Variety Of Health Professionals Research Articles

Health Professionals’ Perspectives on the Infant Feeding Practices of Low Income Mothers

The purpose of this study was to determine the perspectives of health professionals on assisting low income mothers with infant feeding. Low income mothers interact with a variety of health professionals through medical care and public health programs. Mothers indicate that health professionals are an important source of infant feeding information; however, they also report this information to be conflicting or difficult to follow. Five focus groups were conducted with 36 health professionals (pediatricians, nurses, WIC professionals, and Cooperative Extension nutrition educators). Individual interviews were also conducted with WIC professionals who were unavailable to meet as a group. Focus groups and interviews were audio taped, transcribed, and analyzed for common content categories. Six major content categories emerged from focus groups and individual interviews with health professionals: (1) Mothers' sources of infant feeding information, (2) Helping mothers deal with multiple sources of infant feeding advice, (3) Use of infant feeding recommendations by health professionals and their clients (4) Reasons mothers introduce cereal early to their infants (5) Mothers feeding infants in poor mealtime environments, and (6) Ways of providing education to mothers on infant feeding. A better understanding of health professionals' perspectives on working with low income mothers on infant feeding will inform nutrition education for these mothers, and may also inform strategies to improve communication between mothers and health professionals, subsequently improving infant health.

Promoting and supporting self-care management for adults living in the community with physical chronic illness: the effectiveness and meaningfulness of the patient-practitioner encounter.

Review Objectives: The overall objective of the review is to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Review Questions: What is the effectiveness of the patient-practitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how ‘effectiveness’ is defined in this context by patients and different practitioners? Inclusion Criteria for the Review: Types of interventions: The intervention of interest to this review is a patient-practitioner encounter where the aim is self-care management. A `patient’ is taken to refer to an adult with a physical chronic illness and a `practitioner’ may be one of a variety of health professionals since the care of a patient with chronic illness may be monitored by a number of practitioners from different professions such as doctors, nurses, specialists, pharmacists and social workers (Wagner, 2000). Since patients meet various professionals in a variety of community settings regarding their care, the term ‘encounter’ will be used in this review to encompass all types of appointments where patients meet practitioners, and where collaboration may take place. As patients with physical chronic illness may be routinely seen for follow up of self-care management at a hospital, outpatient departments will be included as a community setting for the purpose of this review as well as other settings more commonly associated with community settings such as General Practitioner surgeries and clinics at health centres. Types of outcome: The outcome of this review is effective self-care management. Effectiveness might be measured by objective measures of increased self-care management behaviours e.g. engaging in health promotion activities, and adherence to treatment protocols, and appropriate decision making on the results of self-monitoring. However self-care management may also be measured by subjective means e.g. perceptions of control in self-care management, or personal values and attitudes towards important roles and relationships when the effects of illness are managed in social contexts.

Reflection and reflective practice in health professions education: a systematic review

The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.

Measuring the workload of community nurses in Ireland: a review of workload measurement systems

The primary community nursing service in Ireland is public health nursing and this unique healthcare role incorporates activities and responsibilities undertaken by a variety of health professionals in other countries. Capturing and comparing a measure of the work of any community nurse is complicated due to the difficulty in standardizing the nature of community nursing across care settings. The aim of this paper was to review the varied approaches to measuring the workload/caseload of community nurses to evaluate how they may be applied to measure the workload of the public health nurse in the Irish Republic. Many of the systems designed to measure nursing workload are reliant on measuring tasks and fail to capture the less tangible but core aspects of the public health nursing role like decision-making, assessment and case management. There is a need to develop a workload measurement system for use by public health nurses in Ireland that is capable of measuring the uniqueness of the role.

