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PubMed2006

Impact of instructional practices on student satisfaction with attendings' teaching in the inpatient component of internal medicine clerkships.

OBJECTIVE: To determine the prevalence and influence of specific attending teaching practices on student evaluations of the quality of attendings' teaching in the inpatient component of Internal Medicine clerkships. DESIGN: Nationwide survey using a simple random sample. SETTING: One hundred and twenty-one allopathic 4-year medical schools in the United States. PARTICIPANTS: A total of 2,250 fourth-year medical students. MEASUREMENTS AND MAIN RESULTS: In the spring of 2002, student satisfaction with the overall quality of teaching by attendings in the inpatient component of Internal Medicine clerkships was measured on a 5-point scale from very satisfied to very dissatisfied (survey response rate, 68.3%). Logistic regression was used to determine the association of specific teaching practices with student evaluations of the quality of their attendings' teaching. Attending physicians' teaching practices such as engaging students in substantive discussions (odds ratio (OR)=3.0), giving spontaneous talks and prepared presentations (OR=1.6 and 1.8), and seeing new patients with the team (OR=1.2) were strongly associated with higher student satisfaction, whereas seeming rushed and eager to finish rounds was associated with lower satisfaction (OR=0.6). CONCLUSION: Findings suggest that student satisfaction with attendings' teaching is high overall but there is room for improvement. Specific teaching behaviors used by attendings affect student satisfaction. These specific behaviors could be taught and modified for use by attendings and clerkship directors to enhance student experiences during clerkships.

Adult↗
PubMed1982

Effects of staff changes on psychiatric patients.

The disturbed behavior and dissatisfaction of patients were studied in relation to nurse and junior and senior doctor changes in two different psychiatric wards. One ward represented the medical model of psychiatry and the other a modified form of therapeutic community. The results showed no statistically significant relationship between the weekly level of disturbed behavior and staff changes in either ward. There was a tendency for patients to become more dissatisfied when the nurses left the ward and less dissatisfied with the arrival of senior doctors in the medical model ward only.

Adult↗
PubMedDate not supplied

Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes.

Patients' perceptions of the extent to which their health care needs have been met may affect compliance with prescribed health behaviors and related health outcomes. The authors examined the relationships of "patient request fulfillment" to patient compliance, glycemic control, and several other health care outcomes in 51 adult outpatients with insulin-dependent diabetes mellitus. On average, patients retrospectively cited 4.5 long-term requests, of which over three-fourths were fulfilled. Fulfillment of these requests was significantly associated with patient satisfaction, perceived health status, fewer insulin reactions, and greater insulin injection time reliability (p less than 0.05), but not with several other measures of compliance. Higher patient request fulfillment at single visits was correlated, as hypothesized, with subsequent reduction in glycosylated hemoglobin, but this association was not statistically significant. These results suggest that patient request fulfillment is associated with several aspects of health behavior and health status in adults with insulin-dependent diabetes. Further studies are needed to confirm these observations and determine whether strategies to enhance patient request fulfillment can enhance health care outcomes.

Adult↗
PubMed1975

A client-developed methadone maintenance program.

A realistic methadone maintenance program is a continuum of four related areas: intake, rehabilitation with on-going evaluation, detoxification, and postdetoxification followup, each jointly administered by client volunteers and professional staff. In the early stages of client treatment, pharmacists have more frequent contact with program participants than do other staff professionals. At the Minneapolis Pilot City Health Center, 31 of 69 participants in the methadone maintenance program were interviewed by their pharmacist to determine client understanding of program objectives, interpretation of program effectiveness, and suggestions for program improvement. Client understanding of the objectives or program elements ranged from 30 to 97 %. Client evaluation of the effectiveness of program elements ranged from 0 to 65%. The client-developed program included intake procedures to establish for each client the program objectives, rules, evaluation, guidelines, client goals, dismissal guidelines, and a review of supportive services. Rehabilitation would be continuous with consistent on-going evaluation to measure goal attainment, a decline in disruptive behavior, and freedom from illicit drug use. Detoxification should be undertaken after the client's behavior has stabilized and he has developed a marketable skill. Monitoring of the client to assure a drug-free state would be an important element of the postdetoxification follow-up.

Allied Health Personnel↗
PubMed1985

Does ethnicity matter? Utilization, responses to medical problems, attitudes and satisfaction in a medically underserved community.

Sample surveys offer only surface knowledge of complex questions in healthcare. When properly designed, administered, analyzed, discussed, and acted on, however, they can serve as an educational/communications device. Strategic planning necessitates evaluation of external and internal factors that affect the organization. In the community served by the health organization that sponsored this research, key administrative personnel believed that ethnic attitudes and behavior could influence program utilization. The survey and subsequent discussion of its findings helped to corroborate this premise. As a result, administrative efforts were made in improving communications, hiring and training, and program structure to obtain higher level of community acceptance.

