Professional Health Care Providers Research Articles

Family Caregivers of People with AIDS

The purpose of this grounded theory study was twofold: (a) to examine AIDS family caregivers' interactions with professional health care providers, and (b) to evaluate the applicability of Swanson's middle-range theory of caring to characterize these interactions. The sample consisted of 12 family caregivers including gay partners, friends, and parents. Negotiating Partnership, defined as working out care with one another for the common good of the person with AIDS, was the basic social process explaining interactions between family caregivers and health care providers. Dimensions of negotiating partnership included conveying information, knowing, being accessible, and maintaining belief.

Cultural aspects of caring for Navajo Indian clients.

Cultural factors significantly influence the Navajo's interactive processes as well as perceptions of health and illness. Unfortunately, very limited published information is available about the problems that may occur when health care practitioners ignore the influence of culture. The interactive processes are made even more complex when health care providers have cultural expectations that are different from those held by their patients. The article reviews some of the complex factors (i.e., family structure, health/illness beliefs, traditional remedies, and cultural practitioners) that influence the Navajo's decision to seek, accept, or reject the assistance of professional health care providers. In addition, some implications, strategies, and suggestions are included that may assist the nurse in improving the quality of care provided to the Navajo patient.

Preparing for cultural diversity through education.

A MERICA’S increasingly diverse population is preventing the “pot” from melting. There is no longer an expectation that all cultures are to be blended into one homogenous nation (Beckham, 1992). The number of minorities in this country has continued to grow dramatically from 1980 to 1990.” The Asian Pacific, Hispanic, and black populations have grown 107%, 53%, and 13%, respectively, whereas the white population has grown only 6%” (Friedman, 1992, p. 10). We, as professional health care providers, must prepare ourselves to deal with this growing diversity in the American population. To effectively provide quality care for patients of diverse cultures, we must go beyond cultural awareness and sensitivity (Leininger, 1991). We must provide care that incorporates the cultural values and beliefs. The acknowledgment and understanding of cultural values, beliefs, and barriers that can influence an individual’s behavior towards health and illness should become an ongoing component of our staff development process. A group’s learned and common values, beliefs, norms, and practices that direct thinking, decisions, and patterns of behavior have been described by Leininger as the group’s culture (Leininger, 1985). Culture is an entity that provides the individual with a powerful sense of belonging and identity. This is evident when we examine the importance of our own culture in our daiIy lives. Values are those things that we hold important. Values influence our decision-making process and behaviors. Understanding a culture’s value orientation can be instrumental in understanding the behavior of its people. Some cultures value the extended family with a system that determines role designation. For example, a

Coping With Grief in Response to Caring for Persons With AIDS

AIDS has or will affect virtually every professional health care provider. Occupational therapists are in a key position to identify and intervene with the social and occupational changes and losses commonly experienced by this patient population. Suggestions are provided to assist occupational therapists in helping patients with AIDS maintain meaning in their lives. Strategies to help occupational therapists prevent burnout resulting from the emotional stress related to caring for patients with AIDS are suggested as well.

Facilitating Adherence to ACS and NCI Guidelines for Breast Cancer Screening

1. Measures are needed to increase awareness of the incidence of breast cancer, and perhaps to increase the perception of susceptibility to breast cancer among all women. 2. Common reasons for noncompliance with the established guidelines include: fear of the carcinogenic effect of radiation, unfamiliarity with the guidelines, belief that mammography is ineffective, or fear that detection will necessitate mastectomy. 3. While cost, accessibility, and availability are critically important in enhancing public compliance, professional health care providers have a tremendous burden to obtain current information regarding the breast screening guidelines, and communicate the information to the public. 4. By helping to establish accessible and affordable breast screening programs, nurses have an excellent opportunity to play a role in the reduction of morbidity and mortality associated with breast cancer.

