Personal Counseling Research Articles

How do Persons Perceive Rehabilitation Counseling? A Qualitative Study on Experienced Rehabilitation Counseling Implemented by the Federal German Pension Insurance among Persons with Approved Vocational Rehabilitation

Persons with approved vocational rehabilitation participate in a conversation with a rehabilitation consultant shortly after approval. The aim of the consultation is to select individually suitable services from the available range of services, based on the illness and employment biography of persons with approved vocational rehabilitation. The initial consultation is thus of essential importance for the further rehabilitation process. To date, there has been little research about what characterizes successful counseling from the point of view of persons with approved vocational rehabilitation. The aim of the qualitative study was to examine the perspective on counseling for persons with approved vocational rehabilitation financed by the German Federal Pension Insurance. Telephone interviews based on guidelines were conducted with 16 persons. The interviews were recorded and transcribed. The data was analyzed with MAXQDA using qualitative content analysis and the technique of inductive category development. Three perceived forms of counseling could be distinguished: a supportive counseling, a passive counseling and an inhibitory counseling. Persons with experienced passive and inhibitory counseling reported uncertainty and withdrawal in the further rehabilitation process. There is an individual perception of the counseling and support provided by the rehabilitation consultant, which can have an impact on the attitude and behaviour of persons in the further course of vocational rehabilitation. The challenge is to enable supportive experiences within the time-limited framework of the initial consultation.

Impact of Art as A Therapeutic Intervention in Improving the Quality of Life among Geriatric Population

Objective: To study the impact of art as therapeutic intervention in improving the quality of life among geriatric population. Method: Quasi experimental pre-post test study design was used to allocate geriatric population in experimental group (n=5) and control group (n=5). Sequential session of 15 minutes of Mandala art coloring sheets followed by 15 minutes of personal counseling session and another 15 minutes of projective art time where the person can choose between creative writing or projective art, with transition of activities between the session the client was given with breaks of 5 minutes each in the experimental group. Only personal counseling sessions of cognitive behavior therapy were given to the control group. Results: All participants in both groups who began treatment completed the therapy program SF-36 was used both as screening method as well as outcome measure and showed significant changes in the quality of life in the experimental group. Conclusion: Art as therapeutic intervention for geriatric population shows positive effects on the mental health and wellness which in turn improves their quality of life.

Professional medical consultation: history and modernity

Introduction. The article is devoted to the 100-year period (1921-2021) of the development of medical professional orientation (MPO) and medical professional counseling (MPC) in Russia. The aim of MPO is a helping student to develop their professional self-determination, taking into account the state of their health and the possible adverse impact of occupational factors on the pathogenesis of existing health disorders. MPO is performed by a doctor in two forms. The first is to introduce adolescents and their parents to the medical problems of choosing a profession. The second - MPC - individual counselling of persons with health disorders and specific recommendations on occupations, places of study and rational employment. Medical professional counselling is a necessary element of medical support for schoolchildren. Over the past 100 years, the theoretical and methodological approaches to conducting MPO and MPC have changed. The purpose of this expert-analytical study is to determine the relevance, prominent trends, features and challenges of professional medical counselling in current socio-economic, scientific and technical conditions. Material and methods. scientific literature and methodological documents on the issues of occupational health of adolescents, MPO and MPC; 35-year experience of conducting MPC of adolescents in Yaroslavl (more than 3,500 schoolchildren), the experience of teaching the basics of MPC to students at the pediatric faculties of Sechenov University and Yaroslavl State Medical University, and experience of conducting career guidance work in the “Medical Sechenov Pre-University.” Results. The concept, principles, methods, and regulatory documents required for the MPO and MPC have been established to have undergone specific changes in connection with scientific and technological progress, new scientific data on the impact of occupational factors on the health of adolescents, changes in the structure of school morbidity, transformations in the system of vocational education and the reform of socio-economic conditions in Russia. Conclusions. Professional medical consultation remains relevant, methodological approaches require changes in connection with the digitalization of the economy, and the circle of consultants should include adolescents and young people.

