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PubMed1991

Discussing life-sustaining treatment. A teaching program for residents.

Ideally, physicians and patients should discuss patient preferences for life-sustaining treatment before the onset of cognitive impairment or a life-threatening illness; however, these conversations often do not occur. We developed an educational program in which residents practiced discussing advance directives with volunteer simulated outpatients and then received feedback from the patient, an observing resident, and a faculty member. Residents found the training sessions to be realistic, relevant, and useful. Resident self-ratings improved significantly on eight items representing knowledge, skills, and attitudes about discussing advance directives with patients. Resident learning occurred in four major areas: technical knowledge about advance directives; introducing the topic to patients; giving patients information; and eliciting patients' values and feelings. We conclude that residents need and want training in this area and that simulated patients act as a catalyst for their learning.

Advance Directives↗
PubMedDate not supplied

Survival from a wild animal attack: a case study analysis of adolescent coping.

TOPIC: Adolescent coping strategies and long-term effects of a life-threatening event are examined in this retrospective case study. PURPOSE: To describe the hospital care and follow-up support given to an 11-year-old girl who was savagely mauled by a cougar. An in-depth analysis of the patient's significant memories six-and-a-half years after the incident is also presented. SOURCES: Two hour semi-structured, information gathering interviews with the adolescent when she was 16 years old. RESULTS: The outcome of this case study analysis served as a partial debriefing of the experience for the adolescent girl. IMPLICATIONS FOR NURSING PRACTICE: This case study provides a useful resource to practitioners and patients who may experience similar situations. Nurses have a role to play in anticipating and preparing children for later hospital-based, post-trauma interventions and assisting other adolescents who are injured and hospitalized.

Adaptation, Psychological↗
PubMed2006

Analysing ethnobotanical and fishery-related importance of mangroves of the East-Godavari Delta (Andhra Pradesh, India) for conservation and management purposes.

Mangrove forests, though essentially common and wide-spread, are highly threatened. Local societies along with their knowledge about the mangrove also are endangered, while they are still underrepresented as scientific research topics. With the present study we document local utilization patterns, and perception of ecosystem change. We illustrate how information generated by ethnobiological research can be used to strengthen the management of the ecosystem. This study was conducted in the Godavari mangrove forest located in the East-Godavari District of the state Andhra Pradesh in India, where mangroves have been degrading due to over-exploitation, extensive development of aquaculture, and pollution from rural and urbanized areas (Kakinada).One hundred interviews were carried out among the fisherfolk population present in two mangrove zones in the study area, a wildlife sanctuary with strong conservation status and an adjacent zone. Results from the interviews indicated that Avicennia marina (Forsk.) Vierh., a dominant species in the Godavari mangroves, is used most frequently as firewood and for construction. Multiple products of the mangrove included the bark of Ceriops decandra (Griff.) Ding Hou to dye the fishing nets and improve their durability, the bark of Aegiceras corniculatum (L.) Blanco to poison and catch fish, and the leaves of Avicennia spp. and Excoecaria agallocha L. as fodder for cattle. No medicinal uses of true mangrove species were reported, but there were a few traditional uses for mangrove associates. Utilization patterns varied in the two zones that we investigated, most likely due to differences in their ecology and legal status. The findings are discussed in relation with the demographic and socio-economic traits of the fisherfolk communities of the Godavari mangroves and indicate a clear dependency of their livelihood on the mangrove forest.Reported changes in the Godavari mangrove cover also differed in the two zones, with significantly less perceptions of a decrease in the protected area, as compared to the adjacent non-protected area. A posteriori comparisons between sequential satellite imagery (retrospective till 1977) and respondents that were at least 15 years back then, revealed a mangrove decrease which was however perceived to different extents depending on the area with which the fishermen were familiar. While local needs had not been incorporated in the existing policy, we created a framework on how data on ethnobotanical traditions, fishery-related activities and local people's perceptions of change can be incorporated into management strategies.

Adolescent↗
PubMed1988

Interviews or postal questionnaires? Comparisons of data about women's experiences with maternity services.

