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Self direction in a problem based learning program.

Baccalaureate nursing graduates must enter their professional careers with the understanding and ability to engage in continuing learning in order to ensure competence in professional practice. The graduate's ability to be self directed in learning is an important indication of the ability to pursue continuing learning as a practitioner. It has been surmised that Problem Based Learning nursing programs facilitate the development of abilities to become self directed in learning. A quasi-experimental design using the self directed learning readiness scale (SDLRS) was used to examine the self directed learning (SDL) of students at the beginning and end of one year in a problem based learning (PBL) program. In order to complement the quantitative data, year end focus group interviews were held with students to explore their experiences with SDL. Students demonstrated average self directed learning readiness scores at the beginning and end of the first year in the PBL program. Although students did not demonstrate any increase in SDLRS at the end of one year in a PBL program, they were able to describe themselves as having developed many of the documented characteristics associated with self directed learners.

Adolescent↗

Important aspects of nursing care in surgical wards as expressed by nurses.

The aim of this study was to find out clinical nurses' perceptions of important aspects of nursing care that might have an impact on quality of care in surgical wards. A qualitative approach using focus group interviews was used. The data analysis revealed 15 categories of important aspects of care which could be condensed into two dimensions, here called 'prerequisites' (i.e., staffing, routines and attitudes) and 'elements of performance' (i.e., detecting and acting on signs and symptoms and acting on behalf of the patients). These aspects could be a starting point for developing quality indicators. Carper's four fundamental patterns of knowing were used to make a theoretical interpretation, and three of them were identified.

Adult↗

Changes in practice at the nurse-doctor interface. Using focus groups to explore the perceptions of first level nurses working in an acute care setting.

A unique combination of factors has recently triggered a rapid change in the clinical practice of nurses in the UK. This study was carried out to explore the consequences of changing practice at the nurse-doctor interface, as perceived by first level nurses working in an acute care setting in the UK. Qualitative data were collected using focus group interviews and analysed thematically. Findings suggest that role change to these nurses is represented by a 'shift' in the practice of technical activities from junior doctors and a corresponding delegation of nursing activity to care assistants. It is suggested that the wholesale incorporation of technical interventions into the role of the nurse without an increase in the number of qualified nurses is turning nursing back to a task system of care delivery. This has the potential to depersonalize patients and reduce work satisfaction for nurses.

Focus Groups↗

The nurse practitioner role in Fiji: results of an impact study.

The Nurse Practitioner role, a relatively new role in Fiji, was introduced by the Ministry of Health in order to increase local access to adequate health care for people living in remote areas. Both developed and developing countries have introduced Nurse Practitioner or similar roles in order to provide a cost effective and sustainable health workforce. This paper provides the results of a qualitative, descriptive study undertaken to explore the introduction of this role and its impact on health service delivery in Fiji. It involved semi structured and focus group interviews with nurse practitioners, key stake holders and community members. The findings demonstrate the positive impact of the role and its benefits to people living in the remote areas of Fiji. It also outlines the satisfaction of villagers with Nurse Practitioners and the extensive scope of practice undertaken by these practitioners. Issues related to the introduction of the role are also discussed. Finally, recommendations for future research and practice are offered.

Attitude of Health Personnel↗

Knowledge and attitudes in Puerto Rico concerning dengue prevention.

OBJECTIVE: Dengue has been endemic in Puerto Rico for three decades. Multiple educational and community-based efforts have been developed to inform the population about dengue prevention. We undertook this study to understand the community members' knowledge, attitudes, and practices related to dengue prevention and to elicit their ideas for future prevention campaigns. METHODS: A qualitative study based on grounded theory analysis was conducted between February and May of 2001. The study involved a total of 34 participants in four group interviews who had been identified through the Puerto Rico dengue surveillance system. RESULTS: In general, participants had correct knowledge about dengue prevention, but they did not associate the mosquitoes inside their houses with Aedes aegypti. Participants insisted that "neighbors" needed to control larval habitats, and the participants also asked the Government to fumigate. CONCLUSIONS: The patterns of knowledge and opinion that emerged in the discussions can be arranged along an axis going from high levels of correct knowledge to low levels of correct knowledge about dengue and dengue hemorrhagic fever and related practices. There were few participants at either extreme. Three themes explained these patterns: misconceptions about dengue (based on previously delivered information), the "invisibility" of dengue (as compared to other diseases), and responsibility (individual and Government). Four strategies for preventive behaviors were recommended: developing community groups to identify community priorities on prevention, developing volunteer groups to deliver prevention messages, making house visits to demonstrate specific control measures, and conducting a complementary media campaign to support these strategies.

Dengue↗

Psychosocial aspects of health seeking behaviours of patients with Buruli ulcer in southern Benin.

We investigated cultural beliefs and psychosocial factors associated with Buruli ulcer in southern Benin in order to elaborate and deliver appropriate health education messages. We conducted a qualitative study among 130 adults and 30 children in Zou province, a highly endemic region. Focus group interviews of inhabitants, patients and their assistants, health care professionals and traditional healers took place in Dasso, Ouinhi, Sagon and Zagnanado. Drawing sessions followed by individual interviews were organized among school children in Dasso and Sagon. We found that although Buruli ulcer is well known and recognized - even at a very early stage of the disease - and perceived as threatening, most people are reluctant to seek treatment at the health care centre. They are unclear about the origin of the disease (environmental factors or sorcery) and treatment is considered devastating, expensive and ineffective in some cases.