Suporte informacional como elemento para orientação de pais de pré-termo: um guia para o serviço de acompanhamento do desenvolvimento no primeiro ano de vida

Information support as an element for advising parents of preterm infants: a guide for development follow-up services during the first year of life Introduction: The literature shows that preterm infants are at high risk of biological and psychological disorders and consequently require a higher level of care than is provided for full-term infants. Objective: To draw up a guide advising on development follow-up during the first year of life, for parents who attend a child development follow-up service. Method: The inclusion criteria were that participants should be parents of preterm infants with a corrected age between zero and six months that did not present neurological diseases and did not require physiotherapeutic intervention. This study was of qualitative nature. Data collection was by means of direct observation and interviews with mothers and with the professionals at this infant development follow-up service. The guide was produced based on analysis of the observations on attendance at the service, frequency of responses in the interviews with professionals and mothers regarding needs and doubts about handling and caring for infants, and associations with the literature. Results: A guide was produced containing information on infant development, divided into the first four trimesters of life. It draws attention to the importance of calculating corrected ages in order to adequately follow up development markers. Conclusions: This guide may be used by a variety of health professionals and by professionals who develop educational activities for parents.

Apley’s concise system of orthopaedics and fractures

This is a textbook which needs no introduction. Ten years since the last edition, and now dedicated to its originator, this outstanding book remains the introduction to orthopaedics for undergraduates and a variety of health professionals. It is also an ideal book for orthopaedic trainees to refresh

Multidisciplinary Management of Hypertension

disease. Chronic disease management techniques have recently been heralded as the solution not only to our national but also to the global health care crisis. One of the key principles of chronic disease management is the use of multidisciplinary teams. What this means is that a variety of health professionals, working together, are able to synergistically use their respective skills for the benefit of the patient. Multidisciplinary teams supply the right provider, at the right place, at the right time. Pharmacists can be key players on the multidisciplinary health care team, particularly as applied to hypertension. We know that patients see pharmacists much more frequently than they see physicians — an average of 14 times per year versus twice per year. This gives the pharmacist an opportunity to play a key role in the management of hypertension, through: Screening: We know that about half of those with hypertension are unaware that they have it. Thus, screening for hypertension in a pharmacy setting can be a valuable means of bringing such people to medical attention. Control: There is a major emphasis on home and other out-of-office blood pressure monitors in the Canadian Hypertension Education Program (CHEP) guidelines. Such devices facilitate accurate diagnosis, patient adherence, and improved control of blood pressure. Pharmacists can play an important role in helping hypertensive patients select appropriate home blood pressure monitors or in providing access to out-of-office blood pressure measurement devices. Education: Busy physicians often have little time to discuss the use, interactions, and side effects of antihypertensive medications during an office visit. The pharmacist is an obvious source for such information. Moreover, pharmacists can provide useful information on how to most appropriately take blood pressure medication.

SEAM - improving the quality of palliative care in regional Toowoomba, Australia: lessons learned

The proliferation of professional palliative care services in recent years has increased access for people with palliative care needs; however, gaps in services continue to exist, particularly in rural and remote areas of Australia. In order to address one gap in rural health service delivery, the Support, Education, Assessment, and Monitoring (SEAM) Service for regional and rural people in Toowoomba, Queensland, Australia, was introduced. This new model of service delivery aimed to provide palliative services to patients and their families who live in the regional city of Toowoomba and its rural catchment area. It also aimed to facilitate education, support and networking among health-care professionals, particularly general practitioners and nurses employed in general practice (practice nurses). The evaluation involved twenty face-to-face interviews with a variety of health professionals who had contact with the SEAM service from June 2003 to June 2004. Qualitative data analysis of the transcribed interviews provided the basis for the evaluation. The emergent themes regarding the SEAM service included: satisfaction and benefit of the SEAM service; knowledge of and contact with the SEAM service; the SEAM role; and expansion of the role. The data indicate that the majority of health professionals who had contact with the SEAM service were satisfied with the service and found it to be of benefit to them and their clients. Participants commented on the extensive networking and support work established by the SEAM nurse with other health service providers. Difficulties experienced with the SEAM service included poor utilisation by GPs and, therefore, clients in need of palliative support. This was predominately due to lack of knowledge of the service as well as limited understanding of the SEAM nurse role. The SEAM service has resulted in increased links between health professionals providing palliative care to rural clients. The most successful strategy was the use of multidisciplinary case conferencing which not only built links among health professionals caring for individual clients, but also resulted in improved care for those clients. As a result of better integration and communication, palliative care services to rural people have been improved. However, with regard to the delivery of direct patient care, or in the support of GPs for the management of palliative care patients, it was apparent that the service did not meet its objectives. The lack of use by GPs and patients appears to be related to a lack of awareness of the existence of the service. A positive outcome of this poor utilisation is, however, that the model has allowed the identification of factors that work as barriers to GPs and client/family utilisation of rural palliative care services.

