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PubMed1995

Registered nurses' perceptions of gerontological continuing education needs in the United Kingdom and in the USA.

This descriptive research was conducted to determine perceived gerontological continuing education needs and priorities in the United Kingdom. The data collection questionnaire utilized was developed and previously implemented with gerontological registered nurses in the US. Findings and similarities from both samples are discussed. In the British study, a convenience sample of 123 gerontological registered nurses participated in the study. In the US study, a statewide random sample of 152 gerontological nurses and a purposive sample of 10 nurse experts completed surveys by post. All respondents were asked to rate either personal educational need or to rate the needs of nurses in general. In both the US and UK a degree of need was indicated for every topic on the survey, with little concensus of the top priorities. t-Test analysis (P < 0.05) revealed significant differences between general and personal perceptions for 75% of the topics in the UK study and 57% of the topics in the US study. A noteworthy finding in both studies was the consistent perception that educational need was greater for nurses in general than for personal need. The high level of identified need for educational preparation and the diverse perceptions regarding priorities, along with disparity in the personal versus general educational need, supports the need for future research to refine needs assessment strategies which may require a variety of strategies.

Adult↗
PubMedDate not supplied

Reliability and validity of the Critical Care Family Needs Inventory in a Dutch-speaking Belgian sample.

OBJECTIVE: The purpose of the study was to provide psychometric evaluation of the Dutch version of the Critical Care Family Needs Inventory. SETTING: The study took place in an intensive care unit of a university hospital. PARTICIPANTS: The participant group included 200 adult family members visiting a patient within the 72-hour interval after admission to the intensive care unit. RESULTS: Principal factor analysis with varimax rotation resulted in a 5-factor solution distinguishing 5 need types: need for information, need for comfort, need for support, need for assurance and anxiety reduction, and need for proximity and accessibility. The internal consistency of the resulting subscales ranged from 0.80 to 0.62, and all factors were significantly related to each other. The Critical Care Family Needs Inventory subscales were found to be clearly related to the demographic variables age, sex, and education level. CONCLUSION: The reliability and validity of the Dutch-language Critical Care Family Needs Inventory as a diagnostic tool in family needs assessment are supported.

Adult↗
PubMed1992

Plasma exchange therapy reduces the nursing care needed in Guillain-Barré syndrome.

The authors compared the effect of plasma exchange therapy on the need for nursing care for 26 patients with acute idiopathic Guillain-Barré syndrome. The patients were randomized either to a plasma exchange (PE) or conservative treatment group. The need for nursing care and the need for specialist nursing services was assessed daily by the nurses at the Department of Neurology. At first, the average need for care was the same for the two groups of patients, but the pattern of care over time was different, with the PE group needing more care at the beginning and then very much less care, whilst the conservative group needed a more uniform amount of care over the entire stay at hospital. In the PE group the need for specialist nursing services increased markedly, and the need for nursing care decreased rapidly after the first 2 weeks to a level lower than that needed by control group patients, probably because PE increased muscle forces of patients. This study suggests that PE treatment is useful in reducing patients' needs for nursing care, especially after the first 2 weeks following the treatment.

Adult↗
PubMed1984

The needs of hospice patients and primary caregivers.

It would appear that hospice care providers in the program investigated here are highly accurate in their perceptions of their clients' needs. The program therefore is in an excellent position to accomplish its goals. However, findings also suggest that nurses are most accurate in their perceptions of social, emotional, and physical needs. They don't do as well in estimating the importance of material needs, such as financial and legal concerns. Nurses are also more likely to misperceive the importance of religious and spiritual needs. Hospice programs might consider implementing a structural mechanism to assist nurses in the task of understanding these patient and family concerns. Encouraging nurses to routinely inquire about the need for assistance with these issues is one potential remedy. Specific in-service training to teach nurses how to cue in on material and religious needs may also be beneficial. Another approach would be to further integrate staff persons who have specific training in understanding these types of needs into hospice programs. Attorneys, financial consultants, and clergy may need direct contact with patients and families rather than being called into a specific case only after nurses identify the need. Another implication of these results stems from the finding that nurses' perceptions become more similar to caregivers over time. This is particularly true for the assessment of patients' needs. Previous research shows that a substantial proportion of patients do not enter hospice until a few days prior to their deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed2004

Supportive care needs of parents of children with cancer: transition from diagnosis to treatment.