Adolescent↗

Cardiac pain or panic disorder? Managing uncertainty in the emergency department.

Emergency department admissions for chest pain might be related to a psychological problem, such as panic. Panic disorder adversely affects the person's lifestyle, general health, and psychological well-being. Panic disorder is difficult to recognize, so nursing assessment and management of these clients is important. This paper presents research findings from a New Zealand study that explored emergency nurses' differentiation of non-cardiac chest pain from panic disorder and raised significant issues in the nursing assessment and management of such clients. The data were gathered from focus group interviews and were analyzed thematically. Three themes, prioritizing time, managing uncertainty and ambiguity, and the life-threatening lens, were identified. The findings confirm that a panic disorder is not always diagnosed when biomedical assessment is used in isolation from a psychosocial assessment. Emergency nurses are pivotal in reversing the cycle of repeat presenters with non-cardiac chest pain. Recommendations for assessing and managing this complex condition are presented.

Adult↗

An evaluation of dependency assessment: experiences of staff, patients and carers in a UK hospice.

AIM: To evaluate the experiences of health-care professionals, service users and carers of service users from a UK hospice in relation to dependency assessment. DESIGN: Qualitative evaluation. SAMPLE: Purposive, convenience sample of hospice staff, patients receiving hospice services and carers of patients receiving hospice services. METHODS: Focus group interviews with hospice staff and carers of hospice service users. Individual interviews with patients. RESULTS: Staff felt the tool used produced inaccurate results, in part because of omissions in content. They did not perceive the data produced affected working practice, e.g. staffing levels. Patients described unobtrusive assessment and stated their needs were met. Carers reported feelings of isolation. They also described differing information and support needs from the patients. CONCLUSION: Further research is required to improve the validity of dependency data collection. Further investigation of carer assessment is also justified.

Aged↗

The effects of community, coworker and organizational support to job satisfaction of nurses in Cameroon.

This study examined the effects of community, co-worker and organizational support with the job satisfaction of nurses in Cameroon in six major components of the job namely; work, pay, promotion, supervision, co-worker relationships and the job in general. Each variable was examined separately. A convenience sample of 158 staff nurses, participated in this study. The Job Descriptive Index (JDI) questionnaire and the Job In General (JIG) scales were used to measure job satisfaction. Focus group interviews and a content analysis of major themes were conducted. Inferential statistics were used to test the effects of community, co-worker and organizational support and job satisfaction. Results showed significant, positive effects between perceived level of community support, coworker support and organizational support with components of job satisfaction sub-scales. These results are useful for nurse educators, and researches in the formulation and implementation of effective health policies for nurses and health care organizations.

Adult↗

Perceptions of changes in public health nursing practice: a Canadian perspective.

This paper describes public health nurses' perceptions of changes in their practice. The participants were 28 public health staff nurses from six Alberta, Canada health units serving urban and rural populations. Data were collected in 1993-94 using individual and focus group interviews. Content analysis was used to identify the following themes: "pulling back", "from hands on to arms length", "handing over responsibility", "developing working partnerships", and "doing less surveillance". These themes are discussed in terms of their implications for population health and for public heath nursing, using as a point of reference the principles of Primary Health Care. Continuing research is needed to chronicle further changes in public health nursing practice that will result from health care restructuring and health system reform.

Alberta↗

Promoting the nursing profession: the perceptions of non-English-speaking background high school students in Sydney, Australia.

By using an ethnographic approach, this paper explores the perceptions of nursing among the non-English-speaking background high school students in Sydney, and describes how the nursing profession could be promoted to them. A volunteer sample of four groups of high school students with parents from Lebanon, Vietnam, Korea and mainland China were recruited. In-depth focus group interviews were conducted. Through constant comparison of categories, 10 concepts emerged from the three major themes to describe the students' career preferences and their influencing factors; their image of nursing and their suggestions on how nursing could be promoted to them. These findings highlighted the significance of social, cultural and political factors that influenced the students' perceptions of nursing and their career choice. Implications and suggestions for marketing and recruitment strategies are discussed.

Adolescent↗

The impact of simulation on people who act as simulated patients: a focus group study.

OBJECTIVE: Previous studies have shown that people who act as simulated patients (SPs) experience negative effects caused by performing patient roles. This study was performed to further explore the impact of simulation and the factors that might affect this impact. The aim was to find ways of preventing negative effects of simulation impacting on our SPs. METHODS: Focus groups interviews were conducted among 35 SPs at Skillslab, University of Maastricht. The discussion was guided by 6 pre-established items. RESULTS: The majority of the SPs appeared to experience negative effects of performing a patient role. The effects were considered as inherent to acting as an SP or due to simulation being a strenuous activity. The impact was short-lived and did not affect SPs' enjoyment of their work. Factors that appeared to affect the impact of performing included: the type of role (whether it is emotionally complex or not); the number of consecutive performances; the length of time between performances; the giving of feedback; the amount of experience, and students. DISCUSSION: Although the SPs were found to experience negative effects caused by playing patient roles, the frequency and intensity of the negative effects were minor. The focus group discussions led to various suggestions for measures to reduce the impact of simulation.

