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PubMed2004

Negotiating multiple roles: link teachers in clinical nursing practice.

BACKGROUND: The background to this study was a concern about the teacher's role in clinical practice. Experience suggested that teachers believed that their role in practice was important but that there were significant forces which impeded their ability to move with ease between education and practice. A discrepancy between previous research findings and theoretical discussions, and the reality experienced by teachers, led to the adoption of grounded theory as a way of exploring uncertainties in the situation. METHOD: Data were gathered over a period of 7 years and involved 28 in-depth interviews with nurses with a range of educational roles, employed in educational institutions and practice settings in inner city and provincial areas in the South of England. FINDINGS: The data revealed four categories, 'gaining access', 'negotiating credibility', 'being effective' and the core category 'negotiating multiple roles'. The core category is addressed in this article. Experiences of moving from a position of clinical practitioner to link teacher involved: 'disassembling the self' through leaving behind old identities; 'reconstructing the self' through clarifying new ways of being; and, finally, 'realizing the self' through reciprocal interpersonal activity with students, educational and nursing colleagues. CONCLUSIONS: It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co-ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice.

Clinical Competence↗
PubMedDate not supplied

Prior episode of sexually transmitted disease and subsequent sexual risk-reduction practices. A need for improved risk-reduction interventions.

Persons with a history of a sexual transmitted disease (STD) are at increased risk for infection with human immunodeficiency virus (HIV). The extent to which women with a previous history of a STD report currently practicing protective behaviors against STD transmission is examined. Specifically, whether having experienced one or more previous episodes of an STD was related to current STD/HIV preventive practices was studied. Of the study group, 36% had at least one prior STD episode. Results of bivariate analysis show no relationship between previous STDs and current STD/HIV preventive practices: 47% of women with no previous STD episode, 64% of women with 1 previous episode, and 46% of women with 2 or more previous STD episodes reported currently practicing moderate to high levels of STD/HIV prevention methods. To adjust for potentially confounding variables, logistic regression analyses were also performed. The logistic regression model included age, alcohol use with sex, drug use with sex, marital status, and perceived risk of becoming infected with an STD in the next year. Results from the logistic regression analyses also showed no relationship between prior STD episode and current level of preventive practices against STD/HIV. Variables found to be significantly associated with level of STD/HIV preventive practices were marital status, age, and drug use with sex. These findings suggest that greater advantage should be taken of the opportunities presented when women are diagnosed with an STD to teach individuals at risk of acquiring STDs or HIV to practice risk-reduction behaviors.

Adolescent↗
PubMedDate not supplied

The use of pit and fissure sealants.

This paper reviews key issues of sealant use and methodology and poses recommendations to inform the discussion toward a consensus statement by participants. A comprehensive review of sealant literature, including policy recommendations from previous conferences that reviewed best practices for sealant use, was completed. Building on the review paper by Simonsen and on previous policy statements by dental and public health groups, this paper discusses key questions about sealant use in light of contemporary caries data and cost-benefit analyses. In addition, newest material advancements are reviewed to establish the next step in sealant improvement for young patients.

Child↗
PubMedDate not supplied

Knowledge and beliefs about breast cancer and breast self-examination among athletic and nonathletic women.

Women' knowledge of breast cancer and their beliefs about susceptibility to breast cancer and benefits of breast self-examination were explored in relation to frequency of practice of breast self-examination. Previous findings indicated that knowledge and beliefs may affect the practice of preventive health behaviors. A self-report questionnaire was administered to 263 women contacted through sorority alumnae groups and Y.M.C.A. groups. Subjects were grouped according to levels of physical exercise (high, moderate, or none) and compared on knowledge and beliefs about breast cancer and breast self-examination (BSE) and practice of BSE. Data were analyzed using descriptive statistics and chi-square analysis. Results showed women overestimated the prevalence of breast cancer but were correctly aware that most lumps are not malignant. They generally were uninformed of the risk factors of breast cancer, except for a positive family history of breast cancer. The majority perceived themselves as strongly susceptible to breast cancer and almost all perceived BSE as beneficial in reducing the threat of death from breast cancer. Only 37 percent of the women practiced breast self-examination regularly. No significant relationship existed between knowledge or beliefs and frequency of performance of BSE. Nor were there any significant differences in frequency of practice between the exercisers and nonexercisers. It may be concluded from this study that knowledge of breast cancer, beliefs about breast cancer and breast self-examination or engaging in regular physical exercise as a preventive health behavior do not affect the practice of breast self-examination.

