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PubMedDate not supplied

Primary care supports for children with chronic health conditions: identifying and predicting unmet family needs.

OBJECTIVE: To examine unmet needs among families of children with chronic health conditions treated in primary care settings and to identify predictors of these needs. METHOD: Primary care physicians referred 83 caregivers of children with chronic health conditions. Mothers completed the Family Needs Survey, as well as other measures of child and family functioning. RESULTS: Mothers reported a high prevalence and broad range of unmet family needs. The most frequent area of need was for information about services and ways to promote child health and development. Predictors of total number of family needs included demographic characteristics, ratings of social support, and appraisals of family burden. Predictors of specific types of family needs varied according to category of need. CONCLUSIONS: Innovative psychosocial intervention programs are needed in primary care settings to reduce family needs and promote child health. More intensive family supports may be indicated for those with minority-group or low socioeconomic status, limited social support, or high perceived burden.

Adolescent↗
PubMed2001

Long-term life quality and family needs after traumatic brain injury.

OBJECTIVES: This investigation assessed the life quality and long-term family needs of caregivers of persons with brain injury. DESIGN: Respondents completed the Virginia Traumatic Brain Injury Family Needs Assessment Survey. SETTING: Community-based sample. PARTICIPANTS: Respondents included 57 caregivers of persons with traumatic brain injury who were at least 4 years after injury and who resided in Virginia. Respondents ranged in age from 19 to 82 years and were primarily women and Caucasian. OUTCOME MEASURES: The Family Needs Questionnaire (FNQ) and quality of life questions. RESULTS: Results indicate diminished life quality after injury. With regard to family needs, Health Information (51.43%) and Involvement with Care (47.93%) needs were most often rated as met. Instrumental Support (31.52%) and Professional Support (28.38%) needs were most often rated as not met. CONCLUSIONS: Family needs and support systems for those needs change over time. This investigation provides evidence that unmet family needs extend well beyond the acute setting and that caregiver life quality diminishes over time. The importance of appreciating long-term family needs and other life quality issues should not be underestimated.

Adult↗
PubMed1997

Meeting the service needs of HIV-infected persons: is the Ryan White CARE Act succeeding?

To evaluate the success of the Ryan White CARE Act in meeting HIV-related service needs, we surveyed HIV-infected clients (n = 1,056) at San Francisco CARE-funded agencies. Most CARE clients were male (85.1%), 51.7% were nonwhite, 84.9% were uninsured or underinsured, and 43.9% had a most recent CD4+ count < 200 cells. The most common HIV risk groups were gay/ bisexual male noninjection drug user (IDU) (53.3%) and gay/bisexual male IDU (22.1%). Health care needs were high for medical (85.5%), dental (70.2%), and mental health care (69.7%); need for basic necessities was great for food (57.2%) and living expenses (55.5%). Unmet health care needs were common for dental care (41.0%), home health care (39.9%), and alternative therapies (38.6%); unmet needs for basic necessities were frequent for childcare (59.5%), household help (52.3%), and transportation (47.9%). Unmet needs for medical care (5.8%) and food (14.7%) were low. Poor persons, those with dependents, and gay/bisexual male IDUs had greater unmet needs. Women and racial/ethnic minorities did not consistently have greater unmet needs. The CARE Act is serving those it intended to reach, is successfully meeting two important service needs, and has equalized access to services for women and racial/ethnic minorities. Remaining unmet needs require continued funding and strategies to increase access to care.

Adult↗
PubMed2005

The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature.

AIMS AND OBJECTIVES: Insight into the needs and experiences of family members is an initial but necessary step in providing appropriate care for both family members and the patient. This literature review aims to structure the available scientific knowledge on needs and experiences of family members of intensive care unit patients with particular extension to coma patients. Qualitative as well as quantitative studies are discussed. METHOD: Literature review. RESULTS: Needs are divided into four categories: cognitive, emotional, social and practical needs. The need for accurate and comprehensible information that leaves room for hope is universal. Family members want to speak to a doctor every day about the condition of and the prognosis for the patient, and want a nurse to explain to them about the care, the unit, the equipment and what they can do for the patient during visiting hours. Family members place great importance on being called at home if the condition of the patient changes. Emotional needs as hope, reassurance and being able to remain in the vicinity of the patient are crucial. Family members always give priority to the welfare of their relative. In their confused state, they often do not get around to paying attention to themselves. Caregivers underestimate all of the needs of family members and do not do enough to meet these needs. RELEVANCE TO CLINICAL PRACTICE: Priority needs should be central in the nurses' approach of family members. The initiative for meeting the needs must be with the caregivers. Future, focused and well-designed qualitative research over a longer period of time could clarify the process that family members go through and explain the results of quantitative studies.

