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Knowledge, beliefs, and practices concerning seat belt use during pregnancy.

OBJECTIVE: This study seeks to evaluate the comprehension of and attitudes toward proper restraint use among women attending prenatal care clinics. METHODS: Four-hundred and fifty women were asked to complete a survey during prenatal care visits at county health department clinics; the response rate was 92.0%. Women were asked to provide demographic information and report their frequency and knowledge of proper automobile restraint use. RESULTS: Nearly all subjects (95.4%) either maintained or increased their pre-pregnancy frequency of restraint use. Three-hundred (72.5%) subjects demonstrated that they wore their restraints in the correct location, with women who wore restraints more frequently being more likely to report correct placement. Two-hundred and forty-nine (60.1%) of women reported that restraints would protect their baby if they were involved in a collision, while 48 (11.6%) thought the restraints would cause injury to their baby, and 153 (37.0%) were unsure. Women who reported that restraints would protect them and their baby if involved in a collision were significantly more likely to report always wearing restraints compared with those who were unsure or had negative perceptions of restraints (84.4% vs. 64.6%; p < 0.0001). The most commonly reported reasons for lack of restraint use were lack of comfort (52.8%) and forgetfulness (42.5%). Only 36.9% percent of women reported receiving information regarding restraint use during their current pregnancy. CONCLUSIONS: Many gravid women lack information regarding proper seat belt use and their role in injury prevention. Consequently, the frequency of seat belt use and its correct placement are negatively impacted. Health care workers should take an active role in educating pregnant gravid women about proper restraint use.

Adolescent↗

How rehabilitation therapists gather, evaluate, and implement new knowledge.

INTRODUCTION: Rehabilitation therapists are strongly encouraged to apply research to their practices, but relatively little is known about the processes therapists use for continuing their education. This study examines the strategies used by a sample of therapists to gather new knowledge, evaluate its appropriateness to their clinical problems, and implement new learning into their practices. METHODS: Twenty-four randomly selected occupational therapists and physical therapists from a large metropolitan area participated in in-depth interviews. Descriptive codes within interview transcripts described participants' individual approaches to continuing education (CE). Themes derived from comparative analysis across interviews were interpreted, building on prior understandings and suggesting strategies for CE research and programs. RESULTS: Participants valued formal CE highly and expressed frustration concerning its limited availability. Most participants relied on informal consultations with peers as their first educational resource. Peers also supported participants' evaluation and implementation of new knowledge. Although seven participants reported use of systematic methods to access, evaluate, and implement new knowledge, others described more haphazard approaches toward evaluation and application of their learning. Participants identified economic, administrative, and interprofessional barriers to integration of new knowledge into their practices. DISCUSSION: There is a need to develop and incorporate guidelines for evaluating and implementing learning within formal and informal CE programs. The appeal of formal CE suggests that more efficient strategies for continuing rehabilitation are required. Therapists' heavy reliance on peers suggests that educationally influential therapists may be effective media for informal CE interventions. CE targeted to policy makers should focus on promoting organizational change to enhance therapists' translation of research into practice.

Canada↗

The lived experience of Ojibwa and Cree women healers.

The purpose of this phenomenological research study was to describe the meaning and essence of the lived experience of Ojibwa and Cree women healers. The research question, "What is the experience of being an Ojibwa or Cree woman healer?" was asked of a purposive sample of four indigenous women healers, aged 48 to 59, residing in Canada and the United States. The data were collected and analyzed utilizing methods to preserve integrity within the indigenous community. Seven themes emerged from the data. They are as follows: recognizing and unfolding the healing gift; placing faith in the healing ability; mastering indigenous culture, values and traditions; wholesome use of self; interconnection with all; living a balanced, circular life way; and embracing mankind. These seven themes can be employed by nurse healers and/or holistic nurses to practice the art of holistic nursing.

Canada↗

Counselling on breastfeeding: assessing knowledge and skills.

