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PubMed2006

Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States.

Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet psychosocial needs and their relationship with health-care outcomes among individuals receiving HIV care in the southeastern US (n=526). We used multivariate logistic regression to examine the association of seven categories of unmet needs with HIV medication use and adherence. Most participants (84.5%) reported at least one service need in the past year. Nearly half (47%) of participants with service needs reported that at least one need was not met. Participants with one or more unmet needs were less likely to be taking any HIV medications (p = 0.007) and reported poorer medication adherence (p=0.013). The specific unmet needs for benefits (including Social Security, health insurance and prescription coverage) (p = 0.006) and a support group (p=0.040) were associated with being less likely to be taking any HIV medications. Unmet need for mental health-related counseling was associated with poorer medication adherence (p=0.003). Study findings regarding the high level of unmet need and the association of unmet need with poorer outcomes illustrate the importance of interventions to address these needs.

Adult↗
PubMedDate not supplied

Perceived needs following traumatic brain injury.

OBJECTIVES: (1) Provide population-based estimates of perceived needs following traumatic brain injury (TBI) and the prevalence of unmet needs 1 year postinjury; (2) identify relations among needs that define unique clusters of individuals; and (3) identify risk factors for experiencing selected needs. DESIGN: Telephone survey 1 year after injury of a prospective cohort of all people hospitalized with TBI in the state of Colorado during 2000. MEASURES: Self-reported need for assistance in 13 areas of functioning. RESULTS: A total of 58.8% of persons hospitalized with TBI experienced at least 1 need during the year following injury; 40.2% will experience at least 1 unmet need 1 year after injury. Most frequently experienced needs were "improving your memory, solving problems better" (34.1%), "managing stress, emotional upsets" (27.9%), and "managing your money, paying bills" (23.3%). Cluster analysis revealed 8 distinctive groupings of subjects. If a need existed, those least likely to be met involved cognitive abilities, employment, and alcohol and/or drug use. CONCLUSIONS: Results were consistent with findings from previous assessments of need for services based on surveys of convenience samples; however, the prevalence of unmet needs 1 year after injury may be higher than previously suspected. More post-hospital services addressing cognitive and emotional problems appear needed. Risk factors for experiencing needs suggest potential avenues for clinical intervention.

Activities of Daily Living↗
PubMed2005

A model of consequences of need-driven, dementia-compromised behavior.

PURPOSE: To extend the original need-driven, dementia-compromised behavior (NDB) model by explaining the consequences of behavioral symptoms for the person with dementia. ORGANIZING CONSTRUCT AND METHODS: Literature is reviewed and the consequences of expressing needs through need-driven, dementia-compromised behaviors are posited. The consequences of need-driven, dementia-compromised behavior (C-NDB) theory is proposed as a framework to improve understanding of the person with dementia and the consequences of behavioral symptoms and unmet needs. FINDINGS: Instead of normative verbal communication, people with significant dementia commonly communicate need via non-normative behaviors, making it difficult for caregivers to know that the person has a need and the extent of such need. Not meeting needs of people with dementia affects the person with dementia, care factors, and contextual factors. Cascading effects occur in which not meeting the original need results in new needs and behavioral symptoms. CONCLUSIONS: This framework indicates the consequences of expressing need behaviorally rather than verbally and shows that caregiver actions might moderate the events that lead to many needs being unresolved. Suggestions are made regarding future research questions deduced from the model.

Attitude of Health Personnel↗
PubMed1998

Assessing local health needs in primary care: understanding and experience in three English districts.

