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PubMed2004

Breastfeeding attitudes, intention, and initiation in low-income women: the effect of the best start program.

This study compared breastfeeding attitudes, intention, and initiation among low-income women exposed or not exposed to the Best Start program. A between- (experimental vs control group) and within-factor (pretest vs posttest) repeated measures design was employed. A nonprobability sample of 54 subjects was randomly assigned to a control group (n = 28) or an experimental group (n = 26). Using the Breastfeeding Attrition Prediction Tool, statistically significant group by time interaction effects were found for negative breastfeeding sentiment, positive breastfeeding sentiment, and breastfeeding control scales. Compared to the control group, the experimental group had significantly increased positive breastfeeding sentiment (P <.01), decreased negative breastfeeding sentiment (P <.01), and increased breastfeeding control (P <.01) from pretest to posttest. Following exposure to the Best Start program, subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group. Practical implications are discussed.

Adult↗
PubMed2003

Using clinical outcomes to explore the theory of expert practice in physical therapy.

BACKGROUND AND PURPOSE: Theoretical models of physical therapist expertise have been developed through research on physical therapists sampled solely on the basis of years of experience or reputation. Expert clinicians, selected on the basis of their patients' outcomes, have not been previously studied, nor have the patient outcomes of peer-nominated experts been analyzed. The purpose of our study was to describe characteristics of therapists who were classified as expert or average therapists based on the outcomes of their patients. SUBJECTS: Subjects were 6 therapists classified as expert and 6 therapists classified as average through retrospective analysis of an outcomes database. METHODS: The study was guided by grounded theory method, using a multiple case study design. Analysis integrated data from quantitative and qualitative sources and developed a grounded theory. RESULTS: All therapists expressed a commitment to professional growth and an ethic of caring. Therapists classified as expert were not distinguished by years of experience, but they differed in academic and work experience, utilization of colleagues, use of reflection, view of primary role, and pattern of delegation of care to support staff. Therapists classified as expert had a patient-centered approach to care, characterized by collaborative clinical reasoning and promotion of patient empowerment. DISCUSSION AND CONCLUSION: These findings add to the understanding of factors related to patient outcomes and build upon grounded theory for elucidating expert practice in physical therapy.

Adult↗
PubMed1999

Lay people's perceptions of sexually transmitted infections in Uganda.

In order to understand lay people's perceptions of sexually transmitted infections (STIs) focus group discussions and semi-structured interviews were held with community members and patients with STIs in Mbarara and Kampala, Uganda. Symptoms of common STIs and the modes of transmission methods were known. STIs were perceived as naturalistic diseases caused by a tiny insect called akakoko or akawutka, although female infertility, one of the common complications of STIs, was perceived as a supernatural ailment. There was no stigma towards people with AIDS, although stigma towards people with other STIs was high. There were also strong negative attitudes towards the use of condoms. More than 60% of the patients interviewed had received treatment from the informal sector which included self-treatment and traditional healers. To reduce the incidence and complications of STIs, there may be a need to collaborate with the informal sector, to further evaluate the beliefs and practices identified in this study and to target them for health education.

Adolescent↗
PubMed2004

Pre-randomization decisions and group stratification in a randomized controlled trial to improve prescribing.

