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PubMed2005

Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study.

Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients' hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group (n=34) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group (n=32) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers' individual needs.

Adolescent↗
PubMed1996

The needs of relative visiting adult critical care units as perceived by relatives and nurses. Part I.

This was a descriptive study, aimed at identifying the needs of relatives while they were visiting adult critical care units. A convenience sample of 24 critical care units participated, involving 351 critical care nurses and 255 visiting relatives. Using an adaptation of Molter's Critical Care Family Needs Inventory, the objectives of the study were: To compare (in ranking order) relatives' perceptions of how important their needs were with how important critical care nurses perceived them to be. To identify how satisfied relatives were with how their needs were met, while visiting the unit. To compare who relatives perceived to be the most appropriate person to fulfill each of their needs, with who nurses assessed to be the most appropriate person to fulfill the relatives needs. Relatives highlighted the importance of re-assurance and their need for sufficient information about their family member. Critical care nurses were only moderately accurate in assessing how important relatives' needs were, according to the findings from this relatives' group. Relatives were 'satisfied' with how the majority of their needs had been met. Only 10 of the 30 needs were considered to have been met to 'very satisfactory' level by at least 60% of the sample group. Nurses were identified by relatives as being the most appropriate person to fulfil 19 out of the 30 needs. Whereas nurses perceived themselves to be the most appropriate people to fulfill 25 of the 30 needs for relatives. The implications for clinical practice are also discussed.

Adult↗
PubMed2000

Perceived need for mental health care, findings from the Australian National Survey of Mental Health and Well-being.

BACKGROUND: The Australian National Survey of Mental Health and Well-being was designed to detect and describe psychiatric morbidity, associated disability, service use and perceived need for care. The survey employed a single-phase interview methodology, delivering a field questionnaire to a clustered probability sample of 10,641 Australians. Perceived need was sampled with an instrument designed for this survey, the Perceived Need for Care Questionnaire (PNCQ). This questionnaire gathers information about five categories of perceived need, assigning each to one of four levels of perceived need. Reliability and validity studies showed satisfactory performance of the instrument. METHODS: Perceived need for mental health care in the Australian population has been analysed using PNCQ data, relating this to diagnostic and service utilization data from the above survey. RESULTS: The survey findings indicate that an estimated 13.8% of the Australian population have perceived need for mental health care. Those who met interview criteria for a psychiatric diagnosis and also expressed perceived need make up 9.9% of the population. An estimated 11.0% of the population are cases of untreated prevalence, a minority (3.6% of the population) of whom expressed perceived need for mental health care. Among persons using services, those without a psychiatric diagnosis based on interview criteria (4.4% of the population), showed high levels of perceived met need. CONCLUSIONS: The overall rate of perceived need found by this methodology lies between those found in the USA and Canada. The findings suggest that service use in the absence of diagnosis elicited by survey questionnaires may often represent successful intervention. In the survey, untreated prevalence was commonly not accompanied by perceived need for mental health care.

Adult↗
PubMed2001

Needs-led assessment: the challenges and the reality.

The NHS & Community Care Act 1990 heralded a new era in community care in the UK. Needs-led assessment and case management were to form the cornerstone of high quality care. Practitioners were challenged to alter their attitudes and practice to accommodate the needs-led approach. Previously they had assessed need to ascertain eligibility for statutory services, now they were required to identify "need" per se. The pivotal role given to assessment meant the success, or otherwise, of the reforms lay in part on the ability of practitioners to make this transition. However, to make needs-led assessment a reality, practitioners would have both to overcome conceptual barriers--need being an unclear concept, with no clear framework existing to assess need--and also to deal successfully with the conflicting requirement to ration services. In order to investigate whether the shift to needs-led practice had been possible, the opinions of social and healthcare practitioners providing services for older people in North Wales were sought through semi-structured interviews in 1994-1995 and 1998-1999. Supports and constraints to practice were also explored. Practitioners indicated that whilst they welcomed the needs-led philosophy, putting it into practice was difficult, if not impossible. The main constraints were a lack of resources (financial, service provision and staffing) and the conceptual difficulty of separating "need" from the "need for a particular service". Ever-tightening budgets and service eligibility criteria over the period of the study indicate that a shift of focus from assessment of need to rationing has taken place.

