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Nurses' perceptions of their problem-solving ability.

A problem-solving approach to nursing practice has been advocated in the nursing literature for some time. However, the extent to which nurses perceive themselves as capable problem solvers or improve their problem-solving ability during their nursing education is not generally known. The purpose of this study was to determine the relationship between nurses' perceptions of their problem-solving ability and their course of study. The Problem-Solving Inventory (PSI) was developed by Heppner and colleagues (1982) to assess attitudes towards and perceptions of problem-solving behaviour. The instrument provides a global appraisal of oneself as a problem solver and assesses perceptions of problem-solving ability. In this study, data were collected from 67 pre and post-registration nursing students in two phases; during their course and on completion of their course. Data from each phase were compared to identify changes in perception of problem-solving behaviour over time. While there was no overall improvement in perceptions of problem-solving ability by phase 2, confidence in problem solving had improved significantly (P less than 0.01). There were improvements according to age, experience, and course being undertaken for the likelihood of approaching rather than avoiding problems, and having personal control over problem solving.

Adult↗

Use of technological equipment in critical care units: nurses' perceptions in Greece.

AIMS AND OBJECTIVES: The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants. BACKGROUND: Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole. DESIGN: Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions. METHODS: The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview. RESULTS: A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel. CONCLUSIONS: The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care. RELEVANCE TO CLINICAL PRACTICE: Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.

Adult↗

Visceral perception thresholds after rectal thermal and pressure stimuli in irritable bowel syndrome patients.

BACKGROUND AND AIM: Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects. METHODS: A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread. RESULTS: Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds. CONCLUSIONS: Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS.

Adult↗

m-Chlorophenylpiperazine exacerbates perception of salicylate-induced tinnitus in rats.

The serotonin receptor 5-HT2c agonist m-chlorophenylpiperazine (mCPP) has been widely used to induce anxiety-like states in animals and anxiety in humans. We here addressed the effect of an intraperitoneal injection of mCPP on the perception of tinnitus in a behavioural protocol based on an active avoidance paradigm. In control saline-treated animals, mCPP did not change compound action potential audiograms or measurable tinnitus. In contrast, mCPP to animals demonstrating salicylate-induced tinnitus exacerbated tinnitus perception by nearly twofold. We went on to test whether manipulation of the peripheral generator of tinnitus (i.e. the cochlea) could extinguish this exacerbated perception by applying the N-methyl-d-aspartate (NMDA) antagonist 7-chlorokynurenate (7-CK) into cochlear fluids using a 7-CK-soaked Gelfoam ball placed on the round window of each of the animals' two ears. In addition to blocking the tinnitus induced by salicylate alone, 50 microm of 7-CK clearly abolished tinnitus in animals receiving salicylate and an injection of mCPP. The demonstration that cochlear NMDA receptor blockade abolishes the exacerbated perception of tinnitus is highly relevant in terms of treatment. In addition to psychotherapeutic treatment that may help to attenuate an individual's perception of tinnitus, targeting cochlear NMDA receptors represents a promising therapeutic strategy, even in depressed or chronically anxious patients.

Animals↗

Perceptions of control in adults with epilepsy.

That psychosocial problems are extant in epilepsy is evidenced by a suicide rate among epileptic persons five times that of the general population and an unemployment rate estimated to be more than twice that of the population as a whole. External perceptions of control secondary to repeated episodes of seizure activity that generalize to the social sphere have been implicated as causes of these problems. The hypothesis that individuals who continue to have seizures become more and more external in perceptions of control was tested by a survey mailed to a sample of individuals with epilepsy in a metropolitan area of the Midwest. Dependent variables were, scores on instruments measuring locus of control and attributional style. The independent variable was a measure of seizure control based on present age, age at onset, and length of time since last seizure. Gender, socioeconomic status, and certain parenting characteristics were included as control variables, as they are also known to affect perceptions of control. Analysis by multiple regression techniques supported the study's hypothesis when perceptions of control was conceptualized as learned helplessness for bad, but not for good, events. The hypothesis was not confirmed when perceptions of control was conceptualized as either general or health locus of control.