PURPOSE/OBJECTIVES: To analyze research related to the pediatric oncology population supportive care needs from diagnosis to treatment. DATA SOURCES: Articles published from 1992-2002. DATA SYNTHESIS: 49 studies were included. All six categories of the Supportive Care Needs Framework were found, with most studies addressing one to three of the need categories. Informational (88%) and emotional (84%) needs were identified most frequently. CONCLUSIONS: No one study examined the entire range and types of supportive care needs from diagnosis to treatment. This knowledge is key to planning appropriate care and services. Future research should be directed at understanding the full constellation of needs encountered by parents during this time. Further refinement of the Supportive Care Needs Framework is required to fully define the categories of need. IMPLICATIONS FOR NURSING: Although more research is required, supportive care that focuses on informational and emotional support appears to be most important from diagnosis to treatment. Using a conceptual framework such as the Supportive Care Needs Framework provides a methodology for planning care based on needs.

Adolescent↗
PubMed2002

Perceived addiction treatment needs among alcohol using injection drug users.

Hazardous drinking is common among active injection drug users (IDUs). This report examines: (1) the perceived alcohol and drug treatment needs of a cohort of IDUs, and (2) whether perceived needs predict treatment entry. One hundred and eighty-seven AUDIT-positive (> or = 8), active IDUs were recruited between 2/98-10/99 for the Brief Alcohol Intervention for Needle Exchangers (BRAINE) trial. At entry, about 18% of participants perceived no need for substance abuse treatment, 52% for drug treatment alone, 26% for drug and alcohol treatment, and only 3% a need for alcohol treatment only. Very high levels of drinking and adverse drinking consequences were observed among those perceiving no need for treatment of alcohol problems. Perceived need for alcohol treatment was positively associated with measures of adverse drinking consequences and DSM-IV diagnosis for alcohol dependence. Persons who at baseline perceived the need for alcohol treatment were more likely to enter alcohol treatment at 6-month follow-up than those without a perceived need (20% vs. 5%; p = .006). We conclude that IDUs with co-occurring alcohol-use disorders perceive alcohol treatment needs as less immediate than drug treatment. Because perceived need predicts treatment entry, changing alcohol treatment perceptions in IDUs promises the potential of significant long-term public health benefits.

Adult↗
PubMed2004

The role of perceived need within the theory of planned behaviour: a comparison of exercise and healthy eating.

OBJECTIVES: This study examined the effect of perceived need on exercise and healthy eating using the theory of planned behaviour (TPB). In addition, it investigated the determinants of perceived need. METHOD: Participants completed a questionnaire measuring components of TPB and perceived need. A follow-up questionnaire 1 week later measured behaviour. The questionnaires were completed by e-mail. The initial questionnaire was completed by 331 adults, and 286 follow-up questionnaires were returned. RESULTS: Perceived behavioural control was the main predictor of exercise intention and affective attitude was the main predictor of healthy eating intention. Perceived need significantly contributed to the prediction of healthy eating intention but not to exercise intention. Intention and perceived behavioural control predicted actual behaviour but perceived need did not. Reasons reported for the perception of needing to engage in both behaviours mainly focused on physical health and weight control. CONCLUSIONS: Reasons reported for low perceived need suggest that the concept of perceived need may be rather ambiguous, particularly in the case of exercise. Therefore, further research is needed to elucidate the role of perceived need in relation to a variety of health behaviours.

Adult↗
PubMed2000

Access to health care for children with special health care needs.