Adult↗
PubMed1993

Is there a relationship between a mother's mental state and consulting the doctor by the family? A study in a military general practice.

A total of 174 families of service personnel with children between 3 and 6 years of age were studied over a 6 month period. All contacts with the general practitioner, both in and out of hours together with the local casualty department were recorded. Mothers of the children were posted a specially designed questionnaire to measure how seriously they perceived various childhood symptoms to be and a copy of the general health questionnaire, 28 question version (GHQ 28). The perceived severity questionnaire had been piloted previously in a neighbouring practice. The overall response rate was 77%. Analyses of the data showed that the factors most significantly associated with a child's consultation frequency were the psychological state of the mother, the mother's own consultation frequency and the number of children in the family; the last being an inverse relationship. No evidence was found to suggest that the perception of the severity of illness varied with the psychological state of the mother. In addition, the childhood consultation rate was not influenced by the mother's perception of the severity of childhood illness as measured by the perceived severity questionnaire. Other factors such as the age of the mother or child, within the age range studied, were not found to be significantly related to the child's frequency of consulting. A mother's own consultation frequency was highly correlated with her GHQ 28 score, but more specifically with the subsections that scored for depression and somatic symptoms. From the study, doctors who see children should seriously consider the main reasons for a child's consultation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

A monkey could do your job!

The present ethos in the health service of cost effectiveness and quality assurance requires nurses to identify the value of nursing practice in a way previously unheard of. Questions arise from this in relation to nursing and the nature of nursing. Some managers I have discussed these issues with believe that nurses are not required in theatre. It is not really surprising that such beliefs abound. Nurses have traditionally been more preoccupied with getting the work done than analysing the value of the nursing role. Much of this role is practical and there has, in the past, been little written about the nature of practical nursing let alone specifically about the practice of theatre nurses. Benner's work, with its emphasis on practice and recognition of nursing expertise, has brought about a reconceptualisation of the value of practice and of the knowledge found in that practice. In addition, the whole area of practical knowledge and expertise is now benefiting from further exploration.

Clinical Competence↗
PubMed2005

Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey.

OBJECTIVE: To replicate a previous study of nonmusculoskeletal responses to chiropractic intervention and to establish whether such responses are influenced by the country of study, chiropractors' attitudes, and information to patients, patients' demographic profiles, and treatment regimens. METHODS: Information obtained through questionnaires by chiropractors and patients on return visit within 2 weeks of previous treatment from chiropractic practices in Canada, United States, Mexico, Hong-Kong, Japan, Australia, and South Africa. In all, 385 chiropractors collected valid data on 5607 patients. Spinal manipulation with or without additional therapy was the intervention provided by chiropractors. Outcome measures included self-reported improved nonmusculoskeletal reactions (allergy, asthma, breathing, circulation, digestion, hearing, heart function, ringing in the ears, sinus problems, urination, and others). RESULTS: The results from the previous study were largely reproduced. Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%). Some variables were identified that somewhat influenced the outcome: patients informed that such reactions may occur (odds ratio [OR] 1.5), treatment to the upper cervical spine (OR 1.4), treatment to lower thoracic spine (OR 1.3), and female sex (OR 1.3). However, these had a very small "explanatory" value (pseudo R2 3%). CONCLUSION: A minority of patients with self-reported nonmusculoskeletal symptoms report definite improvement after chiropractic care, and very few report definite worsening. Future studies should use stringent criteria to investigate a possible treatment effect and concentrate on specific diagnostic subgroups such as digestive problems and tinnitus.

Adult↗
PubMed1992

Differences in time devoted to practice by male and female dentists.

Previous studies have found that female dentists work fewer hours per year than male dentists. This study examined factors which may explain the differences in hours worked per year that exist between male and female dentists in private practice. In 1988, a weighted, stratified random sample of dentists in Australia was surveyed by mailed questionnaire. There were 855 respondents (response rate = 75.5%) with 566 dentists from private practice (361 males and 205 females). Annual time devoted to dental practice was significantly lower for females, for dentists who were not the sole earner of the family income, and for dentists with young children. A significant interaction between sex of dentist and child age showed that hours per year in practice decreased only for females with young children. Hours worked per year were significantly higher among female dentists with no children, or older children. For males, hours worked remained at a higher level. The amount of time devoted to dentistry requires monitoring in the estimation and projection of capacity to supply dental services.