Adaptation, Psychological↗

Family perception of interpersonal behavior as a predictor in eating disorders: a prospective, six-year followup study.

This study assessed family perception patterns of interpersonal behavior in families with a daughter diagnosed with an eating disorder 6 years after treatment that used a prospective design. Family perception patterns of patients found to have a poor outcome at followup (n = 15) were compared with patients with a good outcome (n = 23), as well as a control group (n = 36). Using the system of multiple level observation of groups (SYMLOG), all 238 family members evaluated themselves and each other. The index patients with a poor outcome perceived themselves as friendlier and more positive than they were perceived by their families. In comparison to parents of daughters with a good outcome and the control group, parents of daughters in the poor outcome group perceived themselves to be less friendly than their partners perceived them to be. A rigid polarization of the perception of the index patient by family members and a discrepancy in this perception between the index patient and the rest of the family were found to be indicative of a poor prognosis. Implications for treatment based on family perception patterns of interpersonal behavior are discussed.

Adolescent↗

Resident perception of academic skills training and impact on academic career choice.

OBJECTIVES: 1) To evaluate residents' perceptions of the quality of training in basic academic skills and the availability and quality of research resources during residency; 2) to evaluate the association between these attitudes and choice of an academic career; and 3) to assess residents' attitudes toward the importance of postgraduate fellowship training for success in an academic career. METHODS: A 15-item survey was administered to all U.S. emergency medicine (EM) residents in conjunction with the February 1997 American Board of Emergency Medicine (ABEM) In-service Examination. The survey assessed resident interest in a career in academic EM, and resident perception of the general quality of training in academic (research and teaching) skills. Residents were also asked to rate the quality of their training in the following specific academic skills: medical and grant writing, bedside teaching, lecturing, the use of computers, study design, statistics, and the use of audiovisual aids. Resident perceptions of the availability of the following resources were also assessed: teaching and research role models, data collection and analysis support, laboratory facilities, financial support of research, research fundamentals lectures, and computers. RESULTS: The response rate was 93%. Forty-four percent of the respondents were interested in academic EM, 36.6% were undecided, and 19.6% were not interested in an academic career. On a scale of 1 (unprepared) to 5 (well prepared), the residents rated their overall preparedness for an academic career fairly high (3.97 [0.86]). In contrast, they perceived the quality of their training in the specific academic skill areas assessed and research resource availability to be only fair. Despite resident perception of relatively inadequate training in basic academic skills, only 24% of the respondents indicated that they believed fellowship training was important for success in an academic career. Logistic regression analyses demonstrated that participation in a research project in medical school, the length of the training program (4- vs 3-year), being a first-year resident, and a better perception of one's overall academic skill preparation were factors independently associated with having a greater interest in an academic career. CONCLUSIONS: A relatively high percentage of residents initially express an interest in an academic career, but this interest wanes as residency progresses. A minority of residents believe that their training provides them with the specific skills needed to succeed in academics, or with adequate exposure to research resources or mentors. Emergency medicine may be able to increase the number of qualified academic faculty by recruiting medical students with prior research experience, and providing residents with better research training and role models.

Adult↗

Perceptions of dental aesthetics in the United States and Nigeria.

The standard dental aesthetic index (DAI) is an orthodontic treatment need index based on perceptions of dental aesthetics in the United States. It is a regression equation that links perceptions of the social acceptability of dental aesthetics with the objective intraoral measurements of ten occlusal traits. For the index to be universally acceptable, the perceptions of dental aesthetics in other countries must be similar to those of the United States. This study was designed to determine whether the perceptions of dental aesthetics of Nigerian students are similar to those of different groups of the US population. The same 25 stimuli (photographs of dental configurations, a subset of the 200 stimuli used in deriving the standard DAI equation) were rated for dental aesthetics by Nigerian students. Their ratings were compared with ratings of the same 25 stimuli by US parents, students and orthodontists. Spearman rank-order correlations ranged from 0.75 to 0.84. These correlations were highly significant (P<0.0001), and showed that the perceptions of dental aesthetics of Nigerian students were very similar to those of the US groups. The study therefore concluded that standard DAI could be used as a screening tool and without modification in epidemiological surveys among Nigerians.

