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PubMed2001

The NHS--a patient's perspective.

A narrative account, from a user's perspective, of NHS service and procedures. Whilst there is much to applaud in the service and communications between staff and patients, some practices do not foster patient empowerment.

Anecdotes as Topic↗
PubMed2001

Who wants to know if their care is rationed? Views of citizens and service informants.

OBJECTIVE: To explore the views of citizens and service informants about whether they would want to know about any rationing of their own health care. DESIGN: In-depth interviews using a semistructured schedule. Data were analysed using the methods of constant comparison. SETTING AND PARTICIPANTS: Citizens and service informants. MAIN VARIABLES STUDIED: Issues around health care rationing were explored within the context of the United Kingdom health care system. RESULTS: The views of citizens and service informants were very similar in terms of whether they, personally, wanted to know about any rationing of their own care, with the vast majority wanting to be given this information. Informants were also similar in terms of their reasons for wanting to know about rationing: to be given a 'good explanation' to enable them to judge whether the decision made had been correct; and to enable them to change the decision if necessary, either through protest or payment. Many informants suggested that they would indeed be likely to react either by challenging the decision or by paying for care. CONCLUSIONS: The findings suggest that policies to be open with people about the rationing of care would be welcomed, but also indicate that if protest follows such openness, it may be difficult for the health service to cope with greater explicitness. Further research is needed among patient groups actually facing this situation.

Adult↗
PubMed2002

Safety and comfort work of nurses glimpsed through patient narratives.

The everyday work done by nurses in hospital has a taken-for-granted character, yet it has great significance for patient safety, comfort and satisfaction with care. Perceptions of how adequately this work is done have a bearing on the public image of, and the community's confidence in, the professional nurse. A qualitative exploration of patients' perceptions and experiences of comfort and discomfort provided glimpses of the safety and comfort work of nurses. This work was conceptualized as 'anticipating, managing and limiting threat and vulnerability.' Safety work, which is clearly intended to protect and to comfort, was generally recognizable to informants, but was at other times unobtrusive and puzzling. In addition, nurses' work could take on a routine character, which was disconcerting and uncomfortable for informants. Nursing interventions described by informants as comforting were predominantly physical, psychological, emotional and social. Informants felt safe and comforted when their nurses knew what they were doing and seemed to care.

Anecdotes as Topic↗
PubMed2003

Leading the development of nursing within a Nursing Development Unit: the perspectives of leadership by the team leader and a professor of nursing.

Leadership within nursing is receiving unprecedented focus and development. This reflective narrative explores the nature of leadership, termed scholarly leadership, by an academic and a clinical leader of a Nursing Development Unit. The narrative explores the characteristics of such leadership and highlights how it empowered a nursing team to further reach its potential. Two areas, patient-centered care and the characteristics of practice, are focused upon to highlight the leadership style that the clinical leader adopted. The paper concludes by suggesting what structural and systems changes need to be put in place in order to bring about change.

Anecdotes as Topic↗
PubMed2001

Building bridges: towards integrated library and information services for mental health and social care.

This research focuses on identifying the information needs of health professionals, social workers and staff from voluntary agencies, who work together in the provision of services for people with a mental illness. The aim is to provide a fully integrated library and information service for mental health and social care. A number of recent government reports have prompted this research. These have culminated in the publication of the National Service Framework for Mental Health. It was decided to conduct a qualitative study using 17 semistructured interviews with individuals and multi-professional groups. A thematic analysis highlighted a number of key themes including: information need, information seeking behaviour and information flows. Results have indicated that because of the dispersed nature of mental health services, across primary and secondary care, and from statutory and non-statutory organisations, information technology is viewed as the only realistic vehicle to provide the required information. As specialist mental health trusts are configured, covering wider geographical areas, this can only increase the reliance on information technology, for information access and information sharing.

Adult↗
PubMedDate not supplied

Therapeutic use of parental stories to enhance Mexican American family socialization: family transition to the community school system.

An ethnographic study was carried out in Hidalgo County, Texas, among 23 Mexican American families to field-test a methodology of using parental stories to enhance family socialization when a firstborn child enters the community school system. Thirteen of the 23 families shared their parental concerns about the child beginning school in audio-taped interviews in 1998. In 1999, the investigator assessed the parental concerns of the remaining 10 families who were about to have their children enter the school system. The investigator elicited parental stories of how the 13 experienced families managed their parental concerns during 1998, transcribed 65 parental stories verbatim, and shared the parental stories that addressed the specific concerns of each of the 10 inexperienced families. The assessment showed the stories addressed concerns that were similar, the inexperienced parents acquired new ways of managing their parental concerns, and their overall concern was lessened as a result of listening to the stories.

Adult↗
PubMedDate not supplied

Nothing is going to stop me now: obstacles perceived by low-income women as they become self-sufficient.

As low-income women struggle to become self-sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low-income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self-esteem, especially relating to school; "bad" relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.

Anecdotes as Topic↗
PubMed2002

Cross-cultural similarities and differences in attitudes about advance care planning.

OBJECTIVE: Culture may have an important impact on a patient's decision whether to perform advance care planning. But the cultural attitudes influencing such decisions are poorly defined. This hypothesis-generating study begins to characterize those attitudes in 3 American ethnic cultures. DESIGN: Structured, open-ended interviews with blinded content analysis. SETTING: Two general medicine wards in San Antonio, Texas. PATIENTS: Purposive sampling of 26 Mexican-American, 18 Euro-American, and 14 African-American inpatients. MEASUREMENTS AND MAIN RESULTS: The 3 groups shared some views, potentially reflecting elements of an American core culture. For example, majorities of all groups believed "the patient deserves a say in treatment," and "advance directives (ADs) improve the chances a patient's wishes will be followed." But the groups differed on other themes, likely reflecting specific ethnic cultures. For example, most Mexican Americans believed "the health system controls treatment," trusted the system "to serve patients well," believed ADs "help staff know or implement a patient's wishes," and wanted "to die when treatment is futile." Few Euro Americans believed "the system controls treatment," but most trusted the system "to serve patients well," had particular wishes about life support, other care, and acceptable outcomes, and believed ADs "help staff know or implement a patient's wishes." Most African Americans believed "the health system controls treatment," few trusted the system "to serve patients well," and most believed they should "wait until very sick to express treatment wishes." CONCLUSION: While grounded in values that may compose part of American core culture, advance care planning may need tailoring to a patient's specific ethnic views.

Advance Directives↗
PubMed2002

Talking about money: how primary care physicians respond to a patient's question about financial incentives.

Patients sometimes express concern about the influence of "perverse" financial incentives on their care. We recruited a convenience sample of 101 primary care physicians and obtained information on their compensation. Then we audiotaped them as they role-played a response to a videotaped mock patient who asked them how they were paid and how their method of compensation affected clinical decisions. Overall, 36% of the physicians did not give enough information in their role-play response to allow an independent determination of how they were paid. Adopting a broad spectrum of attitudes and approaches, nearly every physician avoided discussing the role of incentives and stressed instead that he or she could be trusted under any circumstance.

Adult↗