OBJECTIVE: To select and evaluate characteristics of primary care practice groups relevant for stratification prior to randomization. METHOD: Structured telephone interviews and pre- and post-intervention prescription data. SETTING: Additional study in an RCT to rationalize prescribing in primary care, addressing groups of pharmacists and doctors. Representatives of 61 primary care practice groups in the Netherlands. MAIN OUTCOME MEASURES: Identification and evaluation of primary care practice group characteristics related to changes in prescribing. These characteristics were evaluated by estimation of incidence rate ratios (Poisson regression). RESULTS: Of practice groups 40 representatives (66%) participated in our study. Three characteristics were found to be most relevant for stratification: the purpose of the practice groups (whether they participated in information exchange (n = 14) or binding consensus on pharmacotherapy (n = 26)), the use of a formulary (22 practice groups did and 18 groups did not) and the use of feedback data (22 groups did and 18 groups did not). These characteristics strongly modified the effect of the program on prescribing behaviour. While the overall effect of the program was to significantly reduce the prescribing of the targeted drugs, this change was not consistent in all strata. CONCLUSION: Assessment of the characteristics of practice groups made it possible to define factors to be used for a stratified randomization of practice groups which in retrospect indeed modified the effect of an educational intervention directed to change prescribing. Such pre-randomization assessments can be a useful tool in interventions designed to improve practice patterns in groups of physicians.

Communication↗
PubMed1996

How nurses in a stroke rehabilitation unit attempt to meet the psychological needs of patients who become depressed following a stroke.

Fourteen qualified nurses working in a stroke rehabilitation unit were interviewed in order to ascertain their understanding of post-stroke depression, what they do to help a patient who becomes depressed and what they feel unable to do. They were also asked what would improve the situation. The nurses were able to describe the characteristics of depression following a stroke and recognize its effect on the subject's rehabilitation. They were able to identify patients who were becoming depressed and tried to help them to the best of their abilities. They felt constrained, however; mainly by lack of time, limited skills and lack of appropriate training. They themselves wanted to be able to meet the needs of depressed patients and thought that this could be achieved through better staff education and access to other health professionals experienced in providing psychological care. It is recommended that nurses have access to expert personnel both as a source of referral for patients and as a resource for support and guidance to staff. In addition, an education programme combining theoretical and practical aspects of psychological care would be useful.

Cerebrovascular Disorders↗
PubMed1999

Outcome measures of interventions in the study of children of substance-abusing parents.

Children of substance-abusing parents, including children of alcoholics (COAs), are one of the highest risk groups of youth for substance-abuse problems. For both genetic and family environmental reasons, COAs and children of drug abusers are very vulnerable to becoming alcohol or other drug abusers.1,2 With drug use rates increasing in the past 7 years,3 prevention practitioners must work harder to identify and evaluate effective ways to prevent future substance abuse in these at-risk children. Most prevention programs designed specifically for COAs or children of drug abusers have struggled with identifying, attracting, maintaining, and measuring outcomes. This article focuses on general and unique measurement methods and instrument problems in prevention interventions for children of substance-abusing parents. Part I covers the need for improved measurement in research and practice with children of substance-abusing parents and recommended measures for different hypothesized outcome variables. Part II covers considerations in selecting measures, and Part III covers how to select measures. This article concludes with recommendations to improve measurement in research and practice.

Adult↗
PubMedDate not supplied

A model for professional nursing in organizations: the Rainbow.

This paper presents a model of professional nursing in organizations that provides cohesive direction to the development of patterns that shape how nursing is structured in an organization. Such cohesive direction can foster integration between the practice and the discipline components of nursing. The model can influence the structure of nursing on a macro level within the organization and on a micro level by influencing patterns of nursing care delivery. A set of values, assumptions, dimensions, constructs, principles and propositions have been identified and brought together in this model. As a framework, it can be used to shape the structures and processes that contribute to professional nursing excellence in practice settings.

Health Knowledge, Attitudes, Practice↗
PubMedDate not supplied

Nurses' attitudes to evidence-based practice: impact of a national policy.

Clinical effectiveness and evidence-based practice should be key cornerstones of current nursing practice. This study used postal questionnaires to explore the impact of a national initiative on nurses' attitudes, knowledge and practice relating to these twin concepts. Results indicated that attitudes can be influenced by national policy initiatives. Influencing behaviour, however, appears to be more difficult; no change was seen in reported application of evidence-based practice. Nurses did, however, report a desire to increase their implementation of evidence-based practice; reasons for not doing so included lack of the necessary skills and time in the working day. It is recommended that these education and training needs must be addressed by allocating sufficient protected learning time and funds. A more difficult issue relates to the burden of clinical work, which may also be preventing greater uptake of evidence-based practice.