Just Because You Can, Doesn't Mean You Should … Now. A Practical Approach to Counseling Persons with Diabetes on Use of Optional CGM Alarms.

Advances in glucose monitoring technologies have led to the development of different types of continuous glucose monitoring (CGM) platforms: traditional CGM and flash CGM. Both platforms provide critical glucose data that enable persons with diabetes (PwDs) to make more informed decisions in their self-management. Until recently, a key advantage of traditional CGM over flash CGM was the availability of automatic alarms that warn users about current or impending hypoglycemia and hyperglycemia. However, with the introduction of the FreeStyle Libre 2 (FSL2) system (Abbott Diabetes Care, Alameda, CA), PwD can now utilize flash CGM with the option to set low and high glycemic thresholds and receive alarms when these thresholds are crossed. In addition, having the option to use or not use the alarms may attract previous traditional CGM users who grew fatigued by constant alarms. However, despite the additional layer of safety that alarms provide, many PwD are reluctant to switch from self-monitoring of blood glucose to CGM due to concerns about how alarms could impact the quality of their daily lives. This reluctance is heightened by their perceptions that use of alarms is mandatory. Because the functionality of the FSL2 alarms differs from current traditional CGM devices, it is important that clinicians become familiar with these differences. Moreover, clinicians will be challenged to help PwD overcome their concerns about the use of alarms. This article presents a comprehensive description of the FSL2 alarms function and provides guidance to clinicians when counseling PwDs about the strengths, limitations, and various ways that the FSL2 alarms can be used in daily diabetes self-management.

How does “locus of control” affect persons with epilepsy?

PurposeLocus of control (LOC) is the degree to which people believe that they have control over the outcome of events in their lives. A person's locus can be internal, external, or chance. A person with internal locus of control believes that one can control one's own life. A person with external locus of control believes that his life is controlled by external factors or people over which he has no influence. A person with chance locus of control believes that fate, chance, or luck controls his own life. The aim of the current study was to determine the health locus of control, anxiety, and depression levels in persons with epilepsy (PWE) and to assess whether locus of control has relation to anxiety, depression, and seizure control. MethodsPatients aged 18 years or older with a history of epilepsy for at least 1 year were recruited from the outpatient epilepsy clinic or from the inpatient epilepsy monitoring unit at SCTIMST, Trivandrum from January 2019 to May 2020. Patients filled the questionnaire form consisting of demographic data, age of onset of seizures, present seizure control, and the current antiepileptic drugs. The Hospital Anxiety and Depression (HAD) scale was used to estimate the level of anxiety and depression in these patients. The Form-C of the Multidimensional Health Locus of Control (MHLC) scale was used to evaluate the health locus of control. Healthy controls aged 18 years or older and free of any chronic disease or psychiatric illness were also recruited. They were asked to fill the questionnaire forms with basic demographic data. HAD scale was used to estimate the level of anxiety and depression and form-C of MHLC was used to evaluate the health locus of control in the healthy controls. The mean scores of anxiety, depression, and locus of control were compared between the two groups. ResultsA total of 170 participants were recruited which consisted of 100 PWE and 70 healthy controls. The mean anxiety and depression scores were 8.13(SD = 4.23) and 5.85(SD = 3.66) in the PWE group and 6.75(SD = 3.39) and 4.14(SD = 2.96) in the control group, respectively. The mean internal, external, and chance LOC scores were 24.95(SD = 10.92), 26.94(SD = 4.96), and 24.41(SD = 6.46) in the PWE group; and 29.44(SD = 5.62), 26.53(SD = 5.79), and 19.9(SD = 7.13) in the control group, respectively.Persons with epilepsy had higher chance LOC scores and lower internal LOC scores compared to controls (p = 0.00003, p < 0.00001 respectively). There were no differences in the external LOC scores between the two groups (p = 0.620). Persons with epilepsy with some level of anxiety had lower internal LOC scores compared to patients with no anxiety (p = 0.04). PWE with poor seizure control had higher external LOC score and lower internal LOC scores which however did not reach statistical significance. Persons with epilepsy with poor seizure control had higher anxiety and depression scores. ConclusionsPersons with epilepsy had low perceptions of internal and strong perceptions of chance health locus of control. This means that PWE feel that luck plays an important role in their disease control. This information is important in the counseling of persons with epilepsy.