BACKGROUND: Assessing the health needs of a local population has been promoted as a key component in effective targeting of healthcare services and quality improvement. The understanding and experience of assessing health needs in general practice were investigated in three English districts. AIM: To identify the issues surrounding the potential for assessing health needs in primary care. METHOD: Postal survey of 347 general practices in three health authorities. Telephone interviews with a random stratified sample of 35 general practitioners. RESULTS: Although most practices identified assessing health needs as important, it is clear that this identification was typically based on an understanding of assessing needs as primarily focused on individual patient care, based on clinical priorities and involving practice held data. Most practices had not undertaken local consultation, whatever their understanding of assessing health needs. The few practices which had completed population oriented, proactive assessment of needs considered it to have led to tangible improvements in clinical or practice management. Overall, there was apparent confusion over the nature and purpose of assessing needs, although the principled aims and objectives of a population oriented, proactive component to primary care were generally upheld. The need for additional resources and support was identified. In four out of the five cases where specifically population based assessment of health needs had been undertaken, the local public health department had been involved. CONCLUSION: The value of the concept of assessing health needs in primary care holds considerable uncertainty and ambivalence. The findings from this study show that any attempts to promote assessing needs into primary care which focus either primarily or exclusively on the provision of "education" are unduly simplistic. More fundamental questions about the perceived relevance and opportunities for assessing health needs should be considered if primary care groups are to meet future commissioning challenges.

Community Health Planning↗
PubMed2006

A sociodental approach to assessing children's oral health needs: integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning.

OBJECTIVE: We adopted a sociodental approach to assess the real dental needs of Thai primary school children, and integrated an oral health-related quality of life measure (OHRQoL) into oral health service planning. We then compared the results of this sociodental assessment with standard estimates of a child's oral health needs. METHODS: We developed a new model of sociodental needs assessment and used it to assess the level of impact that various oral health conditions have on the everyday lives of school children. We then carried out a cross-sectional study of all grade-6 children (11-12 years old) in Suphan-buri Province, Thailand. We examined the sample (n = 1034) to assess the children's oral health and then we interviewed each child individually to assess what impact any dental conditions he or she may have on their quality of life. This assessment was done using an OHRQoL indicator, the Child Oral Impacts on Daily Performances index (child-OIDP). We integrated the results obtained using this indicator with those estimates obtained using more traditional, standard clinical methods, in order to generate a clearer picture of exactly which non-progressive dental conditions really needed treatment. These results take into account the impact those conditions have on the overall well-being of children and their ability to function normally and unimpeded. We were then able to prioritize their dental needs according to the severity of disruption caused in their daily lives. FINDINGS: Using standard or "normative" estimates of dental health care needs, the children's need was 98.8%. This level of need decreased signifi cantly to 39.5% when adopting the sociodental approach (P <0.001). Overall, per 100 children with a standard or normative need for dental treatment, only 40 had a sociodental need for treatment when taking into account the impact their condition has on their everyday lives. Children thus identifi ed as requiring treatment were further categorized according to the severity of impact their condition had: 7.2% had severe, 10.3% moderate and 22.0% had minor impacts on OHRQoL. CONCLUSIONS: There was a marked difference between the standard normative and the sociodental needs assessment approach, with the latter approach showing a 60% lower assessment of dental health care needs in Thai 11-12-year-old children. Different levels of "impacts" on daily life can be used to prioritize children with needs.

Child↗
PubMed2003

Treatment needs for dental caries in schoolchildren in Riyadh, Saudi Arabia. A follow up study of the oral health survey.

OBJECTIVE: To determine the magnitude and severity of treatment needs for dental caries of school children of Riyadh, Kingdom of Saudi Arabia (KSA), 14 years after the conduct of the Oral Health Survey (Phase I) (OHS (I)) in KSA. METHODS: Six hundred and two primary school first graders (primary school (PS)) (5-8 year-old) and 205 intermediate school first graders (intermediate school (IS)) (11-14 year-old) children were randomly selected, using stratified cluster random sampling, from schools of Riyadh, KSA during April 2001 to May 2001. All the children were examined for caries and treatment needs, using the World Health Organization criteria. RESULTS: Ninety-three percent of PS children required some type of restoration and 36.7% needed extractions. Ninety-five percent of IS children required restorations and approximately one-quarter were needed extractions. Amongst male PS children approximately 7 teeth needed one or more surface fillings, whereas 6 teeth of female PS children needed the same. Of the male IS children, 6.5 teeth needed one or more surface fillings, whereas 4 teeth of female IS children needed the same. These differences were all statistically significant. On average, one tooth of male children needed extraction, whereas approximately 0.7 teeth of female children needed the same. The difference was also significant. There were significant differences between urban and rural children for various types of treatment needs. However, nationality of the children did not show any significant effects on treatment needs. CONCLUSION: The results indicate that the treatment needs for dental caries have increased in schoolchildren of Riyadh significantly 14 years after the conduct of OHS (I).