Analysis of Variance↗
PubMed2003

Access to services and maintenance of safer sex practices among people living with HIV/AIDS.

Access to services and their relationship to the maintenance of long-term safer sex practices are addressed in this study of 360 HIV+ adults recruited from outpatient medical facilities. Protease inhibitors, antiviral therapies, and entitlements were reported as the most needed services, while entitlements and money to pay for housing were reported as the largest unmet needs. Differences across ethnic and gender groups were observed. One-third of all respondents reported at least one occasion of unprotected anal or vaginal intercourse in the previous six months. The practice of unsafe sex was found to be significantly related to both the number of needed services and the number of unmet needs, even after controlling for demographic variables. In addition, a higher proportion of those who engaged in unsafe sex reported a higher need for psychological counseling and social support. These findings underscore the important linkage between access to services with avoidance of high-risk sexual behavior in HIV+ persons. Implications for the delivery of culturally appropriate, gender-specific and community-based interventions are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The experience of caring for someone over 75 years of age: results from a Scottish General Practice population.

AIMS AND OBJECTIVES: To understand the unpaid carers' experiences of looking after someone aged over 75 at all stages of their caring career. BACKGROUND: The role of, and support for, unpaid carers have become central in the debates surrounding community care in the UK. This paper presents the findings of a study to elicit the complexities of the caring role and inform the Primary Health Care Team to help support carers more effectively. DESIGNS AND METHODS: A quantitative research design was employed. Carers of people over 75 years of age in a General Practice, who had been previously identified from a screening questionnaire, were sent the Carers Assessment of Difficulties Index, the Carers Assessment of Satisfactions Index and Carers Assessment of Managing Index questionnaires which examine the experience of caring. RESULTS: From a sample of 247 carers, a 70% response rate (n = 172) was achieved. Satisfactions lay in the quality of care provided; difficulties reflected the potential and actual family tensions generated; coping strategies included reframing difficulties, using humour and practical problem solving. The data show that caregivers' reactions, such as feeling angry about the situation, or the consequences of their involvement, such as tensions within the family, cause them more difficulties than the actual care-giving tasks they perform. CONCLUSION: This study adds to the understanding of carers' roles by including carers across a range of situations, including those at an early stage of their caring career. Service providers are better able to support carers if they understand the complex interplay of difficulties, rewards and personal coping strategies associated with the caring role. RELEVANCE TO PRACTICE: The study helps illuminate the less obvious, but important, emotional aspects of carers' difficulties and suggests strategies which service providers may find helpful in assessing carers' needs and determining the appropriate interventions.

Aged↗
PubMed1983

Factor influencing the duration of treatment with psychotropic drugs in general practice: a survival analysis approach.

There have been few previous attempts to study factors which affect the duration of treatment with psychiatric drugs in general practice. In the present study 'duration of treatment' was regarded as analogous to 'survival time', and techniques of survival analysis were applied to data from a previously published study of psychotropic drug use in general practice (Williams et al. 1982). Methods of logistic modelling were used in an attempt to construct a comprehensive and parsimonious model to describe and predict the duration of psychotropic use. Such a model was found to include the effects of previous psychotropic treatment, social problems, duration of treatment and general practitioner behaviour. The implications of the findings, vis à vis the prevention of unnecessary long-term psychotropic drug use, are discussed.

Adult↗
PubMed2006

The association between the body mass index of first-year female university students and their weight-related perceptions and practices, psychological health, physical activity and other physical health indicators.

