Previous Healthcare Experience Research Articles

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.

Public perception and attitude of saudis toward organ and tissue donation.

Biobanks depend on the willingness of people to contribute samples for both research and storage; however, the requirements to perform research on biobanked samples are different than the requirements for their use in organ transplants. The objectives of this study were (1) to characterize public attitudes toward tissue and organ donation for transplantation and biobanking and (2) to identify significant predictors of these attitudes. A cross-sectional study was conducted with a total of 1051 adult subjects, all of whom accompanied their ill relatives to the outpatient clinics at King Abdulaziz Medical City. All subjects were given an interview questionnaire about their previous healthcare experiences and an attitude scale to assess their willingness to participate in organ donation for transplantation or tissue donation for research. A total of 64.7% of all participants reported having a positive attitude toward organ donation, and 68.8% of participants reported having a positive attitude toward biobanking. There was a significant and direct correlation between the attitude score related to organ donation and the attitude score related to tissue donation for research (r = 0.513, P < 0.001). After adjusting for other variables by multiple regression analyses, a positive attitude toward either organ donation or tissue donation for research was significantly more prevalent among females (P < 0.001), those who had previously participated in health-related research (P < 0.001 and P = 0.002, respectively), and those who were aware of organ retention controversies (P = 0.036 and P = 0.001, respectively). Other significant predictors of positive attitudes toward only biobanking were a history of previous blood tests (P = 0.038) and the completion of secondary education (P < 0.001). The attitude of the Saudi public is favorable toward both organ donation and tissue biobanking. Attitudes about the 2 types of donations are related. Previous participation in health-related research and awareness of organ retention controversies are significant predictors of attitudes toward both types of donations.

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.

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.

Patient satisfaction with nursing care: a concept analysis within a nursing framework

This paper is a report of a concept analysis of patient satisfaction with nursing care. Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept. Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007. Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes. The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.

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.

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.

How do women who choose not to participate in population‐based cervical cancer screening reason about their decision?

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores how women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et al.'s ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge.

A study of children's concepts of their internal bodies: A comparison of children with and without congenital heart disease

This study examined the following: (1) the knowledge children with and without congenital heart disease have about their internal bodies, (2) the relationship of this knowledge with age, disease severity, and previous health care experiences, and (3) how the differences between beliefs about the interior body and the value assigned to specific body parts differed between children with congenital heart disease and their unaffected peers. One hundred participants, 50 with cardiac disease and 50 comparisons, between 5 and 15 years of age, completed the Inside the Body Test; the severity of the conditions of the children with cardiac problems was evaluated with the Permanent Impairment Evaluation Guide. Results indicated that there were no differences between the 2 groups on knowledge of body parts, body-part function, nor the values that were assigned. Implications for practice are discussed. Copyright © 2000 by W.B. Saunders Company

Use of the ED as a Regular Source of Care: Associated Factors Beyond Lack of Health Insurance

Study objective: To determine the characteristics and health care experiences of patients who identify the ED as their usual source of care. Methods: We conducted a cross-sectional survey in a Level I trauma center ED at an urban teaching hospital. Our population comprised 892 adults who presented to the ED over the course of 30 days. We asked participants about their regular source of health care, previous health care experiences, and perceptions of the use of the ED. Results: Patients who reported the ED as their regular source of care were three times more likely to have used the ED more than once in the preceding year. Among the regular ED users, 68% desired a physician as their regular source of care, and 46% of these subjects said they had tried unsuccessfully to get one in the preceding year. Five variables were associated with self-report of the ED as the regular source of health care: annual income less than $30,000, having been refused care in an office or clinic in the past, perception that an ED visit costs less than an office visit, absence of chronic illness, and unwillingness to use the ED if a $25 copayment were in effect. Conclusion: Low income, perceived mistreatment by health care providers, and misperception about charges contribute to use of the ED as a regular site for health care. These factors suggest the difficulty of altering health care use patterns in this group. [O'Brien GM, Stein MD, Zierler S, Shapiro M, O'Sullivan P, Woolard R: Use of the ED as a regular source of care: Associated factors beyond lack of health insurance. Ann Emerg Med September 1997;30:286-291.]

Pre-registration midwifery programmes: a case study evaluation of the non-midwifery placements

Objective: to evaluate the effectiveness of non-midwifery placements in enabling pre-registration (direct entry) student midwives to learn about caring for childbearing women with medical, surgical or mental health problems and needs. Design: case study. Setting: a large midwifery education department and three acute general hospitals in England. Participants: 15 student midwives in the first intake of one college's three-year diploma programme in midwifery plus the practitioners involved in their education. Main outcome measures: the learning needs of student midwives, who have no previous health-care experience, to enable them to care effectively for women with medical/surgical/mental health problems; the teaching processes and learning opportunities related to these aspects of care; how the views of teachers and practice placement staff compare with those of the students; the factors that influence the teaching and learning processes and experiences for pre-registration student midwives. Findings: the broad range of experiences in medical/surgical/mental health placements enabled students to increase in maturity, and confidence and develop their communication skills. The variety of placements enhanced student understanding of the multi-disciplinary team's contribution to health care, students learned new practical skills which were transferable to maternity care contexts and all students had opportunities to care for adults with most of the medical/surgical/mental health problems seen in childbearing women. Conclusions: this action research project provided data for curriculum development and helped to avoid premature reaction to individual staff and student response. The value of the medical/surgical/mental health placements and the importance of staff and student preparation for effective learning was established. Whilst it might be essential to identify what and where student midwives should learn, it would appear that developing each student must be an equal, if not greater, priority for curriculum designers.

The relationship of empathy to clinical experience among male and female nursing students.

While a number of educational interventions aimed at increasing empathy among nurses have been undertaken, research on empathy has yielded inconsistent findings. This study used a new multidimensional measure to study empathy levels among BSN nursing students during their first year of nursing education. Thirty-five nursing students completed Davis' Interpersonal Reactivity Index (IRI) at four times during their junior year. The results of a repeated measures ANOVA indicated high consistency for all IRI scores across the four data collection periods. T-tests were also performed to compare IRI scores by gender. Males scored significantly lower than female nursing students on the Personal Distress Scale. While there were no other consistent, significant differences, males did not tend to score slightly higher than females on Perspective Taking. This response pattern is the opposite of what has been reported for other groups, although it is consistent with previous nursing research. The relationship between age, previous health-care experience, and IRI scores also varied by sex. Implications of these findings for educational interventions, recruitment, and retention of nursing students are discussed.