Client Knowledge Research Articles

Significant Conversations or Reduced Relational Capacity? Exploring Couple and Family Therapists' Expectations for Including a Client Feedback Procedure

Little information exists on the specific reflective processes that precede therapists' choice of including or not including a structured feedback procedure in their established practice. In the present study, we aim to describe and explore experienced couple and family therapists' expectations for how the comprehensive therapy feedback procedure Systemic Therapy Inventory of Change might influence their practices. Through a thematic analysis of six focus group interviews, two main themes were elicited. The first main theme involved values embedded in current practice, with the following subthemes: (1) balance between the therapist's expert knowledge and the client's experience-based knowledge; and (2) making time to build alliances. The second main theme concerned the presumed influence on current practice, with the following subthemes: (1) ‘Systemic Therapy Inventory of Change will disturb the therapist's capacity to stay present’; (2) ‘Systemic Therapy Inventory of Change will shape conversations’; and (3) ‘Systemic Therapy Inventory of Change will contribute to increased qualitative depth’. We discuss these results in relation to the notion of Systemic Therapy Invention of Change as a ‘third party in the room’. We also discuss the results in relation to implications for collaborative practices, and for client and therapist autonomy.

Reproductive Health/Family Planning in Basrah: Evaluation of the knowledge, utilization & satisfaction of the service users.

Background: Reproductive Health and Family planning is critical for the women’s health and their families, and according to the World Health Organization, the right of having reproductive health services including family planning is identified as one of the targets of the United Nations Millennium Development Goals (MDGs) Objectives: This study aimed to explore the utilization of reproductive health services, together with having opinions and satisfaction of the target group regarding these services. Subjects and method: A client satisfaction and knowledge assessment questionnaire was used through health facility exit face to face with a total of 265 women at governmental health facilities in Basrah Results: The study showed that only 27% of the interviewed respondents were completely satisfied with the service they received and among those who were not satisfied, crowding of the health facility was the main cause of non satisfaction. 34% of the respondents were found to have an unmet need for a reproductive health service at the public health facility level. The study also showed that 16% of the respondents found to be using a contraceptive method of which 51% were from the private source. Conclusion: The study showed that the majority of the women aged (15-49) years living in Basrah were not aware of the availability of specific reproductive health services including breast and cervical cancer detection, postnatal care (PNC), Sexually Transmitted Infections (STDs), Acquired Immune Deficiency Syndrome (AIDS), infertility management, gender based violence and youth health services..

“We have to try and have this child before it is too late”: missed opportunities in client–provider communication on reproductive intentions of people living with HIV

Men and women living with HIV with access to ARVs are living longer, healthier lives that can and often do include bearing children. Children occupy a key space in men and women's personal and social lives and often play a fundamental role in maintaining these relationships, irrespective of illness concerns. Couples living with HIV need to balance prevention needs and ill-health while trying to maintain healthy relationships. Health-care providers serving the reproductive needs of HIV-affected couples need to consider the social and relational factors shaping reproductive decisions associated with periconception risk behaviors. This paper based on qualitative research at three hospital sites in eThekwini District, South Africa, investigates the childbearing intentions and needs of people living with HIV (PLHIV), and the attitudes and experiences of health-care providers serving the reproductive needs of PLHIV, and client and provider views and knowledge of safer conception. This research revealed that personal, social, and relationship dynamics shape the reproductive decisions of PLHIV, and “unplanned” pregnancies are not always unintended. Additionally, conception desires are not driven by the number of living children; rather clients are motivated by whether or not they have had any children with their current partner/spouse. Providers should consider the relationship status of clients in discussions about childbearing desires and intentions. Although many providers recognize the complex social realities shaping their clients' reproductive decisions, they have outdated information on serving their reproductive needs. Appropriate training to enable providers to better understand the relationship and social realities surrounding their clients' childbearing intentions is required and should be used as a platform for couples to work together with providers toward safer conception. The adoption of a more participatory approach should be employed to equalize client–provider power dynamics and to ensure clients are more involved in decision-making about reproduction and conception.