Application of psychoanalysis theory in personal counseling to improve the ego function of Junior High School students

The application of ego counseling is a counseling approach that emphasizes the function of the ego. This research is motivated by the weak function of the ego that is owned by students at this time, while it is the ego that develops everything. For example, the ability of students, their circumstances, social relationships and the distribution of their interests. A student must have a healthy and strong ego to respond to environmental conditions as a process of adapting. The research method used is an experimental research method . The sample in this study was class VIII students at MTs , while for the research design, the researcher used the pre-experimental method. with the type used is a one-group pretest-posttest design. M using an experimental quantitative approach. In this study, students of class VIII who have a low ego function. Based on the findings above, it can be concluded that there is an increase in ego function in students after being given individual counseling services using psychoanalytic theory.

Embedding Aphasia-Modified Cognitive Behavioral Therapy in Script Training for Primary Progressive Aphasia: A Single-Case Pilot Study.

Purpose This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA). Method Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews. Results The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of loss and resilience at both time points, and emerging themes of positive self-perception, sense of agency, and emotional attunement following treatment. Conclusions Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA. Supplemental Material https://doi.org/10.23641/asha.14925330.

NINTH GRADE STUDENTS' PERCEPTIONS OF ADMISSION, CAREER PATH AND SUCCESS IN LIFE. CASE STUDY REGARDING THE FIRST DUAL VOCATIONAL SCHOOL IN ALBA COUNTY

Choosing a career and career path is very important and difficult for many young secondary school graduates, especially since very few students in Romanian schools benefit from personal and professional counseling and guidance during their high school years or in the period immediately preceding the enrollment in the high school or professional cycle. In this sense, even if in many county events are organized in which each school promotes its educational offer, after the end of the admission process and enrollment of students, too little emphasis is placed on the reasons that led high school graduates to choose a certain educational institution. This study accomplished in a technological high school in Alba County captures exactly this aspect, while highlighting students' perceptions about success in life, counseling and career guidance, as well as the factors they consider to be determinants of academic and professional success. This educational unit was not chosen by chance, here operating the first dual vocational school in Alba County and among the first of its kind in the country.

What student support practitioners know about non-traditional students: a practice-based approach

ABSTRACT Student support practitioners, who provide personal counseling and academic advising to non-traditional students, play a key role in widening participation efforts, but their perspectives are rarely researched. To address this gap, this study draws on the practice perspective on knowledge and learning, and explores the practice-based knowledge shared by support practitioners working in Israeli higher education institutions. The study is based on interviews with 43 practitioners who work in 17 higher education institutions, and addresses their expertise, insights and practices. The discussion focuses on practitioners’ collectively developed understandings of the student lifecycle and their situated knowledge and support practice in the organizational context of academic faculties. Practitioners suggest that support at the stages of enrollment and withdrawal are missing elements in the student lifecycle approach. Advice at the enrollment stage could significantly reduce students’ difficulties, as well as the likelihood that they will change their course of study or withdraw. Support for students who withdraw requires a nuanced and contextual understanding of withdrawal – one that includes ‘healthy withdrawal’. Finally, practitioners suggest that it is more useful to consider the faculty or department as the relevant organizational level for student support, and call for a distributive structure of support services. This would strengthen relations with students and staff and generate faculty-situated support knowledge and practice. The study calls for taking into consideration the practice-based expertise of support practitioners to improve understanding of the experiences, needs and challenges of widening participation.

