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PubMed2000

Motivations for and barriers to engaging in continuing veterinary medical education.

OBJECTIVE: To identify reasons for engagement in continuing veterinary medical education (CVME) activities, obstacles to participation, ways to provide more effective programs, and ideas to improve participation in CVME. DESIGN: Focus group interviews. SAMPLE POPULATION: Selected practicing veterinarians from a state that did mandate continuing education for relicensure. PROCEDURE: 12 focus group interviews were held throughout the state of California between May and September 1998. Practitioners were asked to respond to questions about where they obtain information to improve their practice, what value they see in CVME, what motivates them to participate, what obstacles to CVME participation exist, and ways CVME providers and practitioners could overcome those obstacles. RESULTS: 84 practitioners participated in the focus group interviews. In addition to the educational value of CVME, participation was used to rejuvenate practice life and prevent feelings of isolation. Continuing education activities ranged from problem-oriented chats with colleagues to formal educational programs. Timing of events, distance, money, solo practice, stage of career, and family demands were identified as barriers to participation. Designing and marketing CVME with specific learning objectives and for specific career stages and using new educational delivery technologies were suggested to overcome some of these barriers. CONCLUSIONS AND CLINICAL RELEVANCE: If CVME is to improve practice and patient care, it should be integrated into a practice's strategic planning and considered a legitimate business expense. Decisions about CVME participation are made easier if program objectives are clearly outlined.

Animals↗
PubMed2004

"How can we stay healthy when you're throwing all of this in front of us?" Findings from focus groups and interviews in middle schools on environmental influences on nutrition and physical activity.

This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.

Adolescent↗
PubMed2003

Supernumerary status: definition, operationalisation and its effect in practice.

This paper presents an evaluation of the implementation of supernumerary status in intensive care units in the Greater Belfast area. The evaluation focused on three questions, what did staff understand by the term supernumerary status. How was supernumerary status implemented in the Trusts? What effect did supernumerary status have on the staff/Trusts involved? The results of the evaluation are presented here and issues for further development identified. The study was qualitative in nature and used semi-structured interviews and focus group interviews to collect data. Participants were purposefully selected by virtue of their experience of supernumerary status. Interviews and focus groups were audiotaped and transcribed verbatim. These transcripts were then analysed line-by-line and coded. Data analysis described 10 common themes. In general, the concept of supernumerary status was well received and was supported by all involved who believed that its goal of producing adequately trained and skilled practitioners in an intensive care environment was a worthwhile exercise that benefited both staff and patients. Overall, exploring the operationalisation of a supernumerary status programme helps us to explore the challenges of supporting neophyte nurses in all areas of practice and challenges service providers to consider creative approaches to providing such support. However, whilst making a positive contribution to the recruitment and development of nurses new to the intensive care environment, further study is required to gauge the long-term effect of this programme on retention of staff.

Education, Nursing, Continuing↗
PubMedDate not supplied

Periodic abstinence from Pap (PAP) smear study: women's perceptions of Pap smear screening.

BACKGROUND: The purpose of this study was to explore attitudes, beliefs, and perceived barriers to risk-based cervical cancer screening through focus group interviews of patients. METHODS: We conducted 8 focus group interviews of women using semistructured interviews. The investigators independently reviewed the focus group transcripts and identified the overall themes and themes unique to each question using an immersion and crystallization approach. RESULTS: Women are in agreement that cervical cancer screening is important and that women should get Pap smears regularly as an important way of protecting their health. They are not open to the idea of reducing the frequency of Papanicolaou (Pap) smears, however, because they perceive annual screening to be successful in reducing cervical cancer mortality. Additionally, they have concerns about test accuracy. Women are distrustful of the rationale for reducing the frequency of Pap smears. Women's previous bad experiences have reinforced their need for self-advocacy. CONCLUSION: Women are reluctant to engage in risk-based cervical cancer screening. In this environment, risk-based cervical cancer screening recommendations are likely to be met with resistance.

Adult↗
PubMed2005

Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires.