Aged↗
PubMed2001

An assessment of the patients' needs in mental health education.

AIM OF THE STUDY: The aim of this study was to identify the specific educational needs of Chinese patients with schizophrenia using a Chinese version of the Educational Needs Questionnaire. BACKGROUND: Patient education provides adequate clinical information to patients, increases understanding of their illness condition and encourages their health-promoting behaviour. A full understanding and satisfaction of patient needs in relation to specific illness has played an important part in the development of an education programme for psychiatric patients. However, psychiatric patients' perceptions of their specific educational needs and whether or not these needs are being met have seldom been explored for the purposes of optimizing the effects of patient education programmes. This study served the purpose of assessing the learning needs of Chinese patients with schizophrenia in Hong Kong. DESIGN: A cross-sectional survey was conducted in Hong Kong with 192 Chinese outpatients with schizophrenia. The principles for determining the equivalence of translated tools were applied to the development of the Chinese version of the questionnaire. RESULTS: Patients gave high importance to gaining information about mental illness, strategies for improving social relationships and solving daily problems. Socioeconomic factors including education level and membership in a mutual support group correlated significantly with need importance and the unmet-need score. Length of illness negatively correlated with need importance, indicating the adverse effect of illness on patients' interests in fulfilling needs. CONCLUSIONS: Assessment of mental health consumers' perceptions of their specific educational needs and tailoring patient educational curricula to the expressed needs appear essential. The importance of validity testing of a translated tool is also highlighted in this study.

Adult↗
PubMed2006

A socio-dental approach to assessing children's orthodontic needs.

Traditional methods of assessing orthodontic treatment need using mainly clinical measures are inadequate and would be improved by integrating normative, oral health-related quality of life (OHRQoL), and behavioural propensity measures. This study aimed to develop and test a socio-dental system of orthodontic needs assessment, and to compare normative and socio-dental estimates of orthodontic need. The socio-dental system integrates three types of need: normative need (NN), impact-related need (IRN) and propensity-related need (PRN). A cross-sectional survey of all 1,126 children aged 11-12 years in Suphanburi, Thailand, was carried out to test the new system. The dental health component of the Index of Orthodontic Treatment Need was used to assess NN, and the simplified oral hygiene index for oral hygiene status. Oral impacts were assessed using the child-Oral Impacts on Daily Performances (child-OIDP) index. A self-administered questionnaire recorded information on demographic and oral health-related behaviour. Treatment needs were assessed according to the developed socio-dental system. The socio-dental approach to assess orthodontic needs was easy to use and readily accepted by the children. The estimates of orthodontic need assessed normatively and socio-dentally differed markedly. The prevalence of NN and IRN was 35.0 and 10.5 percent, respectively, thus representing a reduction of approximately 70 percent in the volume of treatment need according to the new method. Children with IRN had different levels of propensity for orthodontic treatment, and therefore required appropriate treatment plans according to their PRN. Of the 10.5 percent with IRN, 6.9 percent had high or medium-high PRN, while 3.6 percent were at medium-low and low levels of propensity.

Child↗
PubMed2004

Unmet need for personal assistance services: estimating the shortfall in hours of help and adverse consequences.

