Interventions In Health Care Settings Research Articles

Responding to Patient-Initiated Humor

Over the past few decades, increasing evidence has shown the beneficial effects of humor. The use of caregiver-initiated humor as an intervention in healthcare settings has both physiological and emotional benefits. Little has been written, however, about another very important aspect of humor, patient-initiated humor. When patients use humor to relieve their feelings of stress, uncertainty, or embarrassment, they are trying to communicate with their caregiver. This use of humor by patients is not to "make light" of the situation, but rather a way to reduce their feelings of dehumanization. Humor is an interactive process of sharing and an important aspect of communication. Patients will observe the caregiver for a response. An open, accepting response signals understanding; a negative or null response, however, may serve to isolate the patient. The guidelines discussed in this article for recognizing, interpreting, and responding to patient-initiated humor will help home care and hospice nurses to foster increased open patient/caregiver communication and create a supportive humanistic atmosphere for patient care.

Type 1 diabetes as a risk factor for stroke in men and women aged 15–49: a nationwide study from Sweden

The main objective was to determine premature stroke risk in men and women in Sweden with previous hospital admission for Type 1 diabetes or without previous hospital admission. All individuals in Sweden aged 15-34 years at first hospital admission for Type 1 diabetes and aged 15-49 years at first hospital admission for stroke during the study period (1987-2001) were identified. Standardized incidence ratios (SIRs) were calculated to compare premature stroke risk between individuals admitted to hospital with Type 1 diabetes and individuals without hospital admission, after controlling for age, time period, occupation and geographical region. SIRs were also calculated for individuals with diabetic complications. The overall SIRs for premature stroke in men and women with hospital admission for Type 1 diabetes were 17.94 [95% confidence interval (CI) 12.87, 24.36] and 26.11 (95% CI 18.81, 35.32), respectively. Men and women with diabetic nephropathy had the highest significant SIRs of premature stroke: 48.87 and 73.53, respectively. Our data indicate that young to middle-aged individuals with Type 1 diabetes had a considerably higher risk of premature stroke than those without Type 1 diabetes. This underscores the need to implement vigorous interventions in healthcare settings in order to decrease the risk of premature stroke in individuals with Type 1 diabetes.

Cluster Randomized Trials of Professional and Organizational Behavior Change Interventions in Health Care Settings

Individual patient randomized trials are the gold standard for assessing the effects of health care evaluations. However, individual randomization may not be possible for practical, logistical, ethical, or political reasons, for example, when evaluating health care professional and organizational behavior change interventions. Under such circumstances, cluster randomized trials are commonly used. This article discusses the practical and ethical issues in the design, conduct, and analysis of cluster randomized trials of professional behavior and organizational change strategies using examples from two primary studies evaluating health care provider behavior change strategies. Cluster randomized trials are commonly used in health care. They raise distinct ethical and methodological issues that have rarely been adequately addressed in studies to date.

Prenatal Care for Women Who Are Addicted: Implications for Gender-Sensitive Practice

This article examines legal and gender-sensitive interventions for prenatal drug abuse and the greater benefits that accrue to women when gender-sensitive approaches are used. It also discusses the disparate use of legal proceedings against poor women and women of color, pejorative attitudes and behaviors of prenatal health workers that compromise their relationship with women who are addicted, and sexist practices that place mothers who use drugs more at risk of legal interventions in health care settings than fathers who are addicted. Attention is given to the 2001 U.S. Supreme Court decision that makes it unlawful for health care providers to conduct involuntary drug tests of pregnant women who are suspected of drug use.

From rapid smoking to the Internet: five decades of cessation research.

This review summarizes the author's smoking cessation research from the 1960s into the 21st century. Both contextual and personal factors that led the author to undertake cessation research and to move from intensive clinical interventions to brief, population-focused interventions, especially in healthcare settings, are described. Suggestions are offered as to how research can address the problem of inconsistent delivery of effective interventions in healthcare settings.

Prenatal Care for Women Who Are Addicted: Implications for Gender-Sensitive Practice

This article examines legal and gender-sensitive interventions for prenatal drug abuse and the greater benefits that accrue to women when gender-sensitive approaches are used. It also discusses the disparate use of legal proceedings against poor women and women of color, pejorative attitudes and behaviors of prenatal health workers that compromise their relationship with women who are addicted, and sexist practices that place mothers who use drugs more at risk of legal interventions in health care settings than fathers who are addicted. Attention is given to the 2001 U.S. Supreme Court decision that makes it unlawful for health care providers to conduct involuntary drug tests of pregnant women who are suspected of drug use.

