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PubMed2007

Difficult interactions with veterinary clients: working in the challenge zone.

As veterinarians, effective interactions with clients and coworkers are fundamental to our professional satisfaction and success. This article first reviews the basis of a difficult interaction and provides specific communication skills to help the veterinarian more successfully manage situations that he or she may find difficult. Then, the authors offer exercises to assist veterinarians in practicing these skills. The information in this article relies closely on the work provided through the Bayer Animal Health Communications Project.

Animals↗
PubMed2005

"Reduced to nods and smiles": experiences of professionals caring for people with cancer from black and ethnic minority groups.

Despite growing research in the UK suggesting that patients from black and ethnic minority groups feel that they do not always receive the best treatment and care, little is known about how care professionals themselves respond to working with this group. The study, involving focus groups with health and social care staff, was undertaken to learn about their views and experiences. The principal finding was the extent to which staff experience difficulties in caring for patients from black and ethnic minority groups. Entailing serious challenges to their own professional practice, these were found to arise at all stages of patients' experience of cancer, including at diagnosis, during treatment and at the palliative phase. Staff were concerned that their inability to communicate with some patients meant that they were not able to provide them a good service, as they could not develop an easy relationship and talk around issues. Yet it could be difficult to work with interpreters, as well as family members, both of who could be reluctant to translate important information. They were also conscious of not being fully sensitive to patients' differing cultures, while noting the importance of not making assumptions about particular beliefs or behaviour. Staff would welcome training to help them to explore their attitudes and assumptions in working with black and ethnic minority patients, but did not seek induction into the detailed practices of different cultures. Some staff felt they would benefit from training in working with interpreters.

Adaptation, Psychological↗
PubMed2004

Experiences of foreign European nurses in The Netherlands.

As a result of the shortage of nurses, Dutch health care organizations want to recruit nurses from outside Europe (e.g. Indonesia, South Africa). The Dutch government, however, is not encouraging this policy and prefers to recruit within the European Union. In order to better support such nurses, it is important to know the problems European nurses encounter in The Netherlands. This study is about the experience of nurses from other European countries in The Netherlands. This paper addresses itself to three principal questions. First, how many nurses qualified in other EU or EU candidate states are starting to work in The Netherlands. Second, why do they come to The Netherlands. And finally what problems do they encounter when working in The Netherlands. A questionnaire has been send to all registered nurses trained in another EU or EU candidate state. The response has been 987 or 67%. Thus, far approximately 1500 nurses from other EU/candidate states have come to The Netherlands. Personal reasons, including marriage, are the most important reasons for their coming here. Half of the nurses took one or more courses before starting work in nursing in The Netherlands. These were often Dutch language courses. The nurses had to make a number of adjustments. Major difficulties were unfamiliarity with Dutch laws and the fiscal and social security systems, recognition of their qualifications and application for permits. Some basic issues, such as how to write a letter of application, caused problems. The language and unfamiliarity with the Dutch health care system made it difficult to find a job. When they had gained employment in nursing these problems remained the most serious. The conclusion is that international employment mobility in nursing is rather low in the case of The Netherlands. If the Dutch government decides to encourage the employment of nurses from abroad, several measures can be taken to make working in The Netherlands more attractive.

Adult↗
PubMed2005

Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge.

UNLABELLED: There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. CONCLUSIONS: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.

Adult↗
PubMed2004

Crossing cultures: the lived experience of Jordanian graduate students in nursing: a qualitative study.

This qualitative phenomenologic study explores the meaning of crossing cultures as experienced by Jordanian graduate students in nursing. Seven male and female students participated in conversations and journals regarding their experiences in the academic, social and professional realms of an American culture at a private, mid-Atlantic university. An analysis of the text revealed an overarching theme, "metamorphosis of self." Events leading to the metamorphosis included being chosen, experiencing a time full of memories, feeling bombarded with stimuli and "looking to do something" as professional nurses in Jordan.

Acculturation↗
PubMed2005

Resisting vulnerability: the experiences of families who have kin in hospital-a feminist ethnography.

