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Pain assessment in the perspective of action science.

Pain assessment is examined in the perspective of action science with the aim to discover espoused theories and theories-in-use for pain assessment. In action science there are 2 sets of theories of action: espouse theories and theories-in-use, which often exist in practice inconsistently with each other resulting in haphazard actions. Espoused theories of pain and pain assessment and a set of theories-in-use were revealed. Alignments between the espoused theories and the theories-in-use, and disparities between these theories were found in the pain assessment situations. The findings point to possible explanations regarding problems in pain assessment, and provide insights into our understanding of nursing practice especially in relation to pain assessment.

Attitude of Health Personnel↗

Identification of nutrition communication styles and strategies: a qualitative study among Dutch GPs.

OBJECTIVE: The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables. METHODS: Nine focus groups with 81 GPs were used to obtain GPs' perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST. RESULTS: Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses. CONCLUSION: The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted. PRACTICE IMPLICATIONS: We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians.

Attitude of Health Personnel↗

Autopsy consent practice at US teaching hospitals: results of a national survey.

BACKGROUND: Autopsy rates continue to fall despite the enduring benefit of the procedure to families and medical science, yet there are few data about the consent process itself. OBJECTIVE: To evaluate the current practice of obtaining autopsy consent, by assessing the consent forms currently in use, the knowledge and attitudes of chief residents on the procedure, and the expert opinion of pathologists in those institutions. DESIGN: Cross-sectional survey. SETTINGS AND PARTICIPANTS: One hundred twenty-seven US teaching hospitals. RESULTS: Of all autopsy consent forms we surveyed, 84.7% contained 7 of 10 elements recommended by the College of American Pathologists. Only 7.1% of institutions supplied educational materials for the physician, as recommended by the College of American Pathologists. Overall, 50.1% of chief residents reported deficiencies in their knowledge of the autopsy procedure. Correspondingly, greater than 74.5% felt that educational materials would be beneficial for physicians and the family. Finally, 93.3% of chief residents believed that a limited autopsy should be offered to families, while 68 (90%) of 76 pathologists at these institutions believed that limited autopsies are an unsatisfactory alternative to the complete procedure. CONCLUSIONS: Chief residents at US teaching hospitals reported substantial deficiencies in their knowledge about autopsy and desire more training on the consent process. Autopsy consent forms are often lacking information that might help physicians and families in making an educated choice about autopsy. Teaching institutions need to reevaluate the training for the autopsy consent practice.

Autopsy↗

Attitudes, practices, and beliefs of individuals consuming a raw foods diet.

OBJECTIVE: Describe dietary practices of U.S. raw foods leaders, examine diet rationale, attitudes and health practices of raw foodists. DESIGN: Nonexperimental, descriptive, using semistructured qualitative interview data. PARTICIPANTS: Purposeful (nonrandom) sample of 17 U.S. raw foods leaders, including 11 males and 6 females. Leaders were targeted to provide insights into practices modeled for larger community. PHENOMENA OF INTEREST: Attitudes, practices, and beliefs of individuals consuming a raw foods diet. ANALYSIS: Text analysis and simple descriptive statistics. RESULTS: Subjects averaged 13 years on the diet (range: 3-32 years). Twelve subjects reported a diet at least 85% raw. All diets were primarily vegan. Primary constituents included fruits and juices, vegetables, nuts and seeds, and vegetable fats. Subjects consumed no dairy, eggs, meat, fish, poultry, commercial sweets or alcohol in a typical week. Only one subject used a commercial, nonfood-based supplement weekly (vitamin B12). Six subjects consumed food-based supplements, and remainder used no supplements at all. On average, subjects met or exceeded recommended intakes of vegetables, fruits, and fats and did not meet recommendations for calcium-rich foods, protein-rich foods, and grains. CONCLUSIONS AND IMPLICATIONS: Those counseling raw foodists must understand the rationale and practices that characterize this eating style. Further research is needed on larger populations to validate findings and determine the extent to which reported health benefits may compare to those from other vegetarian diets. Further studies should examine food-handling and preparation practices in relation to food safety and raw produce.

