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PubMed2006

Globalization, migration health, and educational preparation for transnational medical encounters.

Unprecedented migration, a core dimension of contemporary globalization, challenges population health. In a world of increasing human mobility, many health outcomes are shaped by transnational interactions among care providers and care recipients who meet in settings where nationality/ethnic match is not an option. This review article explores the value of transnational competence (TC) education as preparation for ethnically and socially discordant clinical encounters. The relevance of TC's five core skill domains (analytic, emotional, creative, communicative, and functional) for migration health and the medical-school curriculum is elaborated. A pedagogical approach that prepares for the transnational health-care consultation is presented, with a focus on clinical-clerkship learning experiences. Educational preparation for contemporary medical encounters needs to include a comprehensive set of patient-focused interpersonal skills, be adaptable to a wide variety of service users and global practice sites, and possess utility in addressing both the quality of patient care and socio-political constraints on migration health.

Journal Article↗

PubMed2006

Issues of informed consent for intrapartum trials: a suggested consent pathway from the experience of the Release trial [ISRCTN13204258].

Service users within the NHS are increasingly being asked to participate in clinical research. In Liverpool Women's NHS Foundation Trust, approximately 35% of women take part in research during their pregnancy. For many studies the consent process is simple; information is provided and signed consent is given. There is a difficulty, however, with obtaining informed consent from women in pregnancy who become eligible only when they develop unforeseen complications, especially when they occur acutely. The problem is compounded with women in labour who may be frightened, vulnerable, in pain, under the effect of opiate analgesia, or all of the above. If research to improve the care of these women is to continue, then special consent procedures are needed. These procedures must ensure that the woman's autonomy is protected whilst recognising that women under these circumstances vary enormously, both in their desire for information and their ability to comprehend it. This paper will discuss the obtaining of consent in this situation, and describe an information and consent pathway for intrapartum research which has been developed in collaboration with consumer groups as a way in which these issues can be tackled.

Editorial↗

PubMed1999

Improving outcome after traumatic brain injury--progress and challenges.

This article describes the rapid advances in the head injury field which have taken place within the professional lifetime of many doctors in practice today. These have led to a better understanding of what happens in the injured brain and how these events might be manipulated to achieve better outcomes. Clinical tools we now take for granted, like the CT scanner and the Glasgow Coma Scale, were new developments 25 years ago. They provided a foundation on which clinicians and basic scientists could build what we now know: what to assess in the patient, how to respond to certain findings, what imaging to do, how to plan treatment rationally, how to minimise brain damage at different stages after injury, how to predict and measure outcome, what disabled survivors need, and how to organise the service to do the greatest good for the most people. Some of these topics raise as many questions as answers. The head injury field may be broad but it has essential unity. At one extreme, some patients have a life-threatening illness where the acts and omissions of the clinical team can powerfully influence not only survival but its quality. Later the drama of the acute phase gives way to the 'hidden disabilities' of the long-term deficits which so many survivors have. At the other end of the severity spectrum is the relatively vast number of people who suffer an apparently mild head injury, a few of whom deteriorate and need urgent treatment, and many of whom have unspectacular but, nevertheless, disabling problems. The article attempts to address this broad canvas. Clinicians, neuroscientists, policy makers, and service users must work together to address the major scientific, individual, and population challenges posed by head injury. Much has already been achieved, but much remains to be done, especially in translating 'what we know' into 'what we do'.

Brain Injuries↗

PubMed2004

Factors associated with sexual problems in HIV-positive gay men.

