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PubMed2006

The outcomes of partnerships with mental health service users in interprofessional education: a case study.

This paper reports findings from a 5-year evaluation (1998-2003) of a postqualifying programme in community mental health in England which made a sustained attempt to develop partnerships with service users. Users were involved in the commissioning of the programme and its evaluation, as trainers and as course members. The evaluation employed mixed methods to assess: learners' reactions to user-trainers and users as course members; changes in knowledge, attitudes and skills; and changes in individual and organisational practice. Data were collected from participant observation of training, 23 individual and 18 group interviews with students and their managers (n=13), and student ratings of knowledge and skills at the beginning and end of the programme (n=49). The quality of care provided by students was rated by service users (n=120) with whom they worked, using a user-defined questionnaire. The quality of care, and mental health and quality of life outcomes were compared to those for two comparison groups (n=44) in areas where no training had taken place. In general, the students reported positive learning outcomes associated with the partnership orientation of the programme, and learning directly from and with service users. A higher proportion of programme users reported good user-centred assessment and care planning, and showed greater improvement in life skills compared to the comparators. This case study provides evidence of the value of partnership working with service users in interprofessional postqualifying education in mental health. The success is attributed to the design of the programme and the responsiveness of the programme board, which included service users. It may provide a useful model for programmes elsewhere and for other user groups. The case study itself provides a possible model for the systematic evaluation of partnerships with users in education and training.

Community Mental Health Services↗

PubMedDate not supplied

A qualitative study of problem solving and diabetes control in type 2 diabetes self-management.

PURPOSE: The purpose of this study was to explore and compare diabetes-related problem solving in urban African Americans in good and poor diabetes control. METHODS: Two focus groups were conducted, one with participants in good diabetes control and one with participants in poor control. Based on a theoretical model, focus group interview questions were designed to elicit responses about 3 aspects of diabetes-related problem solving: (1) problem-solving orientation, (2) problem-solving process, and (3) transfer of past experience. Transcripts were analyzed using a qualitative data analysis software program, and expert panel members independently reviewed responses and coding. RESULTS: The primary types of problems with diabetes self-management were similar in the good control and poor control groups. Predominant problem-solving themes in the good control group reflected a positive orientation toward diabetes self-management and problem solving, a rational problem-solving process, and a positive transfer of past experience. In contrast, predominant themes in the poor control group revealed a negative orientation, careless and avoidant problem-solving processes, and negative transfer of past learning to new situations. CONCLUSIONS: The problem-solving model may help identify ineffective problem-solving patterns in persons with poor diabetes control. Empirical studies testing the model are warranted.

Black or African American↗

PubMed1994

Use of focus groups to explore nutrition practices and health beliefs of urban Caribbean Latinos with diabetes.

OBJECTIVE: Although Caribbean Latinos are two to three times more likely than non-Hispanic whites to develop diabetes, cultural influences on nutrition and health are poorly understood. To provide insight into important features of diabetes prevention and management, we conducted focus groups to explore nutrition practices and health beliefs. RESEARCH DESIGN AND METHODS: Thirty low-income urban Caribbean Latinos with non-insulin-dependent diabetes mellitus (NIDDM) and four family members participated in four focus group interviews that were conducted in Boston and Cambridge, Massachusetts. Interviews were conducted in Spanish, were tape recorded, and were led and analyzed by Latino professionals from a community-based health organization. RESULTS: Consistent themes described by participants were feelings of social isolation, little understanding of long-term consequences of diabetes, fatalism regarding the course of the disease, multiple barriers to diet and exercise interventions, skepticism regarding the value of preventive health behaviors, prevalent use of traditional nonmedical remedies, and a clear need for culturally sensitive health-care providers and services. CONCLUSIONS: The information from focus groups provides useful information for planning innovative intervention programs for chronic disease risk reduction that emphasize practical skills development, family/peer networks, empowerment techniques, and bilingual providers. We conclude that the focus group technique can be used effectively with low-income, urban minority populations to provide information on lifestyle behaviors and beliefs regarding chronic diseases that impact on health and nutritional status.

