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Ethnicity and proficiency in English as factors affecting community cardiopulmonary resuscitation (CPR) class attendance.

Communities with a high prevalence of cardiopulmonary resuscitation (CPR) knowledge have a greater out of hospital cardiac arrest survival rate. Within metropolitan Adelaide, 12.4% of the community is from a non-English speaking country and 20.3% of these have a poor proficiency in English. The purpose of this study was to examine the effect of ethnicity (specifically, Southern European born (SEB) and South East Asian born (SEAB)) and a poor proficiency in English (PENG) on CPR skill acquisition. Population Census postcode data were compared to postcode student CPR classes attendance. Results showed a negative correlation between SEB (-0.44), SEAB (-0.36), PENG (-0.42) with CPR class attendance. Postcodes with a less than community average of SEB, SEAB and PENG had an average proportion of CPR class attendees of 2.64% (C.I. 2.43, 2.85), 2.54% (C.I. 2.35, 2.73) and 2.65% (C.I. 2.35, 2.73), respectively, whilst those postcodes with a greater than community average had 2.03% (C.I. 1.90, 2.16), 2.07% (C.I. 1.90, 2.24) and 2.04% (C.I. 1.90, 2.18) proportion of CPR class attendees. The difference for each category was significant to a P < 0.001. This study points to SEB, SEAB, and PENG as factors associated with fewer CPR class attendances. Future CPR classes should specifically target and cater for ethnic groups from non-English speaking countries with poor English skills if CPR skills are to be widely disseminated throughout the entire community.

Adolescent↗

Diffusion of pain language with affective disturbance confounds differential diagnosis.

Two experiments examined the use of pain descriptors by chronic pain patients with different medical and/or psychiatric diagnoses. Experiment I subjected patients' responses to the 20 descriptor categories on the McGill Pain Questionnaire to 3 separate multiple discriminant analyses to examine the differential diagnostic properties of pain language. None of the analyses generated a discriminant function, indicating that chronic pain patients do not use pain descriptors in a precise and systematic manner. Experiment II demonstrated that as affective disturbance increased within a chronic benign pain population pain language became more diffuse. These results suggest that pain language is not accurate for medical diagnosis in patients who suffer affective disturbance.

Affective Symptoms↗

The family's viewpoint of chronic pain.

An indentical questionnaire are administered separately to 100 chronic pain patients and a close family member of each. The majority of patients and relatives agreed on the answers to these questions about the pain problem. Highest congruency between patient and relative was associated with cases in which there were management problems and an ultimately poor treatment result. Rather than reflecting excellent communication between patient and relative, this appears to indicate an undesirable mutuality. Patient answers indicate to us as examiners that their pain is greater than they have revealed to relatives, yet the relatives say the patient is showing more than he realizes.

Adult↗

Cross cultural issues in patient education.

This paper discusses the role of patient education within the context of cultural diversity and adult learning theory. Cultural variations in health care beliefs are illustrated with examples from multiple ethnic groups. Strategies for developing effective cross cultural educational programs are presented.

Adult↗

Communication problems on an oncology ward.

Within the field of oncology, the communication of an unfavourable diagnosis is regarded as a stressful event that affects all members of the oncology team, as well as the patient. In this exploratory study we found that the communication problems between doctors, patients and nursing staff were related to insufficient information exchange. A psychosocial registration sheet was developed in order to improve communication on the ward. The effects of the new approach are briefly commented upon.

Communication Barriers↗

Evaluation of the informed consent procedure in cancer patients candidate to immunotherapy.

By addressing questionnaires to 24 cancer patients candidate to immunotherapy, we evaluated both the effects and the effectiveness of the medical information provided to the patient on their knowledge of the disease and the treatment. Most patients had correctly understood the information but 69% stated that they had been unable to ask all the questions they wished, and 62% required additional information. Most patients admitted to being emotionally distressed throughout the interview. These results are not significantly different from those obtained in patients candidate to new chemotherapy agents, but show that important improvements in the informed consent procedure are required.

Attitude to Health↗

The communication process with ventilator patients in the ICU as perceived by the nursing staff.

