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Biomedical subjects

M Johnston

Publications and source records attributed to M Johnston.

At least 325 records · Page 18Linked to original sources
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Using the theory of planned behaviour to develop an assessment of attitudes and beliefs towards prosthetic use in amputees.

PURPOSE: To develop a questionnaire based on the theory of planned behaviour (TPB) to predict prosthetic use. METHOD: In part one, 31 amputees over 50 years of age with peripheral arterial disease completed attitude items containing 27 bipolar adjectives and open-ended questions on behavioural, normative and control beliefs relating to using the prosthesis. Academic, clinical and patient experts (n = 12) identified bipolar adjectives with best face validity. In part two, 15 amputees completed three behavioural format questions relating to prosthetic use and were asked to indicate the easiest to answer. RESULTS: Following the completion of the attitude items by the amputees and the expert panel review, 5 items remained (Cronbach's alpha = 0.87) with corrected item-total correlations ranging from 0.43 to 0.83. Modal behavioural beliefs concerned mobility (46.5%), independence (25.6%) and participation restrictions (16.3%), normative beliefs concerned family (33.3%), NHS staff (31.7%), friends (19.1%) and other patients (15.9%) and control beliefs concerned stairs (21.1%), slippery/rough surfaces (28.9%), disabled facilities (54.8%) and people helping (22.6%). In relation to part 2, an exact numerical report of hours and days of prosthetic use was found easiest to answer (73%). CONCLUSIONS: Based on this qualitative and quantitative development work, the questionnaire contains five attitude items, six behavioural, eight normative, eight control belief items and two self-report questions of the behaviour.

Aged↗
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Admission motor impairment as a predictor of physical disability after stroke rehabilitation.

The purpose of this study is to investigate the Fugl-Meyer Motor Impairment Scale and physical disability as measured by the Functional Independence Measure (FIM) as predictors of physical independence after stroke inpatient rehabilitation. Forty-eight patients admitted to a rehabilitation hospital within 6 wk of their first unifocal stroke were prospectively studied. Upper and lower extremity Fugl-Meyer scores were obtained near rehabilitation admission. FIMs were obtained on admission and discharge. Discharge FIM self-care was predicted best by admission FIM total (rs = 0.75; P < 0.0001), although admission FIM self-care, other FIM components, and upper- and lower-extremity Fugl-Meyer scores were also good predictors. Discharge FIM mobility and locomotion correlated well with their admission counterparts (rs = 0.54 and 0.45; P < 0.001 and < 0.01, respectively) but were even more strongly related to admission Fugl-Meyer scores (rs = 0.63 and 0.74, respectively; P < 0.0001). As expected, cognitive and psychosocial components of the FIM at discharge correlated poorly with admission Fugl-Meyer. These data confirm the strong motor impairment basis for the physical disability subdimensions of the FIM and suggest that dependency in physical activities of daily living after stroke is primarily determined by degree of motor impairment.

Activities of Daily Living↗
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Practice and career satisfaction among physiatrists. A national survey.

To evaluate physiatrist career satisfaction and current practice patterns, a 15-page survey was mailed randomly to 400 fellow members of the American Academy of Physical Medicine and Rehabilitation. The 208 questionnaires (52%) returned revealed respondents' level of satisfaction with career choice, current practice, relationships with other physicians, their own residency training, and problems experienced that impede their practice. Factor analysis identified six areas of satisfaction: time demands, organizational support, current practice, current specialty, profession, and training. Problems with work consisted of four factors: external intrusions into practice, having to deal with non-rehabilitation problems, dealing with PM&R problems, and insufficient time for patients. Results showed that 75% of physiatrists were satisfied with their practice/profession. Satisfaction with current practice was greater with fewer external intrusions into practice, a larger percentage of income from traditional non-managed payment sources (including Medicaid), and less competition. Changes in health care, such as managed care, competition, and increased external regulations, appear to interfere with current practice. Variation in satisfaction was not significantly correlated with size of community, variation in rates of payment denials, workloads of greater than 50 hours per week, and a number of other factors that one might expect to affect satisfaction. Physiatrists had made many changes in their practice in response to the changes in the health care environment but had not cut care for indigent patients. Needs for greater residency training in outpatient clinics, physicians' offices, managed care, and long-term care settings were expressed. This is the first comprehensive published report on physiatric satisfaction in a changing health care environment. Further research in some of the areas will be required.

Adult↗
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One program's experience of OSCE vs. written board certification results: a pilot study.