OBJECTIVE: To assess the role health insurance plays in influencing access to care and use of services by children with special health care needs. METHODS: We analyzed data on 57 553 children younger than 18 years old included in the 1994-1995 National Health Interview Survey on Disability. The survey obtained information on special health care needs, insurance status, and access to and use of health services. Bivariate and multivariate analyses were used to assess the association of insurance with several measures of access and utilization, including usual source of care, site of usual care, missed or delayed care, and use of ambulatory physician services. RESULTS: Using the federal Maternal and Child Health Bureau definition of children with special health care needs, we estimate that 18% of US children under 18 years old had an existing special health care need in 1994-1995. An estimated 89% of these children had some form of health insurance coverage, most often private health insurance. Insured children were more likely than uninsured children to have a usual source of care (96.9% vs 79.2%). Among those with a usual source of care, insured children were more likely than uninsured children to have an identified regular clinician (87. 6% vs 80.7%). Insured children were less likely to report unmet health needs, including medical care (2.2% vs 10.5%), dental care (6. 1% vs 23.9%), prescriptions, and/or eyeglasses (3.1% vs 12.3%), and mental health care (.9% vs 3.4%). Insured children were also more likely to have a physician contact in the past year (89.3% vs 73.6%) and have more physician contacts on an annual basis (8.5 vs 4.1 contacts). Unexpectedly, no differences were found between insured and uninsured children in availability of after hours medical care (evenings and weekends) or satisfaction with care. We also found some modest differences in access between publicly and privately insured children. Privately insured children were more likely to have a usual source of care (97.6% vs 95.3%) and a regular clinician (91.0% vs 81.1%). Privately insured children were also less likely to report dissatisfaction with care at their usual site of care (14. 9% vs 21.0%) and have access to care on evenings and weekends (6.8% vs 13.4%). No substantial differences were found between privately and publicly insured children in prevalence of unmet health needs or delays in obtaining care due to cost. CONCLUSIONS: This study illustrates the importance of health insurance for children with special health care needs. Continued efforts are needed to ensure that all children with special health care needs have insurance and that remaining access and utilization barriers for currently insured children with special health care needs are also addressed.

Adolescent↗
PubMed2006

Achieving family and provider partnerships for children with special health care needs.

BACKGROUND: During the past 2 decades, family-centered care has evolved as the standard of care for children with special health care needs. A major principle of family-centered care is a strong partnership between the family and provider, working together to address issues and barriers to accessing comprehensive care and related services. The federal Maternal and Child Health Bureau defines a positive family-provider partnership as a core program outcome. Our objective was to assess the extent to which families of children with special health care needs feel as though they are treated as partners in decision-making by their doctors. METHODS: We analyzed the 2001 National Survey of Children With Special Health Care Needs, a nationally representative telephone survey of caretakers for 38,866 children with special health care needs. Bivariate and multivariate statistical methods were used to assess the frequency of meeting the partnership core outcome, as well as the demographic and socioeconomic predictors of meeting core outcome. We also examined the effect of partnership on indicators of access and well-being for children with special health care needs. RESULTS: Among children with special health care needs, 85.8% of families reported usually or always feeling like a partner in their child's care. However, living in poverty, minority racial and ethnic status, absence of health insurance, and depressed functional ability placed children with special health care needs and their families at elevated risk of being without a sense of partnership. We found that sense of partnership was associated with improved outcomes across a number of important health care measures, including missed school days, access to specialty care, satisfaction with care, and unmet needs for child and family services. CONCLUSIONS: Results of the survey demonstrated that whereas most families of children with special health care needs feel they are partners in the care of their child, further work is needed, particularly for poor, uninsured, and minority children, as well as those with functional limitations. The survey results also demonstrate the importance of partnership; children whose care met the partnership core outcome experienced improved access to care and well-being.

Adolescent↗
PubMed1997

Need probability affects retention: a direct demonstration.

Recent memory theory has emphasized the concept of need probability--that is, the probability that a given piece of learned information will be tested at some point in the future. It has been proposed that, in real-world situations, need probability declines over time and that the memory-loss rate is calibrated to match the progressive reduction in need probability (J.R. Anderson & Schooler, 1991). The present experiments were designed to examine the influence of the slope of the need-probability curve on the slope of the retention curve. On each of several trials, subjects memorized a list of digits, then retained the digits in memory for 1, 2, 4, 8, or 16 sec. Some trials ended with a recall test; other trials ended with the message, "no test." In Experiment 1, the likelihood of encountering a memory test (i.e., the need probability) was made to either increase or decrease as the retention interval increased; in Experiment 2, need probability either was flat (invariant across retention intervals) or decreased as the retention interval increased. The results indicated that the shape of the need-probability curve influenced the slope of the retention curve (Experiment 1) and that the effect became larger as the experimental session progressed (Experiment 2). The findings support the notion that memory adapts to need probabilities and that the rate of forgetting is influenced by the slope of the need-probability curve. In addition, all of the forgetting curves approximated a power function, suggesting that need probability influences the slope but not the form of forgetting.

