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PubMed1999

Self-reported legal needs of women with or at risk for HIV infection. The Her Study Group.

Women at risk for human immunodeficiency virus (HIV) infection are often poor and members of racial or ethnic minorities. In addition to legal concerns that might be common among persons with similar sociodemographic characteristics, HIV infection adds the potential of possible stigma and discrimination, as well as the prospect of illness and increased mortality. To determine women's perceptions of need for and access to legal services and whether such perceptions are affected by HIV infection, from November 1993 through September 1995 we interviewed 509 women with or at risk for HIV infection by virtue of injection drug use or high-risk sexual behaviors in New York and Baltimore, Maryland. A majority of women, regardless of HIV serostatus, reported current or future needs for legal assistance with government benefits. More than 25% reported needing current or future legal help with housing, debts, arrangements for care of children, a will, and advance directives. Substantial minorities of women reported other legal needs. HIV-positive women were significantly more likely to report anticipated future need for help with paternal custody or visitation, current need in making a will, and anticipated future assistance with advance directives. For most items, a majority of women thought they knew where to receive help. However, among women reporting a current need, only a minority actually were receiving legal assistance. This study suggests that the extent of legal needs among women with or at risk for HIV infection is substantial, and that few receive legal assistance. With few exceptions, at least for women early in the course of illness, HIV infection does not appear to alter the pattern or extent of legal needs. There are dramatic differences, regardless of HIV status, between expectation and reality in women's access to legal services.

Adult↗
PubMed2001

Parental information needs in chronic renal failure and diabetes mellitus.

UNLABELLED: The information needs of parents of children with end stage renal failure (ESRF) or with insulin dependent diabetes mellitus (IDDM) were assessed by questionnaires over a 2-year period. Questionnaires were posted on seven occasions at 4-monthly intervals and were sent to both mothers and fathers. Most information needs were reported to be for detailed test results, for new information about the condition and about the child's future social development. Questions responsible for the three highest scores were concerned with the future: the child's fertility; their social, career and marriage prospects; and the hope for a new improved treatment. For the IDDM mothers, scores were significantly different depending on age of the child (P = 0.02). Change in treatment mode had no significant effect on the information needs of parents of children with ESRF (P = 0.81). Occupation was significantly associated with the mean general information needs scores for parents, with occupations of a lower socioeconomic status associated with higher information needs scores. There were no significant differences between the reported mean general information needs scores of parents of children with ESRF and of parents of children with IDDM (P = 0.69) or between mothers and fathers mean general information needs scores (P = 0.58). CONCLUSION: Multidisciplinary team members need to tailor information to the needs of the individual families and be sensitive to socioeconomic factors and communication issues.

Adaptation, Psychological↗
PubMed2006

Breast cancer survivors' supportive care needs 2-10 years after diagnosis.

GOALS OF THE WORK: A significant proportion of breast cancer patients experience psychosocial morbidity after treatment, although their longer-term outcomes and supportive care service needs have not been comprehensively documented. The aim of this study was to identify longer-term outcomes and supportive care needs in disease-free breast cancer survivors. MATERIALS AND METHODS: One hundred seventeen patients who had been diagnosed with breast cancer 2-10 years earlier completed questionnaires to assess psychosocial outcomes including supportive care needs, psychological distress, and quality of life (QoL). MAIN RESULTS: QoL and depression scores were consistent with community rates although anxiety scores were higher. Approximately two thirds of survivors reported at least one unmet need, most frequently concerning existential survivorship issues, thereby highlighting the unique needs of survivors. Years since diagnosis was not correlated with need levels. Survivors classified as clinically anxious reported over three times as many unmet needs and survivors classified as depressed reported over two and a half times as many unmet needs. Positive outcomes were frequently reported. CONCLUSIONS: The findings have direct clinical relevance: irrespective of years since diagnosis, comprehensive and extended supportive care services are required to identify breast cancer survivors in need of supportive care interventions and remediate high levels of anxiety.

Adult↗
PubMed2004

Assessing the pharmaceutical care needs of asthmatic patients.