Adult↗

The knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip.

A detailed clinical examination of the newborn performed by nurse-midwife practitioners has been recommended as a standard practice throughout the most western countries. The purpose of this study was to evaluate and compare the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip (DDH) before and after a structured lesson. The study was designed as a cross-sectional, pre- and post-test. The number of participants from primary care and secondary care nurse-midwife practitioners were 155 and 208, respectively. A structured questionnaire consisting of 28 statements of medical and practical knowledge, and traditional attitudes with regard to DDH was administered. The results determined that the pre-test scores were much lower than the post-test scores of both primary and secondary care practitioners. Although there was a lack of knowledge about DDH in both groups, the pre-test and post-test scores were higher in the primary care group compared to the secondary care group. In conclusion, the knowledge, attitude and practice of the primary and secondary care nurse-midwife practitioners on developmental dysplasia of hip are in need of improvement. This improvement may be provided by continuing education programmes.

Adult↗

Perceptions of colorectal cancer in a socioeconomically disadvantaged population.

This study examined 500 low socioeconomic adults' perceptions and practices regarding bowel cancer. At least 20 percent of respondents incorrectly believed homosexual men are more likely to develop bowel cancer, exercising regularly will not affect bowel cancer, bowel cancer does not run in families, and eating foods high in fat does not increase bowel cancer risks. Approximately 7 in 10 respondents did not perceive themselves as more susceptible to developing bowel cancer even though the same number of respondents acknowledged that poor people are more likely to develop bowel cancer. The majority (54 percent) believed that if you develop bowel cancer, it will kill you. The majority of respondents did not believe that fecal occult blood tests could help save their lives if they had bowel cancer since 90 percent perceived bowel cancer as incurable even if found early. The main barriers to screening for bowel cancer identified by the respondents were: being too embarrassed to have a proctoscopic exam (77%), not wanting to know if they had bowel cancer (78%), preferring to die rather than have their bowel removed for cancer (80%), and trouble with transportation (81%). Thirty percent of the respondents had personally done a stool occult blood test and the same number claimed they had a proctoscopic exam. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of economically disadvantaged subjects regarding bowel cancer.

Adult↗

A training needs survey of doctors' breastfeeding support skills in England.

The study examined the training needs of paediatricians and general practitioners (GPs). Respondents rated their competence on 23 breastfeeding support skills, importance of update in the next 2 years, actual and potential helpfulness of different forms of professional updates, and accessibility in the next 2 years. The perception of organizational barriers to breastfeeding support and practitioners' knowledge of policies and guidance on breastfeeding were also examined. The sample comprised 120 paediatricians and 57 GPs. Response rates were estimated as between 4% and 29%, depending upon the method of recruitment. Although both groups rated themselves as fairly competent in most of the skill areas, they welcomed training in key areas of practice. Paediatricians identified more areas for update than GPs (t = 3.44; d.f. = 178; P < 0.00001). Those who believed that they were less competent in clinical skills were least likely to seek update (r = 0.35; P < 0.00001). Practical forms of training were most often welcomed. Only 47% of GPs and 62.5% of paediatricians had access to a local breastfeeding policy. There were evident gaps in knowledge on key aspects of public health policy, which could influence local practice; for example, 50.8% of GPs and 47.5% of paediatricians identified a younger age for introducing solids than the minimum according to current government guidance. Organizational barriers to breastfeeding support were experienced by all respondents. Recommendations include purposively targeting training to those least likely to seek training, and developing effective self-study and observational methods of learning. All training should be evaluated and implemented alongside breastfeeding policies and clinical leadership to improve the practice of all healthcare practitioners.

Breast Feeding↗

Missed opportunities to immunize: psychosocial and practice correlates.