This article reviews 32 patient-interview studies that revealed that the most common barriers to adherence revealed by patients included concerns about drug safety and cost and a belief that the patient's asthma was not severe enough to require daily treatment. Important but less commonly cited concerns included worry about dependence or diminished effectiveness with long-term use of the medication. Children and their parents expressed concerns about safety, dependence, peer stigmatization, and parent-child conflict over taking medication. Low-income and minority patients cited similar concerns and barriers that included cost, difficulty of obtaining medication, daily life hassles, and a general distrust of the medical establishment. The information obtained from patients' perspectives indicates the need to reappraise current strategies for the management of asthma, including a more flexible approach to the use of expert guidelines for the treatment of asthma.

Activities of Daily Living↗
PubMed2006

Funding sources and consequences: the subverting of an Indigenous community outreach program.

INTRODUCTION: The Yolngu people of North-east Arnhem Land, Northern Territory, Australia, have lived with alcohol for just over 30 years. For some it has had devastating health, social, family and cultural impacts. This is particularly the case for a group of Yolngu people who permanently or transiently camp on the fringes of the predominately non-Indigenous township of Nhulunbuy. The Miwatj Health Aboriginal Corporation Outreach Program was a response to alcohol use by this Aboriginal community. An evaluation, in consultation with Miwatj Health, sought to examine the conception, development and success of the Outreach Program. METHODS: This was a qualitative study that used: unconcealed participant observation, formal semi-structured interviews, group interviews, opportunistic impromptu discussion, and documentary/archival review. Interviews were conducted with Outreach Program staff, Yolngu community members, Aboriginal health workers, Miwatj Health doctors, Living with Alcohol representatives, the town administrator, Nhulunbuy police sergeant, the publican and local council officer. Group interviews were conducted with two groups of campers, Outreach Program workers and Aboriginal health care workers. DISCUSSION: For the Yolngu people the focus of the Outreach Program was meant to be on talking with and counselling drinkers, cultural activities, and liaising with other substance misuse programs and the police. The Outreach Program has achieved some success and helped a small number of Yolngu to limit their alcohol use and reconnect with the community. However, the Outreach Program has come to focus more and more on cleaning up litter; a key issue for the non-Indigenous community. CONCLUSION: This article focused on one key finding from the evaluation and that is the impact that funding (or lack of funding), the source of funding and the parameters imposed by funding bodies can have on the success or otherwise of a community driven program. The ability of Indigenous communities to determine appropriate program approaches and implementation is undermined when funding sources place restrictions which reflect non-Indigenous values and dominate program outcomes.

Alcoholism↗
PubMed1997

Breast self-examination: an analysis of self-reported practice.

The aim of this study was to investigate the relationship between the performance of breast self-examination (BSE) and age, place of residence, ethnic background and religion, as well as whether a group willing to take part in an interview regarding BSE mirrored the whole population. Six hundred and ninety-four (69.4%) women, aged 25-80, responded to the questionnaire. Of these, 69.6% examined their breasts. Whether the subjects lived in urban or rural areas was of no importance for practising BSE, nor was country of birth or number of years in Sweden. A larger proportion of women aged 45-80 practised BSE compared with women aged 25-44 (P < 0.001), the former practising BSE once a month or more. Step-wise logistic regression analysis showed that, for the whole sample as well as for the interview group, age was the only significant predictor of breast self-examination (P < 0.001). There were no significant differences between the whole sample and the interview group. The importance of younger women performing the examination is stressed. Due to nurses being strategically located in a wide range of geographical locations, allowing them to meet women in different settings, they are a good choice for motivating women to practise BSE.

Adult↗
PubMed1995

Examining ethnomedical diagnoses and treatment choices for diarrheal disorders in Lubumbashi Swahili.

