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PubMed2001

Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.

OBJECTIVE: The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains. METHOD: The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview. RESULTS: The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial. CONCLUSION: It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

Adult↗
PubMed2007

Assessing palliative care needs: views of patients, informal carers and healthcare professionals.

AIM: This paper reports a study to assess the palliative care needs of the adult population served by a healthcare provider organization in Northern Ireland from the perspectives of patients, informal carers and healthcare providers. BACKGROUND: Assessing palliative care need is a key factor for health service planning. Traditionally, palliative care has been associated with end-of-life care and cancer. More recently, the concept has been extended to include care for both cancer and non-cancer populations. Various approaches have been advocated for assessing need, including the exploration of professional provider and user perspectives of need. METHOD: Semi-structured qualitative interviews were undertaken with a purposive sample of patients and lay carers receiving palliative care services (n = 24). Focus groups were also conducted with multi-professional palliative care providers (n = 52 participants) and face to face interviews were undertaken with key managerial stakeholders in the area (n = 7). The focus groups and interviews concentrated on assessment of palliative care need. All the interviews were transcribed verbatim and analysed using Burnard's framework. FINDINGS: Professional providers experienced difficulty in defining the term palliative care. Difficulties in communication and information exchange, and fragmented co-ordination between services were identified. The main areas of need identified by all participants were social and psychological support; financial concerns; and the need for choice and information. All participants considered that there was inequity between palliative care service provision for patients with cancer and non-cancer diseases. CONCLUSION: All patients, regardless of diagnosis, should be able to access palliative care appropriate to their individual needs. For this to happen in practice, an integrated approach to palliative care is essential. The study methodology confirms the value of developing a comprehensive approach to assessing palliative care need.

Adult↗
PubMedDate not supplied

Population needs identified for assistance in some ECA member states.

The U.N. Fund for Population Activities (UNPFA) has conducted Needs Assessment Missions in many developing countries as a means of identifying population and related areas in which individual countries would need assistance to achieve self-reliance in formulating and implementing population policies and programs. This exercise is still going on in some of the countries. In ECA member States these needs missions have been conducted in the following countries: Burundi, Cameroon, Comoros, Ethiopia, the Gambia, Guinea, Ivory Coast, Liberia, Madagascar, Malawi, Mauritania, Morocco, Niger, Rwanda, Sierra Leone, Senegal, Somalia, Sudan, Swaziland, Tanzania, Zambia, and Zimbabwe. The areas identified for assistance vary from country to country, however, in some cases the needs are similar. Data collection and analysis is still 1 of population needs for which many countries require assistance. This includes conducting of national population censuses and demographic surveys and establishing or improving the civil registration systems on vital events. Training of nationals in data collection and analysis is another area in which ECA member States need assistance. It was identified that there is lack of integration of population variables in socioeconomic development planning. The various missions recommended assistance to help ECA member States to integrate population variables in development planning. Creation of Population units in ministries of planning and/or other departments was recommended as a means to help this integration. The various missions also identified the need to create or to enhance the awareness of the interrelationship between population and sociodevelopment and their implications. To this end the missions on needs assessment recommended assistance in population information and communication activities, including the introduction of population education in formal and nonformal education, conducting of seminars and workshops on population and development etc. To help formulation of population policies, the establishment of National Population Commissions at the highest level was recommended. Such commissions would examine population issues in detail and formulate suggestions for policy decisions and measures. Other common population related areas which require greater assistance include health programs of maternal and child health care, health education activities, and family planning activities. Last but not least is the need to improve the role and status of women in Africa so that they can be integrated to take a more active part in the various economic and social activities in national development.

Burundi↗
PubMedDate not supplied

Application of the human needs conceptual model of dental hygiene to the role of the clinician : part II.

