Healthcare Workers In Settings Research Articles

Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants aged<2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged<2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely.

Social Work Practice in Health Care: The Need to Use Brief Interventions

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (2001), 14 million U.S. adults abuse alcohol and several million more are at risk of developing alcohol problems because of their drinking behaviors. Heavy drinking increases the risk of serious health problems, with the economic cost of problem drinking estimated to be $185 billion per year (NIAAA). Because individuals with alcohol problems are more likely to seek help from health care professionals than from alcohol treatment specialists (Bien, Miller, & Tonigan, 1993), it is imperative that social workers in health care settings be prepared to intervene. Although more than 7 percent of the U.S. population meets criteria for alcohol abuse or alcoholism (Grant et al., 1994), most people have problems that are considered mild to moderate (NIAAA, 2001), making it vital to intervene with individuals before the problems escalate to a level of alcohol abuse or alcoholism. Because traditional alcohol treatment approaches emphasize the need for abstinence, they are often inappropriate for and unsuccessful with people who have less severe alcohol difficulties (Zweben & Fleming, 1999). Therefore, alternative interventions that can be easily incorporated into social work practice in health care settings are needed. Findings from several meta-analyses have supported the success of brief interventions in helping clients reduce their level of drinking or as a means of facilitating treatment entry (Bien et al., 1993; Dunn, Deroo, & Rivara, 2001; Kahan, Wilson,& Becker, 1995; Poikolainen, 1999; Wilk, Jensen, & Havighurst, 1997). Brief interventions are now considered to have a valuable role in substance abuse treatment and the Consensus Panel of the Substance Abuse and Mental Health Services Administration has recognized them as an effective method for both treating some individuals and for motivating entry into more intensive treatment (Center for Substance Abuse Treatment [CSAT], 1999). In addition to representing a form of evidence-based practice, brief interventions are based on principles compatible with values of the social work profession and have the potential for use with diverse populations. Furthermore, brief interventions can be used to demonstrate the cost-effectiveness of social work services, which should be particularly appealing to those practicing in health care. DEFINITION OF BRIEF INTERVENTIONS Brief interventions are time-limited, self-help, and preventive strategies to promote reductions in substance use in nondependent clients and, in the case of dependent clients, to facilitate their referral to specialized treatment programs (Zweben & Fleming, 1999,p. 253). Interventions may be as short as five minutes, in which participants are given feedback regarding the consequences of heavy drinking and advised to reduce their consumption (Modesto-Lowe & Boornazian, 2000). Longer interventions may involve interviewing, which includes reflective listening on the part of the counselor, articulation of motivational statements by the client, full consideration of the client's ambivalence toward changing his or her risky behavior, and avoidance of client resistance (Dunn et al., 2001). The goal of any brief intervention is to motivate client change (CSAT, 1999; Fleming & Manwell, 1999) in a manner that recognizes the client's willingness to change, acknowledges the client as the expert, and demonstrates respect for client decision making. Core elements of brief interventions are identified by the FRAMES acronym (Miller & Sanchez, 1994): * Feedback is given to the individual about personal risk or impairment. * Responsibility for change is placed on the participant. * Advice to change is given by the clinician. * Menu of self-help or treatment options is offered to the participant. * Empathic style is used by the counselor. …

Sexually transmitted infections and HIV among travellers: A review

Sexually transmitted infections are often acquired during travel. Infections are most often seen in young adults, travelling without a regular partner and among those who have higher numbers of partners while at home. Alcohol and recreational drug use may increase risk. The risks are highest from having unprotected sex with local partners in developing countries where the prevalence of infection can be many times higher than at home. The risks of acquiring HIV are highest in Africa, followed by South Asia. Special precautions are required by those going to work in health-care settings in high HIV prevalence countries. Travellers may benefit from advice about safer sex, condom use, emergency contraception and vaccination against hepatitis B. In special circumstances a starter pack for HIV post-exposure prophylaxis should be considered. Following return travellers should consider attending specialist services for a screen for sexually transmitted infections and HIV if they are concerned about exposure whilst travelling. A number of reports suggest that travel clinics need to pay more attention to the sexual health of travellers.