OBJECTIVES: Perceived unmet need for personal assistance services (PAS) in activities of daily living (ADLs) and instrumental ADLs and its association with reduced hours of help received and with adverse consequences due to lack of help are examined for adults aged 18 and older using data from the 1994-1997 National Health Interview Survey on Disability. METHODS: A two-part multivariate regression model of the probability of PAS use and hours of help received was developed to control for need level, living arrangements, and other characteristics that may differ between persons with met and unmet needs and to determine the shortfall in hours associated with unmet need. RESULTS: Individuals with unmet need for personal assistance with two or more of the five basic ADLs have a shortfall of 16.6 hours of help per week compared with those whose needs are met. The relative shortfall is twice as great for persons who live alone as for those who live with others. People who live alone and have unmet needs fare worse than people with unmet needs who live with others, and both groups are more likely than those whose needs are met to experience adverse consequences, including discomfort, weight loss, dehydration, falls, burns, and dissatisfaction with the help received. DISCUSSION: Overall, just 6.6% of needed hours are unmet among the 3.3 million people needing help in two or more ADLs. We estimate the annual cost of eliminating unmet need among persons with incomes under 300% of the Supplemental Security Income level between 1.2 and 2.7 billion dollars for those living alone and from 2.2 to 7.1 billion dollars for those living with others.

Accidents↗
PubMed2003

Orthodontic treatment need and self-perception of 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools.

AIM: To determine the self-perception and need for orthodontic treatment in young sensory [visual (VI) and hearing (HI)] impaired children attending special schools in Riyadh, Saudi Arabia. Also, to determine if gender and social class background influence the rating and self-perception of malocclusion among the children. LOCATION: Riyadh, Saudi Arabia. DESIGN: A prospective study on orthodontic treatment need in sensory impaired children. SUBJECTS: Seventy-seven VI, 210 HI, and 494 control (C) children aged 11-16 years. METHOD: The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) was determined using the standard 10 pictures for the C group and HI with a modified version (tactile graphic) for VI. The dental health component (DHC) and AC of IOTN were used to allocate each child to no need, borderline need and definite need for treatment subgroups. RESULTS: Sixty-five per cent of VI, 21.8 per cent HI, and 18.7 per cent of the C were perceived to be in need of orthodontic treatment. However, 55.8 VI, 43 per cent HI and 34 per cent C were rated for treatment need based upon the AC. The difference between the examiner and the child's rating of treatment need was found to be statistically significant among the HI and control children (P < 0.001). CONCLUSION: The VI children who were scored for treatment by the examiner as having need for treatment had similar perceptions of their treatment need irrespective of their social background. Male VI children had a higher DHC score, but both VI and HI males had a higher normative and self-perceived need based on AC.

Adolescent↗
PubMed2003

Met and unmet needs of schizophrenia patients in a Spanish sample.

Deinstitutionalization of people with schizophrenia increases the importance of evaluating their needs. This study set out to identify the most common needs of people with schizophrenia who live in the community, analyze how those needs differ when evaluated by staff or by patients, describe the kind of help patients receive, and find out the variables that correlate with having unmet needs. A random sample of 231 outpatients with schizophrenia were evaluated with the Camberwell Assessment of Need and other predictor and outcome variables. Staff detected more needs than patients did. Mean number of needs as rated by patients was 5.36 and staff 6.6 (p < 0.001). Mean number of unmet needs was also greater when assessed by staff than by patients: 1.38 versus 1.82 (p < 0.001). The most frequently detected needs by patients involved psychotic symptoms, house upkeep, food, and information. Staff most often detected needs involving psychotic symptoms, company, daytime activities, house upkeep, food, and information. In a multiple regression model, needs were weakly associated with the clinical variables and quality of life. Needs assessment is complementary to clinical evaluation in schizophrenia.

Activities of Daily Living↗
PubMed2006

Assessment of need for psychosocial interventions in an Asian population of carers of patients with schizophrenia.