In summary, the theories of Maslow and of Yura and Walsh have been highlighted as background for understanding the human needs conceptual model of dental hygiene. In addition, 11 human needs have been identified and defined as being especially related to dental hygiene care, and a sample evaluation tool for their clinical assessment and a dental hygiene care plan have been presented. The four concepts of client, environment, health/oral health, and dental hygiene actions explained in terms of human need theory, and the 11 human needs related to dental hygiene care constitute the human needs conceptual model of dental hygiene. Within the framework of the human needs conceptual model of dental hygiene, the dental hygiene process is a systematic approach to dental hygiene care that involves assessment of the 11 human needs related to dental hygiene care; analysis of deficits in these needs; determination of the dental hygiene care plan based on identified deficits; implementation of dental hygiene interventions stated in the care plan; and evaluation of the effectiveness of dental hygiene interventions in achieving specific goals, including subsequent reassessment and revision of the dental hygiene care plan. This human needs conceptual model for dental hygiene provides a guide for comprehensive and humanistic client care. This model allows the dental hygienist to view each client (whether an individual or a group) holistically to prevent oral disease and to promote health and wellness. Dental hygiene theorists are encouraged to expand this model or to develop additional conceptual models based on dental hygiene's paradigm.

Body Image↗
PubMed2007

Psychosocial needs assessment among an underserved, ethnically diverse cancer patient population.

Little attention has been directed towards identifying and addressing the psychosocial needs of ethnic minority and underserved cancer patients. This study describes the development of a psychosocial needs survey and patterns and predictors of need among an ethnically diverse underserved cancer patient population in Bronx, New York. A 34-item psychosocial needs assessment survey was developed to assess 4 categories of need: Informational, Practical, Supportive, and Spiritual. A total of 248 oncology outpatients (48% non-Hispanic whites, 25% African Americans; 19% Hispanic) completed the survey in oncology clinic waiting rooms. The survey demonstrated high internal consistency and face validity. Ethnicity was the sole predictor of needs (P < .02), even after controlling for education, time since diagnosis, treatment status, marital status, and age. The mean percentage of needs endorsed by African Americans, Hispanics, and non-Hispanic whites respectively was 81%, 85%, 70% for Informational; 63%, 68%, 36% for Practical; 69%, 73%, 48% for Supportive; and 49%, 60%, 31% for Spiritual needs. This needs assessment offers clear directions in which to focus QOL intervention efforts among underserved and ethnic minority cancer patients. Cancer 2007. (c) 2006 American Cancer Society.

Black or African American↗
PubMedDate not supplied

Perceived needs of wives of stroke patients.

The purpose of the study described in this article was to determine the difference between the importance that wives of hospitalized stroke patients attached to their own needs and the degree to which they felt those needs were met by members of the nursing staff. Fourteen wives whose husbands had survived an initial stroke completed the Stroke Family Inventory, a 27-item self-administered questionnaire, and participated in a structured private interview to further explore the impact of the stroke on their lives. The wives were asked to reflect on their needs as perceived during the acute stage (the first 2 weeks) of the stroke. Of the 27 needs identified by the wives, four were perceived to be most important. These were (a) a wife's need to know what she could do to assist with her husband's care, (b) a need to be included in discharge planning for her husband, (c) a need to know that nursing personnel cared about her husband, and (d) a need to know what kind of activities her husband was able and/or would be able to do. Results showed that the wives perceived that 18 (66%) of the 27 needs were not met very well by hospital nursing staffs.

Adult↗
PubMed2003

From research to practice: a local mental health services needs assessment.

BACKGROUND: Service planning based on aggregated needs assessment is rarely practised. There is a lack of research into how population-based needs assessment approaches can be translated into routine clinical settings. AIMS: This study aimed to ascertain the 2-month period prevalence of psychosis in Gloucester City, to investigate the level of need among those in contact with mental health services, and to identify the compromises which are involved in routine collection of data to inform services, compared with specifically funded research studies. Method People with ICD-10 diagnosis of functional psychosis were identified by searching General Practice and mental health service records in Gloucester City. The needs of the sub-sample in touch with mental health services were assessed using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). RESULTS: Four hundred and seventy-four cases were identified, including 403 in contact with mental health services. Staff CANSAS data were collected for 225 patients, with a mean rating of 7.0 met and 3.6 unmet needs per patient. Unmet need was higher in the non-Caucasian group. CONCLUSIONS: In this locality, patients with functional psychosis were largely in contact with mental health services, were in employment, were disproportionately looked after by a few City centre General Practitioners, and high levels were in supported accommodation. Higher levels of need were found than previously demonstrated. Systematic assessment of needs with research instruments to contribute to locality service planning is possible without a major research grant, but involves compromises on established research designs.