Characteristics and Counseling Needs of Prospective First-Generation College Students: Implications for School Counseling

This study examined the personal characteristics and counseling needs of high school seniors who were strongly committed to attending a 4-year university. The results of this comparison study revealed that prospective first-generation college students reported lower perceived academic ability and a higher need for counseling in academic planning and career preparation than prospective continuing-generation college students. Subsequent analysis for the first-generation group by race revealed significant group differences in the perceptions and needs of school counseling.

Evaluation of a Pharmacist-Led Remote Warfarin Management Model Using a Smartphone Application (Yixing) in Improving Patients' Knowledge and Outcomes of Anticoagulation Therapy.

Background: The management of warfarin-treated patients has been recognized as a challenge due to narrow therapeutic range and food and drug interactions in warfarin therapy. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy. Methods: Eligible patients who had received warfarin therapy after mechanical heart valve replacement were enrolled. The intervention group was offered a pharmacist-led remote warfarin management model using the app named Yixing. Yixing incorporates functions including automatic daily reminder, personal health record, educational program, and online counseling. The control group received traditional pharmacy services without Yixing. Co-primary outcomes were patients’ awareness score of warfarin therapy obtained from questionnaire, the medication adherence measured by the percentage of the correct-warfarin-taken days in the monitored period, the fraction of time in therapeutic range (FTTR), and the incidence of anticoagulation-related complications. The needed information of the patients was acquired via electronic medical records from the hospital, Yixing system and telephone follow-up when necessary. Results: 64 and 66 patients were initially in the intervention and control groups respectively. After propensity score matching, 50 patients were assigned in each group. The intervention group had a median age of 51.0 years, in which 27 (54%) were male. The control group had a median age of 50.5 years, in which 28 (56%) were male. Patient awareness score in the intervention group was 8.00 (2.00), which was higher than that in the control group, with score at 6.50 (2.50) (p = 0.001). No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p = 0.520). The median (interquartile range) value of FTTR was 80.3% (21.9%) and 72.1% (17.7%) in the intervention and control groups respectively (p = 0.033), and no significant differences in the incidence of anticoagulation-related complications were observed (p = 0.514). Conclusion: The pharmacist-led remote warfarin management model using Yixing improves patients’ awareness of warfarin therapy and increases FTTR, but may not have significant improvements on medication adherence and safety.

GUIDANCE AND COUNSELING PROGRAM (FOCUSING ON PERSONAL-SOCIAL) TO IMPROVE STUDENT RESILIENCE

This research is motivated by the phenomenon of adolescent maladjustment behavior. In this study, adolescents' wrong behavior is considered the impact of adolescents' failure in facing adversity conditions in their lives. The individual's ability to deal with adversity conditions is known as resilience. This research's product is the design of a personal social counseling and guidance program that is hypothetically effective in increasing students' resilience. The research method uses a quantitative approach, with descriptive methods. This study population was 414 students of class X SMK Profita Bandung and 157 students as a sample. The research sample was taken using a simple random sampling technique; that is, the research sample was obtained randomly. This study resulted in (1) an overview of the resilience of class X students of Profita Vocational School, Bandung City, most of whom are in the medium category; (2) there is no significant difference between the level of resilience of students from intact families with students from not intact; and (3) the design of a hypothetical social, personal counseling and guidance program to increase the resilience of students. The results of this study are recommendations for (1) guidance and counseling teachers, as a follow-up effort in implementing social, personal guidance and counseling programs in increasing the resilience of students that have been designed; (2) The next researcher can continue the research conducted by the researcher and look for methods or techniques that are more effective in increasing student.

Predicting survival in head and neck cancer: External validation and update of the prognostic model OncologIQ in 2189 patients.