This article examines the basis of ethnomedical classification of diarrheal disease among the Swahili speaking population of Lubumbashi, Zaire and the association of specific diagnoses with treatments given. Results from two research methods are reported: group interviews and large sample surveys. A series of group interviews with mothers of small children provided information about how they commonly diagnose illnesses related to childhood diarrheal disease as well as which symptoms, causes, and treatments they associate with those illnesses. Data from the interviews were used to formulate questions about the diagnosis of illness and treatments given for recent cases of diarrhea. A baseline and a follow-up survey provided information about the symptoms associated with reported episodes of illness and about the treatments given at home. The results provide evidence that ethnomedical diagnoses are based on observed symptoms, that they affect how and why oral rehydration therapy (ORT) is used or not used for diarrhea, and that the terms chosen by survey researchers to ask about diarrhea and ORT may affect survey results in predictable and systematic ways.

Child↗
PubMed1976

Pediatric automotive restraints, pediatricians, and the academy.

Over 70% of the 192 Southern California Academy pediatricians responding to a survey teach parents about pediatric automotive safety devices but less than 3% do so on every visit. To test two methods of increasing the frequency of teaching, these pediatricians were randomly assigned to either a mailing from the Academy's local chapter (mail group) or a brief presentation by a local pharmaceutical representative at his regular visit (interview group); a follow-up was conducted one month later by mail. Sixty-one percent of the mail group and 49% of the interview group claimed that their teaching on this subject had increased since the original contact. While this difference did not reach statistical significance, it was in the same direction as the preferences for sources of pediatric information expressed by both groups of pediatricians. A special letter from the Academy was ranked most effective and a visit from the pharmaceutical representative was judged least effective. Because of the magnitude of the problem, availability of a solution, proof that pediatricians can influence health behavior related to children and acknowledgment of the Academy's role in pediatric education, an appeal is made for an all-out campaign by the Academy and its members to promote use of appropriate pediatric automotive safety devices.

Accidents, Traffic↗
PubMed2005

Researchers' experience of co-operative inquiry in acute mental health care.

AIM: The aim of this article is to reflect upon our experiences of using co-operative inquiry in an acute mental health care setting, with a focus on the methodology used in a 4-year intervention programme developed in Norway between 1999 and 2003. BACKGROUND: Action research plays a crucial role in assisting nurses to integrate theory and research with nursing practice. The central characteristic of this approach is the grounding of research in practice in collaboration with clinical practitioners. METHODS: The research was a co-operative inquiry based on a hermeneutic-phenomenological approach. The research methods used were ethnographic, including participant observation and face-to-face interviews, questionnaires, focus group interviews, and our process notes. FINDINGS: The different methods used in the co-operative inquiry design of the Project Teaching Ward (PTW) had both benefits and drawbacks. In particular, the focus group method proved useful due to its ability to stimulate participants' research interest, and thus motivating them to be actively involved in the development of knowledge. The particular knowledge development process used has been described as a local knowledge dialogue. This dialogue must incorporate critical subjectivity on the part of participants in order to ensure that the research has a reflective resistance, which is decisive for its validity and quality. The findings also highlight the importance of the different roles of project leader in lengthy action research collaboration. CONCLUSIONS: The PTW has illustrated that co-operative inquiry was well suited for developing knowledge relevant to practice, thus contributing to bridging the gap between practice and theory. In order for this to happen, the research collaboration should be characterized by patience, realism and engagement.

Acute Disease↗
PubMed2000

Some dilemmas of master's level nurse education.