Adolescent↗
PubMed1989

Children's human needs in intensive care.

Human needs can be considered as a framework for nursing care. The purpose of this study was to find out which human needs are relevant to nursing critically ill children. Yura and Walsh (1983) listed 35 basic human needs and their classification was used in this study. The shifting emphasis of the human needs of 30 children after open-heart surgery was compared during the operation day, the middle day and the last day in intensive care. The results were classified in six groups, depending on how the emphasis of the needs varied and how well the nurses were able to evaluate the human needs. The need for rest and leisure was the only need that became strongly emphasised during the whole period of intensive care. Some of the human needs became emphasised at the beginning or at the end of intensive care and some of the needs did not become emphasised at all in intensive care. Nurses were not able to assess some of the human needs. This study can be used as a pilot study for further research when trying to find out why certain needs become emphasised in critically ill children and how the needs can be met more effectively.

Adolescent↗
PubMed2001

Needs of carers of severely disabled people: are they identified and met adequately?

OBJECTIVE: To examine the unmet needs of informal carers of community dwelling disabled people and to compare their perspectives to those of disabled people and nominated professionals. It was hypothesised that a poor recognition of carers' needs could have implications for carers' well- being and thus their ability to maintain their caring role. Need was defined as a service or a resource that would confer a health or rehabilitation gain. DESIGN: Face to face interviews with carers and disabled participants, telephone interviews with professionals (Southern England). Disabled participants had been selected randomly from two disability registers. MAIN OUTCOME MEASURES: The Southampton Needs Assessment Questionnaire (carers version), SF-36 (carers' health status). RESULTS: Carers experienced similar health status to people in the general population. The most frequently carer-reported unmet needs were for short breaks, domestic help and respite care. Carers who had reported unmet need for short breaks had significantly poorer levels of mental health and vitality (SF-36) than carers who had not reported this. Similar numbers of unmet carers' needs were reported by disabled participants, professionals and carers themselves. In terms of type of unmet needs, poor concordance between carers and disabled participants occurred in 52% of cases: carers reported more unmet needs than disabled participants for short breaks and domestic help. Poor concordance scores between carers and professionals occurred in 59% of cases: carers reported more unmet needs for short breaks than professionals and professionals reported more unmet needs for formal respite care. CONCLUSION: In line with recent legislation, carers' needs must be independently addressed and services, especially for flexible community support such as short break services, must be developed specifically to meet the needs of carers. Further research is warranted to evaluate whether recent legislation for carers has any effect on carers' well-being and ability to cope with their caring role.

Adolescent↗
PubMedDate not supplied

Need priorities of adrenalectomy patients as perceived by patients, nurses, and physicians.

Patients in this study identified needs they considered important. Perceived need priorities of adrenalectomy patients need to be identified and met both pre- and postoperatively by health team members. Patient-centered nursing and medical conferences should be arranged to provide comprehensive patient care. Establishment of guidelines, based on need priorities perceived by the patient, will provide a master care plan which can assist nurses and physicians in meeting patient needs. These guidelines are important since patients need not only an immediate care plan, but also a long-term plan of care designed to meet individual needs and ever-changing problems of the long-term illness. The study findings show that patients, nurses, and physicians differ in their perception of need priorities of adrenalectomy patients. Nurses and physicians must take heed of patient concerns. Nurses, especially, must realize the needs of the patient in order to provide support, counseling, and education. The necessity for total awareness of patients' needs and perceptions is illustrated by one cancer patient's comments: "Although the disease was diagnosed early and responded successfully to treatment, there was a numbness and fear, the cold chills that accompanied the awareness of the diagnosis and later the altered perception of life, of friends and associates that grew out of the realization that death was never far away. "A human organism with a malignant neoplasm is more than a body with a disease. It is also a reacting individual who has feelings about his illness, and these feelings influence the way he perceives his medical personnel and utilizes his advice and care." It is important that all members of the health team acquire a better understanding of the various need theories and the importance of perceiving the needs of patients as the patient perceives them. In addition, it is essential for health team members to continually refer to the relevant literature concerning needs to improve the quality of total patient-family care.