Assessment and the Ubiquity of Culture: Threats to Validity in Measures of Health-Related Quality of Life

Social workers in health care settings are increasingly using patient-based assessments (PBAs) of health-related quality of life such as the SF-36. However, the validity of many PBAs for use with cultural minority groups is limited. To ensure that cultural minority groups are not misrepresented by standardized measures, social workers--as effective patient advocates--must be familiar with the underlying conceptual assumptions of measurement theory to articulate the strengths and limitations of measures used to investigate populations with which they have not been tested and advocate for cultural minority groups using language and terminology that measurement practitioners can understand and embrace.

Towards Customized Deliberations

ABSTRACT The profession of social work has important contributions to make in the rapidly developing dialog about medical care decision making and to the evolution of hospitals as systems that engage with people as patients, for whom illnesses create increased vulnerability (Gruber, 1998). Professional ethics clearly states that the individual professional social worker has a responsibility to influence processes involving vulnerable populations. Articulating social work's responsibility and potential contributions in the area of medical care decision making begins with an application of social work's mission and values, and then continues with consideration of the profession's evolving role in hospitals. Pertinent aspects of the health care industry, including current models for continuum of care and for provider-patient relationships, are discussed in terms of opportunities to modify the models used to guide interactions with patients. Finally, the impact of a growing number of distinct treatment options is also considered. The objective of the article is to offer social workers in health care settings a conceptual framework for considering professional ethical obligations and for participating in the contemporary dialog regarding medical care decision-making.

Identification of potential candidates for varicella vaccination by history: questionnaire and seroprevalence study

Guidance from the Joint Committee on Vaccination and Immunisation regarding varicella vaccination of workers in healthcare settings is imminent.1 The new recommendations will advise that all those with a negative...

Validation of the health care surrogate preferences scale.

Recent advances in health care technology have increased the number of health care decisions made by acute care patients and those who act on their behalf, known as health care surrogates. This study reports on the validation of a new measure, the Health Care Surrogate Preferences Scale. Designed to assess the willingness of adults to perform and convey the duties required to communicate patient preferences, the scale offers a promising tool for use by social workers in health care settings. Development, evaluation, application of the new measure, and future research needs are discussed.

An ongoing randomized clinical trial in dysphagia

Most of us who have clinical practices firmly contend that the treatments we provide cause beneficial changes in the lives of our patients. Indeed, our clinical experience engenders strong convictions to the point of believing that withholding treatment creates ethical violations. Intellectually, however, we must recognize that the value of treatment needs to be validated through scientific evidence. This paper examines the use of randomized clinical trials as a means of obtaining the type of evidence relevant for work in health care settings. Learning outcomes (1) Readers will be able to explain why randomized clinical trials are conducted. (2) Readers will be able to describe the challenges faced when conducting randomized clinical trials. (3) Readers will be able to explain the ethical considerations involved in study design. (4) Readers will be able to describe the implementation and procedures used in Protocol 201. (5) Readers will be able to describe the two dysphagia interventions and the expected short and long-term effects of these interventions.

An ongoing randomized clinical trial in dysphagia

Most of us who have clinical practices firmly contend that the treatments we provide cause beneficial changes in the lives of our patients. Indeed, our clinical experience engenders strong convictions to the point of believing that withholding treatment creates ethical violations. Intellectually, however, we must recognize that the value of treatment needs to be validated through scientific evidence. This paper examines the use of randomized clinical trials as a means of obtaining the type of evidence relevant for work in health care settings. (1) Readers will be able to explain why randomized clinical trials are conducted. (2) Readers will be able to describe the challenges faced when conducting randomized clinical trials. (3) Readers will be able to explain the ethical considerations involved in study design. (4) Readers will be able to describe the implementation and procedures used in Protocol 201. (5) Readers will be able to describe the two dysphagia interventions and the expected short and long-term effects of these interventions.

Social Work in health care settings: Turning Full Circle?

Social Work in health care settings: Turning Full Circle?

Social Work in Healthcare Settings: Turning Full Circle?

Social Work in Healthcare Settings: Turning Full Circle?