AIM: This paper reports on a study to establish the profile of need for psychosocial family interventions and to examine the concurrent validity of the Relatives' Cardinal Needs Schedule with an Asian population of carers in England, UK. BACKGROUND: Although psychosocial interventions for schizophrenia have a strong evidence base, little is known of the needs of Asian families. A cardinal need is indicative of the existence of a problem causing the carer a strain for which the carer is willing to co-operate if help is offered and for which systematic help has not been provided in the last 12 months. METHODS: The Relatives' Cardinal Needs Schedule was used to assess needs in a small randomly selected sample of Asian carers in one English locality and to compare the results with independent measures of patient symptoms and carer distress. RESULTS: Feedback from carers indicated that the Relatives' Cardinal Needs Schedule was culturally acceptable and appropriate to their needs. There was evidence for the validity of the assessment in that there were large and statistically significant associations between the number of needs detected by the Relatives' Cardinal Needs Schedule and independent measures of both carer distress (as measured by the 28 item General Health Questionnaire) and patient symptom severity (as reliably assessed from case notes). CONCLUSION: The Relatives' Cardinal Needs Schedule may prove useful for nurses and service managers in establishing the need for psychosocial family interventions amongst Asian families in the United Kingdom.

Adaptation, Psychological↗
PubMed2006

The patient's view of need and caregiving consequences: a cross-sectional study of inpatients with severe mental illness.

This cross-sectional study was conducted across inpatient facilities of a metropolitan mental health service in Sydney, Australia. Given shorter lengths of stay in acute inpatient facilities, it is important to ascertain differences between patients' and carers' perceptions of need and support in order to guide delivery of care in the community. The objectives were to: (1) assess the needs of patients recently admitted to hospital and ascertain the level of carer involvement while in hospital; (2) compare the degree of agreement between patients' and carers' perceptions of need and caregiver burden; and (3) determine the relationship between levels of need and carer burden prior to hospitalization. Over a 2-month period, consecutive patients (n = 200) were interviewed using the Camberwell Assessment of Need Short Appraisal Schedule and a modified version of the Involvement Evaluation Questionnaire to assess basic needs and patient perceptions of caregiver burden, respectively. Of the 200 patients interviewed, 68% (n = 135) identified a carer. Patients with schizophrenia had most met needs, those with affective disorders had most unmet needs and patients with other diagnoses recorded the lowest number of needs overall. The level of agreement between patient and carer perceptions of need was low, possibly because of confusion about the definition of need or different views about the support required to fulfil a need. Patients underestimated the consequences of caregiving, especially the impact of strained atmosphere, global burden, worrying about their future and encouragement to undertake an activity, indicating that carers were more burdened than patients perceived them to be.

Activities of Daily Living↗
PubMed2006

Needs of people with severe mental illness.

OBJECTIVE: This study reviews conceptual and methodological issues of needs for care among people with severe mental illness (SMI) and presents data on their prevalence, correlates and consequences for mental health care. METHOD: Focus is on the definition of the concept of need as what people can benefit from and its measurement by means of two instruments, the Needs for Care Assessment (NCA) and the Camberwell Assessment of Needs (CAN). RESULTS: The prevalence of needs among patients with SMI varies between 4 and 10, which appears to be rather unrelated to gender, age or education, but not to severity of symptoms, diagnosis or treatment setting. Important is the perspective of the beholder: patient and professional differ significantly from each other in the assessment of number of needs and their adequate fulfillment. One of two to four needs are unmet, in particular in the area of psychological distress, daily activities, social contacts and psychotic symptoms. Prevalence of unmet needs seems to be related to the system of mental health care and to socioeconomic circumstances as well: the less integrated and continuous care and the poorer the life situation, the more unmet needs. CONCLUSION: Unmet needs are a strong predictor of less favourable health perceptions and a lower quality of life. Needs are to a certain extent changeable, and thus amenable by treatment or mental health interventions. The prevalence of (un)met needs should be an outcome criterion for the evaluation of mental health service systems and for cross-cultural comparison.

Activities of Daily Living↗
PubMed2004

Identifying children with dental care needs: evaluation of a targeted school-based dental screening program.