Adrenalectomy↗
PubMedDate not supplied

Spiritual needs of dying patients: a qualitative study.

PURPOSE/OBJECTIVES: To identify dying patients' definitions of spirituality and their spiritual needs. DESIGN: Descriptive, qualitative. SETTING: Participants' places of residence. SAMPLE: 19 hospice patients (10 females and 9 males), mean age 72, with a range of length of time as a hospice patient of 2 weeks to 12 months. METHODS: Semistructured interviews were conducted. Interview transcripts and field notes were analyzed to reduce data into codes and themes. Data were coded by extracting verbatim phrases used to describe spirituality and spiritual needs. Themes emerged from the data as commonalities among the codes developed. MAIN RESEARCH VARIABLES: Meaning of "spiritual" and perceived spiritual needs. FINDINGS: Participants initially defined spiritual as relating to God or religion; however, as interviews progressed, it was apparent that their spirituality was a part of their total existence. Twenty-nine unique spiritual needs were identified and grouped into six themes: need for religion, need for companionship, need for involvement and control, need to finish business, need to experience nature, and need for positive outlook. CONCLUSIONS: Participants perceived spirituality as a broad concept that may or may not involve religion. Spiritual needs were likewise broad in scope and were linked closely to purpose and meaning in life. IMPLICATIONS FOR NURSING PRACTICE: Spiritual care of dying patients is within the scope of nursing practice. Spiritual needs are quite varied and encompass more than religion. If nurses are to enhance the quality of life of dying patients, spiritual needs must be addressed.

Aged↗
PubMed1992

Identifying the needs of home caregivers of patients with cancer.

Increasing numbers of patients with cancer are being cared for by home caregivers. The primary purpose of this methodologic, correlational study was to identify, categorize, and assess the importance of needs expressed by 492 home caregivers and to determine how well these needs were satisfied. Caregivers surveyed were selected from the records of two nonprofit community cancer agencies and two hospital outpatient oncology clinics in the Midwest. These individuals were identified by at-home patients with cancer as unpaid people who helped with physical care or coping with the disease process. Caregiver characteristics and patient activity were examined to determine their relationships to caregiver needs, and needs were examined over time. The 90-item Home Caregiver Need Survey used in this study was developed by the author in 1989 and demonstrated internal consistency, reliability, and construct validity. Using factor analysis, six need categories were identified: psychological, informational, patient care, personal, spiritual, and household. Caregivers' greatest needs were informational and psychological. Significant correlations between certain caregiver characteristics and caregiver needs and between caregiver needs and patients' activity levels were found. Both the importance and satisfying of needs changed over time. Findings indicate the urgent need for nurses, who usually provide support for caregivers, to establish specific programs and services to meet the identified and unmet informational and psychological needs of caregivers of at-home patients with cancer. Frequent reassessment of caregiver needs seems to be indicated.

Adolescent↗
PubMed1991

Critical care nurse perceptions of family needs.

Family needs research has for the most part focused on the families' perceptions when a significant other is admitted to the intensive care unit. We examined critical care nurse perceptions of family needs. The questionnaire "Needs of Families of Critically Ill Patients" was given to 126 intensive care unit nurses. The tool was an adaptation of Molter's questionnaire "Needs of Relatives of Critically Ill Patients." The revised tool examined nurse perception of family needs, perception of time available to meet the needs in daily practice, and the best professional to meet the family need if the need was identified as best met by someone other than the nurse. The majority of the nurses perceived family needs as important or very important, and 85% of the nurses indicated that they were able to meet family needs and had the time to do so. Cognitive family were ranked higher than psychologic or personal and physical needs. Nurses from the four intensive care units ranked family needs significantly differently, a result that may be influenced by differing patient acuity and patient length of stay on individual units. Nurses' perceptions of family needs were influenced by units worked, length of time practicing in critical care, educational preparation, and length of time in nursing.