Relationship between Customer and Management Knowledge Based of Life Cycle Concept

Modern business world,, the role of consumer knowledge plays an important role in developing a knowledge management in SME respectively in industry sales industry of wholesalers and retailers . With that developed countries, the management team their knowledge harmonizes with the needs of consumers consumer knowledge. Exactly relations between of consumers and management in themselves owns series of problems which need to be resolved to an effective way. This relation in SME by transition countries has not been developed to the level as in the developed countries. Therefore, research is necessary in the SME of countries in transition, which shall first of all to determine level of relations between the consumer and the of the management team of SME the relationship the consumer of knowledge and the of knowledge of management team. Regarding to the main reason of studies and also with the problematic situations research paper require the theoretical model witches divided into two parts The first part of theatrical model is discussion about topics which is quit significant with studies areas as : Knowledge cycle based view with the main elements such are theoretical approach by creation knowledge, capture knowledge and etc. The second part of theoretical background is discussion about customer knowledge on the relation with management cycle and their segments. Empirical data of this research include the total representative number of 323 correspondents where are 253 male and 70 female, according to the statistical method of obtaining a sample size where is expedited P = 30% therefore Suggestion precision d = 0.05. According to the Questionnaires were gathered after completion and were analyzed by SPSS Software, which caring up the results of research variables which means regression analyzes with ANOVAs model will show P=0,35.The regression coefficient give us the discussion between following Hypothesis H0 Knowledge management is in relation with client knowledge in industry of wholesalers and retailers H1 Knowledge management is not in relation with client knowledge industry of wholesalers and retailers. And finally results will give explain about econometric parameters p=0,35 and Ɛ=0,0356. DOI: 10.5901/ajis.2014.v3n2p117

Skills, Knowledge, and Attitudes Important for Present‐Day Auditors

Recent accounting scandals have challenged and transformed the present‐day role of auditors, making it timely and important to re‐examine the skills, knowledge, and attitudes (SKAs) required of auditors in today's business environment. While prior studies have examined SKAs of accountants and internal auditors, and personal attributes of auditors, there is little research on auditors' SKAs. We propose and examine 20 SKAs important to present‐day auditors. We survey experienced auditors in Singapore about the importance of these SKAs. Our participants rate professional integrity, assessing audit evidence, and having a questioning mind (indicative of professionalism competency) as the three most important SKAs. The participants also assess entry‐level auditors' (ELAs) performance for each SKA. The difference between their importance and performance ratings is largest for business competency, particularly for knowledge of client's business. Our findings have implications for various accounting constituencies in terms of developing auditors' competencies.

Global Trade and Commodity Finance: The Next Emerging Securitization Asset Class?

There was approximately $18 trillion of cross-border trade in 2012. The volume of commodity trade is directly correlated with world population and generally retains a share of approximately 30% of total trade. Historically, commodities recover faster than any other sector in an economic crisis. Commodity trade finance is done in U.S. dollars and generally refers to three “families” of commodities: 1) energy, 2) metals and mining, and 3) “softs,” including grain, cotton, and various tropical products (e.g., palm oil and sugar). Critically, commodity trade finance focuses on logistics and not speculation. The commodities have already been sold, import and export letters of credit are normally established, and hedging and insurance are typically arranged. Relatively low-margin commodity trade financing has largely shifted from banks to capital markets as banks have been subject increasingly stringent leverage and liquidity coverage ratios. Withholding taxes, local taxes, and local bankruptcy laws are important factors in the planning of a multi-jurisdictional commodity financing transaction. Fraud risk, mitigated by strong client knowledge, is the biggest risk in commodity trade finance, followed by operational risk, especially involving export and import letters of credit; market risk, which can arise from transportation delays or broken contracts but can be mitigated through commodity hedging and advance ratios; country risk, which can be mitigated through hedging or insurance; and credit risk, which is mitigated by short tenors and the marketability of the underlying collateral.

Are midwifery clients in Ontario making informed choices about prenatal screening?

Informed choice is often lacking in women's decisions about prenatal screening. The aim of this study is to evaluate how well midwives in Ontario, Canada are facilitating informed choice in this area. An Internet-based survey was used to investigate 171 midwifery clients' knowledge, attitude towards and experience of prenatal genetic screening tests, and to determine the proportion of study participants who made an informed choice about prenatal screening. All participants demonstrated adequate knowledge of prenatal screening. The vast majority (93.0%) of participants made an informed choice. Participants who chose to screen had lower knowledge scores than those who opted out of screening. Client satisfaction rates in regard to care received in this area ranged from 97% to 100%. Results of this study suggest that Ontario midwives are effective in conveying information on prenatal genetic screening, contributing to high levels of client knowledge and satisfaction in comparison to similar studies in other jurisdictions.