Attitude to Health↗
PubMed1980

Patient telephone interviews: a valuable technique for finding problems and assessing quality in ambulatory medical care.

Telephone interviews to obtain direct patient feedback about medical care can provide an important means for inducing behavior change of providers as part of an ongoing quality assurance program. This article reviews development of our telephone interview methodology and summarizes our experience with 1.110 patient interviews during a three-year period.

Ambulatory Care↗
PubMed1976

Patient dissatisfaction and attempted suicide.

This paper deals with the presence of suicidal behavior in a mental health clinic and psychiatric emergency room, and its relationships to what has been described in the literature as the "dependent-dissatisfied" personality. Procedures included a suicidal potential scale, projective figure drawings, and a brief interview about past and present suicidal behavior. The scale used significantly differentiated between high and low potentially suicidal groups. The high suicidal group showed a significantly greater dissatisfaction with treatment both past and present. The implications for both evaluation and therapy of suicidal patients are discussed.

Attitude↗
PubMed1983

The structure of a hospital's image.

The study is intended to elucidate the factors that affect the creation of a hospital's image in the eyes of the patient and their relative weight in producing that image. The image of a hospital is important for enhancing the patient's reassurance and relief from possible anxiety that is hazardous to the health, which may result both from the patient's subjectively perceived seriousness of his condition and from his inability to judge the efficacy of the medical treatment in promoting recovery. A study was carried out among a representative sample of expatients of one of Israel's most prestigious university hospitals. Data ascertain the centrality of the physicians' and nurses' affective behavior in the creation of the image. They also show that the crucial factors that predict that image in the patient's eyes are the nurses' affective behavior and the hospital's perceived competence level, which is based predominantly on the patient's satisfaction with the medical treatment given by the physicians. That, in turn, is, to a great extent, predicted by the extent of satisfaction with the physicians' humane attitude toward the patient.

Consumer Behavior↗
PubMed1988

Media-based versus professionally led training for parents of mentally retarded children.

A media-based program for parents of mentally retarded children presented information on self-help skill teaching primarily through videotapes and instructional manuals. Sixty-one families were randomly assigned to media-based training, the same curriculum with a professional leader, or a delayed-training control condition. Media-trained families evaluated their program very positively and showed significantly greater gains than did control parents on all but one outcome measure. Live training increased parents' knowledge of behavioral principles more than did media-based training, but otherwise the results of the two conditions were quite similar. Media-based programs may be a cost-effective way to make parent training more widely available.

Adult↗
PubMed2005

Help seeking behavior and the Internet: a national survey.

Health-related websites have the potential to powerfully influence the attitudes and behavior of consumers. Access to reliable disease information online has been linked to reduced anxiety, increased feelings of self-efficacy, and decreases in utilization of ambulatory care. Studies report that Internet health information seekers are more likely to have health concerns; adult seekers are more likely to rate themselves as having poor health status and adolescent seekers are more likely to demonstrate clinical impairment or depressive symptomatology compared to non-seekers. Although more and more Americans are using the Internet for healthcare information, little is known about how this information affects their health behaviors. The current study extends the literature by examining characteristics associated with help seeking, either from a healthcare provider or from peers, as a direct result of health information found online. Medical care seekers appear to be using the Internet to enhance their medical care; they report using the information online to diagnose a problem and feel more comfortable about their health provider's advice given the information found on the Internet. Support seekers tend to be of slightly lower income compared to non-support seekers. They are also significantly more likely to have searched for information about a loved one's medical or health condition, signaling that many of these consumers may be caretakers.

Access to Information↗
PubMed1987

A QA monitor for the QA department.

Utilizing the User Satisfaction and Departmental Performance Monitor provides information to health care managers on the assistance available from the QA professional. Obtaining responses to the approach the QA professional uses in teaching and assisting with QA activity changes should promote a behavior change in the consultant. The quality assurance professional provides a service and should periodically monitor how that service is used and what can be done to improve it. Trending the responses of the health care managers provides the quality assurance department with direction for future program planning.

Communication↗
PubMedDate not supplied

Determinants of priorities and satisfaction in pediatric care.

AIMS: To investigate determinants of parents' priorities and satisfaction in relation to pediatric inpatient care and to examine the relationship between fulfillment of expectations and satisfaction. METHODS: The study took place in a pediatric acute care inpatient department with 300 parents of children admitted consecutively. Data were collected by means of two self-administered questionnaires. Parents completed one questionnaire immediately after their child's admission and the second after hospital discharge. RESULTS: Having confidence in the doctors, getting answers to questions about care and treatment, and being satisfied with the nurses' and doctors' behavior, were found to be determinants of having a satisfaction score above average. Waiting time was a relatively weak determinant of being satisfied in general, although a short waiting time was one of the items given the highest priority score.

