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PubMed2005

Chronically ill rural women: self-identified management problems and solutions.

OBJECTIVE: To add to the knowledge base of illness management of chronically ill, rural women by describing the self-identified problems and solutions reported by women participants in the online health-education segment of the Women to Women (WTW) computer outreach project. METHODS: WTW is a research-based computer intervention providing health education and online peer support for rural women with chronic diseases. Messages posted to the online chat room were examined to determine the women's self-management problems and solutions. RESULTS: The self-identified problems were: (1) difficulties in carrying through on self-management programmes; (2) negative fears and feelings; (3) poor communication with care providers; and (4) disturbed relationships with family and friends. The self-identified solutions to these problems included problem-solving techniques that were tailored to the rural lifestyle. Although not all problems were 'solvable', they could be 'lived with' if the women's prescriptions for self-management were used. DISCUSSION: Glimpses into the women's day-to-day experiences of living with chronic illness gleaned from the interactive health-education discussions will give health professionals insights into the women's efforts to manage their illnesses. The data provide health professionals with information to heighten their sensitivity to their clients' day-to-day care and educational needs.

Adult↗
PubMed2000

Home management of fever in children: rational or ritual?

Fever is extremely common in childhood. Parents have been shown to have unrealistic fears, resulting in inappropriate management of fever in their children. This study was conducted to survey parents about their knowledge concerning home management of fever in children in their care. Parents of 560 febrile children were randomly recruited and interviewed in the waiting areas of the outpatient clinics or emergency room in four hospitals in Riyadh city using a standard questionnaire. Most of the interviewees were mothers, aged within 20-39 years. Although more than one-half of fathers and one-third of mothers in the study were well educated, most were misinformed about recognition and definition of fever. Most parents had poor knowledge regarding minimum temperatures for administering correct doses of antipyretic drugs or for sponging/bathing with water of the correct temperature. Most parents demonstrated a poor understanding of the appropriate frequency for checking the child's temperature and administering antipyretics. Only one-third of parents indicated a reasonable educational imprint by health-care providers. Considerable efforts will be required to educate parents about fever and its management.

Adult↗
PubMed2001

Analysis of the physician variable in pain management.

BACKGROUND: The role of physician variability in pain management is unknown. OBJECTIVE: To assess the role of physician variability in the management of pain and provide quantitative data regarding the status of pain management in Michigan. DESIGN: A multi-item mail survey was used to determine the physician's perceived knowledge of pain management modalities, goals, satisfaction, and confidence with pain treatment. Participants. The focus of this report was a group of 368 licensed Michigan physicians who provide clinical care. RESULTS: Overall, 30% of the study group reported no formal education in pain management, although younger physicians reported more education (correlation coefficient = -0.252, P <.001). The physicians reported greater confidence in their knowledge of meperidine than other Schedule II opioids (P <.001 ). In regards to the opinion that prescribing strong opioids would attract a medical review, the physician responses ranged from 1 (strongly disagree) to 5 (strongly agree). The median score for this scale was 4, accounting for 46% of the responses. The study group expressed less satisfaction with their treatment of chronic pain as well as lower goals for relief (mean: 3.8; 95% confidence interval: 3.7-3.9). CONCLUSIONS: Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.

Journal Article↗
PubMed2005

[Crisis management and medical disputes related to nursing practice].

The number of medical dispute cases has been increasing, due to uncertainties about medical care quality and outcomes as well as the increased influence of consumer-centered ideology. This situation has created difficulties in the relationships between patients/family members and health care providers. This paper focuses on discussing crisis management and medical disputes as related to nursing practice. Reviewed literature was organized into four parts: understanding crisis management; crises in medical institutions; nursing practice, medical disputes and crisis management; practical implications. The information included in this paper might improve nurses' and administrators' knowledge of crisis management, enhance the implementation of crisis management strategies in medical disputes, and reduce financial losses and psychological distress resulting from inappropriate crisis management.

Malpractice↗
PubMed2005

The challenge of ubiquitous computing in health care: technology, concepts and solutions. Findings from the IMIA Yearbook of Medical Informatics 2005.