Adaptation, Psychological↗
PubMed1995

Perceived importance of needs expressed by parents of hospitalized two- to six-year-olds.

The study describes the needs of 34 parents, 12 fathers and 22 mothers, of hospitalized 2-6 year-olds in a Pediatric Hospital in Iceland. Subjects responded to 43 statements of possible needs during a child's hospitalization on a Likert-type scale based on their perception of the importance of items. The reliability coefficient was over 0.91 for all three parts of the instrument. Parents' perception of importance was significantly and positively correlated with their perception of how their needs were being met and with their request for help from the hospital to fulfil them. None of the statements were perceived to be unimportant. Items related to parents' need to trust nurses and doctors were consistently rated as very important. Items related to the need for information and needs related to other family members were consistently rated as lying between important and very important. Needs related to human and physical resources, and the need for support and guidance were in general rated lowest. Items related to the need to be trusted had a mean importance significantly (p < 0.01) lower for fathers. Although not exhaustive, the statements presented were found to be representative of the needs and concerns of parents during the hospitalization of their children.

Adult↗
PubMed2000

Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport.

OBJECTIVE: To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. METHODS: Developed protocols categorized patients as: 1) needs ambulance; 2) go to the emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on the application of the protocols, first responders and ambulance EMTs categorized patients at the scene prior to transport but did not change current practice. Ambulance reports were reviewed using a predetermined list of critical events that signified the need for an ambulance. RESULTS: The EMTs categorized 1,300 study patients as follows: 1,023 (79%) needed ambulance transport, 200 (15%) could go to the ED by alternative means, 63 (5%) could contact a PCP, 14 (1%) could be treated and released. Categorizations by a first responder and the transporting EMT were compared for 209 patients. Collapsing categories to "need ambulance/do not need ambulance" showed fair concordance (kappa = 0.51). Initially, 30 of 277 (11%) patients determined not to need an ambulance appeared to experience a critical event. After review, 23 patients had events that may not warrant advanced life support transport. Seven (3%) had critical events in the ambulance warranting ambulance transport. Most were miscategorized by the EMT. Overall sensitivity and specificity for identifying patients needing ambulance transport were 94.5% and 32.8%, respectively. CONCLUSIONS: From 3% to 11% of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.

Adult↗
PubMed1999

The association between needs and quality of life in an epidemiologically representative sample of people with psychosis.

The impact of meeting needs on quality of life in the severely mentally ill is investigated in this study. An epidemiologically representative sample of 133 patients meeting ICD-10 criteria for psychosis completed standardized instruments for measuring needs and quality of life. Covariance structure modelling was used to investigate the extent to which latent factors of met and unmet need were associated with latent quality of life. Patients rated about 0.7 more total (met plus unmet) needs than staff, mainly due to differences in rating unmet need. Patient ratings were more reliable than ratings by others of unmet need and quality of life. Both underlying unmet need and met need were negatively associated with underlying quality of life, but unmet need was the stronger relationship. The patient's perspective on their difficulties (especially their unmet needs) must be central to mental health care.

Adolescent↗
PubMedDate not supplied

Does meeting needs improve quality of life?

BACKGROUND: This study investigated the relationship between patient-rated unmet needs and subjective quality of life using routine outcome data. METHODS: 265 mental health service patients from South Verona were assessed using the Camberwell Assessment of Need, the Lancashire Quality of Life Profile, and other standardised assessments of symptoms, disability, function and service satisfaction. At 1-year follow-up, 166 patients were still in contact, of whom 121 patients (73%) were re-assessed. RESULTS: Higher baseline quality of life was associated with being male, a diagnosis of psychosis, higher disability, higher satisfaction with care, fewer staff-rated or patient-rated unmet needs, and fewer patient-rated met needs (accounting for 40% of the variance). Specifically, fewer baseline patient-rated unmet needs were cross-sectionally associated with a higher quality of life (B = -0.08, 95% CI -0.12 to -0.04). Apart from its baseline value, the only baseline predictor of follow-up QoL was patient-rated unmet need (B = -0.08, 95% CI -0.21 to -0.09), accounting for 58% of the variance in follow-up quality of life. Graphical chain modelling confirmed this association. CONCLUSIONS: The association between high numbers of unmet needs and low subjective quality of life appears increasingly robust across several studies. Future research will need to investigate whether changes in needs precede changes in quality of life. This study provides further evidence that a policy of actively assessing and addressing patient-rated unmet needs may lead to improved quality of life.