On Closer Inspection: Learning to Look at the Whole Home Environment

It’s supposed to be a harbor, a haven—it’s home. But some home environments can cause serious health problems. Moisture and molds can inflame asthma and allergies. Broken steps can cause a fall. A leaky oil furnace can produce deadly carbon monoxide. Cockroaches and mice can produce airborne allergens that trigger asthma episodes. A variety of health professionals and inspectors may enter a home for one reason or other, but few are equipped to spot all the possible ways a house can hurt its occupants. Now a new government partnership aims to change that.

Systematic review of rheumatoid arthritis patient education

Rheumatoid arthritis (RA) is a common chronic condition characterized by uncertain disease progression and an unpredictable course of exacerbations and remissions. Approximately 1–3% of the population in Western countries is affected by RA (1). Various interventions may alleviate its course, and patients come into contact with a large number and variety of health professionals. For many patients, pain, disability, deformity, and reduced quality of life persist in spite of treatment. There is room for new approaches to enhance current treatment effectiveness. Patient education is one such approach that is thought to be beneficial in helping patients cope with their disease and cooperate with its complex management (2,3). As with other chronic diseases, there is no cure for most types of arthritis, including RA. Furthermore, the disease course is often unpredictable and the symptoms that patients experience can vary from day to day or even from hour to hour. Because of the nature of pain and disability, the partial and inconsistent effects of treatment, and the unpredictability people with arthritis face on a daily basis, patient education programs have become a complement to traditional medical treatment (4). Thus, patient education programs have given people with arthritis the strategies and the tools necessary to make daily decisions to cope with the disease (5,6). Patient education has been defined as “any set of planned educational activities designed to improve patients health behaviors and/or health status” (7). Lorig has further stated “the purpose of patient education is to maintain or improve health, or, in some cases, to slow deterioration” (7). The focus of arthritis patient education programs is to teach patients to adjust their daily activities as dictated by disease symptoms. In other words, in addition to teaching patients what they should do, patients are also instructed on how to approach situations and to make adjustments that are appropriate for each individual and his or her own needs. There has been increasing research in the field of patient education, and major reviews of published studies have been conducted on the value of education in general (8) and, more recently, on education in arthritis (5,6,9,10). Two reviews on arthritis patient education reported combined effect estimates on main outcome measures, such as pain, functional disability, and psychological outcomes (9,10). Hawley reviewed 34 rheumatic disease patient education clinical trials performed between 1985 and 1995 (9). She reported average effect sizes for treatment groups compared with nonintervention controls for RA patient pain, functional ability, and depression at postintervention of 0.13, –0.16, and 0.01, respectivley; effect sizes for osteoarthritis (OA) patient pain, functional ability, and depression at postintervention were 0.44, 0.28, and 0.56, respectively (confidence intervals were not reported). These data show a trend to greater improvement for OA compared with RA patients (9). Superio-Cabuslay et al compared the effects of 19 patient education trials and 28 nonsteroidal antiinflammatory drug trials between 1966 and 1993 among patients with OA and RA (10). They found an average effect size for treatment compared with nonintervention controls for RA patient pain and funcThis article is a summary of a Cochrane systematic review: Riemsma R, Kirwan J, Taal E, Rasker J. Patient education for adults with rheumatoid arthritis. Cochrane Database Syst Rev 2002;(3):CD003688. An editorial discussing the main results of the review has been published: Riemsma RP, Taal E, Kirwan JR, Rasker JJ. Patient education programmes for adults with rheumatoid arthritis [editorial]. BMJ 2002;325:558–9. The results of a Cochrane review can be interpreted differently, depending on people’s perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors, and are not necessarily shared by the Cochrane Collaboration. The views expressed in this report are those of the authors and not necessarily those of the Dutch Arthritis Association. Any errors are the responsibility of the authors. Supported by a grant from the Dutch Arthritis Association. Robert P. Riemsma, PhD: Centre for Reviews and Dissemination, University of York, York, United Kingdom; Erik Taal, PhD: University of Twente, Enschede, The Netherlands; John R. Kirwan, BSc, MD: Bristol Royal Infirmary, Bristol, United Kingdom; Johannes J. Rasker, MD, PhD: University of Twente and Medisch Spectrum Twente, Enschede, The Netherlands. Address correspondence to Robert P. Riemsma, PhD, Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK. E-mail: rpr1@york.ac.uk. Submitted for publication July 4, 2003; accepted in revised form November 30, 2003. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 51, No. 6, December 15, 2004, pp. 1045–1059 DOI 10.1002/art.20823 © 2004, American College of Rheumatology