Adolescent↗

Environmental perceptions and walking in English adults.

STUDY OBJECTIVE: To examine the relation between adults' perceptions of the social and physical environment and their self reported walking behaviour. DESIGN: Cross sectional survey. SETTING: England. PARTICIPANTS: A national sample of 4265 adults aged 16-74 years. MAIN OUTCOME MEASURES: Self reported walking behaviour was categorised into two dichotomous variables: (a) any reported walking in past four weeks, (b) reported walking > or =150 minutes per week in the past four weeks. Perceptions of the social environment covered safety of walking alone and social support for walking. Perceptions of the physical environment covered attractiveness of local area for walking, access to shops, leisure centres, parks, cycle paths, and traffic density. MAIN RESULTS: In women, perceived safety of walking during the day (OR = 0.53; 95% CI: 0.31 to 0.88), and no shop within walking distance (OR = 0.72; 95% CI: 0.52 to 0.99) were associated with any reported walking occasions. Perceptions of the environment were not related to women walking > or =150 min/week. In men, having a park within walking distance was associated with walking > or =150 min/week (OR = 2.22; 95% CI: 1.18 to 4.35). No other significant associations were found. CONCLUSIONS: Women seem to be more concerned about walking for utility and in safety. Men are more likely to walk > or =150 min/week if they have access to a local park but their walking is not influenced by concerns about safety. Future research should focus on the relation between objective measures rather than perceptions of the environment and physical activity.

Adolescent↗

Patient perceptions of the quality of health services.

As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed. Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.

Attitude of Health Personnel↗

Influence of static magnetic fields on pain perception and sympathetic nerve activity in humans.

Static and pulsed magnetic fields have been reported to have a variety of physiological effects. However, the effect of static magnetic fields on pain perception and sympathetic function is equivocal. To address this question, we measured pain perception during reproducible noxious stimuli during acute exposure to static magnets. Pain perception, muscle sympathetic nerve activity, mean arterial pressure, heart rate, and forearm blood velocity were measured during rest, isometric handgrip, postexercise muscle ischemia, and cold pressor test during magnet and placebo exposure in 15 subjects (25 +/- 1 yr; 8 men and 7 women) following 1 h of exposure. During magnet exposure, subjects were placed on a mattress with 95 evenly spaced 0.06-T magnets imbedded in it. During placebo exposure, subjects were placed on an identical mattress without magnets. The order of the two exposure conditions was randomized. At rest, no significant differences were noted in muscle sympathetic nerve activity (8 +/- 1 and 7 +/- 1 bursts/min for magnet and placebo, respectively), mean arterial pressure (91 +/- 3 and 93 +/- 3 mmHg), heart rate (63 +/- 2 and 62 +/- 2 beats/min), and forearm blood velocity (3.0 +/- 0.3 and 2.6 +/- 0.3 cm/s). Magnets did not alter pain perception during the three stimuli. During all interventions, no significant differences between exposure conditions were found in muscle sympathetic nerve activity and hemodynamic measurements. These results indicate that acute exposure to static magnetic fields does not alter pain perception, sympathetic function, and hemodynamics at rest or during noxious stimuli.

Adult↗

Risk perception and psychological strain in women with a family history of breast cancer.