Intensive care unit (ICU) nurses (n = 27) were interviewed about their experiences and opinions of the communication process with ventilator treated patients. Nurses with limited ICU experience considered the initial contact with a new critically ill ventilated patient more frustrating than experienced nurses. The nurses thought that the content of the communication commonly requested by a patient was dominated by factors related to the clinical condition, prognosis and reassurance that the situation was under control. Factors considered to limit the communication and to create feelings of uncertainty and stress for nurses with an ICU experience of less than 5 years were: work overload, unstable condition of the patient, impaired communication with the patient, and their own personal problems or worries. For nurses with an ICU experience of more than 5 years stress was more commonly evoked by the presence of worried and anxious spouses/relatives, and by the feeling that something was wrong with the patient but they were unable to identify the problem. Failure to understand a ventilated patient could induce feelings of incompetence, stress and sometimes even despair. The present small scale study shows that there are many factors, in addition to ICU experience, that may influence the ability of an ICU nurse to establish and maintain a well functioning communication with ventilated patients and the likelihood of doing so.

Adult↗

Graduate education for nursing students who have English as a second language.

Working with international students, especially those who have English as a second language, is a challenge for any educator. To date there has been little information in the nursing literature that is helpful to faculty who teach and/or mentor these students. The shared personal knowledge gained from participation in planning and providing educational options for foreign students and the empirical cognizance made possible from several years of guiding the program of studies of these students is offered as a beginning framework to other faculty. The need for research in the area is identified.

Communication Barriers↗

Detecting pain in people with an intellectual disability.

The assessment of pain in a person with an intellectual disability (ID) is often a difficult undertaking complicated by idiosyncratic reactions or vague descriptions. The person with an ID may also be unable to verbally communicate their discomfort. For the carer who knows the individual with an ID, knowing how they respond to painful stimuli assists the carer to detect new instances of pain. The emergency nurse is unlikely to have met the person with an ID and therefore detecting pain by observing behaviour or using self-report measures is unlikely to succeed. There have been some attempts to categorize behavioural responses to pain by people with an ID, however, they have not been developed into a useful assessment tool. Emergency nurses must therefore rely on the person who knows the person with an ID.

Communication Barriers↗

What general emergency nurses want to know about mental health patients presenting to their emergency department.

This paper presents the findings of a qualitative project conducted to investigate the education and training requirements that non-mental health trained emergency nurses need to enable them to effectively care for psychiatric patients presenting to a West Australian emergency department. Non-mental health trained nurses are ill-equipped in their psychiatric knowledge, assessment and communication skills to provide best possible care to the one in ten patients presenting to the emergency department with a complex mental health issue. The area of assessment and management of mental health patients in the emergency department is a complex one and staff are required to assess, triage and manage these patients appropriately. Furthermore, with aggression and violence increasing, emergency department nurses are concerned about their safety in the workplace. Focus groups with emergency nurses and semi-structured interviews with subject matter experts were conducted at one West Australian teaching hospital. The findings of the project demonstrated that these nurses considered that customer focus, workplace aggression and violence, psychiatric theory, mental health assessment and chemical dependence as key learning areas. These findings will form a platform for further education and training for ED staff.

Attitude of Health Personnel↗

A definition and operational framework for health numeracy.

Health numeracy has often been overshadowed by health literacy, either ignored completely or identified simply as a subset of health literacy. Only now are researchers beginning to realize the importance of health numeracy as a separate entity. One of the first steps in this evolution is to establish a distinct definition for health numeracy, something that has not been addressed in the literature to date. This paper proposes such a definition, as well as a set of clarifying categories in hopes of helping researchers both to advance the field of health numeracy and to focus their topics within the realm of health numeracy.

Communication Barriers↗

Disparities in access to fresh produce in low-income neighborhoods in Los Angeles.

BACKGROUND: Access to fresh produce and other healthy foods differs between poor ethnic and wealthier non-ethnic neighborhoods. Given the need to improve access, emergency food organizations, such as food pantries, can provide assistance. Food pantry clients, many living in poor ethnic neighborhoods, are at highest risk for inadequate intake of fruits and vegetables as emergency food assistance often does not include a supply of fresh produce. This study examines the extent to which food pantry clients live within reasonable walking distance of stores carrying fresh produce, and it proposes a strategy to increase accessibility of produce to those clients. METHODS: Addresses for 3,985 food pantry clients residing in Pomona, California, in 2003 and 84 food stores categorized as selling a "variety of produce" or "limited produce" were geocoded using geographic information systems technology in 2004. A 0.8-km network buffer was used to measure access to stores. Cluster areas with high densities of food pantry clients, or hot spots, were determined. RESULTS: Forty-one percent of Pomona food pantry clients were within walking distance of a store with fresh produce. Eighty-three percent were within walking distance of stores with limited produce, and 13% were not within walking distance of either store type. Seventeen cluster areas of food pantry clients accounted for 48% of clients with no access to a produce store. CONCLUSIONS: Using individual-level data allowed for the identification of significant numbers of food pantry clients with limited access to stores carrying a variety of fresh produce. Identification of the location of high concentrations of food pantry clients provides a potential solution to increase fresh fruit and vegetable access via mobile produce trucks.