Our objective was to determine factors associated with sexual problems in a sample of HIV-seropositive gay male clinic patients. Using a cross-sectional survey design a volunteer sample of 78 outpatient HIV-seropositive gay male service users completed a self-report questionnaire. This examined sexual problems, their perceived causes and associated factors including demographics, health status, sexual behaviour, self-justifications for sexual risk-taking and mood state (Hospital Anxiety and Depression Scale). Fifty (69%) of 78 HIV-positive gay men reported one or more sexual problems. Erectile dysfunction (ED) was reported by 38% rising to 51% in the context of trying to use condoms. Loss of interest in sex was reported by 41% and 24% experienced delayed ejaculation. The presence of sexual problems affected condom use in that 33 (90%) of the 37 gay men who had ED associated with condom use were inconsistent condom users in insertive sex compared to 28% of those not having this type of ED (P < 0.001). The presence of ED did not reduce the frequency of anal intercourse but those with ED associated with condoms were significantly more likely to have had receptive anal sex in the past three months (62%) compared to men without ED with condoms (38%) (P = 0.05). Risk cognitions such as wanting to lose oneself in sex, leaving responsibility for condom use to the active partner and perceptions that condoms interfere with pleasure were significantly more likely to be endorsed by those who report ED with condoms. Other factors associated with sexual problems included low T-cell counts (i.e. < 200). Psychological explanations were the most frequently cited causes of sexual problems, whether alone or in interaction with HIV disease itself, and combination therapy. A high incidence of sexual problems was found amongst this sample of HIV-positive gay men. Untreated sexual dysfunctions may contribute to sexual risk-taking and therefore HIV clinics need to address both issues. Further research is required to better understand the role of psychological factors, HIV disease itself and combination therapy in the incidence and treatment of sexual problems.

Adult↗

PubMed2000

Informed choice in cancer pain: empowering the patient.

Cancer and palliative care service users can often feel isolated and disempowered. (Tower, 1999). Physical changes, medical interventions and pain can mean that they no longer feel in control of their bodies or their futures. In recognition of this, many health professionals within cancer and palliative care have adopted the mantra of 'patient empowerment', but it is not always clear what it means for either the patients or the professionals. Empowerment is an interactive process that develops and increases power through cooperation, sharing and working together (Marquis and Huston, 2000), and it plays a central role in health professionals' personal and working lives. A person's ability to make decisions and choices demonstrates control of his or her own destiny. This article aims to direct health professionals' participation and involvement in restoring this ability to patients who have pain related to cancer.

Adult↗

PubMed2003

Health visiting at the crossroads: which way to the 21st century?

This article presents a response from a group of lecturers at Florence Nightingale School of Nursing and Midwifery, King's College London and one service user to the perception of a crisis of confidence within health visiting. Changes in registration procedures and shifts in policy have led health visiting to question its place within primary care and the model of preparation for health visiting practice. The group argues that this debate is based on a misunderstanding of the changing health care environment and that health visiting can find a place within the primary care team. Key to this is the continued adherence to a basic nursing training. The authors suggest an incremental model of health visitor training to provide the fullest scope to implement the new health agenda.

Attitude of Health Personnel↗

PubMedDate not supplied

The experience of advocacy.

This article explores the concept of advocacy and its relationship to the empowerment of service users. Forms of advocacy are described and their potential applications in practice are discussed. The practice implications for nurses and carers of vulnerable client groups are considered. A subsequent article will examine the process and outcomes of self-advocacy from the perspective of a group member with a learning disability.

Humans↗

PubMedDate not supplied

Communication skills workshops in learning disability nursing.

This article investigates the effects of a combination of direct speech, language therapy and staff training on the communication skills of nursing and support staff working with people who have a severe learning disability and challenging behaviour. The approach aimed to help staff choose, prioritize and implement changes in communication. The input was effective in increasing the knowledge of the staff group with regard to challenging behaviour and communication breakdown, and in changing the communicative behaviour of staff. The changes measured were those of longer interactions occurring between staff and service users, and the use of non-verbal communication to support interactions. The implementation of the communication strategies is being audited.

Clinical Competence↗

PubMedDate not supplied

Adam: a case study of a young person's journey through madness.

