Previous Care Experience Research Articles

Dental anxiety and symptoms of general anxiety and depression in 15‐year‐olds

The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean=9.8, SD=4.3). Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.

Sex differences in the mother–neonate relationship in wild baboons: social, experiential and hormonal correlates

In mammals, maternal care is essential for offspring survival, yet individual differences in this care can dramatically affect offspring growth and development. Few studies have, however, investigated the sources, magnitude and consequences of naturally occurring interindividual variation in maternal care during the neonatal period. In this study, we examine several hormonal and nonhormonal predictors of naturally occurring variation in the mothereneonate relationship during the first 8 weeks of infancy in 34 wild baboon (Papio cynocephalus) mothereinfant dyads in Amboseli, Kenya. We use data on physical contact and suckling patterns to assess the quality of the mothereneonate relationship and to evaluate the extent to which variation in this relationship is predictable from perinatal ovarian steroids (i.e. faecal oestrogen and progesterone metabolites), previous infant care experience, maternal dominance rank and offspring sex. We found that newborn infants of more experienced mothers initiated higher rates of changes in mothereinfant contact than newborns of less experienced mothers. However, at each level of maternal experience, newborn males initiated higher rates of changes in mothereinfant contact than newborn females. Moreover, we found evidence suggesting that variation in suckling activity among daughters (but not sons) was predictable from maternal dominance rank and faecal oestrogen (fE) concentrations before birth. To our knowledge, our study provides the first evidence of (1) the influence of cumulative maternal experience on the mothereinfant relationship and (2) the emergence of sex differences in the mothereinfant relationship during the neonatal period in wild primates. Our results suggest that the well-documented sex differences in life history, behaviour and ecology in primates (and other social mammals) may originate very early in life. 2012 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All rights reserved. For vertebrates, mammalian newborns are unusually dependent on their mothers for nourishment, transport, protection and support (Clutton-Brock 1991). Although offspring eventually transition from complete reliance on their mothers to nutritional, locomotor and social independence, the timing of these events can vary widely across individuals of the same species (Clutton-Brock 1991). Despite the critical importance of the neonatal period in the life of each individual, few studies have investigated the sources, magnitude and consequences of interindividual variation in the mothereoffspring relationship during the neonatal period in wild mammals (Altmann 1980; Bales et al. 2002). In this study, we

Factors Affecting Burnout When Caring for Older Adults Needing Long Term Care Services in Korea

The purpose of this study was to address factors related to caregiver burnout as a result of caring for an older adult with a chronic disease. Characteristics of care recipients and caregivers as well as social support were included to identify the relationships with caregiver burnout. The analysis was based on a sample of 334 older adults and their caregivers in Korea. The logistic regression results indicated that the period of being in need of another's help among care-recipients, co-residence, caregivers' health condition, previous care experience, and caregivers' free time were correlated with the caregivers' future caregiving. Interestingly, the more experience caregivers had in caring for older adults, the more willing they were to provide care in the future. Thus, the discussion focuses on services for those who are new to providing care for older adults because they tend to have less coping skills.

A History of Interpersonal Trauma and the Gynecological Exam

Cervical cancer is preventable, in part, by routine Papanicolaou (Pap) testing, but some women avoid routine screening. African American women have the greatest mortality among all groups of women in the United States. Personal reasons have been found to contribute to screening avoidance behavior, such as a history of sexual abuse and intimate partner violence. Fifteen African American women with a trauma history participated in personal interviews. The Interaction Model of Client Behavior was employed for exploring the women's social influence, previous health care experience, cognitive appraisal, affective response, and motivation associated with routine Pap testing. Study findings suggest that providers need to assess and provide accurate information about Pap testing and cervical cancer to increase patients' knowledge. Personally reflecting on one's approach to conducting a woman's gynecologic exam (and how it is performed) might prevent triggering unwanted memories, making that visit a positive experience and facilitating repeat screening behavior.