Despite an increase in the growth of master's level provision for qualified nurses in the United Kingdom uncertainty exists regarding the characteristics of master's level performance in respect of professional practice. This paper presents selected findings from a multidisciplinary study that sought to examine the characteristics of master's level performance in health professional courses that had an expressed practice orientation. It focuses specifically on dilemmas nurse educators encountered in relation to British master's level nurse education. Following an initial pilot stage involving focus group interviews with separate groups of nurses, occupational therapists and physiotherapists, an interview agenda was developed to explore participants' perspectives of the characteristics of master's level performance. Individual in-depth interviews were undertaken with a purposive sample of 18 nurse educators drawn from eight universities in England. Interview transcripts were coded and thematically analysed. Six kinds of dilemma emerged from the interviews. These were breadth vs. depth in the conceptualization of master's level for nursing, relevance to practice vs. academic detachment, facilitating creative thinking vs. reinforcing rigidity, encouraging or suppressing different modes of critical thinking, postgraduate nurses as loyal change agents vs. the problem of well-qualified mavericks, and professional experience as facilitating or hindering master's level performance. These dilemmas raise important questions about course design and the role of stakeholders in determining curriculum content. Moreover, a pervasive tension between a utilitarian emphasis on the application and utility of knowledge on one hand, and aspirations to promote creativity and critical thinking which look to alternative possibilities on the other hand, suggests that nurse educators exercise a degree of conservatism in relation to master's level. It is concluded that this apparent quest to maintain a safe variant of the status quo as the best way of promoting the wellbeing of patients should be subject to profound questioning.

Attitude of Health Personnel↗
PubMed1997

Understanding lay perspectives: care options for STD treatment in Lusaka, Zambia.

Understanding lay persons' perceptions of STD care is critical in the design and implementation of appropriate health services. Using 20 unstructured group interviews, 10 focus group discussions and 4 STD case simulations in selected sub-populations in Lusaka, we investigated lay person perspectives of STD services. The study revealed a large diversity of care options for STD in the communities, including self-care, traditional healers, medicine sold in the markets and streets, injections administered in the compounds, private clinics, health centres and hospital. The factors identified as influencing care seeking behaviour are: lay referral mechanisms, social cost, availability of care options, economics, beliefs, stigma and quality of care as perceived by the users.

Attitude to Health↗
PubMed1994

The clinical utility of the Safe Times Questionnaire.

PURPOSE: To evaluate a valid, reliable self-report health behavior screening instrument, the Safe Times Questionnaire (STQ), in a clinical setting. METHODS: One hundred and fifty-two patients at a primary care health center completed the STQ and were randomized into two groups; physicians in the "STQ group" (79 patients) used the STQ while physicians in the "interview group" (73 patients) were blinded to the STQ. Physicians rated each patient on their need for intervention in nine topic areas. Patients then had a psychological interview and were rated on the same topic areas. RESULTS: The total time of the patient visit was significantly longer in the interview group than in the STQ group. Physicians in the STQ group had significantly higher accuracy in identification of subjects at risk for depression and family conflict. CONCLUSIONS: The Safe Times Questionnaire is a potentially useful instrument to efficiently screen adolescents.

Adolescent↗
PubMed2001

Perceptions and experiences of primary nursing in an ICU: a combined methods approach.

With the introduction of the Patient's Charter, greater emphasis has been placed on 'named nursing' (Department of Health 1991). While there is much literature extolling the benefits of this method of delivering care to patients (Reed 1988; Manley 1989; Macguire 1991); there is a dearth of empirical studies exploring primary nursing in an adult intensive care unit (ICU). In addition, little is known about how nurses feel about being a 'primary nurse'. The aim of this study was to determine qualified nurses' perceptions and experiences of the effect of primary nursing on patient care in an intensive care environment (ICU) and to explore nurses' experiences of being a primary nurse. This study was carried out in an ICU in Northern Ireland. Primary team nursing was the system of organizing care within this unit. This system consisted of teams of 'primary' and 'associate' nurses. A total of 65 qualified nurses were surveyed. Sixteen nurses took part in focus group interviews. A combined methods approach comprising a questionnaire and focus group interviews was employed for the study. Part one of the questionnaire provided data on professional and demographic details. Part two facilitated nurses to elaborate on their feelings and perceptions of the concept of primary nursing. The focus groups facilitated in-depth exploration of the respondents' personal feelings and experiences about their role as a primary nurse. The data obtained from the two-part questionnaire were analysed using descriptive statistic and content analysis. The data obtained from the focus groups were analysed using content analysis and the development of emerging themes. Analysis of the data revealed that the nurses' views were similar to those highlighted in the existing literature. Nurses perceived primary nursing to relate to the responsibility for the care of one patient, from admission to discharge with the primary nurse assessing, planning, implementing and evaluating care and the associate nurse assisting in the delivery of this care. Thus, continuity of care was seen as the major advantage of primary nursing. The findings, however, suggested that further teaching on the concept of primary nursing was required. In addition, many of the nurses admitted they experienced considerable stress, particularly in relation to their close proximity over a long period of time, with patients and their relatives. This is an important finding and highlights the need for primary nurses in ICU to have the opportunity (in some instances), to be relieved of their responsibility for a named patient, thereby reducing some of the potential for stress. It is acknowledged that the findings of this study may not be generalized beyond the identified sample. Further empirical studies exploring nurses' perceptions and experiences of primary nursing in an ICU are therefore needed.

