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PubMed2002

Job strain among staff of rural nursing homes. A comparison of nurses, aides, and activity workers.

Caring for growing numbers of residents with Alzheimer's disease and related dementias increases the potential for stress among nursing home staff. To better understand occupational stress among caregivers in rural nursing homes, the authors studied differences in job strain among registered nurses, nursing aides, and activity workers. The authors discuss data from their survey questionnaires and focus group interviews with staff, providing insight into job strain and possible intervention strategies to improve the work environment.

Adult↗

PubMedDate not supplied

Benefits of nurse teachers returning to clinical practice.

This article outlines an action research study developed to facilitate nurse teachers returning to clinical practice. The article explores how the teachers established partnerships with clinicians through which they were able to share the experience of returning to an area of nursing that they had previously only visited. It discusses four categories: expectations of self and others; entering someone else's world; more awareness of student needs; and teaching theory and practising nursing. These categories emerged following the analysis of journals, focus group interviews and individual interviews and led to a number of recommendations concerning the implications for other teachers wishing to return to clinical practice.

Attitude of Health Personnel↗

PubMed1983

The elderly at risk: a critical examination of commonly identified risk groups.

This study assessed the nature and extent of the risk or disadvantage for 11 subcategories of the elderly population usually referred to as risk groups. Interviews with 619 over-60-year-olds living in Aberdeen were used to score the ;personal resources' for coping with difficulties-health, psychological, activity, confidence, support, material resources. Risk profiles have been drawn up and these show substantial variation in both the nature and extent of risk or disadvantage between the groups.Of the 11 groups, we concluded that the isolated, the childless and the never married are probably the least disadvantaged. The recently widowed, those living alone, the poor and those from social class V form an intermediate group with both strengths and weaknesses in terms of risk. The groups at greatest risk are the recently moved, recently discharged, divorced/separated and the very old, who all score worse than the whole sample in terms of health and psychological functioning.

Aged↗

PubMed2002

[Teenagers with asthma. A qualitative survey among teenagers with asthma of their expectations and attitudes when it comes to offered health care services].

INTRODUCTION: We wanted to examine the factors that were of importance for the hospital outpatient treatment of teenagers with asthma. MATERIAL AND METHODS: A total of 89 teenagers received a postal questionnaire and an invitation to participate in a focus group interview on outpatient asthma follow-up. RESULTS: Only 16 answered the questionnaire and 7 participated in the interview. The importance of personal contact was stressed and the teenagers expected much from the personnel aiming to help them. In a questionnaire follow-up of initial non-responders, 82% still had asthma and 75% of these received asthma medication. DISCUSSION: The low participation rate and the high expectations explain why teenagers with asthma constitute a group of patients with less than optimal results of treatment.

Adolescent↗

PubMed1997

Using telematic interventions to meet older peoples' needs (ACTION).

The overall conclusion from both the focus group interviews and the survey are that carers want: more information about a range of professional services and other facilities; a central repository for information storage, access and retrieval; and local, flexible, respite facilities.

Aged↗

PubMed2006

"When patients have cancer, they stop seeing me"--the role of the general practitioner in early follow-up of patients with cancer--a qualitative study.

BACKGROUND: The role of the general practitioner (GP) in cancer follow-up is poorly defined. We wanted to describe and analyse the role of the GP during initial follow-up of patients with recently treated cancer, from the perspective of patients, their relatives and their GPs. METHODS: One focus group interview with six GPs from the city of Bodø and individual interviews with 17 GPs from the city of Tromsø in North Norway. Text analysis of the transcribed interviews and of free text comments in two questionnaires from 91 patients with cancer diagnosed between October 1999 and September 2000 and their relatives from Tromsø. RESULTS: The role of the GP in follow-up of patients with recently treated cancer is discussed under five main headings: patient involvement, treating the cancer and treating the patient, time and accessibility, limits to competence, and the GP and the hospital should work together. CONCLUSION: The GP has a place in the follow-up of many patients with cancer, also in the initial phase after treatment. Patients trust their GP to provide competent care, especially when they have more complex health care needs on top of their cancer. GPs agree to take a more prominent role for cancer patients, provided there is good access to specialist advice. Plans for follow-up of individual patients could in many cases improve care and cooperation. Such plans could be made preferably before discharge from in-patient care by a team consisting of the patient, a carer, a hospital specialist and a general practitioner. Patients and GPs call on hospital doctors to initiate such collaboration.

