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Army dependents: childhood illness and health provision.

This small qualitative study explored attitudes of a group of Army wives to childhood illness and their expectations of health provision. The author's practice serves a population mainly comprising of Army dependents where GP attendance rates are double the national average. Two focus groups were organised using health visitor groups attached to the practice. Transcripts were examined to produce a framework for semi-structured interviews with nine mothers, who were selected by purposive sampling. Mothers were asked about symptoms, coping, social problems, decisions to take action, health provision and support. Data were analysed and sorted, using the principles of grounded theory, into four main themes: attitude to child's illness, coping, Army culture and accessibility to health services. Many Army wives appear to suffer from high levels of stress. It seemed that the coping ability of the mother was affected by the constant turbulence and isolation of Army life. While mothers displayed a knowledge of common illnesses, they had fears of the unknown and of life threatening illnesses. They sometimes managed childhood illness at home owing to lack of transport. The author concluded that some Army wives suffer from stress and lack confidence in their mothering skills when their children are ill, which may be due, in part, to the constant cycle of postings and isolation from family and services. They need easily accessible health facilities and information regarding these services. Communication should be encouraged between civilian services and the Army. It appears that Army dependents require more support from their GP practice than the average civilian family, offering opportunity for nurses and health visitors to provide alternative and proactive services.

Adaptation, Psychological↗

Determinants of college students' health-promoting lifestyles.

This descriptive study of 151 university students in Boston, Massachusetts, was undertaken to determine the relationships of their perceived health status, sex, grade point average, and health and nonhealth majors to their health-promoting lifestyles, using the Health Promoting Lifestyle Profile (HPLP) II, based on Pender's model. Students' perceived health status was significantly predictive of total HPLP II, exercise, stress management, and spiritual growth. College women practiced significantly better nutrition, interpersonal relationships, health responsibility, and total HPLP II than men. The whole sample scored lower in stress management than any previous group studied. Male students, those reporting poor health, and all students are targeted for intervention and research in their deficient areas. Guidelines for nursing practice are derived from the HPLP II questionnaire. These clinically significant findings may guide nurse practitioners to intervene in the health awareness and practices of college students.

Adolescent↗

Pneumococcal vaccination: opinion of general practitioners and hospital doctors in Scotland, 1999-2000.

A cross sectional survey by postal questionnaire was carried out to examine general practitioners' (GPs) and hospital doctors' (HDs) knowledge, attitudes and practice (KAP) with regard to pneumococcal vaccination in primary and hospital care in Scotland. Most GPs and HDs considered patients with chronic medical conditions, as recommended by the Department of Health (DoH), to be candidates for pneumococcal vaccination. Although the DoH does not currently recommend the vaccine for all the elderly, 47% of GPs and 46% of HDs reported that the vaccine should be given to this group. GPs (61-85%) and HDs (48-55%) indicated that they considered the vaccine to be safe and effective. The acceptance of pneumococcal vaccine was much lower than for influenza vaccine however, and 79% of HDs and 17% of GPs had never used the vaccine. Documented policies (with or without set targets) for pneumococcal vaccine existed in only 14% of general practice and 3% of hospital settings. Over 70% of respondents indicated that GPs should take responsibility for pneumococcal vaccination. The main sources of knowledge about pneumococcal vaccines were stated to be discussion with colleagues, review of medical literature, past experience, and the DoH recommendations. A clear immunisation policy and financial support for vaccination were identified as important strategies to improve pneumococcal vaccine coverage. Strategies directed toward these factors could enhance vaccine delivery and coverage of vaccine in high-risk individuals.

Cross-Sectional Studies↗

Educating health-care professionals about genetics and genomics.

To biomedical researchers, this is the 'genome era'. Advances in genetics and genomics such as the sequence of the human genome, the human haplotype map, open access databases, cheaper genotyping and chemical genomics have already transformed basic and translational biomedical research. However, for most clinicians, the genome era has not yet arrived. For genomics to have an effect on clinical practice that is comparable to its impact on research will require advances in the genomic literacy of health-care providers. Here we describe the knowledge, skills and attitudes that genomic medicine will require, and approaches to integrate them into the health-care community.

Delivery of Health Care↗

Use of EMS for seriously ill children in the office: a survey of primary care physicians.