OBJECTIVES: To measure patients' perceptions of their care needs, by developing a tool to assess these needs and evaluate its utility in community pharmacy practice. METHOD: A survey tool comprising 37 items was developed to assess asthmatic patients' perceptions of their health-related needs, using data from literature reviews and expert opinions. The tool was piloted on 25 patients to ensure the content of the questionnaire was valid. Changes were made following piloting and the modified tool was then tested in the main study, on 101 patients from thirteen community pharmacies in Portugal. Data from this phase were subjected to factor analysis and reliability testing. RESULTS: 118 asthmatic patients were recruited, of which 101 questionnaires were eligible for analysis. From these, 40 were male (39.6%) and 61 were female (60.4%). The mean age of respondents was 41 years (sd = 19.02). The first changes made to the survey tool included the adding of items relevant to patients recruited in the pilot and the simplification of the scaling used. The survey tool was then subjected to factor analysis and reliability testing. Six scales emerged, which described the need for GP support, specialist support, pharmacist support, nurse support, other carers' support and written support. Internal consistency was good (Cronbach's coefficient alpha ranged from 0.81 to 0.93). Although there were no significant associations between educational level and other factors, other attributes influenced the communication between pharmacist and physician (chi2 = 6.972; P = 0.031). Patients with a lower level of education (up to six years) valued communication between these two professionals more than among patients with higher education. The patient's age group was associated with an expressed need for explanation of inhaler technique (chi2 = 6.494; P = 0.039). There was extended need in both oldest and youngest patients. There was a significant difference between high and low scorers to the factor 'pharmacist's role in asthma' (F1) and patients treated by either specialist or GP (chi2 = 4.935; P = 0.026). There were differences between those who were bothered by their asthma or not and their perceptions of 'Pharmacist's ideal role in asthma' (F1 & 3) (chi2 = 5.967; P = 0.051). CONCLUSION: The tool needs further development to ensure its validity and utility in practice. This will provide greater insight into patients' perceptions of their healthcare needs, which can allow health professionals to target their interventions. Such a tool may then be used in pharmacies that intend to change their current practice, to raise pharmacists' awareness of patients' demands. Developing ways to meet those needs will ultimately lead to an increased quality service and therefore 'client' satisfaction.

Adult↗
PubMed1991

Meeting the needs of visitors--a practical approach.

Large amounts of research have been carried out into the needs of visitors to intensive therapy units and these needs are now well established. These needs may be categorised as emotional, personal and cognitive. What is now required is a quick and easy means by which individual intensive care units can judge their success (or failure) in meeting these needs and a knowledge of strategies to deal with any failures. This paper addresses these issues. Firstly, reasons why nurses should meet visitor needs are listed, secondly these needs are described and thirdly a study by the author is discussed. This study describes a simple yes/no questionnaire approach which may be used to assess the success with which needs are met. A study of the type described here is within the scope of any intensive care unit. Finally, these needs are examined in detail and methods by which these needs may be met are described.

Adaptation, Psychological↗
PubMed2006

Towards patient-related information needs.

The quality of health care depends, among other factors, on the quality of a physician's domain knowledge. Since it is impossible to keep up with all new findings and developments, physicians usually have gaps in their domain knowledge. To handle exceptional cases, access to the full range of medical literature is required. The specific literature needed for appropriate treatment of the patient is described by a physician's information need. Physicians are often unaware of their information needs. To support them, this paper presents a first step towards automatically formulating patient-related information needs. We start investigating how we can model a physician's information needs in general. Then we propose an approach to instantiate the model into a representation of a physician's information needs using the patient data as stored in a medical record. Our experiments show that this approach is feasible. Since the number of formulated patient-related information needs is rather high, it has to be reduced. To reduce the number of formulated information needs we propose the use of additional knowledge. Four types of knowledge are discussed, viz. (a) knowledge about temporal aspects, (b) domain knowledge, (c) knowledge about a physician's specialism, and (d) a user model. Future research has to clarify which type of knowledge (or combination thereof) is most appropriate for our purpose. It is expected that the resultant set of information needs will have a manageable size and contributes to the quality of health care.

Humans↗
PubMed2006

Waiting for a liver transplant: psychosocial well-being, spirituality, and need for counselling.

UNLABELLED: The number of patients in need of a liver transplant vastly exceeds the number of available organs; the demand worldwide for organs leads to increased waiting times and mortality of patients on the waiting list. The aim of our study was to assess the psychosocial well-being of transplant candidates and their need for psychosocial counselling. METHODS: Sixty-nine liver transplant candidates were asked about their psychosocial well-being, quality of life, spirituality, and need for counselling assessed by interview and questionnaire (HADS-D, FLZ, LOT, SOC, SF-36, SBI-15R) during the initial evaluation procedure for organ transplantation as well as 3 and 6 months after listing. RESULTS: Candidates for a liver transplant exhibited a significant limitation in the levels of their quality of life and psychological well-being, compared with the community normal samples. They showed significantly higher levels of anxiety, but lower levels of spirituality. Almost half of the candidates (47%) expressed a need for counselling during the evaluation procedure. Patients with advanced diseases reported a lower need. Age and the personality-related "Sense of Coherence" correlated negatively with need for counselling. On the waiting list, psychosocial parameters and functions remained largely stable; the need for counselling decreased significantly. CONCLUSIONS: There is a relevant need for psychosocial counselling during the process of liver transplant evaluation. Need for counselling is associated with personality and age, as well as with somatic parameters.