Willingness of a Convenience Sample of Horse Owners to Use Stem Cell Therapy for the Treatment of Equine Tendon Injury and Factors that Influence This Decision

Stem cell therapies offer huge potential for the treatment of tendon injury in horses. However, the factors influencing clients' willingness to use these therapies have not yet been investigated. This study examines the willingness of a population of horse owners to choose stem cell therapy for the treatment of equine tendon injuries and the factors that may influence this choice including treatment cost and efficacy, veterinarian advice, client knowledge, and success stories. A short, anonymous questionnaire was delivered to a convenience sample of equine owners. Questions related to (1) respondent background; (2) prior experience with tendon injuries and their treatment; (3) willingness to use equine stem cell therapy; and (4) the importance of factors that may affect their decision to use the therapy. Responses were summarized using graphical methods and compared using Fisher exact test where appropriate. Fifty-four percent of our cohort (n = 113) reported they would be willing to use equine stem cell therapy, 6% were not willing, and 40% were unsure. When asked to rank factors that would influence their decision, scientific proof that the therapy works was ranked highest followed by veterinarian advice. This result may have been influenced by the high proportion of tertiary-educated respondents recruited in this study. This is the first reported study to investigate the willingness of a population of horse owners to use stem cell therapy for their horses. Results suggest that the majority of these equine owners may consider using stem cell therapies for their horses given a larger positive evidence base was provided for the therapy.

Using the health literacy concept to promote self-management in a chronic kidney disease patient

Patients with chronic kidney disease (CKD) must learn and use self-management skills to control their disease and delay disease progression. Comprehension of instructions is thus critical to integrating self-management principles into daily life. In this case report, the client had difficulty implementing the behavioral changes necessary to control diet and blood sugar due to the lack of proper and sufficient information. The authors applied health literacy concepts to assess the client's knowledge and skills related to disease control and then provided health teaching at a level appropriate to the client's health literacy level. This individualized care enhanced the client's confidence and motivation to implement self-care activities. Healthcare professionals should help patients overcome barriers to reading and verbal communication to help low-health-literacy patients successfully self-manage their chronic disease. Clients may thus learn to report their symptoms clearly and accurately.

Providing and funding breast health services in urban nurse-managed health centers

Nurse-managed health centers (NMHCs) are an innovative health care delivery model that serves as an important point of health care access for populations at risk for disparities in health outcomes. This article describes the process and outcomes of clinical breast health services in two NMHCs located in a large Midwestern city. Findings indicate that client's knowledge about breast health was increased after they received breast health services from NMHC nurses. Significant positive changes in behavior related to the early detection of breast cancer were found in the study. NMHCs, identified for expansion in the Patient Protection and Affordable Care Act, offer a unique health care services delivery model that promotes access to care and early identification of breast cancer in very low-income and uninsured women.

Clients' knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria.

Clients' knowledge, perception of and satisfaction with the quality of maternal health services (QMHS) enables maternal health programs to assess the impact of their services from the clients' perspective. The objective of this study is to assess the knowledge, perception of and clients' satisfaction with the QMHS at the primary health care (PHC) level in Nnewi, Nigeria. This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from randomly selected PHC facilities in Nnewi, Nigeria were selected for the study. Data were collected using a mix of quantitative and qualitative methods. Quantitative data were analyzed using Statistical Package for Social Sciences version 16, while qualitative data were reported verbatim, analyzed thematically and necessary quotes presented. A total of 280 women were studied. The mean age of the respondents was 29.2 ± 5.9 years. 231 (82.5%) were married. 89 (31.8%) did not report any knowledge about QMHS. Level of satisfaction was not different among women of different socioeconomic groups ( P > 0.05). Sociodemographic characteristics of clients were not found to be associated to the perception of waiting time: ( P > 0.05). The attitude of health care providers toward the clients was reported as good. Despite the poor quality of services provided, this study showed that client's knowledge of quality of services was good. Furthermore cost, local language used, staff attitude and interaction with clients was acceptable and may be the reason for high level of satisfaction reported.