Reported are the results of a randomized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course "Breastfeeding counselling: a training course". The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo, Brazil. Health workers from 60 health units were randomly assigned to be either participants (20) or controls (40), and their breastfeeding knowledge and skills were assessed before and immediately after the course, as well as 3 months later. Immediately after the course the participants' knowledge of breastfeeding had increased significantly compared to controls. Both their clinical and counselling skills also improved significantly. When assessed 3 months later, the scores remained high with only a small decrease. The implementation of the course was also evaluated. The methods used were participatory observation, key interviews and focus group discussion. In the 33 sessions of the course, the average score was 8.43 out of 10. Scores were highest for content and methodology of the theory sessions, and lowest for "use of time", "clinical management of lactation", and "discussion of clinical practice". "Breastfeeding counselling: a training course" therefore effectively increases health workers' knowledge and their clinical and counselling skills for the support of breastfeeding. The course can be conducted adequately using the material and methodology proposed, but could be more satisfactory if the time allocated to exercises and clinical practice sessions were increased.

Brazil↗

Injection safety: knowledge and practice among health workers.

The increase in the spread of human immune-deficiency virus (HIV) infection among our population calls for measures to check its transmission. Health workers are at risk especially those in clinical practice who work with needles and other sharp objects that could aid transmission of the virus. Professionalism is at its lowest at Primary Health Care level and workers responsible for giving immunization with injections need clear understanding of principles of safe injection. To appreciate how to formulate a training programme, the knowledge and practice of injection safety among the workers were assessed through the use of a questionnaire. Fifty eight percent thought only children receiving immunization were at risk of a disease, 58.3% know the diseases transmissible by needle stick injury. On reasons for prevalence of unsafe injection practices, 27% suggested inadequate provision, 18.3% poverty, 17.7% ignorance, 17.2% improper disposal, 11.8% lack of surveillance and health supervision for workers and 8% negligence. On syringes and needles disposal, 53.2% suggested burning only, 2.1% burying and 44.7% both burning and burying. Less than 9% knew that auto-destruct syringes exist while 38.9% were aware of the joint WHO and UNICEF statement on "bundling approach" in vaccine packaging. Only about 50% of respondents had facilities for disposal of needles and syringes in their health centers, 45.6% wear protective clothing during service delivery. On making injection safer 33.7% suggested re-training of health workers, 22% retraining of workers and public re-education, 16.8% suggested planning budgeting and purchasing of auto-destruct syringes, 16.5% social mobilization and advocacy and 11% suggested the provision of facilities for disposal. It was concluded that awareness on safe injection practices was low among the health workers and that their practices could put them at greater risk of needles stick injury and hence the spread of HIV and other infection among them. Training on safe injection practices is therefore recommended.

Disposable Equipment↗

Attitudes, subjective norm, perceived behavioral control, and intentions related to adult smoking cessation after coronary artery bypass graft surgery.

The purpose of this study was to examine the relationships between intention, attitudes, subjective norm, and perceived behavioral control related to smoking cessation in adults after initial coronary artery bypass graft surgery (CABG). The theoretical framework for the study was derived from Ajzen's Theory of Planned Behavior. Intention, the global and belief-based measures of attitude, subjective norm, and perceived behavioral control were measured with the Determinants of Adult Smoking Cessation (DOASC) Questionnaire developed by the investigator. Thirty-two adult smokers completed the questionnaire 2 to 3 weeks following hospital discharge. Four weeks after the questionnaire completion, a follow-up telephone call was used to determine the participants' current smoking status. The study results indicated that there was a statistically significant relationship between the intention to quit smoking after CABG and the global measure of attitude, and perceived behavioral control. This study highlights some of the beliefs about the outcomes of quitting smoking permanently after CABG which may underlie attitudes, subjective norm, and perceived behavioral control in this population. Implications for theory, practice, and research are discussed.

Adult↗

Patient education in nursing-Polish literature condition.