Cancer patients’ willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network

Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 <euro> per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

Undergraduate nursing student's attitudes towards caring for people with HIV/AIDS

The aim of this quantitative study was to determine the attitudes of Australian nursing students towards caring for people with HIV/AIDS. This research study was conducted among second year undergraduate nursing students at a university in South Australia, during August 2007. The survey tool consisted of six demographic questions and the AIDS Attitude Scale. This questionnaire was completed by 396 students, giving a response rate of 94.7%. The vast majority (95.7%) of students participating in this study demonstrated very positive attitudes towards caring for people with HIV/AIDS and only 4.3% demonstrated negative attitudes. No statistically significant differences were found in attitude score based on participants' age, gender, previous HIV/AIDS education, previous nursing experience or previous experience of caring for someone with HIV/AIDS. A statistically significant difference in AIDS attitude score was found in relation to participants' country/region of citizenship, with nursing students from China, East Asia, South East Asia, and Central Asia and Middle East having more negative attitudes than students from other countries/regions. As an increasing number of nursing students have been recruited to Australia from these countries/regions, nurse educators need to be aware of such differences when planning and delivering HIV/AIDS educational programs in tertiary institutions.

Older men's experiences of community-based health checks in Knowsley, UK

A study using both qualitative and quantitative methods was undertaken to examine the impact of community-based health checks on men in Knowsley, UK. The main objective was to understand whether community-based health checks targeted at specific geographical and age groups were an effective way of improving health in men. Interviews were conducted with 50 service users, and a completed postal questionnaire was received from 178 men who had attended during the service's pilot period. Results indicated that men were generally satisfied with both the content and structure of the health checks. Men spoke favourably of the service they had received, particularly in comparison to their previous experiences of primary care. They reported enjoying using a service that allowed them to examine their own health in a comfortable environment. Knowledge was provided to a group whose awareness of health matters was often poor, and the vast majority of men reported making a variety of positive lifestyle changes as a result of attending. Reported improvements to health included giving up smoking, reducing alcohol consumption, increasing exercise and eating more healthily. The study suggests that services of this nature deserve careful consideration by health care professionals and policy-makers.

The hip and knee replacement operation: an extensive life event

A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation. The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery. A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants' experiences of the hip and knee replacement intervention across the entire perioperative period. Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted. Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.

Niyith Nniyith Watmam (the quiet story): Exploring the experiences of Aboriginal women who give birth in their remote community

Objective to investigate the beliefs and practices of Aboriginal women who decline transfer to urban hospitals and remain in their remote community to give birth. Design an ethnographic approach was used which included: the collection of birth histories and narratives, observation and participation in the community for 24 months, field notes, training and employment of an Aboriginal co-researcher, and consultation with and advice from a local reference group. Setting a remote Aboriginal community in the Northern Territory, Australia. Participants narratives were collected from seven Aboriginal women and five family members. Findings findings showed that women, through their previous experiences of standard care, appeared to make conscious decisions and choices about managing their subsequent pregnancies and births. Women took into account their health, the baby’s health, the care of their other children, and designated men with a helping role. Key conclusions narratives described a breakdown of traditional birthing practices and high levels of non-compliance with health-system-recommended care. Implication for practice standard care provided for women relocating for birth must be improved, and the provision of a primary maternity service in this particular community may allow Aboriginal Women’s Business roles and cultural obligations to be recognised and invigorated. International examples of primary birthing services in remote areas demonstrate that they can be safe alternatives to urban transfer for childbirth. A primary maternity service would provide a safer environment for the women who choose to avoid standard care.