Adult↗

PubMed2003

Health promotion and rehabilitation: a case study.

BACKGROUND: Since the number of people in Sweden on long-term sick leave has rapidly increased since 1996, new non-biomedical models of occupational rehabilitation are at stake. A group of seven women who had finished medical treatment and rehabilitation but were still on sick leave or temporary disability pension for several years, worked in a problem-based rehabilitation group for 6 months. Focus for the group was on a process of change towards health and work ability. PURPOSE: The aim of this case study was to improve understanding of effects of a problem-based rehabilitation model (PBR) on health promoting processes amongst a group of women on long-term sick leave. METHOD: Data source was a focus group interview. The analysis follows the guidelines of qualitative analysis that emerges from grounded theory. RESULTS: The pedagogical model of PBR enhanced the participant's internal resources such as self-confidence and ability to act in a social setting. External resources such as social support were improved. An individual follow-up was conducted 2 years after the rehabilitation process and four out of seven women had returned to work. CONCLUSION: Among this group of women PBR launched health-promoting processes. When the more medically oriented treatment is finished or is not able to contribute further to the individual's recovery, other aspects of the individuals abilities and health resources will be focused upon.

Adult↗

PubMedDate not supplied

Development and evaluation of the cane use cognitive mediator instrument.

BACKGROUND: Canes are among the most underutilized assistive devices for older persons. A significant obstacle to understanding cane use behaviors of older adults is the lack of instruments measuring factors that may influence seniors' decisions to accept or reject these devices. OBJECTIVES: Guided by the Theory of Planned Behavior, this study involved the development and evaluation of an instrument to measure cognitive determinants of cane use among community-living older adults. METHOD: The two-phase design involved: a) instrument formation including item generation from four focus group interviews with seniors (n = 30), expert panel evaluation (n = 10), and pilot testing (n = 10); and b) instrument validation in a cross sectional survey (n = 106). RESULTS: Psychometric analyses of survey data provided empirical evidence of the construct validity and reliability of the instrument. Principal components analysis verified the hypothesized four-factor solution, explaining 63.2% of variance. Independent t-tests yielded statistically significant differences (p < 0.001) in mean scores between the two contrasting groups of cane users (n = 51) and nonusers (n = 55) with respect to each of the four factors identified. Alpha coefficients of 0.81 to 0.96 indicated high internal consistency of the instrument. CONCLUSIONS: The instrument can be used by clinicians and researchers to assess seniors' salient beliefs about the consequences of cane use, guide tailored intervention strategies to promote acceptance and effective use, and evaluate the effectiveness of interventions.

Aged↗

PubMed2006

Black teeth: beauty or caries prevention? Practice and beliefs of the Kammu people.

BACKGROUND: To be beautiful and caries-free, Kammu women in Laos and Vietnam habitually paint their teeth black. Although this practice existed for many generations, it is now known only among the elderly. OBJECTIVES: To describe how the tooth-blackening procedure is performed and to test the black stain for possible antimicrobial effects in laboratory experiments. METHODS: Information on how to blacken teeth was obtained by interviewing groups of elderly Kammu people living in different villages in Laos and Vietnam. Water extracts of the stain were placed in wells in agar plates and the plates incubated with Streptococcus mutans or S. sobrinus. The stain was also let such that it covered half of the strip test-side of the Dentocult SM Strip Mutans test kit and incubated with saliva from five persons known to carry mutans streptococci in their saliva. RESULTS: Interviews revealed that three plants were commonly used: Dracontomelon dao nuts (DD nuts), Cratoxylum formosum (CF) wood or Croton cascarilloides (CC) wood. The parts (nut, wood) were burned and soot collected on metal plates. The fresh soot, which had a viscous consistency, was applied to teeth with the index finger. Extracts of soot of the DD nuts had no effect on the streptococci on agar plates but inhibited the growth of salivary mutans streptococci on strips. Controls using soot from birch tree (Betula pendula) had no effect. CONCLUSIONS: The procedure was simple and resulted in black, beautiful (?) teeth. The soot of DD nuts effectively inhibited growth of salivary mutans streptococci in in vitro experiments.