Attitude to Health↗

Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections.

BACKGROUND: Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections. METHODS: 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the timely administration of prophylactic antibiotics. Using a grounded theory approach, transcripts were analyzed for recurrent themes. RESULTS: Despite having knowledge of guidelines, participants perceived consistent failure in the proper timing of antibiotic administration. Thematic analysis revealed a number of obstacles to the observance of guidelines including: (1) low priority, (2) inconvenience, (3) workflow, (4) organizational communication, and (5) role perception. Workflow and role perception were the dominant obstacles. CONCLUSION: This study suggests that proper antibiotic timing is thwarted by significant obstacles. The gap between evidence-based guidelines and practice is populated by individual values, professional conflicts, and organizational conflicts which must be addressed in order to achieve optimal practice in this domain. Using group interviews to reveal these factors to team members and managers may be a first step to resolving the gap and reducing surgical site infections.

Anesthesiology↗

Toward a model of prostate cancer information seeking: identifying salient behavioral and normative beliefs among African American men.

Public health actions to improve African American men's ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

Adult↗

Home medication injection among Latina women in Los Angeles: implications for health education and prevention.

Reuse of needles and syringes after home injection of medications and vitamins may be a risk for transmission of HIV. An exploratory study was done to determine (1) how commonly injectable medications were used in the home; (2) whether needles and syringes were reused; and (3) common practices for cleaning needles and syringes. A survey was conducted of low income Latina women (n = 216) who were attending a Public Health Foundation nutrition programme for women, infants and children (WIC) in Los Angeles. To clarify and expand on the survey findings, focus group interviews were done with an additional 55 women attending WIC. Quantitative data were analysed using descriptive and comparative statistics. Qualitative data were subjected to content analysis. The use of injectable medications purchased in Mexico was fairly common (43.5%); reuse of disposable needles and syringes (48%) and sharing (36%) among injectors were also common. Methods of cleaning needles and syringes were inadequate to CDC recommended guidelines. Injectors and non-injectors differed significantly in ethnicity, religion, and marital status. The only significant predictor of medication injection was educational level. Analysis of qualitative data revealed the reasons that Latina subjects were injecting medication; how they were transporting medicines from Mexico; and how they were cleaning their equipment. The practical implications for health education and prevention programmes should include an awareness that home use and reuse of needles for injection of medications may be common in some social groups and that knowledge of the potential dangers in reuse and sharing of needles may not extend to home medication injection.

Adult↗

"Painting a picture of the client": implementing the Addiction Severity Index in community treatment programs.

This article discusses the implementation of the Drug Evaluation Network System (DENS) version of the Addiction Severity Index (ASI) among substance abuse treatment providers in Los Angeles County. Thirty-two trained and certified treatment professionals from 14 programs participated in focus group interviews about their use of and experiences with the ASI. All 14 programs were currently administering the ASI at the time of the study. Qualitative interviews revealed variation among the programs in terms of when staff administered the ASI and how they used it in clinical care. Although the ASI creates a comprehensive picture of substance-abusing patients and their functioning, the timing of its administration seems to significantly affect the usefulness of the information. The findings illustrate the importance of practicality, flexibility, and ongoing training for the successful implementation of evidence-based practices.

Adult↗

Homeless veterans: perspectives on social services use.

This study analyzes the nature and scope of homelessness and issues related to social services use. Using focus group interviews, this exploratory study examined the expressed needs of homeless veterans and the obstacles encountered in obtaining health and human services. Types of problems and social services barriers were developed with exemplars from the interviews. These veterans self-reported a high incidence of health and mental health problems, limited resources, negative public perceptions and treatment, insensitive service providers, dehumanizing policies and procedures, and high levels of stress and frustration with the service delivery system. They encountered personal, situational, and bureaucratic barriers to obtaining services and were highly critical of service providers. These findings suggest a need for greater emphasis on advocacy-based case management services, affordable housing, employment opportunities, increased sensitivity in service delivery systems, and empowerment-centered practice.

Adult↗

Why do teens smoke? American Indian and Hispanic adolescents' perspectives on functional values and addiction.

Tobacco use by the young is one of the greatest public health concerns in the United States and is targeted by a number of prevention and control programs. A fuller understanding of the social and cultural values that youths attach to smoking is important in achieving focused, effective prevention strategies. Drawing on data collected through individual and focus group interviews, this article examines reasons that Hispanic and American Indian youths give to explain their smoking. The analysis presented here focuses on two interrelated sets of reasons: the functional values of tobacco use (including mood management, peer influences, and image maintenance) and addiction. This article concludes with a discussion of the implications these data may have for prevention and cessation programs aimed at youth and outlines ideas for an anthropological research agenda on youth and tobacco.

Adolescent↗