BackgroundDisclosing prognostic information is necessary to enable patients to make well‐informed treatment decisions. OncologIQ is a prognostic model that predicts the overall survival (OS) probability in patients with head and neck squamous cell carcinoma (HNSCC). We aimed to externally validate and update the model with new prognostic factors and translate it to a clinically useful tool.MethodsA consecutive retrospective sample of 2189 patients eligible for curative treatment of a primary HNSCC were selected. Discriminative performance was determined using the C‐statistic.ResultsExternal validation showed systematic underestimation of OS in the new population, and reasonable discrimination (C‐statistic 0.67). Adding smoking, pack years, BMI, weight loss, WHO performance, socioeconomic status, and p16 positivity to the recalibrated multivariable model, improved the internally validated C‐statistic to 0.71. The model showed minor optimism and was translated in an online tool (www.oncologiq.nl).ConclusionsThe updated model enables personalized patient counseling during treatment decision consultations.

Process Evaluation of Implementing a Pharmacist-Led Intervention to Improve Adherence to Antihypertensive Drugs Among Patients with Type 2 Diabetes in Indonesian Community Health Centers.

Introduction: A pharmacist-led intervention in Community Health Centers (CHCs) in Indonesia targeted at patients with type 2 diabetes non-adherent to antihypertensive drugs resulted in a significant improvement in adherence to these drugs. The aim of this study was to evaluate the process of implementation this intervention intended to improve adherence to antihypertensive drugs from both the pharmacist and the patient perspective. Methods: Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, we conducted a focus group among pharmacists (N = 5) and a survey among patients with complete follow-up (N = 44) participating in the intervention group. Results: All pharmacists adopted the provided training and found support tools useful. The pharmacists implemented the intervention as intended (adequate intervention fidelity >69%). Factors relevant for implementation included having sufficient time and confidence, home visits for specific patients, multidisciplinary collaboration, and availability of a personal counseling room. To maintain the intervention, the need for practical guidance and support from health care authorities was mentioned. Most patients (96%) were satisfied with the information provided by the pharmacists and they believed the tailored counselling was helpful. Most patients (84%) reported that the duration of counselling was sufficient. The large majority of patients would like to receive the counselling regularly. Conclusion: Positive effects of the pharmacist-led intervention can be explained by adequate levels of reach, adoption and implementation in the participating CHCs. For successful implementation and maintenance in Indonesia or other low-and middle-income countries, sufficient training, resources, multidisciplinary collaboration, guidance and support from health care authorities are expected to be important.

Practical Training of Students-Special Psychologists in the Implementation of Academic Disciplines

The article presents the experience of extending educational activities in the form of practical training to academic disciplines implemented for students of special psychologists at the bachelor’s and master’s levels. According to the new requirements, practical training of students-special psychologists can be carried out both directly at the university and in the organization that carries out activities in the profile of the corresponding educational program. Practical training in the academic disciplines’ implementation is traditionally organized through seminars, workshops, where students master certain types of work related to their future profession. For a special psychologist, all types of professional activities are associated with communication, interaction with people, so the joint productive activity of the teacher and students in the classroom, as well as in the organization that carries out activities in the profile of the educational program, is crucial. The article reveals the content of undergraduates-special psychologists’ practical training in the disciplines “Technologies for designing adapted educational programs”, “Psychological and pedagogical correction of impaired development”, “Psychological and pedagogical counseling of persons with disabilities”, the content of practical training of bachelors – special psychologists in the disciplines “Psychological and pedagogical technologies of correctional work”, “A workshop on solving professional problems in the field of correctional and pedagogical activity”, “Study, education and rehabilitation of persons with complex developmental disabilities”. Keywords: special (defectological) education, practical training, students-special psychologists, children with disabilities, profile organization

A study protocol of a randomized trial evaluating the effect of using defined menu plans within an intensive personal nutritional counseling program on cardiovascular risk factors: The MoKaRi (modulation of cardiovascular risk factors) trial