Adult↗
PubMed1997

Patients' responses to the angioplasty experience: a qualitative study.

BACKGROUND: The number of coronary angioplasty procedures performed has increased more than tenfold in the past decade. Most research to date has focused on efficacy of the procedure, quality-of-life issues, and measures to promote comfort after percutaneous transluminal coronary angioplasty. Little or no research has examined the patient's experience during angioplasty. OBJECTIVE: The purpose of this study was to describe the angioplasty experience from the patient's unique perspective. METHOD: Focus-group interviews were used as the qualitative method for data collection. The sample consisted of 45 patients (26 male, 19 female) who had undergone percutaneous transluminal coronary angioplasty 3 to 18 months before the interviews. Seven focus groups (with four to nine subjects each) were conducted. Each 2-hour interview was tape recorded. Data were analyzed by using a constant comparative method. RESULTS: A wide range of themes emerged from the data. Positive themes included the following: contentment with comfort measures, satisfaction with supportive hospital care, and trust in medical competence. Negative themes included anger over unmet needs for comfort or support, feeling dehumanized, and frustration with lack of control in decision making. CONCLUSIONS: This study uncovered a broad range of experiences among patients undergoing percutaneous transluminal coronary angioplasty. Although most participants described very positive experiences, many patients expressed bitter dissatisfaction regarding several aspects of their care. Healthcare providers must be aware of these possible reactions so that they can anticipate, recognize, and intervene early and appropriately.

Adult↗
PubMedDate not supplied

Spouses' perceptions of and reactions to living with a partner who has undergone surgery for rectal cancer resulting in a stoma.

The aim of this study was to illuminate spouses' perceptions of living with a partner who had been diagnosed with rectal cancer followed by surgery resulting in a stoma. The focus group interview was chosen as method of data collection. Two focus group interviews consisting of 2 meetings each were conducted. A qualitative content analysis was used. Five themes emerged: difficulties of being involved; living with uncertainty; learning to live in a new way; the altered body; and the search for explanations. There were feelings of anxiety about the partner's serious condition and the possible spread of the cancer. After the rehabilitation period, the stoma influenced the spouses' lives in many ways but they coped with the problems together with their partners and helped them adapt to their changed circumstances. This study indicates that the spouses were very much involved in caring for the patient suffering from rectal cancer by protecting them and showing empathy. However, the dependence on the stoma affected and restricted their family and social life.

Adaptation, Psychological↗
PubMed2004

An exploration of midwives' views of the current system of maternity care in England.

OBJECTIVE: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care. DESIGN: an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection. SETTING: 15 focus group interviews were conducted at 14 sites in England. PARTICIPANTS: a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002. FINDINGS: the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.

Clinical Competence↗
PubMed1996

Young people and mentoring-towards a typology?

This study explores young people's perceptions of mentoring relationships and proposes a typology of mentoring forms. A sample of 150 adolescents was interviewed both in groups (n=12 groups of up to 13 young people) and individually (n=30 individuals recruited from the group interviews). Results suggested that a range of forms of mentoring were perceived as valuable by different groups of young people and from these a typology of mentoring forms is devised.

Journal Article↗