Screening and brief alcohol interventions: What, why, who, where and when? A review of the literature

There is a significant body of literature in the field of screening and brief alcohol intervention. This paper reviews that literature in order to provide a comprehensive overview of this important field of study. The format of the paper is not intended to be one of a systematic review with meta‐analysis, but rather a gathering of data to give readers a concise summary of the vast quantity of literature relating to screening and brief alcohol intervention. The review will provide a working definition of screening and brief intervention and explain why it is considered to be an important element of preventive care. Data will also be presented relating to the effectiveness, attitudes, involvement, cost and accuracy of a variety of health professionals involved in screening and brief intervention along with the patient's perspective on these health professionals' roles. The review will also examine the settings in which screening and brief intervention can and does take place.

RURAL SCHOLARSHIP SCHEMES A solution to the human resource crisis in rural district hospitals?

ABSTRACTRecruiting sufficient health personnel for rural hospitals is an ongoing problem. The Friends of Mosvold Scholarship Scheme in northern KwaZulu-Natal is a locally based scholarship scheme that offers the local community a chance to develop its own human resources for health care. Students are required to work in the local hospital during their vacations and sign a contract to work back their scholarship year for year. Already 44 people from Ingwavuma are being supported to study for a variety of health professions. This concept is being extended to the Limpopo and North-West provinces through the Wits Initiative for Rural Health Education. The scheme provides a model for human resource development at a district level that could be usefully adopted by any tier of government.

A training course for oncology nurses in familial cancer risk assessment: evaluation of knowledge and practice.

With the availability of genetic testing for cancer, a variety of health professionals are needed to counsel individuals seeking cancer risk information. To address the educational needs of oncology nurses, a training course in familial cancer risk assessment and counseling was developed at Fox Chase Cancer Center, Philadelphia, Pennsylvania. Four training sessions were conducted with 164 nurses. Knowledge was assessed from pretest to posttest using Wilcoxon's signed-rank test. Comparison of practice in cancer risk assessment (CRA) was measured at baseline and six months with McNemar's procedures. There was statistically significant improvement in knowledge from pre to post test. There was self-reported improvement in collecting family histories and assessing cancer risk. Those reporting current practice in risk assessment post-training were more likely to collect required family history information and had greater confidence in skills. With education and opportunity to practice, nurses can play key roles in CRA.

Prenatal education for mothers with disabilities

Prenatal nurse educators are well prepared to meet the learning needs of many expectant mothers. But how prepared are they to meet the learning needs of mothers with disabilities? To answer this question, eight mothers with various chronic illnesses located in north-eastern Ontario, Canada were asked to describe their maternity experiences. Given the small convenience sample and exploratory nature of the study, a qualitative content analysis was done. The mothers' reports described interaction with a variety of health professionals. This analysis focuses on findings specific to nurses who provide prenatal education. In general, mothers reported they had received insufficient, inappropriate information, especially about their pregnancy and chronic illnesses. The mothers thought that nurses doubted the ability of women with disabilities to be decision-makers or responsible and 'proper' mothers. Suggestions by disabled mothers for quality care in prenatal education are described. A more emancipatory approach to preparing nurses for practice as prenatal educators is recommended. Such an approach can reduce the barriers associated with power differences between women with disabilities as 'learners' and their nurse 'teachers'.