Perceptions regarding the use of physical restraints with elderly persons: comparison of Israeli health care nurses and social workers

In view of the difficulty involved in decision-making regarding the use or removal of physical restraints and the recent pattern encouraging the use of interdisciplinary teams for elder care issues, the present study compared the perceptions of Israeli nurses and social workers in health care settings regarding the use of physical restraints. Data were collected from a convenience sample of 50 nurses and 69 social workers working in long-term and acute care settings. The findings indicated that participants in all professions attributed moderate to low importance towards the use of physical restraints. Social workers' perceptions were similar to those of nurses in psychiatric hospitals and slightly more favourable to the use of physical restraints than those of nurses in nursing homes. Patients' safety (as reflected in the scores of the items related to protecting an older person from falling and protecting an older person from pulling out a catheter) was the most important reason for using physical restraints for both groups. Increased attention should be given to the role of social workers as team members in the process of decision-making regarding the use or removal of physical restraints, especially as mediators between the elderly person, family members and staff members.

END-OF-LIFE DECISION MAKING: PRACTICES, BELIEFS AND KNOWLEDGE OF SOCIAL WORKERS IN HEALTH CARE SETTINGS

The aim of the present study was to examine the involvement, beliefs, and knowledge of social workers in health care settings in the process of making decisions regarding life-sustaining treatments. A convenience sample of 68 social workers participated in the study (65 F and 3 M; mean age = 42.4 ; SD = 10.0 . Fifty-two participants worked at hospitals and 16 at nursing homes. The area in which social workers reported being more involved were activities related to family members. The extent of social workers' involvement was related to their beliefs regarding their role and their knowledge about life-sustaining treatments. Findings of this study emphasize the need for developing educational programs aimed at expanding social workers' knowledge in order to increase their autonomy and professional involvement in end-of-life decision making.

Euthanasia and Assisted Suicide

Whether or not the practices of euthanasia and assisted suicide are viable as societal options presents a challenging dilemma for social workers in health care settings. Social workers should prepare to discuss possible requests for information about these practices in the context of patient and family decision making in end-of-life situations. Along with awareness of definitions, current debate, federal, state, professional policies, other health care professionals' attitudes and practices, social workers must examine their own values, attitudes, and practices in this highly controversial area so that the profession may continue to enhance quality of life and protect vulnerable populations, such as the elderly.

Addressing at-risk pregnant women's issues through community, individual and corporate grassroots efforts.

Prenatal care is crucial to the health and well-being of our youngest children. Yet millions of children are coming into the world without the benefit of this care, and their numbers are increasing. About one-fourth of pregnant women do not receive the recommended level of prenatal care. The percentage of pregnant women who receive virtually no prenatal care (no more than a visit or two in the last few weeks of pregnancy) has increased in recent years. Mothers are less likely to obtain adequate or prompt prenatal care if they are young, poor, unmarried, relatively uneducated, uninsured, or living in inner cities or rural areas (Carnegie Task Force on Meeting the Needs of Young Children, 1994). Pregnant women, new mothers, and families are often ill informed or misinformed about the need for preventive health care and the process of actually getting care. Even if people have the necessary information, they may lack the motivation, friendly guidance, ability to pay, or means of transportation necessary to get to care. Services are provided in different places, and eligibility forms are varied, complex, and designed to frustrate (National Commission to Prevent Infant Mortality, 1989). Mothers who do not receive prenatal care are more likely to have low-birthweight infants (2,500 grams or less). These babies are significantly more likely to have neurodevelopmental handicaps, congenital anomalies, and more frequent respiratory tract infections. Over 40 percent of these infants are rehospitalized more than once in their first year of life (Carnegie Task Force on Meeting the Needs of Young Children, 1994). Consequently, pregnant women who do not receive prenatal care and thus have less chance of delivering healthy, full-term, normal-weight babies are referred to in this article as risk. In spite of considerable investment of resources and the highly skilled and well-equipped medical system, by most measures the overall health status of Americans lags behind that of many other nations' citizens. Among the nations of the world, the United States ranks 19th in infant mortality, 21st in deaths of children under five, and 29th in the percentage of low-birthweight babies. The low childhood immunization rates in the United States are a national disgrace (Children's Defense Fund, cited in Hartman, 1992). Zuravin (1989) defined refusal or delay in providing health care as one subtype of parent behavior resulting in child neglect. Social work studies provide overwhelming evidence that extreme poverty is significant in the etiology of neglect, especially chronic neglect. At the micro level, the multiplicity of problems facing chronically neglecting caregivers requires interventions that are comprehensive, in-home, and longer term. Social services agencies have long been unable to provide the concrete and paraprofessional services necessary to increase household management and parenting skills (Nelson, Saunders, & Landsman, 1993). The crises in health care - the new demands and the need for answers - clearly point to the need for a redefinition of services. Although social work emphasizes the importance of family involvement, research indicates that the actual number of encounters with families is a relatively small percentage of the many interventions provided by social workers in health care settings (Bergman et al., 1993), Society cannot afford to ignore the increasing blight of child maltreatment perpetuated by economic inequities and by the failure of the human services system to adequately meet the needs of families and children (Nelson et al., 1993). Shared Beginnings was established in 1994 to address the needs of high-risk pregnant women in Denver, specifically women enrolled for health care at Provenant Family Medicine Centers. The program involved the collaboration of the medical, social services, and business communities; philanthropic sectors; and community members. This article describes the nature of this program and the steps taken to initiate and maintain such a grassroots program. …