The objective structured clinical examination (OSCE) has been the focus of a lot debate with respect to reliability and validity. Much of the controversy surrounding these components lies in a lack of comparison with a "gold standard." Further work is needed to improve the evaluation of clinical skills to the point that a gold standard can truly be said to exist.

Certification↗
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Changing associate degree nursing curricula to meet evolving healthcare delivery system needs.

Curricular change for evolving healthcare delivery: everyone says to do it, but how, and what do you do? The authors explore the need for curricular change, a process to use in making the changes, essential elements to explore, and what changes one community college made. Included in the curricular revision is the hardest part-what was deleted-as well as what was added, and how nurse educators can continue to evolve.

Curriculum↗
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Mind-mapped care plans: a remarkable alternative to traditional nursing care plans.

Nursing care plans have helped students learn problem solving for nursing practice, but creativity and the interrelationship of patient problems are not stimulated by their linear nature. Joining mind mapping with care planning forces connections, engages whole brain thinking, and stimulates creativity. The authors describe mind mapping, infusion of mind-mapped care plans into the curriculum, the teaching/learning process of mapped care plans, and the positive outcomes of mind mapping nursing care plans.

Colorado↗
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Impact on patients and partners of inpatient and extended cardiac counseling and rehabilitation: a controlled trial.

OBJECTIVES: This study evaluated the effectiveness of cardiac counseling and rehabilitation programs led by a nurse counselor, compared with normal care on outcomes for myocardial infarction (MI) patients and their partners. METHODS: A randomized controlled trial with follow-up to 1 year was conducted with 100 patients recruited within 72 hours of a first MI and their partners: a Control group received normal care; an Inpatient group received cardiac rehabilitation from a nurse counselor while in hospital; and an Extended group received the same cardiac rehabilitation as the Inpatient group, but with additional sessions continuing up to 6 weeks after discharge from hospital. The scales for main outcome measures were 1) knowledge of heart disease and treatment (correct, misconceptions, and uncertainty); 2) mood (Hospital Anxiety and Depression Scale); 3) satisfaction; 4) disability (Functional Limitations Profile). RESULTS: Inpatient cardiac counseling and rehabilitation resulted in more knowledge, less anxiety, less depression, and greater satisfaction with care in both patients and partners and in less disability in patients, with effects enduring to 1 year. There was some evidence of additional benefit from the Extended program. Both nurse counselors achieved benefits on all outcome variables. CONCLUSIONS: This Inpatient cardiac counseling and rehabilitation program resulted in significant and enduring benefits of clinical value. It is likely that it would be acceptable to most post-MI patients, many of whom are not offered or are unable to accept outpatient cardiac rehabilitation.

Aged↗
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Cultural variations in professional and parenting patterns.

Existing parental and professional caring patterns are explored in an attempt to lay a foundation for the development of culturally relevant perinatal programs. Beliefs about bonding behavior are discussed as well as exploring whether this new knowledge is consistent with cross-cultural adaptations to the birth process. New rules and customs being introduced by professionals may be fostering a "detachment" phenomenon rather than the desired result of bonding behavior between parent and infant. Finally, a method of examining culturally divergent health beliefs and practices is discussed as a means of evaluating whether such practices are likely to be beneficial or harmful.

Child Rearing↗
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Stress in nursing and patients' satisfaction with health care.

The aim of this study was to investigate the factors that contribute to the stress reported by nurses and patients. Thirty-four nurses in a London teaching hospital completed the nurse stress index and the Spielberger state trait anxiety inventory, and attitudes towards the ward and nursing care were measured in 52 patients. Nurses in the sample reported significantly greater problems than the norm in dealing with stress (as measured by the nurse stress index). In particular, they expressed difficulty in dealing with patients and their relatives, with conflict between home and work, and with and pressure resulting from problems concerning confidence and competence in the role. Patients were generally satisfied with the health care they received. There was a positive relationship between the time that patients spent talking to nurses and the degree to which nurses were perceived as helpful. Results are discussed in terms of possibilities for further research and implications for the design of future intervention programmes aimed at reducing job-related stress in hospitals.

Adult↗
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Supporting learners.

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Advertising↗
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Insider-out: the health worker as researcher.

This article discusses two dimensions related to the insider-outsider dilemma in conducting anthropological research in the health setting. One dimension concerns advantages of the insider's special knowledge in selecting and conducting successful research in a health institution. The other dimension deals with the ambiguity and confusion of roles attributed by staff to the investigator who may be seen as practitioner as well as social scientist. The patient may also see the researcher as performing dual, and possibly conflicting, roles. The advantage gained in the first dimension may be negated, to some extent, by the disadvantages associated with the second.

Health Workforce↗
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Developing potential.

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Career Mobility↗