Adult↗

PubMed1998

Functional ability among elderly people in three service settings: the discriminatory power of a new functional ability scale.

The purpose is to assess the discriminatory power of the Avlund scales: (1) by assessing the ability of the scales to discriminate between three different populations of elderly people, and (2) by studying groups with a poor fit between use of formal home care and functional ability. The study included (A) all residents in new sheltered housing facilities (response rate 68%, n = 102), (B) a random sample of users of home care (response rate 67%, n = 435), and (C) a random sample of individuals not using home care (response rate 74%, n = 501). All participants were 60+ years old. Data were collected by personal interviews (group A) and by postal questionnaires (group B and C). Functional ability was measured by The Avlund Mob-T scale about tiredness related to mobility and the Mob-H scale about need of help to mobility. Both scales were able to distinguish the three sub-populations. The whole range of the Mob-T scale was used in all three subpopulations, and the whole range of the Mob-H scale was used among the oldest residents and the oldest users of home care. A small group of well-functioning users of home care (n = 52) was characterized by good self-rated health, good hearing, vision and memory abilities; they gave more help to others, had higher social participation, and lived alone (only the women). A somewhat lager group of poor functioning non-users of home care (n = 266) had the opposite characteristics. In addition, they were older, had a poor social network and poor social support.

Activities of Daily Living↗

PubMed1999

A study of student midwives' experiences during their two-year education programme.

OBJECTIVE: To explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. DESIGN: Triangulation, using quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study. SETTING: All seven midwifery schools in Southern Ireland. PARTICIPANTS: All students in the first intake of 1995 in every midwifery school (n = 125). DATA COLLECTION: Individual and group interviews, diary-keeping and questionnaires. The design and conduct of the study are described in this paper and the findings will be presented at a later date.

Adult↗

PubMed2003

Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers--a qualitative study.

BACKGROUND: General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. METHODS: Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. RESULTS: The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. CONCLUSIONS: Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed.

Adult↗

PubMed2001

The adrenaline rush: nursing students' experiences with the Northern Ireland Ambulance Service.

AIM: The aim of this project was to explore nursing students' experiences whilst on placement with the Northern Ireland Ambulance Service. BACKGROUND: The literature suggests that experiential learning can enhance understanding, knowledge and skills and has the potential for reducing the theory-practice gap. DESIGN: A qualitative approach was utilized, employing diaries and focus group interviews to gather data. One hundred and fifty-four nursing students submitted diaries, producing a response rate of 69%, while 190 students partook in interviews (86%). FINDINGS: Content analysis indicated that the students gained a new appreciation of the concept of holistic care, and that increased interprofessional understanding provides the foundation for improved quality of patient care.

Ambulances↗

PubMed2003

A qualitative study of pregnant teenagers' perceptions of the acceptability of a nutritional education intervention.

OBJECTIVE: in order to assess the feasibility of nutritional education intervention sessions for pregnant teenagers, standard dietary assessment schedules were supplemented by a qualitative appraisal. Reported in this paper are the perceptions of pregnant teenagers who attended one or more of these sessions. DESIGN: qualitative study using a phenomenological approach. Data were collected using semi-structured tape-recorded group interviews. SETTING: two community centres and one maternity unit in Tayside, Scotland. PARTICIPANTS: ten pregnant teenagers aged 16-18 years. INTERVENTIONS: all had attended one or more of a series of food preparation sessions led by a midwife. Food to take away was provided, as were supermarket vouchers. FINDINGS: those who attended found the sessions to be social, educational, and practical. These young women appreciated being in a group which did not include 'older' pregnant women. To a limited extent they had changed their dietary habits at home. Food to take home was a significant attraction. Some of the teenagers sought maternity-related information from the midwife leading the session. KEY CONCLUSIONS: nutritional education remains an important public health issue. Despite offering a range of incentives, attracting teenagers to these sessions was difficult, making their economic feasibility questionable. IMPLICATIONS FOR PRACTICE: with better recruitment, such sessions could form an important part of improving nutrition and overall health for current and future generations.