Disability Evaluation↗
PubMed2002

Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status.

OBJECTIVE: Policy discussions regarding the mental health needs of children and adolescents emphasize a lack of use of mental health services among youth, but few national estimates are available. The authors use three national data sets and examine ethnic disparities in unmet need (defined as having a need for mental health evaluation but not using any services in a 1-year period) to provide such estimates. METHOD: The authors conducted secondary data analyses in three nationally representative household surveys fielded in 1996-1998: the National Health Interview Survey, the National Survey of American Families, and the Community Tracking Survey. They determined rates of mental health service use by children and adolescents 3-17 years of age and differences by ethnicity and insurance status. Among the children defined as in need of mental health services, defined by an estimator of mental health problems (selected items from the Child Behavior Checklist), they examined the association of unmet need with ethnicity and insurance status. RESULTS: In a 12-month period, 2%-3% of children 3-5 years old and 6%-9% of children and adolescents 6-17 years old used mental health services. Of children and adolescents 6-17 years old who were defined as needing mental health services, nearly 80% did not receive mental health care. Controlling for other factors, the authors determined that the rate of unmet need was greater among Latino than white children and among uninsured than publicly insured children. CONCLUSIONS: These findings reveal that most children who need a mental health evaluation do not receive services and that Latinos and the uninsured have especially high rates of unmet need relative to other children. Rates of use of mental health services are extremely low among preschool children. Research clarifying the reasons for high rates of unmet need in specific groups can help inform policy and clinical programs.

Adolescent↗
PubMed1998

Variations in mental health needs and fee-for-service reimbursement for physicians in Ontario.

OBJECTIVES: The study examined the match between mental health needs and physician fee-for-service reimbursements for mental health care within age and gender groups and health planning regions in Ontario, Canada. METHODS: Indicators of need (mental disorder, reported disability, and self-rated mental health) from an epidemiologic survey of 9,953 Ontario household residents were compared with per capita reimbursement rates derived from an administrative data set containing all fee-for-service expenditures for mental health care paid by the provincial health plan. RESULTS: Few gender differences were found in overall need, but need varied significantly by age. Those in greatest need were adolescent males and females, who had rates of need from two to four times higher than older respondents. Regional variations in need were less evident. By contrast, per capita reimbursement showed marked gender differences, with rates for women generally twice the rates for men. Considerable variations in reimbursement were also found across age groups; these variations did not match variations in need. Highly urbanized areas had per capita reimbursement rates between two and four times the rates for less populated areas. CONCLUSIONS: Despite Ontario's universal-access health care system, notable discrepancies between need and resource use are evident for males, adolescents, and residents of less urbanized areas. Solutions require a combination of public education, provider training, attention to physician availability and practice patterns, and continuous monitoring of how resources are allocated relative to need.

Adolescent↗
PubMed1997

Support needs in the last year of life: patient and carer dilemmas.

The aim of this study was to identify needs for support and problems in the introduction of support to terminally ill patients and their carers. The design involved semistructured interviews with patients and carers as well as a survey of general practitioners' (GPs) views, and took place in GP practices and homes of patients in Cambridgeshire. The subjects comprised 43 terminally ill patients, 30 carers, 80 GPs and 13 of their GP partners. The main outcome measures were quantitative data about additional help required and qualitative data on reasons for reluctance to seek help. Needs for help with transport, personal care and housework were identified. Carers may also need reassurance from health professionals. The need for outside help may at times conflict with the need to preserve independence, dignity and familiar aspects of life. Sometimes carers may feel that there is need for more help, but that this conflicts with patients' wishes. There may also be reluctance to seek help because of a perceived lack of resources and professionals time. In conclusion, an increase in services is necessary but not sufficient to meet patients' needs fully. Services should be introduced in ways that help patients to preserve independence, dignity and familiar aspects of life. The perception of accessibility to health professionals may need to be improved. Carers' needs should be assessed separately from patients' needs.