Multi-voiced assessment in a mental health final statement

AbstractThe focus of this article is on the records written during an intensive assessment and rehabilitation course targeted at young adults suffering from severe mental health issues. The ability of the clients to cope with everyday life is assessed during the rehabilitation course and the final statement compiled by the keyworker includes the combined results of the assessments of each client. Using intertextual analysis, I examine these final statements and utilize the concepts of voice and direct and indirect reported speech. I ask how and what kinds of voices are used in final statement to assess the clients’ progress during the course and to define the future development tasks for them. Firstly, it is shown that the final statements are multi-voiced texts. They are persuasive statements about the clients’ development stories and descriptions of how the rehabilitation course practitioners have helped the client. Secondly, the analysis shows how voice and client knowledge are present in the final statement. The voices of assessment build the argument dialogically and highlight temporality, and in this way they produce a convincing description of the mental health client’s current ability to function and progress on the rehabilitation course.

The Peripheral Knowledge Paradox: Interfirm Knowledge Partitioning and Integration in Services Contracting

Specialized firms engaged in service offshoring contracts often face a tension between specializing in their own domain and maintaining knowledge in their partners' domains. When knowledge is “peripheral” to a firm's own specialty (e.g., an information technology (IT) service contractor's knowledge of a client's business domain or a client's technical knowledge of a contractor's domain), firms face a paradoxical dilemma of how much of such knowledge to invest in. This paper explores when it is important for clients and contractors to have in-house knowledge beyond their own, to be effective in IT service offshoring. We explore IT service engagements where it is more important for (a) the client to have deeper technical knowledge and (b) the contractor to have deeper business domain knowledge. We define the pattern of client–contractor knowledge overlaps as interfirm knowledge partitioning. The central thesis is that ex ante alignment between interfirm knowledge partitioning and service engagement newness enhances interfirm knowledge integration in offshoring engagements. To effectively organize service offshoring, solutions to interfirm knowledge integration problems in the presence of interfirm specialization are required; this is the underlying idea of this paper. The proposed model is tested using data on IT service offshoring engagements by 209 U.S. firms to foreign IT service firms. The findings offer novel theoretical insights into optimal interfirm knowledge partitioning in services contracting. Implications for service science theory and practice are also discussed.

Enhancing Client-centeredness in Parkinson's Disease Care: Attending to the Psychosocial Implications of Lived Experience

Evidence-based practice requires that clinicians interpret the best research evidence in the context of their clinical experience, while at the same time considering client knowledge and experiences. Although clinicians are becoming increasingly skilled at the evaluation of research evidence, the evidence-based practice process often neglects client values and self-identified health issues. Ignoring these key aspects of client-centered practice may lead to interventions that fail to target the implications of a client’s disease that are important to occupational participation and quality of life (QOL). A focus on client-centeredness is particularly important in progressive neurodegenerative disorders, such as Parkinson’s disease, where there are no known curative treatments, and interventions must instead focus on symptom management. In this paper, we explore the published literature on the psychosocial aspects of the lived experience among individuals with Parkinson’s disease, arguing that such literature provides insight into the implications of the disease and into potential treatment priorities. As such, this literature provides an additional form of evidence that raises awareness of the lived implications of this disease for clients’ occupations and QOL that, in turn, may lead clinicians to be more cognizant of client values and self-identified issues.

Determinants and Consequences of Tax Service Provider Choice in the Not-for-Profit Sector

This study examines the determinants and consequences of tax service provider choice among not-for-profit (NFP) organizations. Understanding how clients choose among professional services firms for tax services is important both because of the economic significance of tax service revenues to public accounting firms and because of regulatory changes to the market for tax services following the Sarbanes-Oxley Act. Because public accounting firms compete with law and consulting firms for tax clients, we examine whether factors that influence the organizational structure of professions – client proximity and knowledge availability – influence clients’ decisions to purchase tax services. Using data from the U.S. NFP sector where the decision to purchase tax services is observable for all organizations, we find that NFPs are less likely to retain their auditor for tax services as distance to the auditor and knowledge availability increase. We document that self-preparing NFPs are more likely to misreport executive compensation on their return, and we find no differences in misreporting between auditor and non-auditor paid preparers. Finally, we find that NFPs receive lower donor contributions after changing from paid preparers to self-preparing the Form 990.