How shall we be judged? Speech and language therapists in educational settings

Speech and language therapists are under ever-increasing pressure to demonstrate the value of their work, both in terms of cost to the pur chaser and benefit to the client. The work of these therapists in school settings differs significantly from their work in health-care settings, not least because of strong philosophical and organizational differences between health and education. This paper argues that the methods developed within the field of educational research are amongst the most productive in the investigation of effectiveness. It provides details of a multidimensional model which could be applied in educational settings.

Decision-Making Situations in Health Care

Social workers in health care settings are constantly required to make clinical decisions about patient care and treatment. Although much attention has been devoted to the normative or ethical aspects of decision making in such settings, little attention has been given to the typical situational aspects of decisions social workers must make in health care. This article discusses four types of clinical decision situations--operational, strategic, authoritative, and crisis--and presents a model to assist in analyzing their components and requirements. Case vignettes drawn from practice experience illustrate each type of decision-making situation. The article concludes that knowledge of the situational aspects of practice decision making can be helpful to practitioners by enabling them to sort out courses of action and intervention.

The transformation of nurses' work?

This paper offers a critical discussion of how current and planned changes in the labour process within the National Health Service (NHS), with particular reference to nursing as an occupational group, are likely to influence the industrial relations aspects of nursing management. An attempt is made to apply concepts developed within the wider sociology of work, to the reality of latter day nurses' experience. In this respect, the question will be addressed: do management approaches to the reorganization of work in health care settings constitute, or herald, an actual 'transformation' of nurses' work? The approach adopted places concern over the introduction of productivity or performance related pay, or the implementation of nursing skill-mix reviews within an analytic context which considers issues of control over working practices. As such, management and unions' responses to NHS Executive calls for increasing reorganization of nurses' work and remuneration structures may be illuminated by an understanding of this issue of control. This would entail a departure from simplistic analyses, focused solely upon narrowly defined efficiency concerns.

Services for infants and toddlers with disabilities: IDEA, Part H.

In October 1986 P.L. 99-457, the Education of the Handicapped Act Amendments of 1986, was enacted. Part H of this legislation obligates participating states to provide early intervention services to children with developmental disabilities from birth up to their third birthday. This act has since been renamed the Individuals with Disabilities Education Act. All states are now planning to implement this act through the development of multidisciplinary, comprehensive service delivery systems, and social workers in health care settings will play a critical role in the identification, referral, and case management of services for the affected population. This article describes the mandates of this legislation and defines the social worker's role.

Social work practice with childbirth-injured women in Nigeria.

Nigerian social workers in health care settings have been actively involved in the treatment of women in northern Nigeria who suffer from childbirth injury during obstructed labor. The patient population studied suffers from vesicovaginal fistula (VVF), a debilitating and chronic condition whereby a woman leaks urine uncontrollably and experiences grave social consequences. Crisis intervention, social rehabilitation, fighting stigma, and discharge planning similar to the American professional model were functions of the social workers in addressing the needs of this patient population. Implications for practice and the universality of social work skills are discussed.