Activities of Daily Living↗
PubMed2005

The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: a Canadian population-based survey.

OBJECTIVES: Prevalence estimates of mental disorders were designed to provide an indirect estimate of the need for mental health services in the community. However, recent studies have demonstrated that meeting criteria for a DSM-based disorder does not necessarily equate with need for treatment. The current investigation examined the relation between self-perceived need for mental health treatment and DSM diagnosis, with respect to quality of life (QoL) and suicidal ideation. METHODS: Data came from an Ontario population-based sample of 8116 residents (aged 15 to 64 years). The University of Michigan Composite International Diagnostic Interview was used to diagnose mood, anxiety, substance use, and bulimia disorder according to DSM-III-R criteria. We categorized past-year help seeking for emotional symptoms and (or) perceiving a need for treatment without seeking care as self-perceived need for treatment. We used a range of variables to measure QoL: self-perception of mental health status, a validated instrument that measured well-being, and restriction of activities (current, past 30 days, and long-term). RESULTS: Independent of subjects' meeting criteria for a DSM-III-R diagnosis, self-perceived need for treatment was significantly associated with poor QoL (on all measures) and past-year suicidal ideation. CONCLUSIONS: Self-perceived need for mental health treatment, in addition to DSM diagnosis, may provide valuable information for estimating the number of people in the population who need mental health services. The relation between self-perceived need for treatment and objective measures of treatment need requires future study.

Activities of Daily Living↗
PubMed1999

Health needs of lone elderly Chinese men with heart disease during their hospitalization.

Hospitalization is a unique health-illness transition for most elderly people. Whether the patient's health-related needs are met or not often influence his or her appraisal of quality of life during hospitalization. This qualitative study explored the health needs of elderly Chinese male cardiac patients during their hospitalization. Eighteen subjects were recruited from a veterans' hospital in northern Taiwan. These men all lived alone before their hospital admission. Data were gathered using semistructured interviews and then analysed by content analysis. Ninety-four per cent of the subjects described up to three categories of needs: met needs (72%), unmet needs (78%), and expected needs (50%). Needs that participants believed were met were those for psychological support, spiritual support, tangible support and information. Unmet needs were those for participation in decision making, maintaining daily activities and resuming a preadmission lifestyle. The expected needs included those for learning self-care strategies to maintain their daily activities after discharge from the hospital. The factors that framed the participants' perceptions of different health needs were identified to be lack of family support and locus of control. Finally, a discussion of the context background of this phenomenon, as well as some suggestions for its implications, are provided from a culturally sensitive ethical aspect.

Aged↗
PubMed2005

Needs of ambulatory patients with cancer who visited outpatient units in Japanese hospitals.

PURPOSE/OBJECTIVES: To document the domains and properties of the self-reported needs of ambulatory patients with cancer. DESIGN: Descriptive. SETTING: Outpatient units in three general hospitals in Japan. SAMPLE: 139 ambulatory patients with cancer. METHODS: The data were collected using questionnaires. Five theoretical groups, which were composed of 30 items, were extracted empirically as domains. Alpha coefficients for each domain ranged from 0.70-0.89. Relationships between each domain and other variables and among the domains themselves were examined. MAIN RESEARCH VARIABLES: Expressed needs of ambulatory patients with cancer, their backgrounds, medical and treatment characteristics, and physical functioning. FINDINGS: All domains for patient needs, except for healthcare needs, were negatively correlated with the level of their physical function. Emotional, physical, and functional needs were positively correlated with the frequency of visiting an outpatient unit. Compared with other needs, adaptation needs were greater for patients who were employed or within three months of discharge. Among patients with one of three cancer sites (i.e., breast, stomach, and colorectal cancers), the needs for individualized care were the lowest for patients with colorectal cancer and highest for patients with breast cancer. CONCLUSIONS: From the needs that ambulatory patients with cancer expressed, five domains were derived. Those domains had relationships with other variables. IMPLICATIONS FOR NURSING: The findings shed light on a segment of ambulatory cancer nursing and may be useful when developing and testing programs needed in the future.

Female↗
PubMed2006

Identifying bioethics learning needs: a survey of Canadian emergency medicine residents.

