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PubMedDate not supplied

Listening to women at risk for preterm birth.

Frequently missing from discussions of the high rates of preterm and low birthweight births in the United States are the voices of pregnant women. In this article, we share the voices of low-income pregnant women who were participants in a 5-year randomized clinical study of nurse telephone intervention to reduce preterm birth. Data were gathered from three sources: a log kept by the study nurses in which they recorded events as they occurred; a telephone survey of randomly selected participants using a structured interview after the program was completed; and spontaneous comments from notes and letters written by study participants. Patients commonly perceived barriers to care, and related them to the nurses. The most frequent barriers concerned communication: miscommunication and misunderstanding between a woman and provider; miscommunication and misunderstanding involving providers giving conflicting information to patients; inaccurate information from provider to patient; failure of a provider to respond to a patient's request for information; and a general feeling among patients that providers were unsympathetic or uncaring. The perspectives of these women raise important questions for nurses and for other healthcare providers about the way we communicate both information and attitudes of caring to pregnant women.

Adolescent↗

PubMedDate not supplied

Transformational leadership: the development of a model of nursing case management by the army nurse corps.

Management philosophy and culture of any organization must match the nursing professions' core value of caring. Organizational conflict symptomology includes communication barriers and widely differing values. Employment of accountability based systems and bringing nurses into governance prevents conflict and improves job satisfaction. This article identifies the barriers to case management program development and discusses strategies for its successful implementation. Today's most successful organizations will implement an institution-wide commitment to a culture within which excellence flourishes. Creative staffing models and professional practice partnerships such as nursing case management will be supported and encouraged by executive leadership; they work as a team and will be jointly accountable for positive outcomes The United States Army Nurse Corps has the framework necessary to develop a premiere nursing organization. Case management departments may adopt these techniques to improve working relationships and leadership capacity within their organizations.

Case Management↗

PubMed1996

Coping with the cancer experience. I. Developing an education and support programme for cancer patients and their significant others.

Cancer patients and their significant others need information to understand events throughout the course of cancer. They also need support in mobilizing coping strategies as situational demands exceed their personal resources. Following a learning-needs assessment, Swedish cancer patients and their significant others demonstrated a desire to learn not only about the disease and treatment procedures, but also about the adaptation process to live with the uncertainty inherent in a diagnosis of cancer. It has, however, repeatedly been reported that communication barriers exist, and that information does not always reach the intended target. Thus, to increase knowledge and facilitate efforts to cope with the cancer experience an approach was used in which the provision of information was combined with emotional support in an education course. Patients and their significant others (n = 149) were actively involved in developing the education and support programme together with extensive learning materials. The programme, entitled Learning to live with cancer, has its roots in the educational philosophy of human learning, and is based on the findings from the original learning-needs assessment.

Adaptation, Psychological↗

PubMedDate not supplied

Diagnoses of the human response pattern, communicating: a proposal for revision.

The authors present an analysis of the concept of communication, and propose a revision of NANDA's taxonomic human response pattern communicating, and its nursing diagnosis, impaired verbal communication. The authors recommend that the definitions of the human response pattern and its diagnosis be modified to incorporate facets other than verbal emissions. The addition of new defining characteristics and related factors also should be considered. New defining characteristics could include modifications of criteria of the American Speech and Hearing Association, highlighting disturbances in speech, language, hearing, and vision in addition to some of the present NANDA defining characteristics. Proposed related factors are classified as alterations in human patterns (developmental, physiological, psychological, social, cultural and environmental).

Communication Barriers↗

PubMed1969

Relevance of the electronic computer to hospital medical records.

During the past 30 years an "information explosion" has completely changed patterns of illness. Unit files of individual patients have become so large that they are increasingly difficult both to store physically and to assimilate mentally. We have reached a communications barriers which poses a major threat to the efficient practice of clinical medicine.At the same time a new kind of machine, the electronic digital computer, which was invented only 26 years ago, has already come to dominate large areas of military, scientific, commercial, and industrial activity. Its supremacy rests on its ability to perform any data procedure automatically and incredibly quickly.Computers are being employed in clinical medicine in hospitals for various purposes. They can act as arithmetic calculators, they can process and analyse output from recording devices, and they can make possible the automation of various machine systems.However, in the field of case records their role is much less well defined, for here the organization of data as a preliminary to computer input is the real stumbling-block. Data banks of retrospective selected clinical information have been in operation in some centres for a number of years. Attempts are now being made to design computerized "total information systems" to replace conventional paper records, and the possibility of automated diagnosis is being seriously discussed.In my view, however, the medical profession is in danger of being dazzled by optimistic claims about the usefulness of computers in case record processing. The solution to the present problems of record storage and handling is very simple, and does not involve computerization.