BACKGROUND: The goal of this pilot study was to correlate missed opportunities to immunize young children with providers' psychosocial characteristics and self-reported immunization practices. METHODS: In a population of children aged 0 to 36 months, missed opportunities to immunize were established for a sample of 28 providers, who also responded to a valid and reliable instrument measuring the aforementioned variables. RESULTS: Missed opportunities were significantly lower among providers with higher vested interest (r=-0.45, p=0.02) and tended to be lower among providers with more positive attitudes toward having all children properly immunized at every healthcare visit (r=-0.33, p =0.09). Neither knowledge nor perceived barriers correlated significantly with missed opportunities. Providers missed opportunities to immunize in over half of the visits studied (mean, 0.58), yet all of them reported always immunizing at preventive and follow-up visits, almost all (96.3%) at chronic illness visits, and a majority (78.6%) at acute care visits. As a result, none of the self-reported immunization practices was significantly correlated with missed opportunities. CONCLUSIONS: Missed opportunities appear to be best predicted by motivational psychosocial factors and not by knowledge or perceived barriers. Self-reported immunization practices do not correspond to actual immunization behavior.

Child, Preschool↗

Addressing issues for early detection and screening in ethnic populations.

PURPOSE/OBJECTIVES: To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. DATA SOURCES: Literature and clinical community practice reports. DATA SYNTHESIS: Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. CONCLUSIONS: Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. IMPLICATIONS FOR NURSING PRACTICE: The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.

Culture↗

Perceived genetic knowledge, attitudes towards genetic testing, and the relationship between these among patients with a chronic disease.

OBJECTIVE: Genetics increasingly permeate everyday medicine. When patients want to make informed decisions about genetic testing, they require genetic knowledge. This study examined the genetic knowledge and attitudes of patients with chronic diseases, and the relationship between both. In addition, patients were asked about their preferred source of genetic information. METHODS: Questionnaires were mailed to participants of a nationwide representative sample of patients with chronic diseases in the Netherlands (n = 1916). RESULTS: The response rate was 82% (n = 1496). Perceived genetic knowledge was low, particularly among older and lower educated patients. Attitudes towards genetics were rather positive, especially among younger and higher educated patients. Some concerns were also documented, mainly about the consequences of genetic testing for employment and taking insurance. Patients who perceived to have little knowledge found it difficult to formulate an opinion about genetic testing. Higher levels of genetic knowledge were associated with a more favourable attitude towards genetics. Chronic patients prefer to receive genetic information from their GP. CONCLUSION: Chronic patients are ill prepared when they require genetic knowledge to make decisions regarding the treatment of their disease. This seems to result from a knowledge deficiency rather than from disagreement with the genetic developments. PRACTICE IMPLICATIONS: When chronic patients are in need of information about genetics or genetic testing, their general practitioner should provide this.

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↗

Health workers' support for breastfeeding in Ibadan, Nigeria.

Breastfeeding in Nigeria is universal, and exclusive breastfeeding was introduced in 1992, yet no study has assessed health workers' support for breastfeeding at the grassroots level. This study assessed health workers' tangible support for breastfeeding at primary care facilities in Ibadan and factors affecting it, including knowledge of and attitudes toward breastfeeding. Among the 386 workers, there was moderate support for breastfeeding (median score = 15.0, maximum = 20). Following multivariate analysis, young age of worker (20-29 years; odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2-6.8), more than 5 years of post-training experience (OR = 2.3, 95% CI: 1.2-4.4), senior profession (OR = 2.1, 95% CI: 1.0-4.4), high breastfeeding knowledge scores (OR = 2.5, 95% CI: 1.4-4.5), and sufficient opportunities to practice tangible breastfeeding support (OR = 4.3, 95% CI: 2.4-7.7) were found to predict tangible breastfeeding support. Deliberate efforts should be made to incorporate continuing education workshops to better prepare health professionals for their role in providing tangible breastfeeding support at the primary care level.

Adult↗