Generic Prescribing, Generic Substitution, and Therapeutic Substitution

Pressures generated by a constellation of professional consumer, legislative, and health care provider vider groups in this era of increasing health care costs have led to enactment of generic substitution laws in 50 states. The general acceptance of this concept, despite conflicting evidence that it has reduced the cost of prescription items to the consumer, has led to the concept of therapeutic substitution. Considerable confusion exists among health care professionals regarding the precise meaning of these concepts. Generic prescribing is the prescribing of a drug by a physician using the generic name. This leaves the choice of brand to the dispensing pharmacist. Generic substitution is a pharmacist-initiated act by which a different brand or an unbranded drug product is dispensed instead of a drug brand that was prescribed by the physician. This means substituting the same chemical entity in the same dosage form for one marketed by a different company. Therapeutic substitution is a pharmacist-initiated act by which a pharmaceutical or therapeutic alternate for the physician-prescribed drug is dispensed without consulting the physician. This denotes replacement of the prescribed drug with a chemically different drug within the same therapeutic category, eg, hydrochlorothiazide for furosemide; ranitidine for cimetidine; chloramphenicol for erythromycin. In 1976, the AAP Committee on Drugs published a commentary in Pediatrics (1976;57:275-277) on generic prescribing and concluded that "the lack of data on bioavailability and bioequivalence in children precludes blanket support of generic prescribing for infants and children." The Committee recently reviewed this issue and concluded that the situation has changed little during the past decade.

Does telephone counselling have preventive value?

Major developments in health care frequently result not from careful planning by professional health care providers, but from social processes whereby a heightened awareness of need leads to new strategies and resources for community support. The development of a network of hospitals in eighteenth-century England was 'the outcome of individual initiative and of coordinated voluntary effort and subscription'. The evolution of mental health care in the United States was influenced greatly by the enthusiasm and advocacy of reformers such as Dorothea Dix and Clifford Beers. The development of telephone counselling services, now an integral part of community mental health care, resulted from a recognition that the psychosocial stresses of twentieth-century life could perhaps be alleviated through support offered by telephone. This recognition has led to the mobilising of many thousands of volunteers who serve in hundreds of telephone counselling services worldwide. For telephone counselling as for many other new developments, the initial period of growth has been followed by one of reflection and evaluation. That telephone counselling services have earned a place in the community mental health network and are here to stay is beyond doubt, though the ways in which they can be used to greatest advantage are still being clarified. At the level of primary prevention there is as yet no convincing evidence that telephone counselling services have reduced the incidence of psychological disorder. It must be added, however, that mental health professionals have also had relatively little success in reducing the occurrence of psychological disorder, and only with carefully designed programs directed toward specific at-risk groups. The evidence is more encouraging at the level of secondary prevention.(ABSTRACT TRUNCATED AT 250 WORDS)

An employee learning needs assessment concerning mental health needs of residents in a long-term care setting.

ABSTRACT A quasi-competency-based employee learning needs/attitude assessment tool, based upon identified mental health needs of residents in a long-term care setting, was developed with the participation of an advisory group of professional health care providers, professional and non-professional employees and residents. The tool, which has a high construct and content validity and interrater reliability, was then used to assess the learning needs/attitudes of the advisory group and employees. The Identified mental health need statements were sorted into 18 categories for the development of inservice education programs. No common learning needs across all groups were identified. Priority learning needs identified by employees included the following categories: Coping with Pain; Staff Need; Crisis Intervention; Sexual Needs; Religious Needs; Resident/Friend/Family Interaction; and Reminiscent Therapy. A correlation between the importance assigned to the item categories by the advisory group and the staff indicated a close compatibility for the categories of Opportunities for Personal Sustenance/Growth; Crisis Intervention; Physical Nursing Care; Security Need; Staff Need; Coping with Pain; and Sexual Needs. The category of Resident/Family/Friend Interaction was recommended as the priority focus for staff development programs since it was a multi-item category and had previously been recognized by Administration as an employee learning need. Attitudes of the staff toward the residents, as identified by the importance assigned to the mental health need statements, were very positive.

Expanding the Theoretical Framework for Effective Nursing

In this paper I have called attention to the need to expand the theoretical framework for effective nursing. The concepts that I have proposed for incorporation are not new. However, they have not been given the prominence in our thinking that is necessary in order to maximize the impact of nursing in resolving problems of health care delivery. This list is not exhaustive. Obviously, we must continue to identify gaps in nursing knowledge and to bridge these gaps. The time is ripe to bring to capitalization the knowledge and skills developed through many years of experience and to expand the theoretical framework in directions that will mobilize the full potential of the largest pool of professional health care providers in the nation. Almost 30 years ago, psychiatric nurses led the way in integrating social and psychologic theories into basic nursing curricula. Leaders in this field must again turn their attention to the need to develop nursing content and approaches for meeting the challenges of current and anticipated trends toward improving health care in general, and mental health care in particular.