Analysis of Variance↗
PubMedDate not supplied

Comparison of manifest needs of nurses and physicians in primary care practice.

Nurses, among other professionals, have been tested extensively using the Edwards Personal Preference Schedule. High scoring needs found in previous studies were order, deference, and endurance. In this study, questions focused on whether these needs remained prominent in a group of nurses, whether there were shifts in the need patterns over time, and how the nurses' needs compared with the needs of physicians. In this study 127 graduate nurses enrolled in a medical nurse practitioner program and 31 physician colleagues completed the EPPS. The rank order of needs among nurses was strikingly different from those collected in previous samples. Need for heterosexuality, dominance, intraception, change, and achievement consistently appeared highest since 1973, whereas need for deference, order, and endurance scored consistently among the lowest six needs. The rank-order correlation between nurses and physicians in this sample, all of whom were working in primary care settings, was high (r = .9). Only one of the 15 needs, intraception, differed significantly between the nurse and the physician groups, the nurses scoring higher. The shift in needs of the nurses and the high similarity of needs of the nurse and physician groups suggest an emerging assertiveness on the part of the nurses and a trend toward similarity of need patterns with physicians practicing in primary care.

Evaluation Studies as Topic↗
PubMedDate not supplied

Needs of relatives of critically ill patients: a descriptive study.

Relatives of critically ill patients were able to identify their needs during the intensive care phase of hospitalization. The universal need identified as very important was the need for hope. Other important needs were concerned with receiving adequate and honest information and feeling that the hospital staff members were concerned about the patient. Although several of the needs appeared to be of great concern to relatives, all the needs were considered very important by at least one relative. The majority of needs were perceived as being met consistently. Various resources were used by the relatives to meet their needs; however, specific needs were expected to be met by physicians and nurses. Since many relatives have similar needs, the use of a group process to deal with them should be investigated. A group process allows for sharing and support among the relatives and also allows one staff member to work with several relatives. The relatives perceived the role of health care personnel to be patientcentered only. If the patient is a member of a family, then the family and staff should recognize that the health care personnel are helping relatives because it is a crucial part of total patient care. This area in providing total patient care needs to be studied carefully. The relatives of critically ill patients have important needs in this crisis period. By recognizing these needs and evaluating how they are being met, total patient care will involve the family. Such involvement is essential to the care of the critically ill patient.

Adolescent↗
PubMed2006

Orthodontic treatment needs in the western region of Saudi Arabia: a research report.

BACKGROUND: Evaluation of self perceived and actual need for orthodontic treatment helps in planning orthodontic services and estimating the required resources and man power. In the present study, the perceptive need as evaluated by patients and the actual need to orthodontic treatment, as assessed by orthodontists, were evaluated at two types of dental practices in the city of Jeddah using the Index of Orthodontic Treatment Need (IOTN). METHODS: A consecutive sample of 743 adults seeking orthodontic treatment at two different types of dental practices in Jeddah; King Abdulaziz University, Faculty of Dentistry (KAAU) (Free treatment) and two private dental polyclinics (PDP) (Paid treatment), was examined for orthodontic treatment need using the dental health component (DHC) of the IOTN. The self-perceived need for orthodontic treatment was also determined using the aesthetic component (AC) of the IOTN. The IOTN score and the incidence of each variable were calculated statistically. AC and DHC categories were compared using the Chi-Square and a correlation between them was assessed using Spearman's correlation test. AC and DHC were also compared between the two types of dental practices using the Chi-Square. RESULTS: The results revealed that among the 743 patients studied, 60.6% expressed no or slight need for treatment, 23.3% expressed moderate to borderline need and only16.1% thought they needed orthodontic treatment. Comparing these estimates to professional judgments, only 15.2% conformed to little or no need for treatment, 13.2% were assessed as in borderline need and 71.6% were assessed as in need for treatment (p < 0.001). Spearman's correlation test proved no correlation (r = -.045) between the two components. Comparing the AC and the DHC between the KAAU group and PDP group showed significant differences between the two groups (p < 0.001). CONCLUSION: Patient's perception to orthodontic treatment does not always correlate with professional assessment. The IOTN is a valid screening tool that should be used in orthodontic clinics for better services especially, in health centers that provide free treatment.