The aim of the review is to present the results of an analysis and evaluation of the state of research on patient education based on the Polish nursing literature. A review and analysis of 139 research works was carried out, which during the years of 1990-2001 appeared in Polish nursing journals as well as in post-conference and convention proceedings and reports. The collected material was evaluated according to the following criteria: defining the research problem, defining and operationalising the variables studied, the research tool applied, the research method used, the size and selection of the research sample, the results achieved. The analysis of research works carried out in the area of patient education became the basis of the objective knowledge of the current state of research and its relation to the nursing practice in this area.

Adaptation, Psychological↗

Knowledge, attitude and practices related to occupational health problems among salt workers working in the desert of Rajasthan, India.

Workers in the salt industry are exposed to direct sunlight, salt dust and contact with brine. To assess their awareness, attitude and practices related to occupational health problems, 205 salt workers were interviewed about health hazards and problems related to their working conditions, usage of protective measures and suggestions for their improvisation. The brine workers had a fair knowledge of their occupational health problems (98.7%), protective measures (100.0%) and their benefits (100.0%) as compared to non brine workers for whom these figures were 89.0%, 85.8% and 78.7% respectively. The brine workers (29.5%) and non brine workers (31.5%) used unconventional measures to prevent contact with salty water, salt dust, raw salt and glare. There was a huge gap between their knowledge and practice with protective devices, though they suggested improvements in protective devices to increase their acceptability.

Adult↗

Addressing limited English proficiency and disparities for Hispanic postpartum women.

The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.

Attitude to Health↗

Predictors of health promotion behavior in women without prior history of coronary heart disease.

The purpose of this study was to determine health promotion behavior (HPB) and the best predictors of HPB in women without prior history of coronary heart disease (CHD). The sample included 119 women aged between 35 and 60 years who had no prior CHD history. The women were asked to complete a self-administered survey regarding their demographic data, personal CHD risk factors, HPB, CHD knowledge, and perceived benefits and barriers to CHD risk factor modification. The women in this study did not practice HPB regularly and had low CHD knowledge levels, a high perception level of benefits, and a moderate level of perceived barriers to CHD risk modification. Backward multiple regression analysis demonstrated that smoking history, family history of CHD, CHD knowledge levels, and perceived barriers to CHD risk modification were the best predictors of HPB in women without CHD. Women with fewer perceived barriers to CHD risk modification, higher CHD knowledge levels, and no smoking history or family history of CHD were more likely to practice HPB.

Adult↗

Introducing insecticide-treated nets in the Kilombero Valley, Tanzania: the relevance of local knowledge and practice for an information, education and communication (IEC) campaign.

Since 1997 the WHO has been recommending an integrative strategy to combat malaria including new medicines, vaccines, improvements of health care systems and insecticide-treated nets (ITNs). After successful controlled trials with ITNs in the past decade, large-scale interventions and research now focus on operational issues of distribution and financing. In developing a social marketing approach in the Kilombero Valley in south-east Tanzania in 1996, a combination of qualitative and quantitative methods was employed to investigate local knowledge and practice relating to malaria. The findings show that the biomedical concept of malaria overlaps with several local illness concepts, one of which is called malaria and refers to mild malaria. Most respondents linked malaria to mosquitoes (76%) and already used mosquito nets (52%). But local understandings of severe malaria differed from the biomedical concept and were not linked to mosquitoes or malaria. A social marketing strategy to promote ITNs was developed on the basis of these findings, which reinforced public health messages and linked them with nets and insecticide. Although we did not directly evaluate the impact of promotional activities, the sharp rise in ownership and use of ITNs by the population (from 10 to > 50%) suggests that they contributed significantly to the success of the programme. Local knowledge and practice is highly relevant for social marketing strategies of ITNs.

Adolescent↗

Satisfaction with formal support and education for children with autism spectrum disorder: the voices of the parents.

