Improve Health Professionals Research Articles

A systematic review of interventions to improve health professionals' management of obesity.

To determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organisation of care for overweight and obese people. A systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organisation of Care (EPOC) Group. Trained health care professionals and overweight and obese patients. Objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors, and measures of body weight, fat, or BMI. Twelve studies that met all the review inclusion criteria were identified. Three were randomised controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before and after study to improve collaboration between a hospital clinic and GPs. A further eight randomised controlled trials were identified of interventions comparing either the deliverer of weight loss interventions or the setting of the delivery of the intervention. The heterogeneity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity management. At present, decisions about improving the provision of services for overweight and obese people must be based on the evidence from patient interventions and good clinical judgement. Future research is required to identify cost-effective strategies for improving health professionals' management and the organisation of care for overweight and obese people.

The use of a rating instrument to teach and assess communication skills of health-care workers in a clinic in the Western Cape.

Research in health communication shows communication to be an important aspect of successful health-care. Moreover, training courses which provide feedback have been shown to improve health professionals' ability to conduct successful interviews. This article describes a rating instrument which was developed in order to facilitate teaching and assessing the communication aspects of health-care interviews. The instrument was found to be useful in a training programme offered to nursing staff of a TB Clinic in Mitchells Plain, Western Cape. The instrument appears as Table 1. In the Table categories of communication behaviours, each indicating an important aspect of the interaction, are given as the six headings. These are: establishing rapport and respect listening receptively confirming the patient sharing control informing effectively and checking perceptions. Within each category the more detailed specific behaviours are listed, allowing for close analysis of a care-giver's interviewing skill. The article briefly discusses the importance in effective communication between the care-giver and patient of each category of behaviours given in the instrument, supported by evidence from research. Lastly the article describes a "case study" on how the instrument has been successfully used in a training programme.

Treatment of obesity: theory into practice.

The purpose of the present paper is to outline the current situation in the management of obesity in adults, and to make some suggestions as to how health professionals involved in obesity treatment can best address this growing problem. Dietitians and nutritionists have long been involved in the treatment of obesity, and have a vital role to play in the battle to reverse the increasing prevalence of this major public health problem. However, the current management of obesity is far from ideal. There is evidence to suggest that in general health care, even when there are clearly effective clinical interventions, health professionals may not practise in the best way. Furthermore, some professionals may also hold negative attitudes towards the obese. These are the subject of a systematic review on improving health professionals' practice and organization of care in obesity treatment, the preliminary findings of which will be discussed in the present paper (Harvey et al. 1998a,b). A new approach to obesity is required, encompassing effective treatment and prevention strategies. A greater understanding of the problems faced by the obese individual in attempting to lose weight is also needed, with a range of treatment approaches on offer to acknowledge the heterogeneity of obesity. Those health professionals involved in obesity treatment must consider the impact of dietary advice given in a consultation against the impact of environmental cues that assail the patient as soon as they leave the room. Tackling the obesity epidemic requires action at the individual and population level if we are to see any reduction in prevalence.

Issues of non-compliance in mental health.

This paper explores and questions the ideas and notions in respect of non-compliant behaviours. Traditionally, research into this area has focused on identifying individual characteristics from within the adult branch of nursing and within the confines of the medical model of compliance. Little research has investigated the phenomena of non-compliance within the specialty of mental health. It may be suggested that identifying characteristics in this setting is futile. There are many factors determining a client's compliance behaviours. These include gender, social class, race and socio-economic status. Those suffering from mental ill health are often the most vulnerable in society and it may be argued that as such are often coerced into accepting treatment with those who refuse frequently being labelled as non-conformist. The ability of the client to refuse treatment should be based upon informed consent, but is often dependent upon the social prejudice of the health care professional, their misuse of power to bring about compliance behaviours and their inability to act as an effective advocate. Finally, by eliciting information, shared negotiation, planning and improved communication health professionals may improve compliance behaviours based upon the client's needs and wishes.

Effective professional practice: protocol for a systematic review of health professionals’ management of obesity

While much attention has been paid to interventions to help overweight and obese people lose weight, relatively little is known about the contribution of health professionals to obesity reduction. As in other clinical areas, variations in the provision of health care for overweight and obese people may affect health outcomes. In this area in particular, there is reason to believe that practice may be adversely affected because of some providers’ negative attitudes towards the patient group.This work aims to identify strategies that are effective in improving health professionals’ management of obesity or the delivery of health care services for overweight and obese people. In contrast to recent systematic reviews of patient‐targeted approaches, this review focuses specifically on interventions designed to improve health professionals’ practice. It is undertaken in association with the Cochrane Effective Practice and Organisation of Care (EPOC) Group. The protocol for this review is described.