Educational Measurement↗
PubMed2004

From patient data to information needs.

The goal of this paper is to contribute to the improvement of the quality of care. For physicians, it is a problem that they are often not aware of gaps in their knowledge and the corresponding information needs. Our research aim is to resolve this problem by formulating information needs automatically. Based on these information needs, patient-specific literature can be retrieved. As a first step, we investigate how to model a physician's information needs. Thereafter, we design and analyse an approach to instantiate the model with patient data, resulting in information-need templates that are able to represent patient-specific information needs. Our experiments show that a physician's information needs can be modelled adequately and can be substantiated into patient-specific information needs. Since the number of formulated information needs is rather high, future research will focus on methods that restrict the set of automatically formulated information needs to a more specialized set.

Information Storage and Retrieval↗
PubMed1985

[Abnormalities of the sensation of the need to urinate in multiple sclerosis. Clinical and urodynamic study. Apropos of 100 cases].

A hundred patients with multiple sclerosis and urinary disorders were examined clinically and by gas or water cystometry. Particular attention was paid to abnormalities in the voiding need sensation. These abnormalities can best be studied by cystometry combined with urethral striated sphincter electromyography. When the sequence of the three degrees of need (usual need, pressing need and urgent need) is respected, there is a good correlation between the progression of the voiding need during the filling phase of the cystometry and during the detrusor action. When there is interference with the sequence of these three degrees of the voiding need, especially the absence of the sensation normally contemporaneous with the detrusor action or immediately preceding it, there is exaggeration of either the hyperactivity or the hypoactivity of the bladder, and this aggravates vesical sensitivity: premature contraction of the detrusor muscle eliminates the first two degrees (usual need and pressing need), while progressive distension of the detrusor muscle eliminates all three stages. As the multiple sclerosis evolves a stage is reached at which there are functional mictional disorders exclusively connected with the interference with the degrees of voiding need pollakiuria and urgency.

Adult↗
PubMed2006

The Camberwell assessment of need as an outcome measure in routine mental health care.

BACKGROUND: Subsidiary findings in several studies indicate that the standard summary scores (total number of needs, met needs and unmet needs) of the Camberwell Assessment of Need (CAN) may conceal important differences among patient populations at the item level of the measure. The aim of this study was to investigate whether changes in need and need status at the item level are adequately reflected by changes in the summary scores. METHODS: In a longitudinal design assessments of need in 1997 and 2003 of 192 outpatients (mean age 45.4 years, 78.1% psychotic disorders) in routine mental health care were compared. RESULTS: None of the summary scores changed between 1997 and 2003. This result, however, was contradicted by significant changes in needs at the item level. CONCLUSIONS: The summary scores conceal changes in need on the underlying items and thus is recommended not to be used as dependent measures when comparisons among populations or between points in time are of interest.

Female↗
PubMed2006

Reducing the unmet needs of patients with colorectal cancer: a feasibility study of The Pathfinder Volunteer Program.

GOALS OF THE WORK: Many cancer patients experience unmet needs and elevated levels of anxiety and depression. This paper describes a volunteer-delivered intervention to reduce the psychosocial needs of cancer patients and presents findings from a feasibility study of this intervention. MATERIALS AND METHODS: The telephone-based intervention, called the Pathfinder Program, involves the assignment of volunteers to patients to assist them in addressing their needs as identified in questionnaires. Fifty-two patients with colorectal cancer were involved in the feasibility study, with 18 in the intervention. Sixty-two percent of the sample was male and the mean age was 64 years. Patients' needs were assessed using The Supportive Care Needs Survey, a colorectal cancer symptom checklist, and the Hospital Anxiety and Depression Scale. All patients completed baseline questionnaires (Time 1) and 47 completed Time 2 questionnaires 3 months later. MAIN RESULTS: The most common needs were fear of the cancer spreading and returning, concerns about the worries of others, gas or wind, changes in weight, and bowel problems such as diarrhea, constipation, and pain. A statistically significant Time 1 to Time 2 decrease in supportive care needs and depression was found for the intervention group. CONCLUSIONS: The Pathfinder Program has been found to be feasible, acceptable for patients, and has the potential to reduce needs and depression. A larger, randomized controlled trial is needed to determine the impact of this program on colorectal symptoms and anxiety.