OBJECTIVES: To describe how primary care physicians (PCPs) transport seriously ill children from their offices to emergency departments (EDs). METHODS: The authors conducted a mail survey of PCPs in upstate New York. RESULTS: The response rate was 60% (119/199). Sixty-six percent (79/119) of the physicians had transferred at least one child from their office to an ED via EMS. Forty-five percent (53/119) had encountered a case of suspected epiglottitis in the office. EMS was used to send 45% (24/53) of suspected epiglottitis cases to the ED, while 40% (21/53) transferred children with possible epiglottitis via family auto. Similarly, the family's auto was used to transport 26% (6/23) of the patients with suspected foreign body aspiration, 46% (32/70) with severe asthma, 59% (30/51) with severe dehydration, and 37% (14/38) with suspected meningococcemia. In contrast, the family's auto was never used for patients with active seizures. The physicians denied that they would call EMS more often if transport time were shorter (58%) or if costs were less (64%). Sixty percent of the PCPs were not sure whether EMS personnel are skilled in pediatric emergencies. CONCLUSION: The PCPs often failed to call EMS for seriously ill children seen in the office and, instead, used the family's auto for emergency transportation. In this survey, transport time and cost were not barriers to use of EMS. The physicians expressed a lack of confidence in EMS providers' pediatric skills. Targeting educational programs to PCPs that highlight 1) the availability, training, and skill of EMS personnel and 2) the medicolegal risks of family transportation may result in more appropriate use of EMS for children.

Adolescent↗

A preliminary study of the decision-making process within general practice.

OBJECTIVE: The aim of the present study was to explore the factors that contribute to the process of decision making within general practice, over and above evidence-based information. METHODS: A qualitative study was conducted using semi-structured interviews on a purposeful sample of GPs, based in the South West of England. Each interview was tape-recorded and transcribed verbatim. RESULTS: Five broad categories emerged from the data: practitioner; patient; practitioner-patient relationship; verbal and non-verbal communication; evidence-based medicine; and external factors. CONCLUSION: The nature of general practice is such that the process of making clinical decisions is complex. In an era when GPs are being overwhelmed by evidence-based information, consideration needs to be given to the implications that the nature of the decision-making process has upon the way 'evidence' is constructed and promoted within general practice.

Adult↗

An Australian study of midwives' breast-feeding knowledge.

OBJECTIVE: To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context. DESIGN: Postal questionnaire. SETTING: National Australia. PARTICIPANTS: Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI). FINDINGS: A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.

Adult↗

Using the diffusion of innovation model to influence practice: a case study.

There continue to be suggestions within the nursing literature that research findings are not being utilized in clinical practice. The reasons for this are well documented. However, less emphasis is given to ways to facilitate utilization. It seemed possible that non-utilization could be due not only to lack of knowledge, but also to the method of implementing change towards research-based practice. The "top-down', authoritarian, approach to dissemination of information within the NHS may have been a block to research use. Could staff be motivated to consider research-based change through use of a different approach? An "action research' approach seemed a possible way to attempt to facilitate research-based practice. Within this study one ward was used with all staff as the participants. The staff identified the area to be studied (devising a protocol for preoperative information-giving). The instruments used were semi-structured interviews and informal discussions and field notes. Rogers' diffusion of innovation model was used to organize data collection and to analyse results. Although the results may not be generalizable, the use of this model provides a useful framework for others interested in an alternative approach to achieving research-based practice.

Clinical Nursing Research↗

Cross-sector learning among researchers and policy-makers: the search for new strategies to enable use of research results.

This paper assesses the preliminary results of a research funding strategy that alters the structure and process of research by requiring interaction between researchers and policy-makers. The five research teams focused on different aspects of expanding social protection in health in Latin America and the Caribbean. Preliminary results revealed negotiation of the research questions at the start of the process, influencing not only the project design, but the decision-makers' ways of thinking about the problem as well. As the projects advanced, turnover among government officials on four of the teams impaired the process. However, for the one team that escaped re-composition, the interaction has led to use of data in decision-making, as well as a clear recognition by both parties that different kinds of evidence were at play. The process highlighted the importance of stimulating systems of learning in which multiple kinds of knowledge interact. This interaction may be a more realistic expectation of such initiatives than the original goal of "transferring" research knowledge to policy and practice.

Administrative Personnel↗

Perceived barriers and motivators to exercise in hemodialysis patients.

Kidney failure and hemodialysis are associated with numerous physical and psychological symptoms and complications, some of which can be reduced or eliminated by adequate exercise. Dialysis patients, however, tend to be quite sedentary on average, which can further complicate their physical and mental health. The goal of this study was to investigate perceptions of barriers and motivators for exercise among hemodialysis patients. It was hypothesized that increased barriers would be associated with decreased exercise, and increased motivators would be associated with increased exercise. The results indicated that both motivators and barriers were associated with exercise behavior, with motivators being more salient. Contrary to what has been previously postulated, lack of motivation, as opposed to health-related impairment, appears to be the primary factor impeding dialysis patient exercise practices.