OBJECTIVES: It has been suggested that changes in the distribution of dental caries mean that targeting high-risk groups can maximize the cost effectiveness of dental health programs. This study aimed to assess the effectiveness of a targeted school-based dental screening program in terms of the proportion of children with dental care needs it identified. METHODS: The target population was all children in junior and senior kindergarten and grades 2, 4, 6, and 8 who attended schools in four Ontario communities. The study was conducted in a random sample of 38 schools stratified according to caries risk. Universal screening was implemented in these schools. The parents of all children identified as having dental care needs were sent a short questionnaire to document the sociodemographic and family characteristics of these children. Children with needs were divided into two groups: those who would and who would not have been identified had the targeted program been implemented. The characteristics of the two groups were compared. RESULTS: Overall, 21.0 percent of the target population were identified as needing dental care, with 7.4 percent needing urgent care. The targeted program would have identified 43.5 percent of those with dental care needs and 58.0 percent of those with urgent needs. There were substantial differences across the four communities in the proportions identified by the targeted program. Identification rates were lowest when the difference in prevalence of need between the high- and low-risk groups was small and where the low-risk group was large in relation to the high-risk group. The targeted program was more effective at identifying children from disadvantaged backgrounds. Of those with needs who lived in households receiving government income support, 59.0 percent of those with needs and 80.1 percent of those with urgent needs would be identified. CONCLUSIONS: The targeted program was most effective at identifying children with dental care needs from disadvantaged backgrounds. However, any improvements in cost effectiveness achieved by targeting must be balanced against inequities in access to public health care resources.

Adolescent↗
PubMed2000

[Information needs of men with prostate cancer and their partners].

OBJECTIVE: To determine the need for information of men with prostate cancer and their spouses. DESIGN: Descriptive. METHOD: In February and March 1998 three questionnaires, especially developed for this study, were administered to 40 men treated for prostate cancer and 24 spouses in the Antoni van Leeuwenhoek hospital, Amsterdam, the Netherlands. The questionnaires concerned need for information and knowledge of prostate cancer. RESULTS: In general, patients and spouses indicated to want as much information as possible about prostate cancer and its treatment. Such needs decreased with increasing age. The need for medical-technical information was found to be higher than the need for psychosocial information. Spouses had significantly more need for information than patients, especially psychosocial information. This difference was partly related to age. The patients' needs for information were largely satisfied, while spouses indicated that their needs were often not met. General knowledge of prostate cancer of both patients and spouses was sufficient. CONCLUSION: Men with prostate cancer and their spouses had a substantial need for especially medical-technical information. Their needs decreased with increasing age. The need of spouses was higher than that of patients. Patients' needs were largely satisfied, whereas those of spouses were not always met. Psychosocial information in particular was inadequate.

Aged↗
PubMedDate not supplied

[Assessment of needs in schizophrenia patients].

BACKGROUND: To optimise appropriate planning of services, the care needs in patients with chronic mental illness, the organisms or individuals that cover these needs, and the relationships between specific needs and sociodemographic variables should be identified. This study was designed to assess needs in a population of persons with mental illness. METHODS: The Camberwell Assessment of Need (CAN) questionnaire was used to obtain and report quantitative information on needs. A total of 246 patients diagnosed as having schizophrenic disorder and 246 staff members of public mental health services, all living and working in the province of Granada (southern Spain, n = 187) or the city of Madrid (central Spain, n = 56), completed the questionnaire. Regression analysis was used to identify correlations between needs and sociodemographic variables. RESULTS: Mean needs score was 6.5; the most frequent needs were those related with daytime activities, company, psychotic symptoms, psychological distress, basic education and money management. The sociodemographic variables most closely associated with these needs were: not living with a life partner, low educational level, and receiving state benefits. The type of help these patients received was mainly from the family (informal help); public services (formal help) covered mainly clinical needs. CONCLUSIONS: The needs of persons with schizophrenic disorder do not differ from those of members of the more marginalised groups in Spanish society. Care provided by family members often represents a considerable burden on relatives.

Adult↗
PubMed2002

Mental health needs of boys in secure care for serious or persistent offending: a prospective, longitudinal study.

