationalists to end this medieval practice.
Adult↗
Methods in translation science.
BACKGROUND: The gap between research findings and practice has been, and continues to be, a concern for the international community. A number of descriptive studies have elucidated barriers and facilitators of evidence-based practice in nursing. It is argued that it is now time to use findings from these studies to design and test interventions that explicitly target barriers to the use of evidence in practice rather than doing further research to describe generic barriers and facilitators to evidence-based practice. This article discusses research methods to advance our knowledge regarding the efficacy of translating research into practice (TRIP) interventions that promote and hasten adoption of evidence in practice. APPROACH: Published research is reviewed and used as exemplars of translation studies. The benefits and challenges in studying natural experiments are addressed as are the benefits and challenges in conducting TRIP studies using experimental designs. DISCUSSION: The article discusses factors such as sample attainment, unit of analysis, intervention characteristics, outcome measurement, and sustainability. Although there are a myriad of initiatives aimed at increasing use of evidence in practice, there is little systematic evidence of the effectiveness of these initiatives. In order to advance knowledge, translation research needs more experimental studies that test TRIP interventions through, for example, partnership models.
Attitude of Health Personnel↗
Definition and identification of child abuse by Finnish public health nurses.
The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.
Adult↗
Using mass media within health-promoting practice: a nursing perspective.
For some time health professionals have recognized the growing importance of utilizing mass media strategies as part of their health-promoting practice. The ever-evolving climate of technology and increasing reliance on mass communications has further reinforced the position of mass media initiatives. The enormous potential for mass media resources to reach certain audiences and influence their health-related behaviours has become particularly well established. Despite these facts, however, it is argued that the nursing profession has been less than pro-active in acknowledging, accommodating and adopting such practices. Consequently, the incorporation of health-related mass media initiatives into nursing's health-promotional role remains an elusive exercise. The maintenance of such a position, it is claimed, is potentially damaging for the profession as a whole. In light of this state of affairs, this paper seeks to review the literature surrounding the nature and processes of mass media strategies, their relevance to health promotion and nursing, how they are currently utilized and how they can be incorporated further into nursing practice. In conclusion, it is argued that nursing should seek to become a more active user of mass communication/media technology--especially in relation to its health-promotional practices.
Attitude to Health↗
Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community.
OBJECTIVE: To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme. METHODS: A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n = 973) and from educational courses (n = 202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion. RESULTS: After attending an educational programme, the patient's willingness to spend 15-40 euros/month for their own health promotion was high but there was no correlation with the income (p < 0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p < 0.001). High levels of cardiovascular risk were associated with low education (p < 0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors. CONCLUSION: Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.
Adult↗
Pluralism and pragmatism: knowledge and practice of birth in Morocco.
This article examines knowledge and practice surrounding birth in Morocco, using women's narratives of their recent birth experiences, observations of medical encounters, and statements about prescribed behaviors during pregnancy and birth, as well as the vocabulary used to refer to physiological processes, disease conditions, and social relationships. The analysis shows that the three major themes that define the traditional Moroccan ethnophysiology of birth--conceptions of hot and cold, the symbolism of blood, and the metaphors of openness and obstruction--are not inconsistent with the precepts of biomedicine and public health and do not in themselves constitute obstacles either to safe home births or the use of formal health services. Women integrate biomedical and local knowledge and practices and simultaneously seek care from "traditional" and "modern" practitioners, creatively combining elements in accordance with their situations and the means at their disposal. Birth narratives show the eclecticism and flexibility that characterize women's attitudes and behaviors regarding pregnancy and birth. Women's decisions are shaped by two overriding considerations: incertitude about what can happen during the last phase of a pregnancy and ambivalence toward the available alternatives for care, both of which reflect a realistic assessment of their situations. By showing how women make decisions in response to these considerations, this article seeks to clarify some of the links between beliefs and practices and to contribute to ongoing discussions regarding the relevance of local knowledge for patterns of health care.
Adult↗
Comparison of nursing interventions performed by medical-surgical nurses in Korea and the United States.