OBJECTIVES: To review recent research efforts in the field of ubiquitous computing in health care. To identify current research trends and further challenges for medical informatics. METHODS: Analysis of the contents of the Yearbook on Medical Informatics 2005 of the International Medical Informatics Association (IMIA). RESULTS: The Yearbook of Medical Informatics 2005 includes 34 original papers selected from 22 peer-reviewed scientific journals related to several distinct research areas: health and clinical management, patient records, health information systems, medical signal processing and biomedical imaging, decision support, knowledge representation and management, education and consumer informatics as well as bioinformatics. A special section on ubiquitous health care systems is devoted to recent developments in the application of ubiquitous computing in health care. Besides additional synoptical reviews of each of the sections the Yearbook includes invited reviews concerning E-Health strategies, primary care informatics and wearable healthcare. CONCLUSIONS: Several publications demonstrate the potential of ubiquitous computing to enhance effectiveness of health services delivery and organization. But ubiquitous computing is also a societal challenge, caused by the surrounding but unobtrusive character of this technology. Contributions from nearly all of the established sub-disciplines of medical informatics are demanded to turn the visions of this promising new research field into reality.

Biomedical Technology↗
PubMed2002

Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey.

BACKGROUND: Heart failure is a prevalent condition that is generally treated in primary care. The aim of this study was to assess how primary-care physicians think that heart failure should be managed, how they implement their knowledge, and whether differences exist in practice between countries. METHODS: The survey was undertaken in 15 countries that had membership of the European Society of Cardiology (ESC) between Sept 1, 1999, and May 31, 2000. Primary-care physicians' knowledge and perceptions about the management of heart failure were assessed with a perception survey and how a representative sample of patients was managed with an actual practice survey. FINDINGS: 1363 physicians provided data for 11062 patients, of whom 54% were older than 70 years and 45% were women. 82% of patients had had an echocardiogram but only 51% of these showed left ventricular systolic dysfunction. Ischaemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, and major valve disease were all common. Physicians gave roughly equal priority to improvement of symptoms and prognosis. Most were aware of the benefits of ACE inhibitors and beta blockers. 60% of patients were prescribed ACE inhibitors, 34% beta blockers but only 20% received these drugs in combination. Doses given were about 50% of targets suggested in the ESC guidelines. If systolic dysfunction was documented, ACE inhibitors were more likely and beta blockers less likely to be prescribed than when there was no evidence of systolic dysfunction. INTERPRETATION: Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required.

Aged↗
PubMed2001

Moving to evidence-based practice for pain management in the critical care setting.

Widespread application of EBPM by bedside providers is needed to demonstrate the success of pain management strategies on patient outcomes. This goal is not easy to attain and generally requires time, patience, and a multidisciplinary team approach. Implementation and evaluation of pain interventions increase awareness and knowledge of pain management strategies and can result in an overall improvement in pain management. The literature and guidelines recommend the use of specific strategies to ensure practice change. Studies suggest that a more intensive or "active" effort to alter practice is generally most successful. The pain management program should be marketed so that both the health care providers and patients are aware of the goal and resources available. It may take 3 to 5 years to infuse the change and see the improvement. Reinfusion over time also needs to be planned. Bedside practitioners need to have knowledge of the current best evidence in pain management of the critically ill patient. Barriers to implementation must be eliminated so that practitioners can conscientiously and judiciously implement strategies to relieve pain. Opinion leaders and change agents need to be available to continually champion EBPM, and prompts to ask about pain should be provided to practitioners and patients.

Diffusion of Innovation↗
PubMed2002

Perceptions of pressure ulcers among young men with a spinal injury.

About 1000 younger people each year suffer a traumatic spinal cord injury that leaves them wholly or partly paralysed. The majority of these individuals are male. Paralysis leads to a host of physical and often psychological problems. Among the major challenges is the management of pressure and the maintenance of skin integrity. Long periods of immobility and loss of sensation make people with a spinal cord injury prone to developing pressure ulcers. While specialist spinal injury units have pioneered a holistic approach to the rehabilitation of those with spinal cord injuries, there has been little research conducted in the UK on the experiences and coping mechanisms of these patients. The study reported here sought to examine the perceptions and experiences of a sample of young men with a spinal cord injury in relation to pressure management and skin integrity, and their experiences of care. The results suggest that these men were knowledgeable about pressure management and highly motivated to look after themselves, but there was an over-reliance on the specialist unit for support.

Adult↗
PubMed1999

A comparative study of nurses' and elderly patients' ratings of pain and pain tolerance.