Adolescent↗

PubMed1997

Utilisation of Australian health care services by ethnic Chinese.

Australia is a multicultural society in which migrants from non-English-speaking backgrounds may be more vulnerable to illness after their new settlement, and language difficulties and cultural differences may affect their use of health services. The present qualitative study used focus group interviews to explore the health services used by Chinese migrants from Hong Kong and China. The general findings included strong preference for Chinese-speaking general practitioners, insufficient interpreter services, low use of preventive services, and lack of knowledge about the existence and role of ethnic health workers. The paper reports specific differences between migrants from China and Hong Kong, and by age group. It discusses reasons for these findings and notes the implications.

Adult↗

PubMed2000

"I could not lift my arm holding the fork...". Living with chronic fatigue syndrome.

OBJECTIVES: To explore and describe symptoms and their consequences for patients suffering from chronic fatigue syndrome (CFS). DESIGN: Qualitative data from a group interview, written answers to a questionnaire and a follow-up meeting analysed in accordance with Giorgi's phenomenological approach. SUBJECTS: Purposeful sample of 10 women and 2 men of various ages recruited from the local self-help patient organisation. MAIN OUTCOME MEASURES: Descriptions reflecting the nature, extent and consequences of symptoms regarded as the most substantial by the informants across the group. RESULTS: Extreme exhaustion exceeding the nature of everyday weariness was reported as the worst symptom. The informants perceived reduced muscular strength, continuous weakness and recurrent pain, problems related to memory and concentration, sleep disturbances and excessive sensitivity towards smell, light and sound. Learning abilities had deteriorated, and housework, conversation, reading and watching TV were characterised as exhausting, leading to an unpredictability of everyday life-disturbing social relations. CONCLUSION: The extent and nature of symptoms suggest that CSF is an essentially different and far more serious condition than the strains of everyday life. Our findings suggest immunological processes affecting the neuromuscular and central neural system comparable to the effects of cytostatic medication.

Adult↗

PubMed2000

Perceptions of sexually transmitted diseases among teenagers.

An exploratory descriptive study was undertaken, focussing on sexually transmitted diseases (STD) among teenagers. The aim of the study was to explore and describe the possible reasons for the high rate of sexually transmitted diseases in teenagers. The perceptions of teenagers and community nurses regarding sexually transmitted disease among teenagers involved in the teenage clinic in a specific predominantly black area were assessed. Twenty teenagers and five community nurses were participants in the study. Two focus group interviews were conducted with teenagers and community nurses. It can be concluded that the attitudes of community nurses may have an influence on the high rate of sexually transmitted diseases among teenagers. The knowledge of the teenagers about sexually transmitted diseases is often based on myths and misconceptions which could be intensified by the community nurse. The recommendations made are that the education standards of all community nurses should be reviewed and adapted to meet the needs of teenagers attending the teenage health services. The policy on in-service training must be reviewed and monitored. Community nurses' intensive training on teenage health service delivery and sexually transmitted diseases services should be in accordance with the principles of Primary Health Care. Community nurses need to attend intensive courses on interpersonal skills specifically related to teenagers. Selection procedures for recruiting community nurses to attend to teenagers specifically should be researched. Teenagers should be involved in planning programs and the teenage clinic should be evaluated frequently to improve the standards. The availability of adequate teenage health services can result in a decrease in sexually transmitted diseases among teenagers.

Adolescent↗

PubMed2000

Confidentiality within physiotherapy: perceptions and attitudes of clinical practitioners.