BACKGROUND: The thinking in health psychology is that patients' willingness to adopt preventive health behavior is contingent on their perceiving an increased risk of disease and is influenced by accompanying psychological stress. In counseling women with a family history of breast cancer, physicians focus on encouraging the patient to undergo early detection examinations as recommended. Therefore, it is essential to examine how women in this risk group perceive their own chances of developing breast cancer and to assess the psychological effects of their situation. MATERIAL AND METHODS: 129 women with at least one first or second degree relative who had developed breast cancer were enrolled in a questionnaire study. The object was to ascertain the extent to which these women may be expected to realistically estimate their own probability of contracting the disease and what influence risk perception and psychological strain have on their willingness to make use of diagnostic opportunities for early detection. Additionally, the effects on their physical and mental well-being were analyzed. RESULTS: Among the women of the study group, a family history of breast cancer did not always correlate with the subject's perception of an increased risk of contracting the disease compared. On the whole, the majority of the women overestimated their personal risk despite prior genetic counseling. Only slightly less than one quarter of the study group correctly estimated their risk; another quarter underestimated it. The majority of those women who exhibited an increased risk perception were also those who overestimated their probability of personally contracting the disease. They underwent recommended screening examinations significantly less often than women with a low risk perception. However, women subjected to intense psychological strain showed above-average participation in screening programs. CONCLUSIONS: Women with a family history of breast cancer often find it difficult to realistically estimate their own risk of contracting the disease. Increased risk perception had a negative effect on participation in recommended breast cancer screening. Therefore, an effort should be made to correct the patient's overestimation of her personal risk. Integrating psychological counseling in screening programs is essential considering that women from high-risk groups are subjected to increased psychological strain. Further studies are required to more precisely evaluate other psychosocial factors in the behavior of women in risk group toward screening.

Adult↗

Perception of emotional facial expressions at different intensities in early-symptomatic Huntington's disease.

BACKGROUND: While there is abundant evidence that patients with Huntington's disease (HD) have an impairment in the recognition of the emotional facial expression of disgust, previous studies have only examined emotion perception using full-blown facial expressions. OBJECTIVE: The current study examines the perception of facial emotional expressions in HD at different levels of intensity to investigate whether more subtle deficits can be detected, possible also in other emotions. METHOD: We compared early symptomatic HD patients with healthy matched controls on emotion perception, presenting short video clips of a neutral face changing into one of the six basic emotions (happiness, anger, fear, surprise, disgust and sadness) with increasing intensity. Overall face perception ability as well as depressive symptoms were taken into account. RESULTS: A specific impairment in recognizing the emotions disgust and anger was found, which was present even at low emotion intensities. CONCLUSION: These results extend previous findings and support the use of more sensitive emotion perception paradigms, which enable the detection of subtle neurobehavioral deficits even in the pre- and early symptomatic stages of the disease.

Adult↗

Effect of budesonide on the perception of induced airway narrowing in subjects with asthma.

The perception of bronchoconstriction may be modulated by airway inflammation. However, the effect of inhaled corticosteroid (ICS) treatment on perception in subjects with asthma has received limited study. The aim of this study was to determine the effect of inhaled budesonide on the perception of breathlessness induced by histamine challenge. Thirty-five subjects with poorly controlled asthma were randomized to receive budesonide (1,600 or 3,200 microg/d) for 8 wk, followed by 8 wk at 1,600 microg/d and subsequent downtitration according to a clinical algorithm. Borg scores were recorded during histamine challenges performed at baseline and at 8, 16, 24, 48, and 72 wk. Perception was estimated as the slope of Borg/% fall FEV(1). The Borg/FEV(1) slope increased significantly after 8 wk of budesonide (0.09 [0.08-0.12] to 0.15 [0.11-0.19], p = 0.002), and remained increased compared with baseline values at all subsequent visits. There were no significant differences in Borg/ FEV(1) slope between subjects who were and were not taking ICS at study entry. The magnitude of change in the Borg/FEV(1) slope did not differ significantly between treatment groups and was not related to changes in baseline FEV(1), airway hyperresponsiveness, blood eosinophils, or serum eosinophil cationic protein (ECP). We conclude that treatment with budesonide enhances the perception of airway narrowing, but the effect is unrelated to budesonide dose, or to changes in circulating eosinophil markers.

Administration, Inhalation↗

Skin blood flow and current perception in pentoxifylline-treated diabetic neuropathy.