Adult↗
PubMed1992

Needs of family members of intensive care unit patients.

To identify important needs of families of critically ill patients, and the degree to which these needs were being met, 64 family members and 58 nurses were asked to complete a modified version of the Critical Care Family Needs Inventory (Molter & Leske, 1983). Family members and nurses identified many similar important needs, such as the need to have questions answered honestly, the need to be called at home about changes in the patient's condition, and the need to know why things were done for the patient. However, family members indicated that some needs were both more important and less satisfactorily met than the nurses perceived: the need to know the occupational identity of staff members, directions as to what to do at the patient's bedside, and having friends for support.

Adaptation, Psychological↗
PubMed1995

Children's comprehension of the distinction between want and need.

Two experiments examined the development of children's understanding of the difference between want and need. In experiment 1, children were tested on their knowledge that want represents an intrinsic desire whereas need represents an instrumental desire. Forty-five children between three and five years of age heard four stories in which one character encountered a problem, while another did not. A desirable object which could alleviate the problem was then introduced, and after both characters requested the object, the children were asked whether each character wants the object or needs it. Three-year-olds were unable to differentiate the two terms in such contexts, whereas four- and five-year-olds were significantly more likely to say that the character experiencing the problem needed the object, while the other wanted it. In experiment 2, 45 subjects between three and five years of age were tested on their understanding that a request employing need expresses a stronger desire than one employing want. Subjects were required to give an object to one of two characters, one of whom asked for it using need and the other using want. In this experiment, three-year-olds were equally likely to give the object to the character using want as to the one using need. Both four- and five-year-olds were significantly more likely to give the object to the character who used need. The results from these two experiments show that the understanding of the semantic and pragmatic difference between want and need develops at about four years of age.

Child Language↗
PubMed1999

A summative evaluation of clinical competence: students' and nurses' perceptions of inpatients' individual physical and emotional needs.

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care.

Adult↗
PubMed2003

Rehabilitation needs of an inpatient medical oncology unit.

OBJECTIVE: To identify prospectively functional impairments and rehabilitation needs in an acute care medical oncology unit. DESIGN: Prospective cohort study. SETTING: Inpatient medical oncology unit at a Veterans Affairs hospital. PARTICIPANTS: Fifty-five patients admitted over a 6-month period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, functionally based physical examination, Rehabilitation Needs Assessment, and Recreational Needs Assessment. RESULTS: On admission, the mean FIM total score was 105 out of 126, the FIM motor score was 72 out of 91, and the FIM cognitive score was 34 out of 35. The functionally based physical examination did not generally correlate with scores obtained on the FIM. Forty-eight (87%) patients had rehabilitation needs on admission. Forty-six (84%) patients had rehabilitation needs on discharge. Rehabilitation Needs Assessment on admission showed deconditioning in 42 (76%) patients; mobility impairment in 32 (58%) patients; a significant decrease in range of motion in 23 (42%) patients; deficits in activities of daily living in 12 (22%) patients; a need for recreational therapy in 7 (13%) patients; potential for benefit from patient education in 30 (55%) patients; and a need for modalities, edema control, or wound care in fever than 5% of patients. The most commonly requested recreational activity was reading. CONCLUSIONS: Patients admitted to inpatient medical oncology units have many unmet, remediable rehabilitation needs that may not be recognized by nonrehabilitation physicians and other clinical staff. These findings suggest that assessment of medical oncology patients may be enhanced by consultation with rehabilitation medicine specialists.

Activities of Daily Living↗
PubMed2003

Need for recovery from work: evaluating short-term effects of working hours, patterns and schedules.