The purpose of this study was to compare elderly patients' and nurses' ratings of pain and pain tolerance. Data were collected through structured interviews with the patients. The attending nurses completed a questionnaire after conducting a pain assessment. Independent of each other, patients and nurses were asked to rate on a VAS when pain should be treated (pain tolerance) and pain intensity. The VAS has been used both by patients and nurses. The initial selection consisted of 43 patients; however, 9% (n = 4) were unable to complete the VAS. These patients were not significantly older than those who completed the study (n = 39). The results shows that nurses tend to overestimate mild pain and underestimate severe pain. Nurses rated pain tolerance significantly lower than patients. The results also suggest that nurses with training beyond basic nursing education tend to assess patients' pain more accurately than those without additional training. For patients who reported that they had pain prior to hospitalization, the nurses' pain ratings showed a higher agreement than for those who reported that they did not have pain before being hospitalized. At the time of the interviews, 21% (n = 8) of patients felt that their pain was so great they needed treatment. Those patients also were recognized by the attending nurses as being in pain. To improve elderly patients' pain management, practicing nurses must collaborate with researchers to develop specific empirical research nursing knowledge within geriatric pain management. This research-based knowledge should be incorporated into nurses' clinical practice regarding pain management. Specific guidelines must be developed for the assessment, treatment, and documentation of elderly patients' pain.

Aged↗
PubMed1998

Visitor Response to Management Regulations-A Study Among Recreationists in Southern Norway

/ The objectives of nature area management are often twofold: To protect the natural environment and to facilitate recreational use. In order to maintain the natural setting, it is sometimes necessary to regulate the recreational use of an area. In deciding on a management action, one problem can be the lack of knowledge about the effects of management actions on visitors. In order to enhance the knowledge base for future management practices, this study empirically evaluates the effects of management regulations in a Norwegian nature area. In this area camping outside commercial campgrounds was restricted in 1992. The management regulations seems to have influenced the use of Sjodalen for camping in several ways. The number of campers using the area has decreased. The user composition seems to have changed, with new campers in the area after the regulation being more tolerant of human influence on the natural environment than the campers before the regulations. In addition, a considerable proportion of the existing users ceased to stay overnight in Sjodalen, totally or partly due to the regulations. The behavioral response among existing users is related both to environmental preferences and place attachment. Implications for management and future research studies on impact assessment in general, and displacement specifically, are discussed.KEY WORDS: Outdoor recreation; Management regulations; Behavioral response; Displacement, Place attachment

Journal Article↗
PubMed2006

Effects of a brief worksite stress management program on coping skills, psychological distress and physical complaints: a controlled trial.

OBJECTIVES: To examine the effects of single-session, small-group stress management program on knowledge about stress, coping skills, and psychological and physical distress. METHODS: A total of 300 employees from a company in western Japan were invited to participate in the study. Those who consented to enter the study were assigned to an intervention (n=149) or waiting list control group (n=151). Participants in the intervention group received a small-group stress management program. The program was primarily aimed at increasing knowledge about stress and improving coping skills. To investigate the intervention effect, change scores in outcome variables were calculated by subtracting the scores at pre-intervention from those at post-intervention (8 weeks after the pre-intervention survey). Next, the difference in the scores between groups was examined using analyses of covariance (ANCOVA) with the pre-intervention score as the covariate. RESULTS: Favorable intervention effects were found on knowledge about stress and on coping skills (P<0.001 and P=0.012, respectively) and adverse effects on psychological distress (P=0.022). However, this adverse effect on psychological distress did not exist among those who initially perceived higher levels of job control. CONCLUSION: The single-session stress management program was effective on improving knowledge about stress, and coping skills, where job control moderated the effect of the program on psychological distress.

Adaptation, Psychological↗
PubMed2026

Operationalizing Local Ecological Knowledge for Aquatic Biodiversity Conservation: A Systematic Review and Management Framework.

Effective conservation and management of aquatic biodiversity is severely constrained by the absence of long-term ecological data in small-scale, tropical, and data-poor fisheries, where roughly one-quarter to one-third of freshwater fish species and 37.5% of elasmobranchs are threatened with extinction once Data Deficient species are accounted for. Conventional monitoring and stock-assessment tools are often financially and technically inaccessible in these systems, leaving managers without the evidence needed to prioritize conservation action or implement precautionary governance. Local Ecological Knowledge (LEK) is a largely underutilized resource for natural resource management that can provide temporal depth, spatial resolution, and species-specific ecological insights unavailable from scientific records. We conducted a systematic review and bibliometric synthesis of 60 peer-reviewed studies (1997-2025) applying LEK to assess fish conservation status, examining how, where, and through what methods this knowledge has been used. Our analysis identifies four complementary pathways through which LEK informs conservation management: reconstructing multi-decadal population changes, documenting spatial contraction and habitat loss, detecting extreme rarity and local extirpation, and characterizing intrinsic sensitivity to exploitation based on life-history traits. Despite growing methodological rigor, freshwater systems and African fisheries remain critically underrepresented, and formal integration of LEK into fisheries governance and biodiversity assessment remains the exception rather than the rule. We propose a practical three-stage framework to operationalize LEK within existing management and conservation systems. Recognizing fishing communities as legitimate co-producers of ecological knowledge is both scientifically necessary and an equity imperative for achieving global biodiversity commitments under the Kunming-Montreal Global Biodiversity Framework.

