Beliefs about back pain: The confluence of client,clinician and community

Patient beliefs play an important role in the development of back pain and disability, as well as subsequent recovery. Community beliefs about the back and back pain which are inconsistent with current research evidence have been found in a number of developed countries. These beliefs negatively influence people's back-related behaviour in general, and these effects may be amplified when someone experiences an episode of back pain.In-depth qualitative research has helped to shed light on why people hold the beliefs which they do about the back, and how these have been influenced. Clinicians appear to have a strong influence on patients' beliefs. These data may be used by clinicians to inform exploration of unhelpful beliefs which patients hold, mitigate potential negative influences as a result of receiving health care, and subsequently influence beliefs in a positive manner.     

天津市养老机构护理人力配置及专业培训现况调查

目的全面了解天津市养老机构护理人力资源配置以及照护人员的培训现况,为确立老年护理人才培养机制、制定老年护理专业培训教材以及构建养老机构护理管理体系提供指导。方法采用自行设计的养老机构调查表对天津市内六区共51家养老机构进行实地走访调研。同时,利用照护人员调查问卷对上述机构调研当天在岗的共计252名照护人员进行了调查。结果51家养老机构现有照护人员总数为571人,其中护士21人;总床位数6 011张,入住老人总数3 539人,老人与照护人员的比例为1∶0.16;所调查的252名照护人员,其平均年龄为(52.13±6.42)岁,多为女性,占72.6%;学历层次相对较低,初中及以下学历占92.5%;聘用方式以临时聘任为主,占59.5%;资格证持有率为46%;工作年限3年以上者占23%;接受过不同形式培训的照护人员占70.6%,培训时间在3个月以下者占62.3%,主要培训内容为清洁卫生、饮食照料、排泄操作、安全操作以及养老机构护理员工作须知五大方面内容。结论天津市养老机构护理人力配置不足,照护人员严重缺乏;现有照护人员整体年龄偏大,文化水平较低;护理培训内现状不理想,养老机构的人力资源配置、管理以及人员培训需进一步改进、完善。     

Training interventions for healthcare providers offering group-based patient education. A scoping review

ObjectivesTo provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education.MethodsA systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis.ResultsTwenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers’ reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers’ experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support.ConclusionsFurther evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation.Practice implicationsEfficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.     

Patient assessment within the context of healthcare delivery packages: A comparative analysis

BackgroundDue to an increased focus on productivity and cost-effectiveness, many countries across the world have implemented a variety of tools for standardizing diagnostics and treatment. In Denmark, healthcare delivery packages are increasingly used for assessment of patients. A package is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery packages.MethodsThe study used a constructivist Grounded Theory approach. Ethnographic fieldwork was carried out in three specialized units: a mental health unit and two multiple sclerosis clinics in Southern Denmark, which all used assessment packages. Several types of data were sampled through theoretical sampling. Participant observation was conducted for a total of 126 h. Formal and informal interviews were conducted with 12 healthcare professionals and 13 patients. Furthermore, audio recordings were made of 9 final consultations between physicians and patients; 193 min of recorded consultations all in all. Lastly, the medical records of 13 patients and written information about packages were collected. The comparative, abductive analysis focused on the process of assessment and the work made by all the actors involved. In this paper, we emphasized the work of healthcare professionals.ResultsWe constructed five interrelated categories: 1. “Standardized assessing”, 2. “Flexibility”, which has two sub-categories, 2.1. “Diagnostic options” and 2.2. “Time and organization”, and, finally, 3. “Resisting the frames”. The process of assessment required all participants to perform the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre-defined scope of relevant diseases targeted by the package. The inflexible frames of the assessment package could cause resistance among clinicians. Moreover, expert knowledge was an important factor for the efficiency of the process. Some types of organizational work processes resulted in many patients being assessed, but without being diagnosed with at package-relevant disease.ConclusionLimiting the grounds for using specialist knowledge in structured health care delivery may affect specialists’ sense of professional autonomy and can result in professionals employing strategies to resist the frames of the packages. Finally, when organizing healthcare delivery packages, it seems important to consider how to make the optimal use of specialist knowledge.     

The examination of Turkish early childhood education teachers’ professional identity

The purpose of the study is to examine professional identity of Turkish early childhood education teachers working in public and private preschools serving children from three to six years. The participants of the study, 1021 early childhood education teachers, were gathered through simple random sampling. The data for the study were gathered through A Professional Identity Scale (PRIS) (Kremer, L., & Hofman, J. E. (1985). Teachers’ professional identity and burn-out. Research in Education, 34, 89–95.), which is adapted into Turkish through preliminary psychometric investigation of its validity and reliability. Based on correlation analysis, independent samples t-test and analysis of variance gender, age, years of experience in occupation, age group of children, monthly income, educational level and background, job position and marital status of teachers were examined. Findings suggest that teachers’ professional identity was affected by such factors as gender, monthly income, educational level and background, job position, current work experience and marital status of teachers.     

A Retrospective Review of Digit Span-Related Effort Indicators in Probable Alzheimer's Disease Patients

There has been extensive research on the use of both stand-alone and embedded measures of effort in neuropsychological testing; however, relatively few studies have reported on their utility in the context of dementia. Previous studies that have examined the specificity of traditionally used cut-scores on embedded measures of effort with dementia samples have largely found high rates of false positive errors. The present study examined the specificity of several Digit Span derived embedded measures of effort in a large clinical sample of patients with probable Alzheimer's disease stratified by level of dementia severity. Of the measures that were examined, only the Vocabulary – Digit Span score demonstrated promising specificity through the moderate level of dementia severity. All of the remaining indices, including Reliable Digit Span, Digit Span Age-Corrected Scaled Score, and Longest Digits Forward (1 & 2 Trials), yielded unacceptable rates of false positive errors as dementia severity increased. The implications for these findings are discussed, including the limitations of importing methods of assessing effort from one sample to another.     

The effect of a situation model nursing education action program on gender-bias awareness and gender-friendliness barriers in novice nursing students

AimThis study presents a workshop on the Situation Model Nursing Education Action program, examines how to promote gender awareness and decrease barriers related to differences in gender friendliness through the implementation of this program and tracks the trends of the relevant variables.DesignPre- and post-observations and a cohort study were conducted.MethodsA total of 58 nursing students (42 females and 16 males) were included. Nursing students were offered a gender-care intervention as two 90-minute workshops and surveys that measure gender awareness and gender friendliness were administered.ResultsThe results concerned gender-bias awareness and gender-friendliness barriers scores across the four weeks of the program intervention, with the generalized estimated difference score compared with the Week 1 baseline. Mean student scores showed that gender-bias awareness was significantly decreased at Week 2 (p < .001) and Week 4 (p < .001) and that mean gender-friendliness barrier scores significantly declined at Week 4 (p < .001).ConclusionsThe findings indicate that a faculty professional learning community workshop that facilitates intentional behavioral change can help faculty to become aware of gender bias, which can improve students’ gender awareness through clinical case discussion and lead to a decline in barriers to students’ gender friendliness.