Computers↗

PubMed1990

Variations in lengths of stay and rates of day case surgery: implications for the efficiency of surgical management.

Variability in lengths of acute hospital stay and rates of day case surgery is shown to be a continuing pattern which occurs both between and within countries. A model of the determinants of health service activity is presented and the contribution of different factors to the observed variations is assessed. Differences in methods of funding health services are identified as a major determinant of the between country variations, while the within country variations largely reflect the influence of local differences in facilities and services and the organisation of care at a hospital level, as well as the independent effects of differences in clinical practice style. The main rationale for advocating a reduction in length of stay and increased use of day surgery is to increase efficiency by reducing costs per case while maintaining the quality of care. These criteria of costs, clinical outcomes and patient acceptability are examined in relation to day case surgery for an intermediate surgical procedure (inguinal hernia repair) and short stay surgery for cholecystectomy. The precise cost savings are shown to depend on the methods of costing, assumptions made and facilities employed, while factors influencing the outcomes achieved include the criteria of patient selection, the surgical techniques employed, and the adequacy of preoperative communication. Barriers to the more widespread adoption of short stay and day case surgery include practical and organisational constraints on clinical practice at a hospital level, lack of awareness among clinicians as to how far their practices differ from current norms, and clinical barriers raised by surgeons who do not see short stay policies as advantageous. Mechanisms to promote changes in clinical practice styles include independent professional audit, peer review, and involvement of clinicians in budgeting and resource allocation. Assessing quality requires that attention is given to patient acceptability and satisfaction as well as to the monitoring of clinical outcomes.

Ambulatory Surgical Procedures↗

PubMed2000

Organisational sources of safety and danger: sociological contributions to the study of adverse events.

Organisational sociology has long accepted that mistakes of all kinds are a common, even normal, part of work. Medical work may be particularly prone to error because of its complexity and technological sophistication. The results can be tragic for individuals and families. This paper describes four intrinsic characteristics of organisations that are relevant to the level of risk and danger in healthcare settings--namely, the division of labour and "structural secrecy" in complex organisations; the homophile principle and social structural barriers to communication; diffusion of responsibility and the "problem of many hands"; and environmental or other pressures leading to goal displacement when organisations take their "eyes off the ball". The paper argues that each of these four intrinsic characteristics invokes specific mechanisms that increase danger in healthcare organisations but also offer the possibility of devising strategies and behaviours to increase patient safety. Stated as hypotheses, these ideas could be tested empirically, thus adding to the evidence on which the avoidance of adverse events in healthcare settings is based and contributing to the development of theory in this important area.

Communication Barriers↗

PubMed2002

Perceptions of Mexican American clients receiving genetic services in South Texas.

OBJECTIVES: The objectives of this study were to assess the perceptions among medically indigent Mexican American clients in South Texas receiving genetic services, and the effects of these perceptions on the utilization of genetic services. METHODS: Using a qualitative ethnographic approach, 16 caretakers of children with genetic conditions and 7 prenatal clients were interviewed. Interview data were analyzed using the NUD*IST 4 computer program. RESULTS: Clients reported challenges with understanding and utilizing genetic services due to language and communication barriers, poverty, cultural differences, and system issues. CONCLUSION: Client perceptions of genetic services were influenced by experiences with other biomedical providers and traditional healers, and by anxieties precipitated by unfamiliar concepts and approaches to medical care. Recommendations are made to improve provision of genetic services.

Journal Article↗

PubMed1997

The effect on risk estimates of excluding cases from a case-control study of ischemic stroke.

There is limited information about the effect on stroke risk estimates of excluding cases who are unable to respond to interviews. A case-control study of ischemic stroke between 1988 and 1990 in Shreveport, La., USA, provided a basis for studying this question. Of 197 consecutively admitted cases of ischemic stroke, 77 were excluded due to dementia, aphasia or impaired consciousness. Information about risk factors and stroke characteristics was obtained from hospital records. Excluded cases had more left hemispheric (52 versus 19%) and fewer vertebrobasilar (12 versus 29%) and lacunar (5 versus 13%) infarcts than included cases. Excluded cases were also older (p < 0.01), and they had larger infarcts (p < 0.01), multiple strokes (p < 0.01) and congestive heart failure (p < 0.01) more often than included cases. Cases were matched to hospital controls by age, sex, race, and date of admission. Odds ratios (ORs) were higher for excluded cases for 5 of 6 exposures with a significantly higher OR for congestive heart failure (p < 0.01). The ORs changed by as much as 63% when excluded cases were added. These results emphasize the importance of acquiring information about excluded cases and considering selection bias when interpreting stroke studies that exclude cases who are unable to respond to interviews.