Adolescent↗

Prediction of social activity 1 year poststroke.

OBJECTIVE: To develop an easy-to-use prediction rule for social activity 1 year poststroke that can identify patients at risk for social inactivity. DESIGN: Inception cohort. SETTING: Rehabilitation center. PARTICIPANTS: Patients with a first-ever supratentorial stroke were selected in 4 Dutch rehabilitation centers. Data of 250 patients were available for analysis. Potential prognostic factors measured at admission were sex, age, marital status, prestroke employment status, educational level, type of stroke, hemisphere, motor impairment, trunk control, communication, and activities of daily living (ADL) dependency. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Social activity measured by the Frenchay Activities Index (FAI) at 1 year poststroke. RESULTS: Multivariate backward linear regression analysis identified sex, age, marital status, motor impairment, communication, and ADL dependency as important predictors of the FAI score 1 year poststroke. An easy-to-use score chart was constructed that could identify patients at risk for social inactivity. The score chart proved to be well able to discriminate poor social functioning from moderate to good social functioning (area under the curve = .85). CONCLUSIONS: Identifying patients at risk enables health care professionals to focus on the social activity of this patient subgroup at an early stage in the care process.

Activities of Daily Living↗

Talking to the dying.

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Attitude of Health Personnel↗

Contemporary issues in adult tracheostomy management.

Airway assessment and management is one of the primary responsibilities of nurses caring for the critically ill adult. Common types of artificial airways, such as endotracheal and tracheostomy tubes, require clinicians to have a complete understanding of indications, complications, and clinical applications. Although tracheostomy tubes are used to a lesser extent than endotracheal tubes in most ICUs, their use typically requires additional education and training because of the complexity and diversity of available tubes, care of surgical site, and other related nursing care issues. The purpose of this article is to provide a review of current practice trends for those caring for the adult patient who has a tracheostomy tube. The first section of the article is an overview of the indications, surgical techniques, and types of tubes used in the critical care setting. The second section examines specific aspects of nursing care of patients who have tracheostomy tubes.

Adult↗

Stress in expatriates.

With economic globalization, the rate and effects of culture shock stress in expatriates and their families are expected to increase. The stressor may occur from the micro-environment, the macro-environment, or the mega-environment. The effects of stress are frequently due to predictable reactions such as insecurity, distress, and homesickness. These symptoms can progress to more severe psychosomatic symptoms, including depressive reactions and overt psychopathic behavior. Cross-cultural training programs are currently the best preventive strategy for culture shock and subsequent stress; however, the true efficacy of these programs is not well characterized. Substance abuse is probably a significant underlying problem for international business travelers; however, the true magnitude and effects of this issue are not well characterized in the expatriate community. There are substantial opportunities for additional medical research in these areas.

Adaptation, Psychological↗

Miscommunication between healthcare providers and patients may result in unplanned pregnancies.

Our objective was to examine the impact of prior healthcare provider counseling on previous use of contraception and knowledge of emergency contraception in women seeking surgical abortion. We performed a retrospective analysis of 342 patient charts from women seeking an office abortion in a private practice setting from January 1999 to June 2001. Data extracted included demographic information, primary method of contraception over the preceding few months, compliance with that method, contraceptive history, knowledge of emergency contraception and postabortion contraception. Patients were primarily white (69%) and unmarried (63%) and had private insurance that covered abortion services (72%). Only 19% of women were using a birth control method with no recognized potential failure. Twenty-two percent of women were using their birth control method correctly but experienced an event that put them at risk for pregnancy, 32% were using their birth control method incorrectly and 27% were using no birth control method at all. Miscommunication between patients and their healthcare provider(s) negatively affected use of a primary contraceptive method in 14% of patients. Of the 77% of women who did not know about emergency contraception, nearly two thirds had an identifiable event for which emergency contraception could have been used. Healthcare providers may contribute to the occurrence of unintended pregnancy if they provide poor medical advice or miscommunicate with patients.

Abortion, Legal↗