Interactive Model of Client Health Behavior and Cervical Cancer Screening of African‐American Women

Explore inductively African American women's use of Pap smear screening services and consider how well the data did or did not affirm the usefulness of the interaction model of client health behavior (IMCHB). The IMCHB guided this qualitative study designed to explore women's social influence and previous health care experience and their influence on the women's cognitive appraisal associated with Pap smears and cervical cancer. Interviews were conducted with 24 women, resulting in 2 groups: routine-use (n = 11) (Pap smears every 1-3 years) and non-routine-use (n = 13). Content analysis approach to data analysis was used, where interview data were considered in relation to elements of IMCHB. Analysis revealed that the IMCHB was useful for framing cervical cancer screening health behavior research. Both groups' data fit well onto the framework. The routine-use group fit the entire model, with iterative (repeat) behavior in cervical cancer screening. The non-routine-use group also fit the model, but their iterative behavior in cervical cancer screening was intermittent due to negative personal influences. This model can provide a focus to the delivery of gynecological care based on a client's unique characteristics that can be addressed with individualized nursing interventions designed to promote positive health outcomes.

Personal Influences That Affect Motivation in Pap Smear Testing Among African American Women

To explore personal influencing factors that contribute to Papanicolaou (Pap smear) testing in African American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing. Qualitative using the interaction model of client health behavior. Community programs, homes, and churches. Twenty four African American women aged 19 to 60. Face-to-face interviews. Data were analyzed using a constant comparison approach. Routine-use group was socially influenced to value preventive health care while the non-routine-use group was not. Previous health care experiences with having a Pap smear and pelvic exam were positive for routine-use group and negative for non-routine-use group. Cognitively, both groups believed Pap smears tested for cancer and sexually transmitted diseases. Vulnerability to cervical cancer was thought to run in families; participants believed they were either safe from risk or hoped that the odds were in their favor. In addition, there was a link between avoiding routine preventive care and a trauma history (sexual, physical, medical), eliciting negative perceptions towards Pap smears and pelvic exams. Differences and similarities in personal influencing factors associated with cervical cancer screening were found in the two groups. Further research is needed to explore these differences and similarities because they may contribute to the reason that African American women have a greater mortality rate from cervical cancer than White women.

Quality of Pediatric Nursing Care: Concept Analysis

This paper is a report of a concept analysis of'quality of pediatric nursing care'. Rodgers's evolutionary method of concept analysis was used. Data were collected from published literature related to quality of pediatric nursing care. Quality of pediatric nursing care was identified with three dimensions and seven attributes: 1) nurse's character: technical competence, interpersonal competence, 2) nurse's activities: developmentally appropriate care, attentiveness, entertainment, 3) nurse-parent interaction: nurse-parent partnership, emotional support. Antecedents of quality of pediatric nursing care were'child and parent's expectation about pediatric nursing care','previous caring experience of pediatric nurses'. Consequences of quality of pediatric nursing care were'meet child and parent's needs' and'better health outcomes.' 'Quality of pediatric nursing care' is a core concept in pediatric nursing practice. Appropriate instruments to operationalize the concept need to be developed.

Positive Effects of a Nursing Intervention on Family-Centered Care in Adult Critical Care

Generally, families of critical care patients are not actively involved in the patients' care in meaningful ways. A family-centered care model formalizes each patient and the patient's family as the unit of care. Family-centered care comprises 3 concepts: respect, collaboration, and support. To evaluate the effects on family-centered care of having critical care nurses partner with patients' families to provide fundamental care to patients. At the control site, patients' families experienced usual care; at the intervention site, patients' families were invited to assist with some of their relative's fundamental care with nurses' support. The family-centered care survey was used to measure families' perceptions of respect, collaboration, support, and overall family care at baseline and 48 hours later. Multivariate logistic regression was used to determine independent predictors of scores. A total of 174 family members of patients participated (75 control, 99 intervention). Total median scores on the survey were 3.2 (control) and 3.2 (intervention) at baseline and 3.2 (control) and 3.5 (intervention) at follow-up. After adjustments in the multivariate model, the family-centered care intervention was the strongest predictor of scores at 48 hours (odds ratio [OR]=1.66; P<.001). Other independent predictors included relatives with previous critical care experience (OR=1.27; P=.006) and those who were partners of the patient (OR=1.33; P=.002). Partnering with patients' family members to provide fundamental care to the patients significantly improved the respect, collaboration, support, and overall scores on the family-centered care survey at 48 hours.