Adolescent↗
PubMed2004

Needs for care of chronic schizophrenic patients in long-term community treatment.

BACKGROUND: Specific problems of long-term community care of chronic schizophrenic patients are an under-researched area interesting for the provision of regional mental health care. METHODS: This study focuses on a 4 1/2-year prospective assessment of normative needs for care in a cohort (initially N = 115) living in the Dresden care region (Germany). At six time-points, normative needs for care were assessed with the Needs for Care Assessment (NFCAS). RESULTS: The total number of problems did not change significantly over the study period. The average number of met needs was lower at the longer-term follow-up assessments,due particularly to a decrease in the social section. This trend is also demonstrated for the average number of unmet needs. In contrast, the mean number of "unmeetable needs" increased. Consistently, 70-80% of the patients exhibit problems in positive psychotic and negative symptoms, household affairs and recreational activities. Communication, occupation and recreational activities constitute a trio of social needs not met for nearly one-third of the patients disabled in these respects. Logistic analyses of regression could not identify a predictive model for the total needs development within the 4 1/2-year community treatment. CONCLUSION: The rather stable pattern of needs for care seems to define clear long-lasting tasks for community mental health services. For chronic schizophrenic patients, services should especially focus on social skills training and psychoeducational approaches. Due to a wide range of possible factors of influence, however, planning long-term context-dependent processes of care in the community lacks a clear evidence base.

Adult↗
PubMed2001

Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses.

OBJECTIVES: This study investigated differences between the perceptions of relatives, physicians and nurses concerning the needs of relatives of critical care patients. DESIGN AND PARTICIPANTS: Perceived needs were assessed in 200 relatives, 38 physicians, and 143 nurses using a 45-item questionnaire. SETTING: Data were gathered at the intensive care unit of the University Hospital Gasthuisberg. RESULTS AND CONCLUSIONS: The overall rankings of the needs by the three groups are very similar. Information emerges as most important factor, with considerably less importance attached to comfort and support. There were significant differences between the groups on all categories and on 24 individual needs. Regarding the need categories, both nurses and physicians underestimate the relatives' need for information and proximity to the patient. Physicians also underestimate the relatives' need for assurance. On the individual need items, relatives' needs are generally underestimated by the staff, but in some cases overestimations are found.

Adult↗
PubMed2006

Factors associated with mental health service need and utilization among unaccompanied refugee adolescents.

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.

Adolescent↗
PubMed2005

Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study.

STUDY OBJECTIVE: There is a high prevalence of unmet substance abuse treatment need among adult hospital emergency department (ED) patients. We examine the association between this unmet need and excess utilization of health services and estimate costs. METHODS: A statewide, 2-stage, probability sample survey was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997. Toxicologic screening augmented in-person interviews. Main outcome measures were ED case disposition; frequency of physician office visits, ED visits, and hospitalizations in the past 12 months; and costs of excess service utilization. Covariates in the multivariate model were substance abuse treatment need status, age, sex, main reason for ED visit, perceived previous health status, history of tobacco use, and health care coverage. Unmet substance abuse treatment need was assessed using 13 overlapping criteria that incorporated use, dependence, denial, and treatment history. Target substances included ethanol and selected illegal and prescription drugs but not nicotine. RESULTS: Compared with patients without substance abuse treatment need (n=1,073), patients with unmet need (n=415) were 81% more likely to be admitted to the hospital during their current ED visit (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.27 to 2.64) and 46% more likely to have reported making at least 1 ED visit in the previous 12 months (OR 1.46; 95% CI 1.12 to 1.84). Their utilization patterns accounted for an estimated 777.2 million US dollars in extra hospital charges for Tennessee in 2000 dollars, representing an additional 1,568 US dollars per ED patient with unmet substance abuse treatment need. CONCLUSION: ED patients with unmet substance abuse treatment need generated much higher hospital and ED charges than patients without such need. Given potential savings from avoidable health care costs, the future burden of substance-associated ED visits and hospitalizations may be reduced through programs that screen and, as appropriate, provide brief interventions or treatment options to these patients.