Physician Contact with Older Community Patients: Is There an Association with Physical Fitness?

Background. Contact with family physicians by older adults may be linked to their physical fitness in addition to other health, behavioral, and sociodemographic determinants. We studied a stratified random sample of urban community-dwelling elderly patients in London, Ontario, Canada, to describe the interaction of physical fitness measures and a number of health and lifestyle behaviors and sociodemographic outcomes with family physician contact over 1 year. We hypothesized that physician contact would be associated with lower indices of physical fitness and that association would be similar to other known determinants of physician utilization.Methods. Three hundred seventy-five noninstitutionalized elderly men (N = 185) and women (N = 190) ages 55 to 84 years were recruited from the municipal tax assessment list for the city of London (population 280,000). Four categories of independent variables were selected to reflect common determinants of health (physical fitness, self-reported and clinically measured health, lifestyle behaviors, and sociodemographics). The association between these categories of variables and self-reported contact with family physicians and a variety of health professionals was determined for the year prior to the study.Results. Forty-six percent of the subjects had at least one physician contact in the month prior to the study and 79% within the previous year. None of the other health professions (including nursing, chiropractic, physiotherapy, homemaking, and dentistry) were contacted more than once in the previous year. Lifestyle and sociodemographic variables including activity habits, smoking, income, marital status, and education were not associated with physician contact, whereas poor self-reported cardiovascular health and use of cardiovascular and pulmonary medications were associated with physician contact. Interestingly, physical fitness variables including maximal aerobic capacity, grip strength, and hip flexibility were not associated with physician contact.Conclusions. The absence of an association among physical fitness, lifestyle, and sociodemographic variables and physician contact was not anticipated and may be due to the selection of individuals who were independent, active community dwellers. It may be that most of the physician contact in this relatively healthy and physically fit sample was preventive in nature, for example, monitoring common chronic disease states in the elderly including cardiovascular and pulmonary disease. This paper reports baseline data from a longitudinal study of the interaction between physical fitness and health outcomes in groups of older community-dwelling individuals. As this group ages further, it would be interesting to determine the use of the health care system in relation to their changing functional and health status. In particular, do chronic health conditions such as cardiovascular disease, which increase in prevalence with age, become modified through maintenance of physical fitness and does this impact on health service use?

Issues in esthetic dentistry for older adults.

Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.

Inconsistencies in the Drug Use Process

Rational drug therapy has historically been viewed as the right drug, in the right dose, at the right time, for the right patient. Today, the emphasis on cost containment has added an extra dimension: cost-effective therapeutic regimens. Most stages of the DUP have not been extensively studied. Evidence presented to date reflects duplication of efforts and suboptimal decisions, with little concerted effort to identify means for improvements that may have a favorable impact on cost and patient outcome. The increasing use of drugs as the primary mode to treat diseases, the reduction in the number of hospital employees at a time increased severity of patient illness, the nursing shortage, and the increasing cost and complexity of drugs, along with the inconsistencies that exist in drug use, demonstrate a need for a complete review of the DUP. The DUP, as it currently operates, is not conducive to the provision of a systematic approach to therapy. The stages in this process are often independent of each other and poorly performed by a variety of health professionals. The subsequent development of strategies for improving the chance for optimal drug therapy through the use of pharmacists as drug therapy experts is needed. The pharmacy profession is in a prime position where expanded patient care services and supervision of the entire DUP may actually decrease the total cost of health care. This expansion represents the key to increasing acceptance of pharmacists' clinical role and for ensuring long-term survival of the profession.

Family intervention

It may be presumptuous to point out to pediatricians new ways of insuring that children have improved health care and the benefits of preventive pediatrics from early infancy. As a group, we have done a great deal in moving academic departments towards expanding the role of ambulatory services and making the ambulatory setting a place where exciting educational developments take place. We have also made a real contribution in bringing the needs of preventive pediatrics to the attention of various levels of government as well as incorporating outpatient departments as important sites for the teaching of medical students, house staff, and a wide variety of health professionals.