Adolescent↗
PubMed2003

The needs of older people with mental health problems according to the user, the carer, and the staff.

BACKGROUND: Individual assessment of needs has been recognised as the most appropriate way to allocate health and social care resources. These assessments, however, are often made by the staff or by a carer who acts as an advocate for the user themselves. Little is known about how these proxy measures compare to how individual patients perceive their own needs. AIM: The aim of this study was to measure and compare ratings of need for older people with mental health problems by the older person themselves, their carer, and an appropriate staff member. METHOD: One-hundred and one older people were identified from various mental health services and 87 users, 57 carers, and 95 staff were interviewed using the Camberwell Assessment of Need for the Elderly (CANE) to identify met and unmet needs. RESULTS: Users identified significantly fewer of their needs (5.5) than either staff (8.1) or carers (8.3) did, but this difference was accounted for by people with dementia reporting less needs. Users identified fewer psychological or social needs (e.g. daytime activities, company, or carer distress) than staff or carers did. The average Kappa indicating level of agreement between staff and user was 0.52, between user and carer was 0.53, and between carer and user was 0.58. This showed only a fair level of reliability between different ratings of need. CONCLUSIONS: User perspectives should be given a high priority when assessing individual needs. Fears that assessment of need would be unduly time-consuming or would simply reflect individual demands should be allayed. A user-based assessment will assist healthcare providers to prioritise needs according to what the user themselves consider to be most important, beneficial, and acceptable to them. Reliance solely on assessment by staff or carers may not lead to the most equitable or appropriate use of services.

Aged↗
PubMed2001

The significant unmet needs of cancer patients: probing psychosocial concerns.

'Significant unmet needs' are those needs that patients identify as both important and unsatisfied. In this article we ask whether the overall needs of cancer patients are actually being met. We believe that the range of unmet need, and the kinds of patients who are more likely to claim unmet need, should be carefully identified. The needs responses of a series of 295 cancer patients in a cross-sectional survey were analysed. The majority expressed the opinion that information and good relationships with health care professionals were important, and few expressed dissatisfaction with these aspects of need. Similarly, needs items about support from family and friends were largely rated as important and satisfied. For a sizeable minority of patients, items of significant unmet need cluster around aspects of managing daily life, emotions, and social identity. The distribution of significant unmet needs is not random but is more likely to be experienced by patients who are younger, have a long-standing illness or disability, do not own/have use of a car, and/or have no religious faith. Furthermore, significant unmet needs relate to patients' ability to talk freely to a carer about the cancer, the degree to which the cancer interferes with social activities, and whether financial difficulties are experienced. Most of the significant unmet need is beyond the remit of services primarily designed for the treatment of disease. We consider whether multidisciplinary cancer teams can be expected to deal with all aspects of the cancer experience.

Activities of Daily Living↗
PubMed1993

Needs of recovering cardiac patients and their spouses: compared views.

Identifying the needs of patients and spouses following an acute cardiac event is an essential first step in the development of nursing interventions to facilitate couples' psychosocial adaptation. Therefore, the self-perceived needs of 49 couples were compared 5 months following the patients' hospitalization for an acute cardiac event (i.e. myocardial infarction or coronary artery revascularization). Both patients and spouses identified the need for information as being most important compared with all other needs; however, significant discrepancies were found in ratings between patients and spouses. Needs which spouses rated as having a high priority included receiving information about the patient's feelings during the recovery period, having time alone, talking with the patient about concerns, and receiving information about the expected psychological recovery. Patients did not consider these same needs as they related to their spouses particularly important. Rather, they rated the need for information about their condition, the need to have honest explanations, and the need to talk with a health professional about their problems as having the highest priority. Many of the needs that both patients and spouses ranked as being important or very important were unmet in 40-70% of the cases. In this study, both patients and spouses expressed similar needs for information, but the type of information that they wanted differed and, in the majority of cases, these needs were not met by nurses and physicians.

Adaptation, Psychological↗