Adolescent↗
PubMed2004

Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living.

OBJECTIVES: To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: General community, international. PARTICIPANTS: Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The need for more help with ADLs. RESULTS: The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS: People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.

Activities of Daily Living↗
PubMed2005

Use and perceived need of physical therapy following severe lower-extremity trauma.

OBJECTIVE: To examine the utilization of physical therapy (PT), the level of perceived need for PT, and the proportion of patients with perceived need receiving no PT in a cohort of severe lower-extremity trauma patients treated at level I trauma centers. DESIGN: Longitudinal, observational study of severe lower-extremity trauma patients. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission, and at 3, 6, 12, and 24 months postdischarge. SETTING: Eight level I trauma centers. PARTICIPANTS: Of 601 patients age 18 to 65 enrolled in the parent study over a 40-month period, 550 with unilateral study injuries and followed up at least once over the 2-year study period were included in this analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patient reported number of PT visits at each follow-up time point, inpatient rehabilitation admissions, and their perceived need for PT. Perceived need for PT was also assessed by an orthopedic surgeon and a physical therapist. Overall, concordance between physician, physical therapist, and patient's assessment of need for PT was low, with kappa statistics ranging between .12 and .41. RESULTS: Amputation and reconstruction patients used comparable amounts of PT services. Regardless of the criteria used to evaluate need, the proportion of patients with perceived need for PT receiving no PT services increased over the course of the follow-up, from 23% to 46% at first follow-up to over 68% by 2 years. Factors associated with increased risk for having a perceived need but receiving no therapy included lack of private insurance, pain, lower levels of education, lower fitness levels at time of injury, being a smoker, and having severe muscle injury. CONCLUSIONS: The results suggest a significant proportion of patients in the severe lower-extremity trauma population have perceived need for PT, yet receive no PT services.

Adolescent↗
PubMed2004

Training needs analysis. A literature review and reappraisal.

Training needs analysis is the initial step in a cyclical process which contributes to the overall training and educational strategy of staff in an organisation or a professional group. The cycle commences with a systematic consultation to identify the learning needs of the population considered, followed by course planning, delivery and evaluation. Although much has been written about training needs analysis in relation to post-registration nursing education, there is disagreement concerning its impact on the training cycle and its potential to influence service delivery. This stimulated the literature review presented below. Initial searches of nursing databases identified 266 works. Twenty three (8.6%) contained empirical findings relating to post-registration nursing education in which assessment of training needs was presented as the major aim. Most of these accounts were concerned with the training needs of nurses in more than one organisation and were classified as macro-level training needs analysis. However, seven studies were concerned with a single, specific organisation (micro-level training needs analysis). Despite their smaller scale and more limited scope, micro-level training needs initiatives demonstrated greater methodological rigour, were more likely to consider the stakeholder perspective, to generate findings which could positively influence the rest of the training cycle and showed the greatest potential for influencing service delivery and quality of patient care. The review drew attention to the similarities between the training cycle and the audit cycle and resulted in the development of a model which could be used to evaluate the effectiveness of the process and outcomes of future training needs analysis initiatives.

Data Collection↗
PubMed2005

Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia.

OBJECTIVE: To analyse the association between symptom dimensions in schizophrenia and number and type of met and unmet needs. METHOD: A sample of 231 outpatients randomly selected from a register that included all patients treated in 5 mental health care centres (MHCC) was evaluated. Assessment instruments included the Camberwell Assessment of Needs (CAN) questionnaire and the PANSS. RESULTS: Number of needs are related to overall severity of psychopathology. Patients with more symptoms have more total needs (p < 0.001) and unmet needs (p < 0.001). A multiple lineal regression model showed that the disorganized and excited dimensions of the PANSS are the most important components for explaining the variance of number of needs. Type of needs is related to subtypes of schizophrenia, specially with disorganized and excited symptoms. CONCLUSION: Psychosocial needs are related to schizophrenia subtypes. Patients with more needs are those with more disorganized and excitatory symptoms.

Adult↗
PubMed2006

The nature and correlates of unmet health care needs in Ontario, Canada.