Adult↗

PubMed1978

Affective disorder in Asian immigrants.

Socio-cultural factors play a contributory role in presentation and symptomatology of affective illness. Cultural shock, communication barriers, fear of loss of racial identity, different child rearing attitudes and dietary restrictions may all contribute towards the manifestation of reactive depression. An understanding of the immigrant's background will greatly help the therapist in management of his patient.

Adjustment Disorders↗

PubMed1982

Interaction of health-care professionals with critically ill children and their parents.

The stress imposed on the emotional equilibrium of a team of health-care professionals by the serious illness of a child can disrupt communication among the team, the child, and the parents. Such stresses may be so severe as to interfere with the ability to the adults to meet the child's needs. Although the feelings and attitudes of critically ill children and their parents are well described in the medical literature, very little has been written about the psychosocial interaction among those responsible for the patient's care. Patterns of interaction which would be most beneficial to the child are still in doubt. The purpose of this article is to review available information, as well as experience at St. Jude Children's Research Hospital, on the psychosocial interaction of the health-care team with critically ill children and their parents. An awareness of the difficulties of caring for such patients is essential in overcoming communication barriers, in reducing any interprofessional tensions that might arise during treatment, and in ensuring high-quality medical care.

Child↗

PubMed2002

e-Community health nursing.

Dissolving boundaries of space and time, the Internet creates another dimension in which to practice community health nursing. Addressing the challenges of health issues in the virtual environment affords new opportunities for holistic nursing practice. Grounded in holistic nursing theory and practice and built on a feminist foundation, this article explores the process of community health nursing within an Internet-based community. A brief review of the literature identifies relevant research findings. Barriers to communication are identified. These include perceived ease of use of computer technology and gendered patterns of communication. Lessons learned in an actual Internet community are discussed.

Communication↗

PubMed2005

Literature review: issues surrounding education of English-as-a-Second Language (ESL) nursing students.

Examined in this article are the challenges faced by English-as-a-Second Language (ESL) nursing students. Nursing faculties need to address these challenges to meet the increasing diversity of the health care system. A key concern is the ability of ESL nursing students to communicate effectively in English. The Cummins model for English language acquisition provides a template for ESL nursing students to bridge this communication barrier. The literature suggests some particular needs of ESL nursing students can be met through modification of nursing programs. Further research into factors affecting the quality of nursing education for ESL students is warranted. A quantitative analysis is required to see if there exists a positive correlation between improved English language acquisition and academic success by ESL nursing students.

Cultural Diversity↗

PubMed1997

Low pharmacist counseling rates in the Kansas City, Missouri, metropolitan area.

OBJECTIVE: To quantify the percentage of patients counseled by community-based pharmacists. METHODS: Phase I consisted of a 15-minute observational period of pharmacist counseling in 50 randomly selected pharmacies in the Kansas City, MO, area. In phase II, a survey was mailed to the same pharmacies to obtain policies, self-reported rates of counseling, baseline workload, and personnel information, as well as perceived communication barriers. RESULTS: Forty-six of 50 pharmacies were observed in phase I after excluding 10 ineligible pharmacies and adding 6 replacement pharmacies. Pharmacists provided counseling in only 14 of the 46 pharmacies (30%). Nineteen percent (20/106) of all patients received pharmacist-initiated counseling. Pharmacists in independent pharmacies were observed counseling a significantly higher percentage of patients than were pharmacists in chain pharmacies (44% vs. 11%; p = 0.014). Technicians were observed counseling 5 patients in chain pharmacies. Detailed verbal counseling, defined as four or more of a group of major counseling components, was provided to only 8 of the 20 patients who were counseled by a pharmacist (40%; 8% of all patients). In phase II, 31 of 51 surveys (61%) were returned. During the requested survey time period, pharmacies estimated that approximately five prescriptions were filled every 15 minutes, 51.5% of which were new. Pharmacists in chain pharmacies reported dispensing greater numbers of prescriptions than did pharmacists in independent pharmacies. These data and the reported counseling rates indicated that 50% of all patient prescriptions should be counseled. This is a higher rate than actually observed. All pharmacies reported that pharmacists completed the counseling; however, 10% of the respondents reported that technicians also counseled patients. Contrary to the findings in phase I, slightly more than 50% of the pharmacists reported using detailed verbal counseling. CONCLUSIONS: The overall observed rate of counseling in community pharmacies is low. In the Kansas City area, independent pharmacists counsel a greater than average percentage of their patients. Even if the national counseling rate is double what was observed, millions of patients are leaving pharmacies without the benefit of pharmacotherapeutic guidance. If pharmacists are slow to meet these challenges, other service providers will relieve pharmacists of that responsibility.