Adult↗

Understanding gender construction: creating space for feminist health care practice and research.

An understanding of imposed cultural norms allows the scientist, researcher, and health care practitioner to move beyond the social construction of gender and illness. From Aristotle's theory of reproduction to neurological and psychological research asserting sex as destiny to present-day attitudes toward intersexuality, we can trace the conceptualization of women in terms of biological inferiority. These theories elucidate the ways in which the cultural assumptions influence the institution of scientific inquiry and vice versa. To assure equal and fair health care practices, a paradigm shift is called for that actively accepts feminist research practices and rejects culturally dominant methods of research in medicine and science.

Female↗

[Therapeutical itineraries in poverty situations: diversity and plurality].

The low-income population's practices and strategies for coping with daily problems, especially in relation to the search for health care, are analyzed by means of therapeutic itineraries. To unveil this population's coping strategies in relation to their health-disease process means identifying the individual and collective strategies and the meaning of these social dynamics related directly or indirectly to health. The search for treatment is described and analyzed here in relation to socio-cultural practices in terms of the paths chosen by individuals in the attempt to solve their health problems. The study thus indicates an interdisciplinary and multi-methodological and conceptual approach relating concepts of practices, strategies, and health and life situations. The point of departure is that ways of coping with health problems require an understanding of the strategies developed in a process of (re)appropriation and (re)construction of knowledge. It is equally important to identify social support networks and individual capacity to mobilize such resources. The recognition of these practices allows (re)directing actions in collective health.

Brazil↗

Survey of smoking knowledge, attitudes and practice in school children in Honduras.

OBJECTIVE: The aim of this study was to survey Honduran pre-adolescent knowledge, perceptions and experience regarding smoking. METHODS: A 12-item survey was administered in the classroom to fifth and sixth grade students. The main outcome measures were a description of demographic factors, personal smoking experience, knowledge of health risks, attitudes about tobacco use and perceived sources of information. RESULTS: A total of 225 students were surveyed. The majority were aware that smoking is bad for health, and most reported never having smoked. Most viewed smoking as ugly. Friends and family were selected as the major source of information. CONCLUSIONS: School children in this area of Honduras are aware of the health risks of smoking and view smoking as unattractive.

Adolescent↗

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↗

Acute-care nurses' attitudes towards older patients: a literature review.

With increases in life expectancy and increasing numbers of older patients utilising the acute setting, attitudes of registered nurses caring for older people may affect the quality of care provided. This paper reviews recent research on positive and negative attitudes of acute-care nurses towards older people. Many negative attitudes reflect ageist streotypes and knowledge deficits that significantly influence registered nurses' practice and older patients' quality of care. In the acute setting, older patients experience reduced independence, limited decision-making opportunities, increased probability of developing complications, little consideration of their ageing-related needs, limited health education and social isolation. Available instruments to measure attitudes towards and knowledge about older people, although reliable and valid, are outdated, country-specific and do not include either a patient-focus or a caring perspective. This paper argues for the development and utilisation of a research instrument that includes both a patient focus and a caring dimension.

Aged↗

Knowledge and attitudes towards attention deficit hyperactivity disorder among elementary school teachers.

OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in child and adolescent psychiatry. ADHD children are at risk for academic and psychological difficulties. Lack of cooperation between schools, parents and therapeutic institutions inhibits a multimodal treatment program. This study surveys teachers' knowledge and attitudes towards attention deficit hyperactivity disorder. METHOD: One hundred and ninety six elementary school teachers in Shiraz, Iran, anonymously completed a self-report questionnaire on ADHD. RESULTS: Knowledge about ADHD was relatively low. 46.9% of respondents agreed that ADHD is due to biological and genetic vulnerabilities and causation. 53.1%of all the teachers considered ADHD to be the result of parental spoiling. The attitude score towards ADHD children was also low. 64.8% agree that the same disciplinary rules used for all students should also be applied to ADHD children. 77.6% believe that ADHD students experience difficulties in their relations with their classmates. There was a significant correlation between teachers' knowledge of ADHD and their attitude. The main sources of knowledge about ADHD were: Television and radio; friends and relatives; periodical, newspapers and magazines. CONCLUSION: Knowledge about ADHD was sound to be very low. PRACTICE IMPLICATIONS: Health and/or Educational Ministry should promote a special course on ADHD for teachers and education should be part of the curriculum in faculty training. Providing these educational programs on television and radio may be highly effective as they were the most common source of information.

Adult↗