Anacardiaceae↗

PubMed2004

An exploration of four web-based open and flexible learning modules in post-registration nurse education.

UNLABELLED: This paper presents an exploratory evaluation of four newly developed web-based modules for post-registration nurses. The topics for the modules were: dermatology; diabetes; mentorship; and prescribing. STUDY OBJECTIVE: To explore the students' perceptions of the web-based modules before and after completing the modules. DESIGN: A pre-post test design using questionnaires and group interviews. PARTICIPANTS: 39 students enrolled on the modules, pre-module data were collected on 74% (n = 29) and post-module data on 71% (n = 28). None of students had previous web-based education experience. 79% (n = 31) completed and 66% (n = 26) passed the modules. Students level of IT skills prior to commencing the modules were important in explaining module completion and outcome. The modules were rated highly in terms of achieving learning outcomes with moderate ratings for level of support and utility of learning materials. The content analysis of the interviews highlighted the importance of preparing students ensuring they have the IT and independent learning skills necessary to participate in web-based learning programmes, together with a number of issues relating to the accessibility of the learning materials. The perceived benefits of this mode of learning were that they offered flexible and resource rich learning. The downside was that the learning can be isolating. CONCLUSIONS: This form of learning may not be suited to all groups of nurses or all educational topics. Further research is required to establish the educational benefits of different approaches to e-learning.

Adaptation, Psychological↗

PubMed1995

Perceived functions and usefulness of health service support workers.

Support workers have been advocated as a means of overcoming a shortage of professional nursing practice, whether this shortage is derived from a decrease in budgeted positions or from a lack of persons to fill positions. The demand for nursing practice has increased because of a rise in the intensity and complexity of patient care. The purpose of this study was to examine professional nurses' views on the non-nursing duties they were currently performing and the possible use of support personnel to assist them in their role of providing patient care. Group interviews of qualified nurses were used to develop a questionnaire comprising 40 items concerning support worker duties, 26 non-nursing duties and one item requesting respondents to indicate if a support worker would be useful: 408 (60%) nurses completed the questionnaire and 71% agreed that a support worker would be useful. Twenty-three support worker activities were statistically significant (P < 0.01) in the level of agreement and variation from the undecided position. The significant groups of support worker activities determined by principal component analysis using a single factor were clerical, cleaning and stocking and direct patient care, while the indirect patient care group of activities was not significant. Forty-six per cent of the non-nursing duties were agreed to, while 50% were seen to be the role of the nurse. There were areas of support worker activity which were related to agreed non-nursing duties and other areas where there was an overlap, with the duties being seen as both nursing and suitable for the support worker.

Adult↗

PubMed2005

Specialist educational intervention for mental health nursing staff: delivery, content and personal impact.

AIM: This paper reports a study to ascertain the views of acute ward-based mental health nursing staff on the delivery, content and personal impact of an innovative 18-day, whole team educational intervention in acute mental health care. BACKGROUND: There are grave concerns internationally about the quality of inpatient mental health care for people with acute psychiatric problems. Educational courses are needed to improve these services. However, existing schemes are often selective, hard to access and limited to developing highly specialist skills for senior nurses. They have also been criticized for making no difference to clinical practice. There is little evidence to guide the development of these or alternative team-based courses. METHOD: Qualitative data were collected over a 6-week period using 12 focus group interviews and individual questionnaires. RESULTS: Four themes were identified. The joint education of nursing staff from different organizations was welcomed and reduced feelings of ward isolation. Mixing qualified and unqualified staff was not regarded positively. In terms of course content and learning themes, unqualified staff were more likely to report positive learning outcomes for knowledge, skills, attitude, morale and personal development; qualified nurses were more likely to indicate positive outcomes in anonymized data from questionnaires than from focus groups. Both groups reported little chance of knowledge implementation without changes in the organization of care. CONCLUSION: Whilst it may be desirable to educate whole nursing teams, more benefit might be gained from shared education between several organizations and separating the education of qualified and unqualified staff before combining these groups in team education. Participants remained pessimistic about their chances of implementing new knowledge and skills in current acute inpatient mental health environments.