In this paper working hours, patterns and work schedules of employees were evaluated in terms of need for recovery from work. Self-administered questionnaire data from employees of the Maastricht Cohort Study on Fatigue at Work (n = 12,095) were used. Poisson regression analyses and multivariate logistic regression analyses revealed that higher working hours a day and working hours a week generally went together with more need for recovery from work. Overtime work was particularly associated with higher need for recovery from work in both genders. Both male and female three-shift or irregular shift workers had higher odds of elevated need for recovery compared to day workers. When additionally controlling for work-related factors, need for recovery levels among shift workers substantially lowered. This study clearly showed that working hours and schedules are associated with need for recovery from work, with different associations for men and women. Especially the associations between work schedules and need for recovery from work were very interrelated with other work-related factors. Future studies could further investigate the possibility that shift work might function as a proxy of other work-related factors that explain the different levels in need for recovery from work, or that job demands are perceived higher among shift workers and may therefore lead to more need for recovery from work.

Adult↗
PubMed1999

Responding to out-of-hours demand: the extent and nature of urgent need.

BACKGROUND: Little research has been undertaken concerning GPs' perceptions about urgent or 'appropriate' out-of-hours demand. OBJECTIVE: We aimed to measure GPs' perceptions about patients' need for urgent out-of-hours general medical help according to indicators of physical, psychological/emotional and social need, and the medical necessity of a home visit. METHODS: Twenty-five practices participated in an audit and research study whereby GPs completed an audit form for all contacts during November/December 1995 and February/March 1996. Each contact was assessed according to the indicators of urgent need and GPs commented on reasons for making such assessments. RESULTS: Audit forms were completed on 1862 patients, and GPs considered that 66.6% (1027) of contacts had either a physically, psychologically/emotionally or socially urgent need for help and were uncertain about a further 10.7% (165). Over half (53.0%) were considered to have an urgent physical need, almost one-third (31.0%) to have an urgent psychological/emotional need and 10.1% (119) to have an urgent social need for help. Over half (55.2%) of visits were considered to be medically necessary, the majority of which (89.9%) were assessed as having an urgent physical need for help. CONCLUSIONS: The findings raise questions about the strategic direction of newer forms of service delivery (GP Co-operatives) and suggest the need for further research to inform the strategic reduction in home visiting, particularly in inner-city areas where many residents have little access to transport out-of-hours to enable them to attend a primary care centre. GP co-operatives are, however, well placed to improve interagency working and cross-referral to other health and social service personnel, and respond more 'appropriately' to some psychological/emotional and social problems.

Adolescent↗
PubMed1998

Information needs, uncertainty, and anxiety in women who had a breast biopsy with benign outcome.

A retrospective, descriptive study to determine the information needs of women who underwent a breast biopsy with a benign outcome and to ascertain the levels of uncertainty and anxiety they experienced was conducted in two community health care sites in Winnipeg, Manitoba. A sample of 70 women completed a four-part survey after learning the benign breast biopsy diagnosis. The survey consisted of an Information Needs Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, State-Trait Anxiety Inventory, and a Demographic Questionnaire. Before the study, nine information needs were identified in a focus group composed of women (n = 9) who had a benign breast biopsy. The nine information needs were arranged in 36 pairs in the Information Needs Questionnaire. Profiles of information needs were developed through Statistical Analysis Systems analysis using Thurstone's Law of Comparative Judgement--Case V. The most important information need of women who underwent a benign breast biopsy was knowing when they would learn the diagnosis. The next four information needs were categorized as information about the risks of developing breast cancer. Information about follow-up and diagnostic tests were less important than information about the threat of breast cancer. Women experienced heightened uncertainty and anxiety levels related to the benign breast biopsy experience. Profiles of information needs were developed for women experiencing various levels of uncertainty and anxiety, women of different age groups, and women who experienced with a loved one with breast cancer.

Adolescent↗
PubMed2001

Determining the needs of chinese parents during the hospitalization of Their child diagnosed with cancer: an exploratory study.

In Hong Kong, as in other modern societies, cancer is the second cause of death among children. Studies show that childhood cancer affects all family members who frequently experience emotional and social problems resulting from managing the stress created by the disease and side effects of treatment. This subsequently results in parents experiencing a range of different needs. There is little evidence available of the needs of Chinese parents during the hospitalization of their child. An exploratory study was undertaken using in-depth semistructured interviews with 5 parents recruited from the pediatric oncology ward of a regional hospital in Hong Kong. The parents were interviewed twice during the active treatment phase to explore their changing needs during this initial period of hospitalization. All interviews were tape-recorded, transcribed, and translated into English before content analysis. The analysis of the parents' data identified 6 main categories common to both interviews: (i) the need for recognition of their reaction, (ii) the need for recognition of their fear of hospitalization, (iii) the need for support, (iv) the need for information, (v) the need for personal time, and (vi) finally the need for help in parenting skills were identified. The implications of these findings for nursing practice are presented.