Adaptation, Psychological↗
PubMed2001

Australian general practice and the meeting of needs for mental health care.

BACKGROUND: This report, drawing on a national epidemiological survey conducted in 1997, examines the role of Australian medical general practitioners (GPs) in responding to needs for mental health care. METHODS: We analysed data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB). The NSMHWB employed clustered probability sampling of all Australian adults, and 10,641 participants were interviewed. The field questionnaire included modules of the Composite International Diagnostic Interview, and instruments assessing disability, service utilisation and perceived needs for care. RESULTS: Eighty-four percent of people with a mental disorder consulted a GP in the year prior to survey, but only 29% consulted in relation to a mental health problem. GP services were seen as more responsive to needs for medication, counselling and information than needs for social interventions and skills training. People with perceived needs for counselling were more likely to consult with other providers, either as alternative or additional consultations to those with a GP. Counselling needs were reported as less well met when people saw a GP alone than when consulting other service providers. CONCLUSIONS: Many people with mental health problems attend primary medical care practitioners without presenting these problems to their physicians. When they do present, perceived needs for medication are rated as well met, but there is substantial unmet perceived need for interventions in social and occupational domains. Perceived needs for counselling are less well met where the GP is the sole provider. To close these identified gaps calls for improvements in primary care physicians' skills and effective collaborative models with other providers.

Adult↗
PubMed2005

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.

INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.

Community Participation↗
PubMed1997

Adolescents report their need for and use of health care services.

PURPOSE: The goals of this study were to describe student access to health care services, identify populations of students who remained in need of health care services, and highlight particular unmet needs for health care identified by these adolescents. METHODS: Students in Grades 9-12 attending 50 schools in Oregon completed the Youth Risk Behavior Surveillance Survey (YRBS). Questions requesting adolescents to report their need for specific types of health care, and access to general and specific types of care were added to the core YRBS. Multivariate logistic regression analysis was used to determine independent relationships between student or community characteristics and health care access or unmet needs for care. RESULTS: Almost 14,000 adolescents completed surveys, of whom 75% reported visiting one or more health care provider within the last 12 months. Nineteen percent of adolescents reported that they had not received 1 or more of 10 specific types of care when needed in the last year. Females, some racial/ethnic minorities, rural, and sexually active adolescents were more likely to report unmet needs for health care. Most frequently, adolescents reported they needed but did not receive care for an illness (7%) or for personal or emotional problems (6%). In addition, about 400 (3%) students reported they needed birth control that they did not receive. CONCLUSIONS: A majority of high school-age adolescents had visited health care providers within the year prior to study. However, the number of adolescents who reported unmet specific health care needs within the same time period remained substantial.

Adolescent↗
PubMed2000

Unmet needs in the community: can existing services meet them?

OBJECTIVE: This prospective study of community cases examined: (a) needs for care; (b) whether services meet the needs; and (c) personal factors associated with unmet needs. METHOD: Two separate 'Needs for Care Assessment Schedule Community version' evaluations identified 38 subjects with No Need (NN), 19 with Met Needs (MN) and 25 with Unmet Needs (UNM). Other instruments included the Diagnostic Interview Schedule-Abridged Version (DISSA) and repeated measures of symptoms and social functioning. RESULTS: (a) Cases did not equate needs. (b) Services utilization did not equate having met needs. (c) Respondents with UNM were more likely to present high rates of lifetime DSM-II-R disorders, no marital relationship ever, no employment, high rates of life events, and physical or sexual abuse in childhood. They have worse outcome in terms of distress and social functioning. CONCLUSION: Personal factors may prevent respondents from seeking, engaging and benefiting from treatment.

Acute Disease↗