OBJECTIVE: To investigate the association between the weight status of first-year female students (FYFS) and various weight management-related characteristics to identify possible components of a weight management programme for students. DESIGN: Cross-sectional study. SETTING: Female residences at a South African university. SUBJECTS: A total of 360 FYFS. RESULTS: Mean (+/-standard deviation (SD)) body mass index (BMI) of the FYFS was 21.8 +/- 2.6 kg m(-2), with 7.2% being underweight, 81.9% normal-weight, 10.0% overweight and 0.8% obese. Underweight, normal-weight and overweight students differed with regard to their perception of their weight (P < 0.001), weight goals (P < 0.001) and previous weight-loss practices (P < 0.001). Mean+/-SD score on the 26-item Eating Attitudes Test (EAT-26) was 8.5 +/- 9.0 with 8.4% classified as high scorers. Mean+/-SD score on the 34-item Body Shape Questionnaire (BSQ) was 87.7 +/- 32.2, with 76.1% classified as low, 11.9% as medium and 11.9% as high scorers. The self-concept questionnaire indicated that 36.7% had a high, 43.9% a medium and 19.4% a low self-concept. Higher BMI correlated with a higher BSQ score (P < 0.001), a lower self-concept (P = 0.029) and a higher EAT-26 score (P < 0.001). Smoking was prevalent amongst 13.1% of students, and 51.2% used vitamin and/or mineral supplements. Students who quitted smoking had higher (P = 0.006) BMI (22.7 +/- 2.9 kg m(-2)) than those who never smoked before (21.6 +/- 2.5 kg m(-2)). Normal-weight students were more physically active than underweight or overweight students (P = 0.038). CONCLUSIONS: The specific weight management-related needs of FYFS include information about supplement use, smoking, realistic weight goals, safe and sound weight-loss methods, weight cycling, body-shape perceptions, eating attitudes and behaviours, self-concept and physical activity. Interventions aimed at correcting these problems should target all students, regardless of their BMI.

Adolescent↗
PubMed1986

Lower limb blocks for children. Lateral cutaneous and femoral nerve blocks for postoperative pain relief in paediatric practice.

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.

Adolescent↗
PubMedDate not supplied

Self-monitoring of blood glucose in a multiethnic population of rural older adults with diabetes.

PURPOSE: The purpose of the study was to describe self-monitoring of blood glucose (SMBG) practices of 698 older adults with type 2 diabetes in the rural Southeast, to identify characteristics differentiating testers from nontesters, and to identify personal and support-related predictors of monitoring frequency. METHODS: The ELDER (Evaluating Long-term Diabetes Self-management Among Elderly Rural Adults) study was a population-based, cross-sectional survey of African American, Native American, and white Medicare recipients > or =65 years with diagnosed diabetes. Data were obtained through in-home interviews. Multiple logistic regression models were used to identify factors associated with SMBG and frequency of monitoring. RESULTS: Seventy-seven percent of respondents practiced SMBG in the previous week; 40% tested every day in that week. No ethnic differences were seen. Significant independent predictors of any SMBG were medication regimen (taking oral agents or insulin with or without oral agents) and health care provider (HCP) recommendation to test. Among those monitoring, significant independent predictors of SMBG frequency were medication regimen, HCP recommendation to test, duration of diabetes, and receiving help with testing, which was negatively associated with monitoring frequency. CONCLUSIONS: Among rural older persons with diabetes, HCP recommendation significantly affected practicing SMBG and SMBG frequency. These findings suggest points of intervention by diabetes educators with this vulnerable population. Further research is needed to determine how older adults use SMBG data in their self-care regimen.

Aged↗
PubMed1980

Practice location preferences at entry to medical school.

Previous studies of the geographical maldistribution of physicians suggest that choice of practice location follows from specialty selection and residency location, although it is plausible that the causal order is reversed. To aid in disentangling the causal order, the locational preferences of entering medical students are analyzed. The findings show that the majority of students prefer a small town or mid-size city for practice and about 70 percent prefer primary care--general practice, internal medicine, or pediatrics. Moreover, nearly 60 percent desire a solo or small-group practice of no more than five physicians. Unexpectedly, the factor which best predicts preference for practice locale is not specialty but form of practice organization, which explains 13 percent of the variance in selected geographic location when other factors are controlled. The relationship between preferences for solo or small-group practice and small or mid-size communities may be explained by a common underlying disposition to independence, autonomy, and freedom from bureaucratic control.

Adult↗
PubMed2002

Fundamental studies of liquid chromatography at the critical condition using enhanced-fluidity liquids.