This case study of a 15-year-old boy diagnosed with bipolar affective disorder considers some of the biological, psychological, social and familial factors that precipitated and perpetuated his mental health problems. His mental health difficulties are considered using anti-psychiatry theories to take into account that his family's construction of "normal" would be considered pathological by others. The impact of labelling a person as a "difficult" client is examined and staff's attitudes (and subsequent behaviour) towards such service users are considered. Despite his immersion in a world of "madness" this young person managed to use the therapeutic interventions that were offered to him in an adolescent unit and he emerged from his mania remarkably intact. The impact of parental mental illness on children and young people is discussed in this case study and some recommendations are made for future practice.

Adaptation, Psychological↗

PubMed2005

Infantilization as elder mistreatment:evidence from five adult day centers.

To prevent maltreatment, aging services must be age appropriate even as consumers suffer from physical and cognitive disabilities. In this paper, it is argued that exposing older persons to childoriented settings, activities and speech patterns in aging service environments represent a form of psychological mistreatment. Ethnographic evidence from 220 hours of field observations in five "social model" adult day centers revealed infantilization of service users in the form of confinement, baby-talk, nicknames, child-oriented decor, teacher-student learning format, reprimands, use of toys, as well as a loss of privacy regulation, autonomy, choice, and adult status. All centers exhibited some mistreatment, but severe examples were present in two of the five centers studied. Negative influences on behavior, well-being, self-identity, relationship formation, and social interaction were detected, which distinguished mistreatment from poor quality of care. Insider interviews (23) revealed resentment and adaptive strategies employed to distance themselves from infantilization.

Journal Article↗

PubMed1999

Interventions for challenging behavior in residential settings.

Predictors of interventions for challenging behavior by residential service providers were examined. Three forms of intervention investigated were (a) Individualized Habilitation Plan (IHP) objectives concerning challenging behavior, (b) one-to-one crisis intervention in the preceding 30 days, and (c) services from behavior management professionals in the preceding 6 months. Findings across these three interventions were largely consistent. Externalized challenging behavior (outwardly directed aggressive or disruptive behavior aimed at other people or objects) was consistently associated with all interventions. The implications of these findings for service providers and service users are discussed.

Adult↗

PubMedDate not supplied

[Role of art at the Psychosocial Assistance Centers -- CAPS].

Study about the employment of the artistic approach in the cares developed at the CAPS. Founded on conceptual bases of Psychiatric Reform, the object of study has been broached by means of an exploratory field research through interview with CAPS's professionals. The results found indicate that activities with artistic basis are used by them aiming at a positive interaction with service users, and in the perspective of their psychosocial rehabilitation. We concluded that the work at the CAPS itself brings up-to-date creative potentialities of both professionals and users, being art assumed as an strategy of care.

Art Therapy↗

PubMedDate not supplied

[Nurse's craft: an analysis and some future perspectives].

This text, while considering nursing as a profession, makes evident, initially, a perspective to develop it: the one that proves that we are capable to transform at least the world of health which we live in. In order to do this I propose myself to know it as e world of work and of health practices which has been, as I debate, historically determined. Such practices, according to their evolution, are configured in capitalism as a service, what gives to it a special characteristic in this production process. The profession of nursing while a participant of the collective work develops, however, its own original task, which has been being defined within this context, based on its own work processes--of care taking, educating, managing, which, keeping in mind its economic, political and symbolic properties discussed in this paper, will be able to open the necessary fissures for the daily action of a project takes uses as a reference the interest of the health service user, represented by his health needs.

Forecasting↗

PubMed2000

[Evaluate of popular knowledge and everyday practices in oral health].

OBJECTIVE: To evaluate the popular knowledge and everyday practices in oral health of public services' users. METHODS: The target population was selected from a stratified sample and included users seeking medical care in health care units in Santa Maria - RS. The data were collected using a semi-structured interview and organized into descriptive categories groups, allowing the distribution in a frequency table. RESULTS: It was verified the predominance of the age group between 21 to 40 years old and females. The socioeconomic pattern is characterized by low schooling and family income. The search for oral diseases control are due to individual awareness of the need of oral hygiene and dental care; fluoride in toothpaste and drinking water and its benefits were not known by the population. CONCLUSIONS: The health programs offered to the population must take into account the knowledge and practices in oral health care to make it possible an improvement of oral health according to their reality. In addition there is a need to promote the collective awareness on health promotion in every level of the society.