Counseling↗

PubMed2003

Language translation of outcome measurement tools: views of health professionals.

Assessing the outcome and effectiveness of treatment is extremely important in nursing practice and it is vital that outcome measures are available to non-English speakers. We investigated health professionals' views on translating outcome measures for use in nursing practice. Semi-structured interviews were conducted with a purposive sample of 10 health professionals. Content analysis of data identified the following two broad themes: meeting need and cultural consideration. Specific palliative care issues were also identified. Low literacy levels among ethnically diverse communities and the need to ensure cultural equivalence were perceived as major challenges for palliative nursing practitioners when translating outcome measures. Given increasing cultural diversity within the UK, health professionals considered clinical tool translation worthwhile because it helps to address inequalities in health-care provision for ethnically diverse communities. A consideration of the cultural context is needed when interpreting responses on translated outcome measure. However, translations into appropriate languages can help overcome communicant barriers and minimize the need for family members to act as interpreters for patients with palliative care needs.

Cultural Diversity↗

PubMed2006

Exploring Aboriginal people's experience of relocation for treatment during end-of-life care.

AIM: to explore indigenous peoples' experience of relocation for medical treatment during end-of-life care. METHODS: the data were collected from 72 qualitative interviews conducted throughout the regional, rural and remote areas of the Northern Territory, Australia, with Aboriginal patients and carers and the health professionals who cared for them. RESULTS: relocation for indigenous peoples is a frightening experience. There are a myriad of fears including: the fear of leaving home, especially for people who had never been away from their home lands; the fear of dis-empowerment associated with leaving the support of family networks; fears about hospital environments and 'high-tech' treatments; fear of cultural alienation for familiar foods and ways of being; fear of travel; fear of loneliness; fear of language and communication barriers; financial fears; and fear of dying away from the homeland. CONCLUSION: the findings demonstrate the strong need for building-up local palliative care services and raise significant questions about the cultural appropriateness of the Western biomedical rationale for relocation during end-of-life care.

Cross-Sectional Studies↗

PubMed2004

Using music as a therapy tool to motivate troubled adolescents.

Children and adolescents with emotional disorders may often be characterized by having problems in peer and adult relations and in display of inappropriate behaviours. These include suicide attempts, anger, withdrawal from family, social isolation from peers, aggression, school failure, running away, and alcohol and/or drug abuse. A lack of self-concept and self-esteem is often central to these difficulties. Traditional treatment methods with young people usually includes cognitive- behavioural approaches with psychotherapy. Unfortunately these children often lack a solid communication base, creating a block to successful treatment. In my private clinical practice, I have endeavoured to break through these communication barriers by using music as a therapy tool. This paper describes and discusses my use of music as a therapy tool with troubled adolescents. Pre- and post-testing of the effectiveness of this intervention technique by using the Psychosocial Functioning Inventory for Primary School Children (PFI-PSC) has yielded positive initial results, lending support to its continued use. Music has often been successful in helping these adolescents engage in the therapeutic process with minimised resistance as they relate to the music and the therapist becomes a safe and trusted adult. Various techniques such as song discussion, listening, writing lyrics, composing music, and performing music.

Adolescent↗

PubMed2005

Developing a standardized comprehensive health survey for use with deaf adults.

THERE IS LIMITED INFORMATION on how communication barriers impact on the health of deaf individuals. The present article describes the development of a standardized interview tool to collect health-related information from deaf adults via face-to-face interviews in American Sign Language (ASL). Questions were selected largely from existing standardized questionnaires. Key steps in standardizing the instrument included the creation of an ASL gloss version of the survey and extensive interviewer training. The instrument was pilot-tested and revised prior to implementation. There were 139 questions on the final instrument. A total of 203 interviews were conducted between November 2002 and March 2003. A standardized interview survey administered in ASL proved an effective and well-accepted means of collecting health-related information from a diverse sample of deaf individuals. Several challenges were encountered throughout the process, and the resulting lessons will be useful to future research efforts.

Adult↗