Adolescent↗
PubMed2004

Educational needs of rural and remote Australian non-specialist medical practitioners for obstetric ultrasound.

OBJECTIVE: To determine the educational needs of rural and remote non-specialist Australian doctors for obstetric ultrasound. DESIGN: Survey design. SETTING: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia. SUBJECTS: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men. RESULTS: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%). CONCLUSION: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non-specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program. WHAT IS ALREADY KNOWN: The authors could not find any published work on the educational needs of Australian non-specialist rural and remote doctors for obstetric ultrasound. There is research about the outcome of obstetric ultrasound education for urban family physicians in the USA, but no information about rural doctors' educational needs or education outcomes. The study needed to be done so that obstetric ultrasound professional development program of the Australian College of Rural and Remote Medicine could be based on the real needs of the target group. WHAT THIS PAPER ADDS: As a result of this research, there is now information on the educational needs of rural and remote Australian non-specialist medical practitioners that can be used by education providers to develop quality education programs in obstetric ultrasound.

Adult↗
PubMed2006

Education needs for integrated care: a literature review.

AIM: This paper reports a systematic review to identify the education needs of the workforce within primary care to promote the effective delivery of integrated health and social care services. BACKGROUND: The need for different professionals to work more closely dominates global health policy. The drive to develop a workforce prepared for the future is crucial to the success of integrated services. However, some have argued that nurses are ill-equipped to meet the challenges of integrated service provision. The ability to work interprofessionally is an important skill which needs to be developed to support integrated working. METHODS: Structured searches were undertaken on organizational websites and the Caredata, CINAHL, Cochrane Library, MEDLINE, Sociofile databases between December 2002 and April 2004 to identify policy documents and primary research studies. The robustness of identified research studies were appraised using recognized appraisal tools. FINDINGS: Six themes were identified which indicate essential elements needed for integrated care. The need for effective communication between professional groups within teams and an emphasis on role awareness are central to the success of integrated services. In addition, education about the importance of partnership working and the need for professionals to develop skills in relation to practice development and leadership through professional and personal development is needed to support integrated working. CONCLUSION: Education which embeds essential attributes to integrated working is needed to advance nursing practice for interprofessional working. Further research exploring this and its impact on integrated provision is essential to ensure that evidence-based services are provided. The reinforcement of partnerships between higher education institutions and health and social care organizations should ensure that the workforce is educated to manage continuous change in service delivery. Innovative ways of teaching and learning which promote inter-professional working need to be explored.

Attitude of Health Personnel↗
PubMed2004

Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study.

OBJECTIVE: To assess how pressures from patients on doctors in the consultation contribute to referral and investigation. DESIGN: Observational study nested within a randomised controlled trial. SETTING: Five general practices in three settings in the United Kingdom. PARTICIPANTS: 847 consecutive patients, aged 16-80 years. MAIN OUTCOMES MEASURES: Patient preferences and doctors' perception of patient pressure and medical need. RESULTS: Perceived medical need was the strongest independent predictor of all behaviours and confounded all other predictors. The doctors thought, however, there was no or only a slight indication for medical need among a significant minority of those who were examined (89/580, 15%), received a prescription (74/394, 19%), or were referred (27/125, 22%) and almost half of those investigated (99/216, 46%). After controlling for patient preference, medical need, and clustering by doctor, doctors' perceptions of patient pressure were strongly associated with prescribing (adjusted odds ratio 2.87, 95% confidence interval 1.16 to 7.08) and even more strongly associated with examination (4.38, 1.24 to 15.5), referral (10.72, 2.08 to 55.3), and investigation (3.18, 1.31 to 7.70). In all cases, doctors' perception of patient pressure was a stronger predictor than patients' preferences. Controlling for randomisation group, mean consultation time, or patient variables did not alter estimates or inferences. CONCLUSIONS: Doctors' behaviour in the consultation is most strongly associated with perceived medical need of the patient, which strongly confounds other predictors. However, a significant minority of examining, prescribing, and referral, and almost half of investigations, are still thought by the doctor to be slightly needed or not needed at all, and perceived patient pressure is a strong independent predictor of all doctor behaviours. To limit unnecessary resource use and iatrogenesis, when management decisions are not thought to be medically needed, doctors need to directly ask patients about their expectations.

Adolescent↗