Health care restructuring, in an effort to control costs, has resulted in marked organizational change with concomitant influences on nursing practice in the hospital and community contexts. Such changes have resulted in increased levels of acuity among patients and shorter hospital stays. As a consequence, families are being asked to assume greater roles in illness care of family members. At the same time societies and therefore patient populations are becoming increasingly culturally and linguistically diverse. Yet, little is known about hospitalization and help-seeking practices of family caregivers in an ethnoculturally diverse context and the nature of support they require from the health care system. This paper addresses this gap in knowledge. Here we draw upon data gathered in two ethnographic studies of illness care and help-seeking practices in an enthoculturally diverse community. Analysis of family data identified 'resisting vulnerability' as a process central to the families' experiences. This paper examines the process of resisting vulnerability and how it was influenced by the practices of health care professionals and structures of the health system. Implications for practice are discussed.

Adaptation, Psychological↗
PubMed2005

Persistent family concerns in long-term care settings: meaning and management.

PURPOSE: The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives. DESIGN AND METHODS: Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes. RESULTS: Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families. IMPLICATIONS: The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.

Adult↗
PubMedDate not supplied

A comparison of verbal and written language in Alzheimer's disease.

UNLABELLED: Few studies have examined characteristics of both verbal and written language of individuals with Alzheimer's disease (AD). This study used parallel measures (picture description, word fluency, spelling to dictation, and confrontational naming) to compare verbal and written language of individuals with mild AD, moderate AD, and normal controls (14 participants per group). Goals were to determine whether verbal/written differences would be exhibited within groups, and to identify measures sensitive to the effects of mild AD. Results showed that increasing AD severity led to decline in performance for most tasks, but only word fluency differentiated subjects with mild AD from normal controls. Confrontational naming was the only task to identify a difference in verbal and written performance for an AD group but not controls; moderate AD subjects performed worse in written naming. Similar verbal and written performance for the spelling to dictation task indicates impairment to central spelling processes in AD. LEARNING OUTCOMES: As a result of this activity, participants will be able to: (1) identify verbal and written language measures which are sensitive to the effects of mild AD; (2) describe similarities and differences in verbal and written language performance among mild AD subjects, moderate AD subjects, and controls; (3) describe how findings may inform clinical practice for individuals with mild AD.

Aged↗
PubMed2006

Treatment plan for integrating evidence-based decision making into dental education.

The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.

Communication Barriers↗
PubMedDate not supplied

Women's experiences of unexpected ultrasound findings.

Ultrasound imaging is an important screening and diagnostic tool in prenatal care, but for many couples in Canada and the United States, it is primarily a meaningful social ritual of seeing and meeting their baby. This article examines how women perceive ultrasound when they receive unexpected abnormal ultrasound findings. Drawing from qualitative analysis of semistructured interviews with 42 Canadian women, the article discusses women's reactions to receiving unexpected findings, and their perspectives on disclosure of results and on seeing the impaired fetus. Implications are discussed for practitioners regarding prescan counseling, informed choice, and disclosure of abnormal ultrasound findings.

Abnormalities, Multiple↗
PubMedDate not supplied

Caring for women from culturally diverse backgrounds: midwives' experiences.

The aim of this study was to show how midwives cared for women from culturally diverse backgrounds. In-depth interviews were used to collect data from 12 experienced midwives who volunteered to participate in the study from a midwifery unit with a culturally diverse population. Study findings revealed that midwives preserved and accommodated the cultural preferences of women from a Chinese background by incorporating the forces of yin-yang into care, heeding the maternal hierarchy and women's stoicism; and for women from an Islamic background by heeding modesty and gender preferences (Hejab), the place of prayer in daily life (Salat), and the imperative of visiting by others (Hadith). Hence, midwives negotiated care that was culturally comfortable for women and their families. Furthermore, triangulated studies addressing the partnership between the midwife and the diverse client are needed, as well as the development of aspects of the health service that are more culturally sensitive.

Adult↗
PubMed2005

A qualitative report of patient problems and postoperative instructions.

PURPOSE: While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. METHODS: African American or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled. RESULTS: A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given informed consent, and 5 participants recalled no elements of informed consent. Overall, 14 participants recalled elements of postoperative instruction. CONCLUSION: Gaps in patient understanding of postoperative care suggest room for improvement in postoperative instructions. Additional research is necessary to design and test high-quality postoperative instructions for surgical treatment and recovery in populations with limited health related literacy.

Adaptation, Psychological↗