Adult↗
PubMed1997

Factors related to non-attendance in a population based melanoma screening program.

A total of 127 non-attenders in a population-based melanoma screening program, 58 women and 69 men, were asked in a telephone interview about reasons for non-attendance. Of those, 105 also completed a mailed questionnaire, measuring perceived susceptibility to and knowledge about melanoma. During the same period, attenders (n = 286) at the screening clinic completed the same questionnaire. The most commonly reported reasons for non-attendance were 'I forgot about it', 'lack of time' and 'no need for examination'. A majority of non-attenders held a positive attitude towards preventive programs in general and to the present invitation. Most of the improvements suggested by the non-attenders were strategies to reduce practical barriers. Non-attenders scored lower than attenders on perceived susceptibility. High and equal levels of knowledge about melanoma were found among attenders and non-attenders. Men were more likely to be non-attenders. Higher perceived susceptibility and a higher level of knowledge about melanoma were found among women as compared to men. The results suggests that there is potential to increase attendance in future melanoma programs by reducing practical barriers.

Adult↗
PubMedDate not supplied

Predictors of physical activity intentions and behaviour for rural homemakers.

This research combined social psychological theory testing with the practical concern of gathering information useful for the social marketing of active living. The study examined variables related to the intentions and behaviour of rural homemakers with respect to moderate physical activity, using the theory of planned behaviour as a framework. Rural homemakers (n = 630) in four Alberta communities were surveyed by telephone concerning their attitudes, self-efficacy, perceived social support, intentions, and present activity behaviour. Intentions, self-efficacy, and various beliefs related to barriers and social support discriminated active from inactive homemakers. For active homemakers (n = 473), attitude, perceived social support, and self-efficacy predicted future intentions. For inactive homemakers (n = 157), only attitude and self-efficacy predicted intentions. The practical implications of the findings are discussed, in terms of fostering enjoyable experiences, reducing barriers, and providing supportive environments.

Adult↗
PubMed2006

Exploring haematology nurses' perceptions of specialist education's contribution to care delivery and the development of expertise.

The role that educational preparation may play in the delivery of care and the development of expertise is a point of some debate [Manley, K., Garbett, R., 2000. Paying Peter and Paul reconciling concepts of expertise with competency for a clinical career structure. Journal of Clinical Nursing 9 (3), 347; King, L., Macleod Clark, J., 2002. Intuition and the development of expertise in surgical ward and intensive care nurses. Journal of Advanced Nursing 37(4), 322-329; Bonner, A., 2003. Recognition of expertise: an important concept in the acquisition of nephrology nursing expertise. Nursing & Health Sciences Journal 5, 123-131; Dunphy, B.C., Williamson, S.L., 2004. In pursuit of expertise. Advances in Health Sciences Education 9, 107-127]. Though education is a concept that may be universally valued, it may be more difficult to clearly discern the significance it has for practitioners who are developing their expertise. This research project employed an interpretive phenomenological design to explore the perceptions of specialist haematology nursing staff on the extent to which specialist education contributes to care delivery and the development of expert practice. A non-representative purposive sample of qualified nurses who had undertaken specialist education in haemopoiesis and work in specialist haematology participated in a focus group and semi-structured interviews. The report concludes that, for these specialist practitioners, specialist educational input had a beneficial impact on their levels of knowledge and confidence. Further to this, involvement in higher education had enabled them to become more active in the learning process. Perhaps the key finding of the study was the assertion by respondents that specialist educational input had enabled them to develop their specialist practice to a level that experience alone could not achieve.

Attitude of Health Personnel↗
PubMed2001

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↗
PubMed2005

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↗
PubMed2000

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↗
PubMed2006

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↗