PURPOSE: To compare the Nursing Interventions Classification (NIC) interventions used in two countries, Korea and the United States. METHODS: Data were collected from 167 nurses working in eight hospitals in Korea and analyzed with descriptive statistics. FINDINGS: Korean nurses selected 202 interventions, nine of which were used by more than 50% of nurses surveyed. In comparison, the Academy of Medical-Surgical Nurses (AMSN) in the United States identified 68 interventions as core interventions. Among the top ranked 68 interventions selected by Korean nurses, 29 (43%) matched those selected by U.S. nurses. CONCLUSIONS: The nursing interventions selected by Korean nurses were more heavily focused on the physiologic domain than those selected by the U.S. nurses. PRACTICE IMPLICATIONS: The identified intervention lists can be used to develop nursing information systems, staff education, competency evaluation, referral networks, certification and licensing exams, and educational curricula for nursing students.
Adult↗
Randomized trial of problem-based versus didactic seminars for disseminating evidence-based guidelines on asthma management to primary care physicians.
INTRODUCTION: This randomized controlled trial (RCT) investigated the effectiveness of and satisfaction with small-group problem-based learning (PBL) versus a didactic lecture approach to guideline dissemination in asthma management controlling for confounders common in comparative educational interventions. METHODS: Sites were selected as either lecture or PBL using simple randomization. All participants were exposed to similar educational resources to ensure treatment equivalency. Instruments included standardized program/speaker evaluation forms and a validated case-based questionnaire with a visual analogue scale measuring the level of confidence of responses. The latter was presented immediately pre- and post-intervention and 3 months later. The statistician was blinded to intervention groups. RESULTS: Overall, 52 family physicians agreed to participate, 23 in the PBL sessions (mean 4.6 per group) and 29 in the didactic lecture sessions (mean 7.25). There was no significant difference between the groups with respect to the knowledge gained at each test administration. Participants rated the lecturer or facilitator equally well as having established a positive learning environment. PBL participants rated the perceived educational value of the program higher than did lecture participants (4.36 vs. 3.93; p = .04). Both groups experienced a significant increase in asthma-related knowledge post-intervention. Attrition rates for the 3-month post-test were 14% for PBL participants versus 32% for lecture-based participants. DISCUSSION: PBL was as effective in knowledge uptake and retention as lecture-based continuing medical education (CME) programs. Further study is warranted to investigate whether the assessment of higher educational value or an increase in response rate to delayed testing is replicable in other RCTs addressing common confounders and if these factors influence future CME participation, changes in physician clinical behavior, or patient health outcomes.
Analysis of Variance↗
European guidelines on cardiovascular disease and prevention in clinical practice.
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Cardiovascular Diseases↗
Development of case statements in academic administration: a proactive method for achieving outcomes.
The complex nature of higher education presents academic administrators with unique challenges to communicate vision and strategic direction to a variety of internal and external audiences. The administrator must be prepared to engage in persuasive communication to describe the needs and desired outcomes of the academic unit. This article focuses on the use of the case statement as a communication tool for the nursing academic administrator. The case statement is a form of persuasive communication where a situation or need is presented in the context of the mission, vision, and strategic direction of a group or organization. The aim of the case statement is to enlist support in meeting the identified need. Fundamental assumptions about communicating case statements are described, as well as guidelines for how the academic administrator can prepare themselves for using the case statement method.
Attitude of Health Personnel↗
Reasons for poor understanding of when and how to access GP care for childhood asthma in Auckland, New Zealand.
BACKGROUND: Attempts to explain why some patients lack the understanding needed to access GP care for childhood asthma are uncommon and have tended to be based on reported statistical associations. OBJECTIVES: The aims of this study were to describe and account for poor patient understanding of when and how to access GP care for childhood asthma in Auckland, New Zealand. METHODS: A general inductive approach was used to analyse 29 semi-structured, personal interviews, during March-May 2001, with Auckland key informants selected through maximum variation sampling. Informant checking and the literature supported the text analysis by two independent researchers. RESULTS: Key informants reported wide variations in the extent to which guardians and asthmatic children understand when and how to access GP services. Two sets of barriers to patient understanding were identified. The first limits the willingness of people to seek understanding and the second limits their ability to understand, even if they want to understand. CONCLUSIONS: Use of qualitative methodology was able to reveal barriers to patient understanding. Strategies operating at the GP and system levels were identified to help overcome these barriers.
Adult↗