Acute Disease↗

PubMed2005

Peer educators--contributing to child accident prevention.

This paper describes the evaluation of an innovative approach to tackling the issue of childhood accident prevention in the home, in a deprived inner city and multi-ethnic community in the north of England. Three local mothers were recruited and trained to take on the role of peer educators. The evaluation design was informed by the theory of change approach that focuses on exploring how and why an initiative works. In order to achieve a diverse exploration of the situation, data was collected using individual and focus group interviews, visit summary forms and accident incidence proforma. The aim of this paper is to describe the qualitative findings and to highlight some of the successes and challenges of this approach in order to provide practice development messages.

Accident Prevention↗

PubMed2006

Heart disease among post-menopausal women: acceptability of functional foods as a preventive measure.

This study reports the results of eight focus group interviews with post-menopausal women (50-59 years, N=73) in Denmark and United Kingdom regarding their views on heart disease among women and the potential acceptability of functional foods as a means of prevention. Although, heart disease was recognised as a serious health problem and its occurrence among women recognised, it was predominantly conceived as a health problem affecting men and as being largely due to the relatively unhealthy lifestyles of men. Only a very small minority of participants were aware of the contribution of menopause to heart disease among women. Functional foods were generally not conceived as a means of prevention that is commensurate with the serious character of heart disease. It emerged from ranking tasks that functional foods do not constitute a product category as such. They occupy an anomalous position between 'food' on the one hand and 'medicine' on the other. Participants tend to dislike the idea of a 'personal' food not intended to comprise part of a shared meal in the household, and also tend to distrust health claims promoted by the food industry. This study indicates a need for further research in these areas.

Awareness↗

PubMed2006

The value of caring in nursing supervision.

AIM: The aim of this study was to explore and describe nurse supervisors' views of the value of caring in nursing supervision and how they strive to make this value visible. BACKGROUND: The academic part of nursing education presupposes scientifically based nursing knowledge. Several strategies have been suggested for ensuring high-quality clinical nursing education, including nursing supervision, as it facilitates the fusion and integration of theory and practice. To achieve high-quality nursing supervision it is important to describe the supervisors' interventions. METHOD: Data were collected by means of focus group interviews and analysed by qualitative content analysis. FINDINGS: Four themes emerged: genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning and consolation. The supervisors' description of how they strived to make the value of caring in nursing supervision visible can be expressed as follows: the value of caring is inherent in all aspects of nursing supervision; in the narratives of the patients' situations; in relation to the professional role; and in the benefits of participating in group supervision. CONCLUSIONS: The value of caring in nursing supervision was described as a genuine encounter, consciousness of one's own value base, confirmation and a relationship characterized by learning in addition to providing consolation. The role of the supervisor is characterized by three dimensions: willingness, knowledge and courage.

Attitude of Health Personnel↗

PubMed2005

Under what circumstances are nurses willing to engage in brief alcohol interventions? A qualitative study from primary care in Sweden.

To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Ostergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

Alcohol Drinking↗

PubMed2006

Immediate life support (ILS) training Impact in a primary care setting?