Outcomes of Social Work Intervention in Health Care Settings

Outcomes of Social Work Intervention in Health Care Settings

Interventions in Health Care Settings to Promote Healthful Eating and Physical Activity in Children and Adolescents

Background. Physical activity and nutrition are related to multiple health problems during youth and to chronic diseases in adulthood. Health care providers have many opportunities to counsel young people about health behaviors.Method. Policy documents and descriptive data on nutrition and physical activity interventions for youth in primary care were reviewed.Results. U.S. children and adolescents made 29.5 million office visits in 1995, and 6.5 million were for well visits. About 80% of young people have seen a physician during the past year. Many organizations recommend that health care providers counsel children and adolescents about nutrition and physical activity. Many pediatricians counsel patients about physical activity and nutrition, but they have low confidence in the success of these efforts. Bright Futures and Guidelines for Adolescent Preventive Services are two national programs with specific guidelines for counseling. No studies could be located that evaluated youth physical activity or nutrition interventions in primary care. Programs for adults in primary care are sometimes effective, but they must target behavior change and be of sufficient intensity and duration. School programs can be effective, but they are much more intensive than is feasible for primary care. It is likely that effective programs for youth in primary care will require interactions with patients and families beyond the clinic encounter. Barriers to effective counseling include lack of financial incentives, provider knowledge and skills, and tested interventions.Conclusion. There is sufficient promise of public health benefit to justify development and evaluation of youth nutrition and physical activity interventions in primary care. The design of programs should be in formed by behavior change theories, knowledge of opportunities within health care settings, research on determinants of health behaviors, and lessons learned from research on similar types of interventions.

Acceptability of computer assessments among ethnically diverse, low-income smokers.

To examine the acceptability of computer-based assessments among an ethnically diverse, low-income population of primary care patients. Although computers have been used to provide assessments and interventions in health care settings, members of ethnic minority and low-income households have less access to computers than other groups, and therefore the acceptability of computers as a health care assessment and delivery tool needs to be examined. We examined the acceptability of computers for providing assessments of smoking history, nicotine dependence, and other related variables among an ethnically diverse, low-income primary care population. No intervention was used in this study. Three inner-city primary care clinics located in hospitals were used as sites for this study. These hospitals were located in areas of the city where low-income and ethnic minority households are overrepresented relative to the total population. Adult male and female smokers (n = 522) were recruited while awaiting appointments in each primary care clinic. A questionnaire assessing smoking rate, patterns, history, motivation to quit smoking, and other smoking-related variables was administered using either a paper-and-pencil format or a laptop computer. Frequency counts, analysis of variance, and chi 2 tests were used where appropriate. Most subjects (78.5%) used the computer to complete the baseline survey. Almost all subjects (92%) rated the computer "very easy" or "easy" to use. Subjects who were Spanish-speaking, were born outside the United States, or were Hispanic tended to rate the program as slightly less easy to use than other subjects. Computer-based assessments appear highly acceptable to individuals in low-income populations.

Effects of interventions in health care settings on physical activity or cardiorespiratory fitness

Introduction: This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions. Methods: Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics. Results: Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effects on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates. Conclusion: Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.

Tobacco cessation interventions in health care settings: Rationale, model, outcomes

Health care settings provide opportunities to reach populations of tobacco users with personalized cessation assistance. We describe a model for doing so which emphasizes a team approach, minimizes the burden on clinicians, and uses brief counseling by allied professionals, videos, written materials, and telephone calls to augment clinician advice. The model has been implemented in several diverse settings including outpatient, inpatient, and dental clinic managed care: fee-for-service dentistry and pediatric practices; and planned parenthood clinics. Data from several randomized trials support the effectiveness of the approach. The brief, low-intensity interventions derived from the model appear to be sustainable on a routine basis in many settings.

Predicting receipt of social support: a longitudinal study of parents' reactions to their child's illness.

A sample of 101 women whose children required medical attention were interviewed at the time of initial hospital contact and again 1 year later. On the second occasion, their spouses were also interviewed for their assessment of their wives' personal and social characteristics. Greater personal resources, more intimate relations, and lower discomfort in seeking support were related to greater receipt of social support 1 year later. Chronic stress conditions were found, however, to diminish the effect of individuals' social characteristics on receipt of support. Spouses assessments showed moderate agreement with that of their wives, lending support to the validity of the findings. Implications for interventions in health-care settings were discussed.