The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients

Health professionals such as doctors and nurses are in a key position to help reduce the high prevalence of affective disorders and psychological problems experienced by cancer patients. This role, however, is inhibited by ineffective communication practices which include the use of distancing strategies and avoidance by the health professional. A number of contributory factors such as skill deficits and anxiety about negative consequences for the patient and the health professional have been identified in previous research and brief problem-focused training workshops developed to address these factors with only limited success. Researchers in applied psychology have recommended that the development of training programmes and their evaluation are based upon approaches which take into account cognitive and affective factors as well as change in skills. The aim of this paper is to develop a conceptual model of communication behaviour in the cancer setting. The model aims to take account of the role that knowledge and skill deficits, self-efficacy and outcome expectancy beliefs and perceived support plays in the ability and willingness of health professionals to assess their patients' concerns. It has been applied to guide the development of a revised approach to brief, problem-focused workshops for health professionals. It also allows a systematic and multi-dimensional evaluation of training outcomes. Preliminary results indicate this is a promising area of communications research.

Patients' perspectives and experiences of day case surgery.

This qualitative study aimed to examine patients' experiences and views of day case surgery to improve health professionals' knowledge and understanding, in order to make recommendations for improving the quality of this service and to provide information which may be considered when further developing services in the future. The grounded theory methodology was adopted using informal conversational style interviews with eight participants. The constant comparative method was employed to identify coherent patterns and themes in the data. Patients expressed dissatisfaction with the scheduling of their operations and emphasized the importance of planning before admission, during their period of hospitalization and in preparation for discharge. Patients unanimously recognized that they were inadequately prepared for day case surgery in terms of information and educational support and from a perceived knowledge gap within the multi-disciplinary health care team. They also believed that there was a lack of continuity of care during their day case experience, and were unprepared for the increased level of patient empowerment but were interested in developing a collaborative relationship with staff. Patients claimed that they like day case surgery because it resulted in minimal disruption to their personal lives. Patients are consumers of the National Health Service (NHS) and have first-hand experience and knowledge of the services provided. In order to improve satisfaction further, patients' perspectives must be used to reshape and make better use of the limited resources to benefit the service, patients and ultimately the NHS.

Evaluation of a patient teaching skills course disseminated through staff developers.

Effective Patient Teaching (EPT), a course designed to improve health professionals' and health professions students' teaching skills, reliably produces gains in participants' skills when presented by its developers. The objective of this dissemination research study was to investigate whether, using a 'training of trainers' approach, seven nurses with staff development responsibilities in five different sites could teach EPT with similar effectiveness. The evaluation included pre- and post-course analysis of audiotaped patient education sessions conducted by 48 health professional participants who took EPT from one of the trainers in their home institutions. Post-course participant satisfaction surveys were also administered. EPT resulted in teaching skill improvements in four of five sites, and overall teaching skills scores improved significantly (P < 0.01). EPT can improve participants' teaching skills when taught by health professional trainers with staff development responsibilities who have recently received EPT training.

Teaching skills of health professionals.

The purpose of this paper is to describe an analytic method that focuses on health professionals' teaching skills. The method involves comparing live or recorded teacher behaviors with operational definitions of 20 skills known to influence learning outcomes, and assigning numerical ratings on a four-point scale. The videotapes prepared for this symposium are rated and compared with other sessions recorded in health care settings. Virtually all patient educators could improve their teaching skills substantially. Although many questions about teaching skills and education process remain unanswered, available data clearly justify training to improve health professionals' teaching skills.

Teaching skills training for health professionals: Effects on immediate recall by Surrogate Patients

Medical educators increasingly recognize patient education skills as an important component of professional curricula. Previous studies have suggested that a 30‐hr course, “Effective Patient Teaching,”; improves health professionals’ instructional skills. This study was designed to further evaluate program impact on students’ teaching skills and on their patients’ recall. Course participants and untrained matched volunteers were asked to provide instruction based on standard content material. College students served as surrogate patients. After instruction, surrogate patients completed a recall questionnaire on the standard content. Course participants exceeded controls on 10 of 16 selected teaching skills. Trained students also taught more content (p < .01), and their patients recalled more of what was taught (p < .05). Time spent teaching was not a significant covariate. Extent of use of teaching skills correlated significantly with patients'recall (r = .57, p < .01). The results suggest that training that improves health professionals’ teaching skills may have measurable impact on their patients.

Training health profession students to be effective patient teachers.

Patient education is an increasingly important part of modern health care. Health professionals' ability to effectively teach their patients is therefore an important concern for medical educators. This report describes a program designed to improve health professionals' teaching skills. Effective Patient Teaching is a 30-hour course which targets 20 specific teaching skills. Course time is approximately equally divided between lectures/demonstrations by faculty, and practice teaching by participants, followed by individual feedback. Comparison of first and last practice teaching sessions to operational definitions of teaching skills showed signifiant improvement in most teaching skills. This study suggests that rapid improvement in health professionals' patient teaching skills can be achieved in a program that includes modeling of effective skills, supervised practice, and appropriate feedback.