A qualitative exploration of how patients conceptualise their acupuncturists: Technicians,caring professionals,and wise healers

ObjectivesTo explore how patients conceptualise acupuncturists, the meanings ascribed to the therapeutic relationship and valued therapeutic behaviours.DesignQualitative study. Semi-structured face-to-face interviews explored patients’ experiences of acupuncture. A diverse sample of 35 participants took part; they had used acupuncture for a variety of predominantly chronic conditions. Inductive thematic analysis was used to identify themes.SettingSouthern England.ResultsParticipants conceptualised acupuncturists in three ways: technician, caring professional, and wise and gifted healer. Each conceptualisation had different implications for patient health. For example, lifestyle advice from a wise healer was seen as inspirational wisdom, while lifestyle advice from a caring professional was seen as evidence of caring. Participants inferred empathy when acupuncturists took a detailed history, took notes during treatment, and provided therapeutic commentaries. Participants inferred knowledge and/or wisdom when acupuncturists made changes to treatments over time, provided explanatory frameworks for their symptoms, and made effective recommendations concerning lifestyle and health behaviours.ConclusionsThe findings provide novel insights into how patients view acupuncturists, suggesting acupuncture-specific models that do not directly map onto conventional models of doctor-patient relationships. Understanding how patients think about their acupuncturist and make sense of clinical interactions could help acupuncturists to hone their therapeutic skills.     

Factors affecting evidence translation for general practice nurses

This paper explores the domains of influence affecting practice nurses' ability to find, evaluate and use clinical evidence. A cross-sectional survey of general practice nurses (n = 590) in Victoria, Australia in 2008 provided data for a principal components analysis. The research replicates a study undertaken in the UK using the Developing Evidence-Based Practice Questionnaire. Five domains of influence on nurses' translation of evidence were identified: skills in finding/reviewing evidence; barriers to finding/reviewing evidence; knowledge from published sources; knowledge from other sources; and barriers or facilitators to change. Each domain was interpreted as underlying the relationship of nurses with evidence-based practice and was comparable to the original study's findings when subjected to factor analysis. Findings from this study show that the Developing Evidence-Based Practice Questionnaire-Au is a valid and useful instrument in determining the influences on practice nurses' ability to effect knowledge translation and conduct practice based on evidence. Given these findings, a new model is proposed that explains the influence of a number of domains on Australian general practice nurses' translation of knowledge into practice.     

Attitudes and knowledge of primary care professionals towards evidence-based practice: a postal survey

OBJECTIVES: To describe the attitudes, awareness and use of evidence across key professional groups working in primary care. METHODS: A postal questionnaire was sent to all lead/chairs, general managers, clinical governance leads, lead nurses, lead pharmacists and public health practitioners working in local health care cooperatives in Scotland. RESULTS: 289 (66.1%) health care professionals responded, ranging from 51% of general managers to 80% of lead nurses. All professional groups supported evidence-based practice. General practitioners (GPs) were less likely to agree that they had the skills to carry out literature reviews or appraise evidence compared to nurses and public health facilitators (36% vs. 75% vs. 80%; 51% vs. 64% vs. 70%). Access to the internet and bibliographic databases was good for all groups but GPs used a narrower spectrum of evidence-based journals, relying mainly on medical literature. Only nurses and public health practitioners appeared to have any understanding of qualitative research terms. Public health practitioners were also least likely to view guidelines or protocols developed by others as the best source of evidence for primary care. The major perceived barrier to practising evidence-based practice was time. Consequently the most important facilitator was protected time, but increased resources (financial and staff) and training were also cited. Professional groups other than GPs perceived inter-professional boundaries as a barrier and suggested multi-professional teamworking and learning as potential supports for evidence-based practice. CONCLUSIONS: While all professional groups welcome and support evidence-based practice, there are clear differences in the starting point and perspectives across the groups. These need to recognized and addressed to ensure that learning the skills of evidence-based practice and implementing evidence are effective. This will also enhance the ability of primary care organizations to develop robust mechanisms for supporting key aspects of clinical governance.     