Development and implementation of early intervention services for young people with psychosis: case study

The development of early intervention services for young people with first-episode psychosis is a priority internationally. To evaluate the development, implementation and impact of existing and newly formed early intervention services in England. Multiple-case study involving staff, users, carers and commissioners of 14 early intervention services. Service numbers increased in response to national policy directives. They were still actively working with 90.6% of service users 12 months after inception. They were highly valued by users and carers as providing a personal service that contrasted with previous experiences of care. Tensions between providing a quality service and meeting case-load targets linked to future funding led teams to adopt a series of survival strategies with some unintended consequences. Early intervention services are highly valued by consumers and engage users effectively after 12 months. Implementation of these services is threatened unless sufficient consistent funding is made available.

The Medical Education Priorities of Parents Who Use Complementary and Alternative Medicine

Many parents use complementary and alternative medicine (CAM) for their children. A number of medical schools are introducing CAM teaching, and this study was undertaken to explore the medical education priorities of parents who use CAM for their children. A total of 27 parents (25 females, 2 males) participated in 1 of 6 focus group discussions. Transcripts were analyzed using an iterative process of concept identification, hypothesis testing, and detailed comparisons. Participant preferences for health care for their children were complex and informed by previous health care experiences and current family health care needs. Using CAM allowed parents choice and control in managing their family’s health care. Many participant priorities for medical education in CAM echoed key principles of patient-centered care in addition to specific suggestions for curriculum development. Participating parents believed that it was important to increase medical students’ knowledge and understanding of both CAM modalities and the perspectives of parents.

The impact of nurse education on the caring behaviours of nursing students

This study aimed to ascertain whether nursing students' perceptions of caring behaviours as part of nursing practice change over a three-year, pre-registration, undergraduate nursing course. Students are expected to have a predisposition to care with nurse education nurturing and developing this into professional caring behaviour. However, there is some evidence that this process inures rather than develops these behaviours. This was a quantitative, single cross section survey of two nursing student cohorts from one Higher Education Institution (HEI) in Wales, United Kingdom (UK). There were two sample groups; sample group A were 80 first year students and sample group B were 94 third year students. Students completed a questionnaire incorporating the caring behaviors inventory (CBI) [Wolf, Z.R., Colahan, M., Costello, A., Warwick, F., Ambrose, M.S., Giardino, E.R., 1994. Dimensions of nurse caring. Journal of Nursing Scholarship 26 (2), 107-111]. The key finding was a statistically significant difference in the means in caring behaviours between first years and third years with third years scoring lower than first years. This was exaggerated for those under 26 and increased further for those under 26 with no previous experience of caring. Caring is a core nursing value and a desirable attribute in nursing students, but the educational process seemed to reduce their caring behaviours.

Utilization of maternal health care services in the department of Matagalpa, Nicaragua

To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.

Physicians and AIDS care: does knowledge influence their attitude and comfort in rendering care?

Adequate knowledge, positive attitude, and feeling of comfort are important factors in providing compassionate care to patients. The purpose of this study was to assess physicians' knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence physicians' attitude and global comfort, and to identify any relationship between their knowledge, attitude and comfort. Consultants and residents (N=211) in two Nigerian teaching hospitals were surveyed using a two-part questionnaire. Part I elicited sociodemographic and previous AIDS encounter information, and Part II assessed knowledge, attitude and global comfort with AIDS patients care. Nigerian physicians showed satisfactory knowledge, but they harbored negative attitude and low level of comfort in caring for PWA. Previous AIDS care experience, age and being a consultant or a senior resident influenced attitude, while male gender and knowing someone with AIDS influenced global comfort. Knowledge is weakly but positively associated with attitude, while attitude is modestly associated with comfort. The study reinforced the need for an ongoing education focused on experiential learning, and professional socialization in order to influence physicians' attitude and enhance their feeling of comfort when caring for PWA. African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 37-43

Formal support of stroke survivors and their informal carers in the community: a cohort study

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.

Personal Influencing Factors Associated With Pap Smear Testing and Cervical Cancer

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.