OBJECTIVE: To evaluate immediate life support (ILS) training in a primary care setting. METHODS: A 12 month pre/post-quasi-experimental and qualitative evaluation of ILS training across the counties of Devon and Cornwall (UK). Data were collected via feedback forms, pre/post course knowledge and skills tests and by focus group interviews with key stakeholders. RESULTS: One hundred and seventy-three professionals from 10 courses took part in the evaluation with a response rate of 93%. Feedback on the course was overwhelmingly positive. A significant improvement in both skills (p < or = 0.001) and knowledge (p < or = 0.001) was shown. However, a proportion of participants had a decline in knowledge by the end of the course. Those attending ILS had a significantly higher knowledge score at the start of the course (p = 0.002) than a group attending a BLS course, indicating that the preparatory course manual had been beneficial. Knowledge did not decline significantly by 6 months but skills did (p = 0.02), but remained higher than pre-course levels (p < or = 0.001). Knowledge (p = 0.008) and skill (p < or = 0.002) retention following the ILS course was significantly higher than in the BLS course sub-group, indicating the added value of ILS. The focus groups raised a number of themes relating to release of staff; funding issues; and the observed and reported effects of assessment inequity mainly relating to 'failure to fail' and 'dove and hawk' approaches. CONCLUSION: The course leads to a significant increase in skills and knowledge with good knowledge retention. Skill decline is significant which raises questions about the practice of practitioners who are not updated regularly. Issues of funding, staff resources and the assessment ethics and strategy need to be addressed.

Advanced Cardiac Life Support↗

PubMed2000

The impact of managed care on nurses' workplace learning and teaching.

This paper examines the impact of managed care on the informal learning process for nurses in a major US-based health organisation. Through the analysis of focus group data we report the nurses' view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US-based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada.

Attitude of Health Personnel↗

PubMed2005

The path to lowest-low fertility in Ukraine.

The phenomenon of lowest-low fertility, defined as total fertility below 1.3, is now emerging throughout Europe and is attributed by many to postponement of the initiation of childbearing. Here an investigation of the case of Ukraine, where total fertility--1.1 in 2001--is one of the world's lowest, shows that there is more than one pathway to lowest-low fertility. Although Ukraine has undergone immense political and economic transformations in the past decade, it has maintained a young age at first birth and nearly universal childbearing. Analyses of official national statistics and the Ukrainian Reproductive Health Survey show that fertility declined to very low levels without a transition to a later pattern of childbearing. Findings from focus-group interviews are used to suggest explanations of the early fertility pattern. These include the persistence of traditional norms for childbearing and the roles of men and women, concerns about medical complications and infertility at a later age, and the link between early fertility and early marriage.

Adult↗

PubMedDate not supplied

Formative evaluation of a computer-assisted learning program in pharmacology for nursing students.

Previous literature on evaluation of computer-assisted learning (CAL) programs has generally not emphasized the importance of evaluation during the design and development phases. A tendency toward an objective model of evaluation rather than a naturalistic model has also meant that there is little consideration given to the context in which students learn. The aim of this study was to demonstrate the benefits of using a combination of objective and naturalistic models when undertaking a formative evaluation of a computer-assisted learning program. During the design and development phases, the program, Pharmacology Resource for Nurses (PRN), was evaluated using observation of student pairs, student questionnaires, and student focus group interviews to address the complex issues underlying program effectiveness. This study confirmed the importance and value of collecting a variety of evaluation data in order to produce a useful learning program for students.

Attitude of Health Personnel↗

PubMed1988

Intropunitiveness and parasuicide: prediction of interview response.

A recently proposed relationship between intropunitiveness and depressive states was examined in interview intervention with parasuicidal in-patients. To test the prediction that highly intropunitive parasuicidal individuals would be most responsive to cognitive intervention, a sample of 48 parasuicidal in-patients were administered a battery of individual difference measures, including the Hostility Questionnaire. Subjects were randomly assigned to one of three interview procedures, namely a cognitive interview, an affective interview or a waiting period (control). Highly intropunitive individuals in the cognitive interview group showed the most improvements on a self-report depressive symptom change measure. In addition to supporting theoretical models of depressive state changes, the study has important clinical implications because of the need to identify parasuicidal individuals who are most likely to benefit from brief interventions.

Adult↗