An interdisciplinary, evidence-based process of clinical pathway implementation increases pathway usage

Clinical pathways have been implemented in many healthcare settings as a link between evidence and practice. Most published research concludes that when clinical pathways are implemented and used by health professionals, there is a positive impact on health outcomes. However, some research also suggests that utilization of clinical pathways by health professionals is low and that implementation strategies for linking evidence with clinical practice often prove to be weak or ineffective. This paper describes a before and after study to determine whether an interdisciplinary, genuinely collaborative, and evidence-based process of clinical pathway implementation resulted in increased documented use of an acute myocardial infarction (AMI) clinical pathway by health professionals in a regional Australian hospital. Underpinning the design and implementation process was the belief that true team involvement would lead to ownership, acceptance, and, ultimately, to increased usage of the pathway. Documented clinical pathway usage was measured in two ways: (1) the presence of the AMI clinical pathway in the medical records of patients diagnosed with an AMI and (2) the proportion of the AMI clinical pathway completed when it was present in the medical record. A total of 195 medical records of those diagnosed with an AMI were audited before (n = 124) and after (n = 71) the implementation process. The interdisciplinary, truly collaborative, and evidence-based implementation process resulted in a statistically significant increase in documented usage of the AMI pathway (22.6% vs. 57.7%; p <.000). Results indicate that involvement of key users in the design and implementation of a clinical pathway significantly increases staff utilization of the document.     

Health beliefs and preferences for medical treatment: a comparison between medical and social science students.

OBJECTIVE: This study looked at the relationship between beliefs in 'scientific medicine', personal health beliefs, attitudes to complementary medical practitioners and medical treatment preferences in two different groups: medical and non-medical (mainly social science) students. It extended the previous work of looking at patient groups. DESIGN: Once the psychometric properties of the four short questionnaires (53 items in all) were established as satisfactory in terms of their factor structure, the two groups were compared. RESULTS: By means of analysis of variance it was established that there were fewer differences between medical and non-medical students than might be expected by chance. A 'higher order' factor analysis revealed three clear factors underlying attitudes to complementary medicine: pro complementary medicine; pro orthodox medicine; and satisfaction with general practitioner. All the students appeared to have a sceptical but positive attitude to complementary medicine.     

Implications for education in complementary and alternative medicine: a survey of entry attitudes in students at five health professional schools

INTRODUCTION: The National Institutes of Health provided grants to the Oregon Health & Science University (OHSU) and 14 other allopathic academic health centers for the development of curricula in complementary and alternative medicine (CAM). A key component of the curriculum evaluation for OHSU was provided by a survey assessing attitudes toward CAM and selected personality characteristics of entering students in chiropractic, naturopathic, Oriental, and allopathic medicine in the Pacific Northwest and Upper Midwest. METHODS: A survey containing a variety of assessments of attitudes toward CAM and the personality traits of adventurousness and tolerance to ambiguity was administered to students entering four Portland, Oregon doctoral-level health professional schools and an allopathic medical school in the Upper Midwest (University of Nebraska College of Medicine) during the 2004-2005 academic year. RESULTS: Students of naturopathy (n = 63) and Oriental Medicine (n = 71) were the most "CAM positive," adventurous and tolerant of ambiguity, and Midwestern allopathic medical students (n = 58) the least. In general, chiropractic students (n = 89) and allopathic medical students from the Pacific Northwest (n = 95) were intermediate in CAM attitudes between these two groups (all p < 0.05). Female students were more "CAM positive" in all schools compared to male students. CONCLUSIONS: Students have high levels of interest in CAM upon entrance to their schools. Health professional discipline, geographic location, personality qualities, and gender appear to influence CAM attitudes in entering students.     

Research knowledge,attitudes and practices of health professionals

Knowledge, attitudes and practices (KAP) in the conduct and utilization of research were assessed using the Nurses' Research KAP Survey© in 746 nurse (n = 538) and non-nurse (n = 208) health professionals. Nurses were older, included more females and had less education than non-nurses. Knowledge and attitudes differed by discipline, but attitudes were generally high in both groups. Both groups reported low knowledge in the area of research implementation and nurses also had low practice scores in this area. Research-related knowledge, attitudes and practices for both groups were higher than those previously reported in the literature. Knowledge and attitudes alone predicted 71% of the variance in practices, suggesting that targeted strategies could foster evidence-based practice. These should include increased administrative support for research, development of multidisciplinary teams, and collaborative partnerships with doctorally prepared nurses to provide the synergy to enhance the conduct and utilization of research in clinical settings.     

Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp

Chiropractors, osteopaths and physiotherapists play key roles in the management of low back pain (LBP) patients in the UK. We investigated the attitudes of these three professional groups to back pain using a recently developed and validated questionnaire, the Attitudes to Back Pain Scale for musculoskeletal practitioners (ABS-mp). A cross-sectional questionnaire survey was sent to 300 of each professional group (n=900). Responses were analysed from 465 practitioners: 132 chiropractors (28%), 159 osteopaths (34%) and 174 physiotherapists (37%). Overall, all three groups endorse a psychosocial approach to treatment, and see re-activation as a primary goal. However, physiotherapists and osteopaths tend to endorse attitudes towards limiting the number of treatment sessions offered to LBP patients more than chiropractors, and chiropractors endorse a more biomedical approach than physiotherapists. When practice setting (NHS versus private practice) was considered (in physiotherapists alone), physiotherapists working for the NHS endorsed limiting the number of treatment sessions more than those working in the private sector and would also less frequently advise their patients to restrict activities and be vigilant. The results may help explain current clinical practice patterns observed in these groups and their uptake of clinical guideline recommendations.     

Attitudes to the contribution of placebo in acupuncture--a survey

Interest in placebo is increasing, and recent research suggests that the therapeutic consequence of placebo is generated through mental processes in which attitudes are important. The aim of this study is therefore to explore attitudes and beliefs concerning placebo effect in acupuncture therapy, among doctors, patients and acupuncturists. From February 1994 until June 1995, four anonymous questionnaires were distributed among 1135 randomly selected doctors, 294 medical students, 432 acupuncturists and a random sample of 653 in the general population in Norway. Fifty-seven percent indicated the treatment effect seen in acupuncture as mainly a genuine acupuncture effect, 30% indicated that half of the effect in acupuncture comes from placebo, while 13% indicated that the treatment effect in acupuncture is mainly based on placebo. Doctors and students express a more skeptical view than the others, and having tried acupuncture for one's own disease is significantly associated with a less skeptical view within all study groups. Attitudes to the use of acupuncture for cancer patients are associated with attitudes to placebo for doctors and medical students, but not for the general population or acupuncturists.     

Defining the severity of workplace violent events among medical and non-medical samples. A pilot study.

The purpose of this study was to describe and compare medical and non-medical individuals' violence severity rank for 13 commonly cited events illustrative of workplace violence. One hundred thirty-six college students were provided a short checklist of 13 violent events in the workplace to determine the violence severity rank for each event. Two groups of college students with (n = 69) and without (n = 67) medical background participated. Student and registered nurses (medical group) agreed on the violence severity ranking of all 13 often-cited workplace violence events. Non-medical and medical groups, however, did not always agree on the degree of violence severity, especially for physical and sexual workplace violence events. Differences between groups may be explained by the possibility that nurses are socialized or desensitized in practice to possibly accept some workplace violence events as "part of the job." Gastroenterology nurses can benefit from this study by raising their sensitivity to and awareness of workplace violence in the practice setting.     

Knowledge and use of evidence-based practice of GPs and hospital doctors

RATIONALE, AIMS AND OBJECTIVES: Clinical effectiveness and evidence-based practice (EBP) are the cornerstone of modern day health care. Although many studies have explored attitudes and perceived knowledge of individual professions few have compared the factors between professional groups and in particular in the medical profession. We report a study comparing the views, knowledge and practice of hospital doctors with their general practitioner (GP) counterparts in terms of EBP and clinical effectiveness. In this way it was hoped to highlight not only any differences between these groups but also the needs of these groups and suggest some ways of fulfilling these. METHODS: A postal questionnaire survey was completed by a random sample of 500 GPs and 500 hospital medics. RESULTS: There was a significant difference between the groups with the GPs rating their skill level as lower that their medical doctor counterparts. Similarly, GPs reported using EBP steps less frequently than hospital doctors. Barriers to implementing EBP differed between the groups with GPs reporting difficulty with accessing a library and making time available. CONCLUSION: A number of differences between GPs and their hospital counterparts were recorded which highlights the difference in educational and policy approach required for greater uptake of EBP.     

循证护理对住院精神分裂症患者依从性的影响研究

目的探讨改善住院精神分裂症患者治疗依从性的护理对策。方法将符合纳入标准的病例196例,随机分为试验组100例,对照组96例。对照组病例遵循常规治疗和护理。试验组则在常规治疗的同时依据以下循证护理路径:确定影响患者依从性的因素、收集证据、评估证据、结合临床实际选择最佳证据与患者共同制定切实可行的循证护理措施。分别在入组时和入组3个月后评估患者依从性的变化,并进行护士用住院病人观察量表(NOSIE-30)和简明精神病量表(BPRS)评定。结果试验组患者遵医行为改善程度显著高于对照组(P<0.05),对降低复发率有明显效果。结论循证护理对提高精神分裂症患者治疗依从性有着积极的促进作用。     

冠状动脉腔内成形及支架植入术循证护理

目的运用循证护理解决经皮冠状动脉腔内成形术及支架植入术患者的护理问题.方法对80例冠状动脉腔内成形术及支架植入的患者按入院时间先后分为常规组和循证组,每组40例,常规组采用常规护理方法,循证组采用循证护理方法.结果循证组患者住院期间并发症发生率低于常规组（P＜0.05）.结论运用循证护理理论指导临床实践改善了护理质量,保证了治疗效果.     

Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care

Lack of nurse?physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician?Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse?physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.     

临床教师职业态度对本科护生职业态度的影响

目的探讨临床教师职业态度对本科护生职业态度的影响。方法采用便利抽样法选择2009年7月至2010年3月在武汉大学人民医院妇科一区实习的180名护理本科生为研究对象。采用随机数字表法将其分为观察组和对照组,每组90名。采用便利抽样法抽取工作5年以上、本科及以上学历的36名临床教师,根据护士职业态度量表评分并由高到低将其分为P1组和P2组,每组18名。P1组为职业态度优良带教组,P2组为职业态度一般带教组。观察组护生由P1组教师带教,对照组护生由P2组教师带教。实习前、实习结束前1周用护生职业态度问卷对两组护生进行问卷调查。结果观察组及对照组实习护生在实习前其专业态度评分的差异无统计学意义(P>0.05),实习结束前1周,两组护生的专业态度评分分别为(8.72±0.85)、(4.72±0.66)分,差异有统计学意义(t=32.52,P<0.05)。结论临床教师只有加强自身对职业的忠诚及热爱,才能有效引导本科护生形成积极、稳定的职业态度。     

Promoting evidence-based practice: the roles and activities of professional nurses' associations

AIM: This paper reports a study exploring the role perceptions and current activities in evidence-based practice promotion of professional nurses' associations in the Netherlands. Background: The promotion of evidence-based practice contributes to professional standards in nursing and good quality care for patients. As professional nurses' associations can be key players in this process, the nature of their roles and current activities deserves to be explored. METHODS: Roles and activities were explored for 43 professional nurses' associations (83% of all national associations). Data were collected using interviews with the associations' board members. Findings from the interviews were validated with those from an analysis of the associations' policy reports and other publications in the previous 2 years. RESULTS: Board members primarily thought that they had roles in the selection and distribution of evidence. The roles of participant (n = 13) and performer (n = 13) in selecting evidence, and those of facilitator (n = 12), initiator (n = 15) and performer (n = 41) in the distribution of evidence were often addressed. A few respondents reflected on roles in generating evidence and implementing evidence-based practice in patient care. A majority of the associations was contemplating activities in the promotion of evidence-based practice. Specific activities for each of six relevant aspects in the promotion of evidence-based practice were found in fewer than five associations. CONCLUSION: Professional nurses' association roles in the promotion of evidence-based practice need to be viewed in relation to the tasks to be accomplished, especially those of selecting and distributing evidence. Although many organizations expressed motivation, professional nurses' associations have a long way to go in the promotion of evidence-based practice among their members.     

Nursing, medication education and the new policy agenda: the evidence base

Current social and demographic trends, combined with ‘the new policy agenda’, highlight the importance of nurses’ role in educating patients about medication. In the absence of previous research investigation, this study set out to explore nurses’ current contribution to medication education and the clinical contextual factors that influence current practice. The evidence base for effective medication education was established from reviews of literature and focus groups with key informants. Nurses’ practice was investigated using a case study approach in seven clinical areas representing adult, care of the older person, mental health and community nursing contexts. Methods used to collect data were: audio-recordings (n=37) and observation (n=48) of nurse–patient interactions about medication, post-interaction interviews with nurses (n=29), post-interaction interviews with patients (n=39), analysis of relevant written documentation and researcher observation and field notes. Data sources within each case were subjected to systematic content analysis in order to identify current practice and contextual influences within each case. Cross-case analysis was also employed in order to identify explanations for any differentiation in practice. Findings indicate that nurses’ contribution to medication education is commonly limited to simple information giving about medicines, involving the name, purpose, colour, number of tablets and the time and frequency that medications should be administered. Nurses’ practice in two of the seven clinical areas was characterised by interactions that more closely demonstrated features of what is known to constitute more comprehensive and effective medication education. Analysis of contextual influences within and between cases allowed explanations to be derived for the types of medication education interactions observed. These concerned: patient characteristics, perceived and expressed preferences of patients for information, characteristics of the nurse-patient relationship, lack of time and high workload, and the philosophy of care within the clinical area. In all clinical areas, nurses were not explicitly and judiciously using available evidence to inform their medication-related interactions. The paper concludes with discussion and implications of the findings.