OBJECTIVES: This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists. DESIGN: Postal survey of universities and focus group interviews with physiotherapists. SETTING: Twenty-five universities in the UK and Ireland and 44 therapists in five hospitals in southern England. RESULTS: The survey of universities indicated that legal and ethical aspects of confidentiality featured in virtually all preregistration courses that responded. However, whereas its inclusion was rated as extremely important, the degree of coverage of confidentiality varied considerably between courses. Within the focus groups, 35 informants recollected coverage of confidentiality in their preregistration education, and 12 in postregistration in-service training; in neither case was this coverage in great detail. Informants identified environmental factors and working practices as barriers to preserving confidentiality. Disclosure to others also gave rise to difficulties. Informants were only aware in general terms of the relevant sections of the Chartered Society of Physiotherapy's Rules of Professional Conduct. CONCLUSIONS: Aspects of hospital-based physiotherapy practice were seen to create specific problems in relation to confidentiality. More detailed sources of education and guidance on this issue appear to be required.

Adult↗

PubMed2004

[Pay for medical labor: a study of systems and forms of payment in general hospitals in Belo Horizonte, Brazil].

A descriptive analysis of systems and forms of payment for medical labor was carried out based on an intentional sample of hospitals, according to preestablished criteria. Hospital administrators, physicians, and representatives of medical and entrepreneurial corporations were interviewed. The results were analyzed according to International Labour Organization (ILO) standards. The "Pay-for-Production System" was used exclusively in private hospitals, while the "Wage System" [based on units of time worked] prevailed in public ones. However, a major share of physicians from both private and public hospitals received different forms of payment simultaneously. "Pay-for-Results" was chosen by all the groups interviewed as the best should be carried out, since professionals have shown great interest in it, and it also a valuable management tool.

English Abstract↗

PubMed2002

An innovative model for teaching and learning clinical procedures.

CONTEXT: Performing a clinical procedure requires the integration of technical clinical skills with effective communication skills. However, these skills are often taught separately. OBJECTIVES: To explore the feasibility and benefits of a new conceptual model for integrated skills teaching. : Design A qualitative observation and interview-based study of undergraduate medical students. METHODOLOGY: Medical students performed technical and communication skills in realistic clinical scenarios (urinary catherization and wound closure), using latex models connected to simulated patients (SPs). Procedures were observed, videorecorded and assessed by tutors from an adjoining room. Students received immediate feedback from tutors and SPs, before engaging in a process of individual feedback through private review of their videotapes. Group interviews explored the response of students, SPs and tutors. Data were analysed using standard qualitative techniques. SUBJECTS: Fifty-one undergraduate students were recruited from the Faculty of Medicine, Imperial College, London. RESULTS: The scenarios provided a realistic simulation of two common clinical situations and proved feasible in terms of time, facilities and resources within this institution. Students found the opportunity to integrate communication and technical skills valuable, challenging and an appropriate learning experience. Immediate feedback was especially highly valued. Some students found difficulty integrating technical and communications skills, but benefited from conducting two procedures in the same session. CONCLUSION: The integrated model was feasible and was perceived to be valuable. Benefits include the opportunity to integrate, within a safe environment, skills which are often taught separately. Promoting reflective practice may enable the successful transfer of these integrated skills to other procedures.

Clinical Competence↗

PubMed1998

Cultural feasibility studies in preparation for clinical trials to reduce maternal-infant HIV transmission in Haiti.

A cultural feasibility study is defined as one that investigates scientific as well as ethical, behavioral, and social issues in the design of clinical trials. The value of such a broadly defined assessment is illustrated through the presentation of two case studies conducted to prepare for clinical trials to reduce maternal-infant HIV transmission on Cité Soleil, Haiti. The first study addressed issues surrounding a trial of breast-feeding and exclusive bottle-feeding among HIV seropositive mothers. The second study focused on the implementation of a double-blind trial of HIV immune globulin and standard immune globulin to be administered to infants of seropositive mothers shortly after birth. Both cases used focus group interviews with mothers and in-depth interviews with key informants to investigate AIDS-related beliefs, acceptability of trial participation, risks to subjects, and community reactions and repercussions to the trial. Findings point to the difficulties posed by attempts to conduct trial involving complex research designs in socially disadvantaged populations. Recommendations highlight the need to consider the community-wide impact of a trial, and the need to undertake extensive educational preparation of participants to ensure informed consent and adherence to protocols.

Bottle Feeding↗