BACKGROUND: The mental health needs of children and adolescents in secure care are a matter of concern, but little systematic research has been done. Our aim was to assess the mental health, social, and educational needs of these young people in a prospective, longitudinal study. METHODS: We enrolled 97 boys aged 12-17 years who had been admitted to secure care. We assessed their needs (n=97) at the time of admission and 3 months later (n=90) with standardised interviews and psychometric tests. RESULTS: 26 (27%) boys had an intelligence quotient (IQ) of less than 70. The need for psychiatric help was high on admission to a secure unit, with the most frequent disorders being depression and anxiety. There were high rates of aggression, substance misuse, self harm, and social, family, and educational problems, and associated needs. The mean number of needs was 8.5 (SD 2.9) on admission and 2.9 (SD 2.4) after 3 months (mean difference 5.6, 95% CI 5.0-6.3). Areas in which needs were mostly met included education, substance misuse, self care, and diet. Areas where the frequency of need fell substantially, but remained high, were social and family problems, and aggressive behaviours. Psychological needs persisted, with new onsets of depression, anxiety problems, and post-traumatic-stress symptoms shortly after admission. The most frequently required interventions were psychological assessment and cognitive behavioural work. INTERPRETATION: Boys in secure care have many needs and a high rate of psychiatric morbidity. During the admission period, secure care units address some domains of need, but others remain unchanged or get worse. Psychological and psychiatric provision in secure units need to be improved.

Adolescent↗
PubMed2000

Growth and micronutrient needs of adolescents.

OBJECTIVE: This paper focuses on micronutrients in relation to needs throughout adolescence, a period which involved growth and development that occur through a complex interaction of genetic instructions, hormones and environmental influences, many of them of dietary origin. In the context of micronutrient 'needs' it is of special importance to differentiate between the 'nutritional needs' and 'metabolic needs'. Two main questions arise in relation to the micronutrient needs: (1) why are micronutrients necessary? and (2) how are their needs assessed? RESULTS: The 'necessary' amount will differ according to the objectives pursued: (a) to achieve a satisfactory rate of growth and development; and (b) to maintain 'optimal health'. The assessment of micronutrient needs and status has proved to be difficult, but when elucidating and establishing them, it is imperative to arrive at the estimates in the light of their interdependent role in metabolism and functions. The knowledge of micronutrient metabolic needs can be approached through epidemiological observations, bioavailability studies and clinical trials. However, there is a nearly total absence of reports on the particular metabolic and dietary needs of adolescents. CONCLUSION: Thus more studies are required in relation to the effect of features associated with adolescence on 'needs', evaluating their impact on bioavailability and turnover (storage and losses), and the interactions among micronutrients in the assessment of metabolic and nutritional needs. Another aim should be to establish static and functional indexes, reference values and cut-off points in adolescence, to be used in clinical and epidemiological studies. Future studies should focus on needs to determine those required to maintain 'optimal functions' and regarding the potential prevention of chronic adult diseases.

Adolescent↗
PubMed1998

Life-style related health promotion needs in oil refinery employees.

This report describes the screening procedure used in the assessment of health promotion needs in a group of oil refinery employees (n = 885). The aim of the study was to assess the life-style related health promotion needs before initiating an intervention programme study. The frequency of different health promotion needs and their distribution according to age, gender and employee group were examined, as well as the factors explaining different health promotion needs. The assessment was based on laboratory tests and questionnaires covering the target areas of physical activity and fitness, dietary habits, overweight, blood pressure, serum lipids, smoking, alcohol consumption, sleep, mental health, and musculoskeletal symptoms. Life-style related health promotion needs were frequent. Self-assessed health was strongly associated with health promotion needs in most of the ten target areas and also with the total number per person of areas with health promotion needs. Health promotion needs were also associated with such demographic variables as age, gender, basic education, and vocational training. If health promotion activities are provided to employees in a company, assessment of individual needs is necessary to find the employees with the greatest need of health promotion actions. This study presents one method of screening, although certain simplification is needed to make it fit into the daily routines. The contents of health promotion activities could also vary according to the differences related to age and gender observed in health promotion needs of the target population.

Adult↗