Biodiversity↗
PubMed2004

Medical and nursing students' knowledge and attitudes toward violence against women in India.

OBJECTIVE: The purpose of this study was to explore the knowledge and attitudes towards violence against women among fourth (final) year baccalaureate nursing students and fifth (final) year medical students from two distinct educational institutions in India. METHODS: Data were collected from 440 students using two questionnaires: the Student Exposure to Woman Abuse Questionnaire (SEWAQ), and the Inventory of Beliefs about Wife Beating (IBWB). Results were analysed based on gender, profession, and educational institution. FINDINGS: Nursing students believed that they had received more classroom preparation and practical skills to better prepare them to assist abused clients than male and female medical students. Only 38% of the participants believed that they had acquired classroom knowledge on woman abuse through their respective educational programs, whereas 43% thought they had practical skills to care for victims. All participants were sympathetic toward abuse victims, but demonstrated varying attitudes about the justification for abuse against women, help given to victims, punishment of the offender and the effect of woman abuse. Female medical students believed more strongly than males and nursing students that wives do not gain from being beaten. CONCLUSIONS: Congruent with existing literature, the study demonstrated that health care students in India do not receive sufficient training, practical skills and classroom knowledge to effectively manage abuse against women.

Battered Women↗
PubMed1989

Motivating middle managers. How to develop their mission potential.

Today's unstable healthcare environment is prompting not-for-profit hospitals to explore ways to preserve a fading altruistic posture. Holy Cross Hospital, Salt Lake City, sees middle management as a key to preserving a mission-oriented commitment to the delivery of healthcare. It is tapping the potential of its middle managers through a specialized management development program linked to mission objectives that attempts to assess and enhance individual abilities. The hospital formed a management development committee to identify several managerial characteristics that could have the greatest positive impact on preserving the hospital's mission objectives. The committee identified six major categories for focus: mission and philosophy; leadership style and influence; staffing, coaching, and developing employees; implementation functions; decision-making functions; and quality assurance issues. The hospital developed a self-assessment questionnaire for middle managers. As a self-evaluation tool, the questionnaire may not accurately represent each manager's specific level of knowledge, but it shows each manager's perceived needs and provides a basis for the development of instructional resources. It has also been useful in raising managers' consciousness of their performance.

Hospital Administrators↗
PubMedDate not supplied

Occupational medicine. An overview of management.

Management is the art of utilizing all available resources to accomplish a given set of tasks in a timely and economical manner. A complete job description for a manager would include diplomacy, coercion, politics, psychology, budgeting, evaluation and a host of other attributes. Each individual manager evolves a personal style within an organizational culture. No two positions or individuals are ever exactly alike. The successful manager must be able to allocate resources and motivate subordinates to accomplish goals often imposed from external sources (i.e., upper management). The successful manager may retain previously acquired technical skills; frequently these are lost, being replaced by new knowledge. The successful manager is one who understands the local organizational milieu. The theories discussed above are only guidelines. Just as each patient is approached differently, so too are different managerial positions.

Commerce↗
PubMed1994

Information revolution in nursing and health care: educating for tomorrow's challenge.

Current emphasis on the national electronic highway and a national health database for comparative health care reporting demonstrates society's increasing reliance on information technology. The efficient electronic processing and managing of data, information, and knowledge are critical for survival in tomorrow's health care organization. To take a leadership role in this information revolution, informatics nurse specialists must possess competencies that incorporate information science, computer science, and nursing science for successful information system development. In selecting an appropriate informatics educational program or to hire an individual capable of meeting this challenge, nurse administrators must look for the following technical knowledge and skill set: information management principles, system development life cycle, programming languages, file design and access, hardware and network architecture, project management skills, and leadership abilities.

Computer User Training↗