Adolescent↗
PubMed1991

Extending the concept of social validity: behavior analysis for disease prevention and health promotion.

A broader definition of social validity is proposed wherein a socially valid behavior-change intervention is directed to a problem of verifiable importance, the intervention is valued and used appropriately by designated target groups, and the intervention as used has sufficient behavioral impact to substantially reduce the probability of the problem's occurrence in target populations. The verifiable importance of a problem is based on epidemiological data, and the value and appropriate use of an intervention are enhanced through the use of conceptual frameworks for social marketing and behavior change and considerable formative and pilot research. Behavioral impact is assessed through efficacy and effectiveness studies. Thus, the social validity of a behavior-change intervention is established through a number of interactive, a priori steps. This approach to defining social validity is related to critical analysis and intervention issues including individual and population perspectives and "top-down" and "bottom-up" approaches to intervention design. This broader definition of social validity is illustrated by a project to reduce the risk of HIV infection among adolescents. Although the various steps involved in creating socially valid interventions can be complicated, time-consuming, and expensive, following all the steps can result in interventions capable of improving a nation's health.

Adolescent↗
PubMed1990

[Orthodontic treatment from the patients' and parents' viewpoint--the results of a practical and clinical questionnaire study (II)].

A questionnaire investigation enrolling more than 300 orthodontic patients and their parents was conducted into the subjective appraisal of treatment means and doctor-patient-interaction. The majority of the interviewees showed a positive respectively indifferent attitude toward their treatment. As patients grow older, their views become more differentiated and critical. Impaired speaking was mentioned most frequently; psychosocial disadvantages caused by appliance wear were suggested mostly by parents. In a minor part of patients, the orthodontist's behavior was not in line with their social-emotional needs and expectations. Slight failures of adherence with prescriptions were admitted for the daytime. Parental supervision appeared to be either energetic or formal yet superficial, or insufficient respectively in one third of our cases.

Attitude to Health↗
PubMed1991

Perceptions of caring by nurse educators.

The purpose of this paper is to report on nurse educators' perceptions of caring behaviors. A review of the literature indicated a lack of consensus between nurses and patients of exactly what constitutes caring behaviors. Since subjects in previous studies were based on nurses educated at various levels, it was hypothesized that a more homogeneous sample of nurses with advanced education might provide different findings. Using the Larson CARE-Q, 110 nurse faculty, managers, and clinical specialists/practitioners were asked to indicate what they believed were the most and least important caring behaviors. Because the 72 educators' findings were similar to those of 38 other nurses with advanced education, their responses were combined. A clear difference between the perceptions of nurses and patients was obtained, and the data support the results of previous studies--nurses have a tendency to consider comfort and trusting relationship items as most important while patients perceive behaviors associated with physical care as most important. No significant differences were found between educators according to type of programs or functional groups, and few differences were found according to age, years of experience, or clinical areas.

Adult↗
PubMed1989

Giving LTC residents that secure feeling. Risk management and loss prevention techniques.

Nursing homes today are promoting the physical, emotional, and psychosocial security of their residents while involving them and their families in the ultimate decision making. These efforts, however, do not minimize nursing homes' responsibility to ensure a secure environment through good risk management and loss prevention techniques. Facility managers should annually evaluate policies and procedures to ensure that department standards are realistic and reflect the accepted standard of care owed to residents. Technological and functional developments in healthcare make continuous staff training programs a necessity. Involving patients and their families in care planning and treatment decisions can enhance residents' feelings of security. These feelings are further bolstered by a safe environment. Staff should also be alert to changes in residents' behavior. When a resident is admitted to a nursing home, managers should obtain signed consent forms for potential future medical treatment and resident trips. Managers' responsibilities also extend to situations beyond their control. All long-term care facilities must have practical plans in case of natural disasters.

Accident Prevention↗
PubMed2003

Representative payeeship and mental illness: a review.

Representative Payeeship (RP) is intended to help individuals who are unable to manage disability payments appropriately to meet their basic living needs. This paper reviews the literature on whether RP is effective among individuals with mental disorders. We also review RP's mental health effects and its use as leverage in achieving behavioral goals. RP appears to be effective in helping clients meet their basic living needs; it also may decrease hospitalization and improve treatment compliance. Finally, we propose a research design to disentangle the role of clinical leverage from the more basic money-management function of RP.

Consumer Behavior↗