There are several anecdotal reports of improvement in diabetic sensory neuropathy following a course of pentoxifylline therapy. Pentoxifylline theoretically could improve skin blood flow, thus reducing ischemia at axonal endings. The authors used laser Doppler techniques to measure skin blood flow and measured sine wave current perception thresholds (CPTs) in pentoxifylline-treated diabetic patients with sensory neuropathy. Twenty-four patients completed a six-month course of treatment. These patients had a predominantly "stocking" neuropathy; all the major abnormalities on clinical, laser Doppler, and current perception testing were found on the lower extremity. Seventeen of the 24 patients reported symptomatic improvement. A careful, graded neurologic examination confirmed that improvement, with a decrease in symptom score on the lower extremity (SSDW) from a baseline of 5.0 +/- 0.7 to 3.5 +/- 0.7 (p < 0.01) and of physical score (PSDW) from baseline 22.0 +/- 2.0 to 16.0 +/- 1.9 (p < 0.01) after six months. On the lower extremity, there was an increase in laser Doppler measured flow score (FS) both at 35 degrees and at 44 degrees C. FSDW (35 degrees) increased from 10 +/- 2 to 14 +/- 3 at six months (p < 0.05). FSDW (44 degrees) increased from 58 +/- 5 to 77 +/- 7 at six months (p < 0.01). There was an improvement in sine wave current perception measured by current perception threshold score (TS). TSDW dropped from 150 +/- 32 to 84 +/- 28 at six months (p < 0.03). In patients with diabetic sensory neuropathy, pentoxifylline appears to improve skin blood flow. Current perception thresholds improve in tandem, corroborating improvement in clinical neurologic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Body size and body shape: perceptions of black women with diabetes.

PURPOSE: This qualitative study was conducted to explore perceptions of body size and shape in a group of black women with Type 2 diabetes. METHODS: Thirty-three black women with Type 2 diabetes participated in one of three focus groups to discuss perceptions about body size and body shape. Transcriptions of the discussion were analyzed for themes of participants' perceptions about their bodies, their ideas about body size and body shape, and personal and environmental influences on their preferences about size and shape. RESULTS: Participants preferred a middle-to-small body size but indicated that a middle-to-large body size was healthier. They also said that a large body size did result in some untoward social consequences. Participants preferred a pear-shaped body (a figure without abdominal adiposity). The three major influences on body image perceptions were children, parents, and the media. CONCLUSIONS: With these findings in mind, diabetes education programs that are geared for black women may benefit from the inclusion of key family members. Additionally, the importance of body image perceptions should be recognized in the design and implementation of weight-related diabetes education programs.

Adult↗

Patients' perceptions of office medical practice: judging quality through the patients' eyes.

With increasing pressure to measure quality, patient-based assessments of medical care are becoming increasingly important. Patients offer a unique perspective for evaluating the nontechnical aspects of medical care. This study reviews the importance of utilizing patients' perceptions to measure quality of care in office settings. It also reviews the principles required to conduct a well done survey. The concept of patient perceptions differs from the more commonly measured concept of patient satisfaction, in that perceptions measure whether a patients' needs and expectations are met, in addition to satisfaction. One of the most accurate and efficient means of measuring patients' perceptions is through the use of surveys. As with all standardized data collection, creating and performing high quality surveys of patients' perceptions can be challenging. Valid and reliable patient survey data can enable practitioners to identify areas for improvement, and demonstrate to external reviewers the quality of care they provide to their patients.

Humans↗

Battered women's perceptions of risk versus risk factors and instruments in predicting repeat reassault.

This study partially replicates and expands on a previous study that showed women's perceptions of risk to be a strong predictor of reassault among batterers. The current study employed a larger and multisite sample, a longer follow-up period of 15 months, and multiple outcomes including "repeated reassault" (n = 499). According to the multinomial logistic regressions, women's perceptions of risk improved prediction with risk factors (ROC area under the curve improved by.04 and sensitivity of repeated reassault increased 12 percentage points). In comparison to simulated risk instruments, women's perceptions by themselves were better predictors than the K-SID, similar in predictive ability to the SARA, and almost as strong as the DAS. The best prediction of repeated reassault was obtained using risk markers, including women's perceptions (ROC AUC =.83; 70% sensitivity) or by using the DAS and women's perceptions together (ROC AUC =.73; 64% sensitivity).

Adult↗