Using data from the Canadian Community Health Survey (CCHS) Cycle 1.2, we examine the nature of unmet mental health care needs in Ontario, Canada and how this is associated with socio-demographic, social support, health status and mental health service use factors. Unmet mental health care needs result from experiencing barriers to three issues: acceptability, accessibility and availability. Unmet needs due to acceptability issues are the most frequent type; the largest proportion of people within this category report experiencing unmet needs because they "preferred to manage the problem themselves". Unmet needs are greater among the young and among females. Surprisingly, service users report higher rates of unmet needs than non-users. Some social support variables have associations with unmet needs. Based upon these results, unmet needs pose a major challenge to the health care system since they cannot be resolved solely by enhancing access to and availability of mental health services. Thus, to address unmet mental health care needs, efforts should be focused on the acceptability barriers that women and young people in particular face. Enhancing education and certain social support mechanisms are potential strategies.

Adolescent↗
PubMed1999

Primary care providers need a variety of nutrition and wellness patient education materials.

OBJECTIVE: To assess and document the need for nutrition and wellness patient education materials. DESIGN: The results of open-ended interviews and focus groups were used to develop a mail-type survey. The 46-item survey addressed barriers to using nutrition and wellness education materials as well as format, education/reading level, foreign languages, and topics needed. North Carolina Cooperative Extension Service (NCCES) family and consumer education agents distributed surveys to family and general practices throughout North Carolina. SUBJECTS: Of the 721 primary care providers surveyed, 303 (42%) returned usable surveys. Respondents practiced in 89 of the 100 counties of the state served by NCCES family and consumer education agents. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics and independent sample t tests were used to analyze survey results. RESULTS: Limited time with patients and inability to obtain materials because of cost or being unsure of sources were most often identified as barriers to using nutrition and wellness materials. Of the 26 topics surveyed, 6 had mean levels of need greater than or equal to high need (mean score > or = 4): weight control for adults, smoking cessation, changing dietary fat intake, exercise guidelines for healthy adults, general stress management guidelines, and healthful eating for older adults. Twenty-four of the 26 topics had mean levels of need greater than or equal to moderate need (mean score > or = 3). Topics with moderate need included guidelines for overweight children and adolescents, nutrition for chronic disease prevention, and healthful eating for various stages of the life cycle. The combined mean score for topics dealing with weight control and exercise for adults, adolescents, and children was greater than the score for high need (mean score > 4). Eighty-three percent of respondents preferred 1-page, printed handouts. Forty-five percent requested materials in Spanish. APPLICATIONS: Dietitians who work in a variety of settings can use techniques similar to those described here to determine the patient education materials practitioners need for the populations they serve. The information obtained from this study will be used to develop 1-page, printed handouts. A registered dietitian and a food and nutrition specialist with NCCES will develop and pilot-test the handouts. These materials will be made available to primary care providers in North Carolina via local NCCES family and consumer education agents, many of whom are registered dietitians.

Data Collection↗
PubMed2003

Normative needs for community-based psychiatric care of patients with schizophrenia in different residential settings.

This study aims to assess the extent of needs for mental health care of patients with schizophrenia living in different residential settings and to evaluate the quality of care in these types of complementary services recently established in the East German region of Dresden. Survey data from the first wave of a longitudinal study of five patient subgroups (N=244) living in (1) a psychiatric nursing home, (2) social therapeutic hostels, (3) sheltered community residential care, (4) at home in the family and (5) alone in one's own home are reported. Normative individual needs for care were assessed using the needs for care assessment (NCA). The patient groups show clear differences in the extent of needs for care, especially in the social NCA section. Patients in the psychiatric nursing home and in the social therapeutic hostels exhibit the highest numbers of areas of need. Positive psychotic symptoms, negative symptoms and neuroleptic side effects are the most prominent clinical areas of need in all subgroups. Patients are most frequently socially disabled in terms of managing household affairs, recreational activities and household chores. Deficits in the need status could be found in the NCA areas of 'negative symptoms,' 'recreational activities,' and 'communication.' The basic needs for mental health care of patients with schizophrenia are met in the established sheltered residential settings. Current deficiencies in providing psychological and educational interventions focusing on coping strategies and social skills training should be minimised in order to decrease the identified deficits in the need status.

Chronic Disease↗