Surveys by personal interview are often assumed to be superior to those conducted by mail questionnaire. An experimental study of experiences and attitudes of 800 newly delivered mothers revealed surprising advantages to postal surveys: they are cheaper, more easily repeatable, and minimize interviewer effects. While response rates differed, the quality of responses was similar, except between middle- and working-class mothers. Postal surveys can be used with considerable assurance in national studies of fairly intimate experiences of pregnancy and delivery.

Asia↗
PubMed2004

[Asthma education - the patient's response. The results of an automated analysis of an interview].

INTRODUCTION: Asthma education is a subject of topical interest and is included in the current guidelines. Everyone agrees on the importance of the concepts of the disease in determining the patient's therapeutic behaviour but there have been few studies of the patient's views on asthma education. METHODS: 42 asthmatics replied to an interview bearing on the following themes: asthma in daily life, therapeutic education and methods of education. The interviews were analysed by the ALCESTE software programme (analysis of co-occurrent lexemes in the simple wording of a text) that extracts the major significant components of a text. RESULTS: The first theme was dominated by thoughts about treatment, long term rather than acute, and by problems of everyday life and relationships with others; the second by the organisation, presentation and form of education and the third by thoughts about the information required, its relevance and implications. CONCLUSIONS: Asthmatic patients' concepts of therapeutic education are poorly defined. There expectations are implicit but they are not fully aware of them. Clarifying these factors will be a way of creating a better basis for an educational programme.

Adult↗
PubMed1976

History-taking for medical students. II-Evaluation of a training programme.

Two experiments designed to evaluate a programme for training medical students in history-taking skills were carried out. Results of the first indicate that students who underwent the programme reported almost three times as much relevant and accurate information after a test interview as those who received only traditional training. Results of the second experiment suggest that most of the programme's effect is attributable to discussion of a printed handout which presents the student with a detailed scheme for taking histories.

Education, Medical, Undergraduate↗
PubMed1999

Workplace health concerns: a focus group study.

Addresses the workplace health concerns of employees at an Acute Hospital Trust. The research conducted utilised a focus group methodology to investigate the health concerns of multidisciplinary groups of health care workers (n = 27). The findings indicate that the concern for the majority was workplace stress. Stressors that were identified as important to the groups were for example, the nature of the work they were undertaking, staffing levels, volume of the work, management styles and their work environments. Health promotion and prevention topics such as motivation and health status, smoking, alcohol and drug misuse, nutrition and weight control and physical exercise were seen of subsidiary concern. Limitations of the study are given. Future research in the subject area is identified.

Attitude of Health Personnel↗
PubMedDate not supplied

Ambivalence and pregnancy: adolescents' attitudes, contraceptive use and pregnancy.

CONTEXT: It is often argued that adolescents who become pregnant do not sufficiently appreciate the negative consequences, and that prevention programs should target participants' attitudes toward pregnancy. METHODS: Data from the first two waves of the National Longitudinal Study of Adolescent Health were used to examine whether 15-19-year-old females' attitudes toward pregnancy influence their contraceptive consistency and their risk of pregnancy. Characteristics and attitudes associated with pregnancy and contraceptive use were assessed using bivariate and multivariate analysis. RESULTS: Twenty percent of female adolescents were defined as having antipregnancy attitudes, 8% as having propregnancy attitudes and 14% as being ambivalent toward pregnancy; the remainder were considered to have mainstream attitudes. Among sexually experienced adolescents, having an attitude toward pregnancy was not associated with risk of pregnancy. However, those who were ambivalent about pregnancy had reduced odds of using contraceptives consistently and inconsistently rather than not practicing contraception at all (odds ratios, 0.5 and 0.4, respectively). Antipregnancy respondents did not differ from proprepregancy respondents in terms of their contraceptive consistency. However, having a positive attitude toward contraception was associated with increased likelihood of inconsistent and consistent contraceptive use compared with nonuse (1.6 and 2.1, respectively). CONCLUSIONS: Programs designed to prevent pregnancy need to give young women information about pregnancy and opportunities to discuss the topic so that they form opinions. Furthermore, programs should emphasize positive attitudes toward contraception, because effective contraceptive use is shaped by such attitudes and is strongly associated with reduction of pregnancy risk.

Adolescent↗
PubMed2006

Review of research methods used to investigate violence in the emergency department.

Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.

Emergency Service, Hospital↗