Adolescent↗

PubMed2004

[Histories of fetal losses told by women: research qualitative study].

OBJECTIVE: To recognize the significance of fetal loss for women who have experienced it, starting from an understanding of the pregnancy process, based on their reports. METHODS: This was a qualitative analysis study based on the histories of seven women who experienced fetal loss in the town of Arujá, State of São Paulo, between July 1998 and June 1999. The women were identified from the death certificates of stillborn infants born within the study period, which were obtained from the Civil Registry Office of Arujá. The methodological procedures involved the utilization of the techniques of oral history-taking to gather data and content analysis to evaluate the material collected. The interviews were recorded, fully transcribed and subsequently prepared for analysis. RESULTS: The findings were analyzed as two points: the circumstantial context of the pregnancy and the impact after the loss, with the adoption of specific thematic categories. The first of these encompassed the woman's perception of the pregnancy, her awareness of the coming of the new baby, health problems up to the time of the loss, and the health service attendance. The significance of the loss for the women in this study was made evident along three central lines: the loss of a part of herself, attribution of the fatality to divine intervention and changes in attitude towards life. The social support network for these women was built on two pillars: family and church. Support from the health services was practically nonexistent. Finally, they all expressed their will to live and the need to work, study and even have another pregnancy. CONCLUSIONS: There needs to be a change in general concepts in the mission to attend to such women. The attendance provided by the healthcare services needs to be humanized. The need for multiprofessional follow-up of healthcare service users who suffered fetal loss was very evident. The importance of a support network for women who have gone through this problem was also shown.

Attitude↗

PubMed2005

[The concept of communicative action: a contribution to nursing consultation].

Nurses often adopt a mechanist view, perceiving the individual from a biological standpoint and giving little attention to psychological, historical and cultural aspects. This evidences the need for a more humane approach, in which the communication between nurses and health service users can be achieved with more comprehension and participation. The aim of this paper is to introduce the concepts of language and communication in nursing consultation, using as a theoretical and conceptual framework Jürgen Habermas' theory of universal pragmatism. In nurses' everyday routine, it is important to intermediate and adapt knowledge and technical skills with a view to effective performance in humanized care for individuals and the community. The dialogic practice, through reflexive and participative communicative action by nurses, is needed for more humane care.

Nurse-Patient Relations↗

PubMed2003

The how and why of workplace adjustments: contextualizing the evidence.

PURPOSE: To identify the problems experienced in the workplace by service users returning to work and to explore how and why adjustments can help overcome them. METHOD: Semi-structured interviews were carried out with 17 people in five employment projects and with their workplace managers. Interviews were tape recorded, fully transcribed and analyzed to identify and compare emerging themes. RESULTS: Problems experienced by individuals included low energy and stamina levels, lack of confidence and psychological barriers to particular types of work. Adjustments to working hours, work schedules and job tasks proved crucial for some people in enabling them to overcome these problems.

Adaptation, Psychological↗

PubMed2006

Physical activity in the process of psychiatric rehabilitation: theoretical and methodological issues.

Physical activity can potentially perform a valuable role within the context of psychiatric rehabilitation in terms of physical and mental health benefits. Theoretical and applied considerations have driven the search for the causal mechanism(s) that underpin mental health change through physical activity. To date, no single mechanism has been found to consistently explain changes. A key reason for this is that the occurrence of, and recovery from, mental health problems is influenced by many diverse factors. Both theoretical and methodological issues affect our ability to identify and understand these factors and, subsequently, our ability to promote psychiatric rehabilitation through physical activity. Alternative theoretical and methodological approaches are discussed here with the aim of encouraging a broad-based research agenda which will most effectively serve the needs of mental health service users. These approaches differ widely in scope but all share one thing in common: a personalized understanding of the process of mental health change in psychiatric rehabilitation.

Biological Psychiatry↗