The improvement in the analysis of telechelic polymer matrixes continues to be a pursuit for many scientists of varying disciplines. This quest for a new technique has led to the continued development of liquid chromatography at the critical condition (LCCC) or liquid chromatography at the critical adsorption point (LC-CAP). LCCC allows for the isolation of one area of the polymer matrix so that other areas of the polymer can be probed with size-exclusion or adsorptive chromatographic modes. Although this technique has been successfully applied to the analysis of telechelic polymers, the practice of LCCC can be difficult. These difficulties include finding and maintaining a solvent system appropriate for the practice of LCCC as well as deterioration of peak shape once the system is operating at the LCCC mode. Because of the specificity of the mobile phase required for the practice of LCCC, the work is routinely practiced by premixing solvents. Previous work with enhanced-fluidity liquid mobile phases demonstrated that these mobile phases removed many of the aforementioned challenges associated with working at the LCCC mode. These mobile phases utilize both pressure and temperature variation in order to maintain the specific solvent strength necessary for the LCCC work. This work studies the coupling and optimization of enhanced-fluidity, EF, liquid mobile phases for LCCC. Several EF-LCCC systems, differing in mobile phase composition, temperature, and pressure, were routinely established, resulting in the effective practice of critical chromatography. The practice of LCCC with on-line mobile phase preparation is demonstrated using commercially available instrumentation. Finally, EF-LCCC is used to analyze triblock and diblock copolymers.

Journal Article↗
PubMed2006

[Summary of the practice guideline 'Diabetes mellitus type 2' (second revision) from the Dutch College of General Practitioners].

The practice guideline 'Diabetes mellitus type 2' (second revision) addresses the diagnosis, treatment and management of adults with diabetes mellitus type 2 in general practice. The aim of management is the prevention and treatment of diabetes-related symptoms and complications such as cardiovascular disease, nephro-, retino- and neuropathy. The general practitioner gives the patient education and lifestyle advice and repeats this regularly. In addition, the general practitioner and the patient strive to achieve good glycaemic control. The agent of first choice in the medicinal treatment of all type 2 diabetic patients is metformin. This is continued even after the addition of a sulphonylurea derivative or insulin. This represents a change compared to the previous version of the practice guideline. The indications for thiazolidinediones are limited. To reduce the cardiovascular risk, it is advised to aim at a systolic blood pressure below 140 mmHg. It is also recommended that each patient be prescribed a statin, unless the patient belongs to a subgroup in which the indication for cholesterol lowering therapy is weak or the patient refuses it. Compared to the former guideline, more emphasis is placed on the prevention of nephropathy. The general practitioner is advised to calculate the creatinine clearance yearly and to test for relevant albuminuria in each patient with a life expectancy of 10 years or more. If microalbuminuria is present, the patient is prescribed an angiotensin converting enzyme (ACE) inhibitor, even if the blood pressure is not elevated. The detection of patients with a high risk of diabetic ulcer is also given more emphasis.

Diabetes Mellitus, Type 2↗
PubMed2001

[Blood transfusion in adults: description of a quality assurance program].

OBJECTIVES: In 1995, a fatal transfusion complication led to the development of a quality-assurance programme (QAP). Initial analysis showed important deficiencies in practice patterns for both nurses and physicians. No written guidelines had been previously produced. STUDY DESIGN: Evaluation of practice patterns and quality-assurance programme. METHODS: A QAP was prepared and implemented, a booklet describing completely the transfusion process and institutional policies and providing practical information was edited and the medical and non-medical personnel was informed and trained on a regular basis. Implementation was evaluated during a three-year period by measuring previously defined surrogate endpoints of the quality of the transfusion process. RESULTS: Implementation became rapidly close to 100% either for well-accepted requirements (i.e. patient's identity reporting on transfusion forms) or when physicians were highly motivated (i.e. autologous blood transfusion). For other indicators, implementation progressed more slowly (i.e. traceability of labile blood products) although significant efforts were made to improve the computerised system of data collection and although hospital administration showed a very positive behaviour. Finally, other indicators showed only partial implementation. Several practical barriers (perceived lack of time, excessive increase in writing requirements) were described for transfusion checklist or transfusion prescription form but more in-depth insufficiencies (patients'information) were also observed. CONCLUSION: The success of a change of practice patterns relies on hospital administration positive role, education and feedback, written and immediately available guidelines, employment of specially trained personnel, long-standing actions. Future accreditation of hospitals based on well-defined and well-implemented procedures will also be a major help to increase the quality of the transfusion process.

Adult↗