The Importance of Positive Client-Staff Social Interactions in Inpatient Psychiatric Rehabilitation Programs

Social support has received much attention and empirical support as being a key component of the psychiatric rehabilitation of individuals with serious mental illness (SMI). Social dysfunction is often a defining characteristic of SMI, and interventions targeting social deficits help to improve client outcomes. The provision of social skills training and psychoeducation to improve social interactions and client knowledge of their illness and treatment options is vital in psychiatric rehabilitation. Since most patient interactions in an inpatient facility are with staff members and others with SMI, staff members must be mindful of the nature of individuals' illnesses, as well as their style of communication with the clients they serve as these are closely associated with rehabilitation outcomes. Staff members also are in charge of educating individuals about their illness and treatment options, and they should be knowledgeable about the information they are imparting. Recommendations for approaches to better prepare inpatient staff members to work with persons with SMI are provided.

Yarning about health checks: barriers and enablers in an urban Aboriginal medical service.

The annual health check for Aboriginal and Torres Strait Islander People has been welcomed as a means of conducting a comprehensive assessment to address preventive health care delivery, identify new diagnoses and initiate new treatments. Rates of health check uptake across Australia have been poor with less than 12% of the eligible population receiving one during 2009/10. This qualitative study sought to identify barriers and enablers to undertaking health checks in an urban Aboriginal Medical Service through semistructured interviews with 25 clinical staff (doctors, nurses and Aboriginal and Torres Strait Islander health workers). Clinical systems for conducting health checks were unclear to staff, with barriers relating to time pressures for both patients and clinic staff, and lack of clarity about staff responsibilities for initiating and conducting the health check. Additionally some staff perceived some content as sensitive, invasive, culturally inappropriate and of questionable value. Other barriers included concerns about community health literacy, disengagement with preventative health care, and suspicion about confidentiality and privacy. The development of clear service-wide systems that support the conduct of health checks are required to increase uptake, combined with supportive local clinical leadership and audit and feedback systems. Staff training, consideration of culture and roles, and critical review of health check content may improve staff confidence and community acceptance. Community-based health education and promotion is strongly supported by staff to increase client engagement, knowledge and acceptance of the health check.

Developing Pluralistic Practice in Counselling and Psychotherapy: Using What the Client Knows

The concept of pluralism is increasingly used to indicate the rich diversity of theory and practice in the field of counselling and psychotherapy. A version of pluralism is described that takes account of the range of ideas about health and healing that exist within contemporary culture, and the expression of these positions in the personal knowledge and preferences held by clients in respect of different therapy formats and techniques. A review of recent research is used to provide a basis for discussion of some of the practical manifestations of client knowledge, and the ways in which practitioners can work with these factors.

일개 여자대학교 학생의 사전의사결정서 작성의향에 영향을 미치는 요인에 관한 연구

Purpose: The purpose of this study was to identify university students` willingness to write advance directives and factors related to this willingness. Method: A cross-sectional survey design was used and 400 nursing students and 287 non-nursing students participated in the study. Data were collected by convenience sampling using self-report questionnaires. Data were analyzed with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. Results: The mean score for willingness to write advance directives was 4.09. From the multiple regression analysis, predictors of willingness to write advance directives were found to be majoring in nursing, awareness of advance directives, preference for autonomous decision making related to the end of life care, family preference related to the end of life care, and self esteem. Conclusion: The study results indicate that various factors are related to willingness to write advance directives and nurses need to consider client characteristics, knowledge, and own values when taking care of issues on advance directives.

65. Hanging Out or Hooking Up: Evaluating Clinical Guidelines for Adolescent Relationship Abuse

Adolescent relationship abuse (ARA) is prevalent among adolescents who utilize clinical services, thus clinics serving adolescents are important sites for ARA identification and intervention as well as for promotion of healthy relationships. The “Hanging Out or Hooking Up” guidelines were developed to support health care providers (HCPs) to promote discussion of healthy relationships and to identify and respond to relationship abuse among their adolescent patients. This evaluation assessed HCP attitudes and behaviors as well as client knowledge, attitudes and behaviors before and after their clinic encounter with a trained HCP.