INTRODUCTION: The aim of the present study was to identify and describe factors associated with variations in the level of parental satisfaction with formal support and education for children with autism spectrum disorder (ASD) in Flanders. METHODS: Participants were recruited by a mailing from a diagnostic centre for pre-schoolers and by advertisements dispersed in the Flemish parent organization for ASD and in services and special schools. The sample consisted of 244 parents of children with ASD (age range: 2.69-17.81 years, male/female sex ratio 4:1). The data were collected using a questionnaire on experiences with education and support, which was compiled for the purpose of this study. The data resulting from the questionnaire were supplemented with information obtained from semi-structured in-depth interviews with a stratified sample of 15 parents. RESULTS AND CONCLUSIONS: The study revealed that parents experienced difficulties with the diagnostic process, with support and education provided by mainstream settings and with the accessibility of autism-specific service provisions. Conversely, parents reported to be satisfied with the quality of autism-specific support and education. Predictors of overall satisfaction were parental involvement in formal support, knowledge of available service provisions and time between first consultation and final diagnosis. Practical implications of the results are discussed.

Adolescent↗

A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the United States.

PURPOSE: To assess the effects of physician specialty on the knowledge, management, and outcomes of patients with coronary disease or heart failure. MATERIALS AND METHODS: We performed a systematic search of MEDLINE from 1980 to 1997, as well as bibliographic references to articles about the effects of physician specialty on the knowledge, treatment, and outcomes of patients with coronary disease or heart failure in the United States. RESULTS: Twenty-four articles met our criteria for inclusion (including eight that involved knowledge or self-reported practices, 14 that described actual practice patterns, and six that measured clinical outcomes). Cardiologists were more knowledgeable than generalist physicians about the optimal evaluation and management of coronary disease but not about the use of angiotensin-converting enzyme (ACE) inhibitors for heart failure. Patients with unstable angina or myocardial infarction were more likely to receive proven medical therapies, and possibly had improved outcomes, if they were treated by cardiologists. The use of lipid-lowering drugs after myocardial infarction was also more common among patients of cardiologists. ACE inhibitor use for heart failure was probably greater, and short-term readmission rates were lower, with cardiology care. CONCLUSIONS: Patients with coronary disease or heart failure in the United States who are treated by cardiologists appear more likely to receive evidence-based care and probably have better outcomes. Investigation of collaborative models of care and innovative efforts to improve the use of proven therapies by physicians are needed.

Cardiology↗

Psychiatry in general practice. A pilot scheme using the liaison-attachment model.

OBJECTIVE: To improve the quality and accessibility of psychiatric service in the primary care setting. DESIGN: Under the liaison-attachment model, a senior psychiatry trainee provided psychiatric consultations part-time in general practice over an 18-month period. Patients regarded by the participating doctors as having significant psychiatric problems were referred to the trainee for consultation. SETTING: Four group general practices, involving 18 doctors, took part in the scheme. PARTICIPANTS: During the study 172 patients with a wide spectrum of diagnoses were assessed. Near the end of the 18-month period the participating general practitioners provided their evaluations of the scheme. INTERVENTION: In almost all cases standard treatment was provided in the primary care setting and administered by either a general practitioner, the trainee or both working collaboratively together. OUTCOME MEASURES: The general practitioners evaluated the results of the consultations and the effect of the service on their referral patterns. They also rated the overall impact of the scheme on their own knowledge and skills, the quality of care, and its accessibility. RESULTS: The quality of outcome, if known, was regarded as satisfactory in 88% of cases. The reported frequency of referrals to psychiatrists in private practice dropped significantly. The participating doctors perceived improvements in their own abilities to deal with psychiatric problems and regarded the quality and accessibility of psychiatric care to be enhanced by the scheme. CONCLUSIONS: The psychiatric liaison-attachment model, developed in Britain, is applicable and effective in the Australian primary care setting.

Australia↗

Using action research in nursing practice with older people: democratizing knowledge.

AIM: This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. BACKGROUND: Action research has gained popularity in nursing and healthcare research, offering a way of developing practice-based knowledge, which can assist in changing practice and democratizing inquiry. METHODS: There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. CONCLUSION: While the principles of action research appear to offer much towards the development of a practice-rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. RELEVANCE TO CLINICAL PRACTICE: If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.

Activities of Daily Living↗