OBJECTIVES: Emergency medicine (EM) postgraduate training programs must prepare residents for the ethical challenges of clinical practice. Bioethics curricula have been developed for EM residents, but they are based on expert opinion rather than resident learning needs. Educational interventions based on identified learning needs are more effective at changing practice than interventions that are not. The goal of this study was to identify the bioethics learning needs of Canadian EM residents. METHODS: A survey-based needs assessment of Canadian EM residents was performed between July 2000 and June 2001. Residents were asked to identify their learning needs by rating bioethics topics and by relating their clinical experiences. Physicians and nurses who work with residents were surveyed in a similar manner and also asked to identify the residents' bioethics learning needs. RESULTS: A total of 129 EM residents (77% of eligible residents), 94 physicians, and 87 nurses responded. Residents, physicians, and nurses all identified issues in end-of-life care as the greatest bioethics learning needs of the residents. Other areas identified as learning needs included negotiating consent, capacity assessment, truth telling, and breaking bad news. A learning need identified by nurses, but not residents, was the manner in which residents interact with patients and colleagues. CONCLUSIONS: This needs assessment provides valuable information about the ethical challenges EM residents encounter and the ethical issues they believe they have not been prepared to face. This information should be used to direct and shape ethics education interventions for EM residents.

Bioethics↗
PubMed1992

Health needs of a suburban community: a nursing assessment approach.

Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind. A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being. Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviors in the population. The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. Public health services are in a state of crisis in many states. Traditional program offerings may no longer be the key to providing the types of services most needed by some communities. Analysis of data on problems related to personal and family well-being in one upper middle class suburban community indicate a need for health promotion and services focused on many of the psychosocial aspects of health. The stress experienced by younger community residents appears to be related to issues of parenting and balancing the dual roles required at work and home. Families of elders are also confronted by issues concerning the decreasing independence of these individuals and the need to find additional support services for them. Community health services must be designed that take these factors into account. Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future.

Adult↗
PubMed1997

The need and demand for orthodontic treatment in 13- to 15-year-olds in Nairobi, Kenya.

The need for orthodontic treatment in Kenya was previously not been investigated. This study was undertaken to assess the need for orthodontic treatment in 13- to 15-year-old children in Nairobi. The objective need was assessed in 919 children by using the Norwegian treatment need index, and the subjective need was assessed in 739 children by using a structured questionnaire. Objective treatment need was recorded in 29% and subjective need in 33% of the children. Less than 1% were allocated the 'very great need' category. Relatively more girls than boys were dissatisfied with the appearance of their teeth, and a significantly higher number of girls (P < 0.001) said they would like to have their teeth straightened. The children's perceived need for treatment correlated significantly with the treatment need index. Fixed appliances were found necessary for correcting malocclusion in 23% of the children and removable appliances in 6%. Future studies in Kenya should be directed at determining the societal perception of malocclusion, upon which treatment standards may be based.

Adolescent↗
PubMed2006

[Knowledge and learning needs related to cancer treatment in gynecological cancer patients].

PURPOSE: This study was to investigate the knowledge and learning needs of chemotherapy in gynecological cancer patients. METHOD: The subjects consisted of 103 gynecological cancer patients receiving chemotherapy from April 2005 to August 2005. Data was collected using a questionnaire about knowledge and learning needs of chemotherapy. The data was analyzed by t-test, ANOVA, Scheffe test, and Pearson's correlation coefficient using SAS. RESULT: Average scores of knowledge and learning needs of general treatment and care were 2.74, and 3.30 respectively. Average score of knowledge and learning needs of chemotherapy were 2.54, and 3.23 respectively. Learning needs of general treatment and care and of chemotherapy were significantly different in relation to marital status, educational level, family support, the operation, and the amount of chemotherapy received. Items with the highest level of learning needs were the symptoms of recurring illness of general treatment, and minimizing side effects of chemotherapy. There were a negative correlation between knowledge and learning needs on general treatment and a positive correlation between knowledge and learning needs on chemotherapy but there were not significant statistically. CONCLUSION: The level of learning needs related to cancer treatment was high, whereas, that of knowledge was low. Therefore, when designing an educational program for gynecological cancer patients, understanding of learning needs is necessary. Also, consideration of a patient's characteristics, and a systematic and detailed educational program should be provided.

Adult↗