ImportanceChanges in dietary habits and lifestyle can reduce the risk of cardiovascular disease which is the leading cause of death worldwide. Objectives of the MoKaRi study The MoKaRi (modulation of cardiovascular risk factors) intervention study is designed to evaluate the effectiveness and potential of the developed MoKaRi concept. The MoKaRi concept comprises three components, each designed to improve dietary behavior. The first component entails using daily menu plans to implement a defined “cardioprotective diet”. This diet consists of seasonal menu plans which are characterized by:(i) a personalized energy supply depending on his or her age, gender, level of physical activity.(ii) an adequate intake of carbohydrates, protein, fat, vitamins, minerals, and trace elements according to the guidelines of the German Society of Nutrition (DGE).(iii) a recommended intake of saturated fatty acids (SFA; < 7% of caloric intake (En%)), monounsaturated fatty acids (MUFA; > 10 En%), polyunsaturated fatty acids.(PUFA; approx. 10 En%), and long-chain n-3 PUFA (≥500 mg per day).(iv) measures to encourage consumption of vegetables and fruits, and.(v) eating more than 40 g dietary fiber every day.Half of the participants will be scheduled to consume an additional 3 g of long-chain n- 3 PUFA every day in the form of fish oil.The second component consists of regular one-on-one nutritional counseling, while a variety of further incentives make up the third component of the MoKaRi concept.The MoKaRi study will provide essential insights into the relationship between defined nutrient intake, markers of food intake and health status. Our specific aim is to investigate the influence of dietary and lifestyle choices have on cardiovascular health.The information and practical tools suitable for daily use, such as the personalized menu plans, could help to transfer knowledge on nutritional facts to the general population. In this way, the validated MoKaRi concept may contribute to the prevention and therapy of cardiovascular diseases. MethodsIn line with our power calculation, we will enroll 60 participants and randomly assign them to one of two parallel arms. Each participant will receive personalized menu plans for each day of the study and will be provided with one-on-one nutritional counseling sessions every two weeks for a study period of 20 weeks (140 days). During this period, blood samples will be taken every 14 days (11 time points) and twice during a 20-weeks follow-up period. Incentives such as a supply of foods approved according t the standards of the study, a sports program, individual feedback on study parameters reflecting health status, and group activities round off the MoKaRi concept.Low-density cholesterol is the primary outcome measure of the MoKaRi study, and the secondary endpoints comprise markers of nutrient status (e.g. fatty acid distribution in plasma and erythrocyte lipids), a metabolomic profiling, diabetes risk markers, clotting markers, and further cardiovascular risk factors, such as blood lipids, homocysteine and high-sensitive c-reactive protein.The MoKaRi study was registered before launch at ClinicalTrials.gov (identifier NCT02637778; https://clinicaltrials.gov/ct2/show/NCT02637778).

A Comparison of Quit Outcomes for Men and Women in a Smoking Cessation Program Offering Personalized Nicotine Replacement Therapy and Counseling in Primary Care Clinics

Women may have greater difficulty achieving long-term abstinence following a quit attempt compared to men. We sought to determine whether there were differences in treatment characteristics or outcome between female and male primary care patients enrolled in a smoking cessation program providing personalized nicotine replacement therapy (NRT) with counselling support. The sample included 27,601 Ontarians (53% female, 47% male) who enrolled in the Smoking Treatment for Ontario Patients program between 2016 and 2018. Dose, type, and duration of NRT supplied was personalized to need. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. Both female and male participants received a median of 8 weeks of NRT. Types of NRT received were similar, with 80% of both female and male participants receiving patch and short-acting NRT. Total cumulative dose was somewhat higher for men (1373mg vs. 1265mg, p<0.001); but when calculated as dose per day, per cigarette smoked at baseline, dose was slightly higher among women (1.6mg vs. 1.5mg, p<0.001). Quit rates at 6 months were lower for women versus men (24% vs. 27%; AOR = 0.84 [95% CI = 0.78-0.90], p<0.001). There were no significant interactions between gender and dose, type or duration of NRT supplied. Women were slightly less likely to quit than men, despite receiving similar treatment. There was no evidence that women benefitted more or less from variations in dose, type or duration of NRT supply.

Spiritual Care Competence among Malaysian Staff Nurses

Background: Perceptions and levels of understanding of spiritual care vary among nurses, which may affect their competency to meet the patient’s spiritual needs. Therefore, determining nurses' perception of spiritual care is the first important step in addressing the spiritual needs of patients, and may also help nursing management in developing spiritual care education and training programs.Purpose: This study aimed to assess the competence of Malaysian nurses toward providing spiritual care and identify the relationship between nurses’ spiritual care competence and their sociodemographic factors. Methods: This study employed a cross-sectional design to assess nurses' competence in spiritual care by using a simple random sampling method which involved 271 staff nurses from a public hospital in Northeast of Peninsular Malaysia. Spiritual care competence scale in Bahasa Malaysia version was used for data collection. Data analysis was performed using descriptive (frequency, percent, mean, standard deviation) and inferential (Chi-square and Pearson’s correlation test) statistics.Results: This study showed that 69.7% of staff nurses had an average level of competence toward providing spiritual care for the patients (M=95.44, SD=4.34). The highest mean difference among the domains was personal support and patients counseling (MD=5.789), while the lowest mean difference was assessment and implementation of spiritual care (MD=1.258). Furthermore, there was no significant relationship between spiritual care competence and sociodemographic factors (gender, age, marital status, educational level, nurses' experience, race, religion, and previous participation in training spiritual care programs).Conclusion: The majority of nurses have an average level of competence toward providing spiritual care. There is no significant relationship between nurses’ spiritual care competence and sociodemographic factors.

Linkage to intensive adherence counselling among HIV-positive persons on ART with detectable viral load in Gomba district, rural Uganda

BackgroundAntiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. The World Health Organization recommends that adherence support interventions be provided to people on ART, but implementation is suboptimal. We evaluated linkage to intensive adherence counselling (IAC) for persons on ART with detectable viral load (VL).MethodsBetween January and December 2017, we conducted a retrospective chart review of HIV-positive persons on ART with detectable VL (> 1000 copies/ml), in Gomba district, rural Uganda. We abstracted records from eight HIV clinics; seven health center III’s (facilities which provide basic preventive and curative care and are headed by clinical officers) and a health center IV (mini-hospital headed by a medical doctor). Linkage to IAC was defined as provision of IAC to ART clients with detectable VL within three months of receipt of results at the health facility. Descriptive statistics and multivariable logistic regression analyses were used to evaluate factors associated with linkage to IAC.ResultsOf 4,100 HIV-positive persons on ART for at least 6 months, 411 (10%) had detectable VL. The median age was 32 years (interquartile range [IQR] 13–43) and 52% were female. The median duration on ART was 3.2 years (IQR 1.8–4.8). A total of 311 ART clients (81%) were linked to IAC. Receipt of ART at a Health Center level IV was associated with a two-fold higher odds of IAC linkage compared with Health Center level III (adjusted odds ratio [aOR] 1.78; 95% CI 1.00–3.16; p = 0.01). Age, gender, marital status and ART duration were not related to IAC linkage.ConclusionsLinkage to IAC was high among persons with detectable VL in rural Uganda, with greater odds of linkage at a higher-level health facility. Strategies to optimize IAC linkage at lower-level health facilities for persons with suboptimal ART adherence are needed.

The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century

Objective There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. Design A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner’s (GP) appointment for high-risk persons. Screening and interventions were performed during 2005–2006. Setting A public health care centre in the town of Harjavalta, Finland. Subjects All home-dwelling 45–70-year old inhabitants without manifested CVD or diabetes. Main outcome measures All-cause and CVD mortality. Results Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants’. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. Conclusions Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis. Key Points Previously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community. Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons. Subjects not willing to participate in health surveys have the worst prognosis.