Wards. Caring about sharing

A small study of surgical patients in one hospital showed that most women preferred single-sex wards. But more than half the men had no preference. Most day-case patients wanted single-sex accommodation. Patients whose stay was seven days or longer showed greater tolerance of mixed-sex wards than others.     

Sexuality, dementia and residential care: managers report and response

There is a growing literature on the subject of sexuality and an increased knowledge of sexuality and older people, but there is a dearth of information about sexuality and people with dementia, particularly those in residential care. The concern of this paper is with people with dementia; it also considers the impact of gender on their sexual expression. The expression of sexuality by people with dementia is an area which has been largely neglected by research, yet in practice appears to be of concern. The types and prevalence of sexual expression by people with dementia in residential care and staff's responses to such expression are examined. A postal questionnaire sent to managers of social work residential homes in one region in Scotland explored a number of different issues, including: the public versus private expression of sexuality by people with dementia, the public response versus the private feelings of managers to such expression, the influence of carer involvement on staff's responses, exploitation of one resident by another and sexual expression directed at staff by residents. Permeating all these was the issue of gender. The majority of homes were staffed predominantly by female managers and female care staff. Most residents were female yet the majority of incidents involving sexual expression, reported by managers, involved male residents directing their attention towards female staff or other residents. Female residents with dementia do express sexuality but numbers reported are considerably less with staff actions tending towards the protective. Some types of sexual expression appear to be of more concern than others, and some are reported to occur more frequently.     

A cross-sectional prospective study of seclusion,restraint and involuntary medication in acute psychiatric wards: patient,staff and ward characteristics

Background  

Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards.     

A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings

BACKGROUND: Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention. METHOD: The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention. RESULTS: The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting. CONCLUSIONS: Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.     

Attitudes toward sex in the aged

Eighty university students and 40 staff members of a nursing home for the aged rated their reactions to three stories: a neutral (decision-making) story, a coital story, and a masturbatory story. For each story, the age and gender of the main character were varied. Results indicated an absence of negative attitudes toward sex in the aged. However, sex in the aged was less credible than sex in young people. Nursing home staff members had more negative attitudes toward sexual stories than did the students. Gender of rater had little effect. Coitus was rated more favorably for the male character than for the female character, and the reverse was true for masturbation.     

Opinions of staff in the trial phase of standardized documentation of complementary psychiatric services

A computerised standardised documentation system for non-hospital based psychiatric and psychosocial care is being developed in Saxony. A range of non-hospital based services was involved in the development process. Staff members were interviewed concerning their experience in using the documentation system. Results showed a critical appraisal by staff members, emphasising particularly (a) the investment of time required, and (b) the perceived usefulness of the documentation which was considered to be limited. Besides staff members feared that data protection issues might be disregarded and that data would be used to cut expenditure. Findings are compared with other studies assessing staff attitudes towards data collection in mental health services. It is concluded that the study adds to the existing evidence of staff scepticism towards computerised standardised documentation systems.     

What is the preimplantation embryo?

We present results from our 'bioethical field studies', which explore and compare the views of experts, patients and the general public on the beginning of human life and the status of the preimplantation embryo in Germany. Using a qualitative and quantitative multi-method approach, we found crucial differences in the categorization of the beginning of human life within the expert group (representative samples of human geneticists n=104, ethicists n=168, midwives n=294, obstetricians n=147, paediatricians n=166), and between expert and lay samples (IVF couples n=108, high genetic risk couples n=324, general population n=1017). The majority of lay respondents as well as paediatricians and obstetricians chose nidation, the moment when the implantation of the fertilized egg into the uterus takes place, as the crucial boundary that marks the beginning of human life, whereas the majority of (female) human geneticists, ethicists and midwives voted for conception as the decisive point in time. The views of all groups on the status of the preimplantation embryo differed from the assumptions underlying German legislation (Embryo Protection Act). Religiousness and religious affiliation, gender, attitudes towards disabled people, post-material values and a present desire for a child were identified as independent factors influencing attitudes towards the preimplantation embryo in the population sample. The results are discussed within a broader philosophical and social science perspective of constructivism versus essentialism, proposing a truly interdisciplinary approach to such bioethical core issues as new reproductive technologies and the status of the preimplantation embryo.     

Changing attitudes and beliefs towards a woman’s right to protect against HIV risk in Malawi

Female empowerment and positive attitudes towards women’s rights in sexual relationships have been found to be key elements of successful behaviour-based HIV prevention programmes. However, HIV prevention programmes that do not specifically engage with gender issues may also affect attitudes and beliefs towards women’s rights within sexual relationships. Using data from the Malawi Longitudinal Study of Families and Health we compare measures of female empowerment and changing gender norms between intervention participants and non-participants. Results suggest that female intervention participants were more likely than non-participants to believe that: (1) women have more rights within sexual relationships in general and (2) women have the right to protect themselves against HIV risk (indicating possible increases in female self-efficacy in making HIV prevention decisions). Male intervention participants showed no substantial positive change in attitudes towards women’s rights. These results highlight an important positive effect of HIV prevention programmes on women’s attitudes towards their own rights.     

Hospital, nursing homes become partners in psychiatric care

Hospital psychiatric staffs can effectively share their expertise with nursing homes. One hospital's psychiatric out-reach program has reduced patient management problems at participating nursing homes, improved patients and staff morale, changed staff attitudes, garnered physician support, and extended services provided by the psychiatric department.     

Sexual behavior and attitudes of University students in Northern Ireland

Two surveys of a Northern Ireland student sample were conducted in 1987 and 1988. A total of 419 female and 201 male subjects completed self-administered anonymous questionnaires concerning their behavior, knowledge, and attitudes towards sex, AIDS, homosexuality, contraception, and relationships. Results indicated a relatively low level of sexual experience, and for those with experience, relatively few partners. The possible influences of gender and religiosity on sexual behavior and attitudes, in the context of Northern Ireland, are discussed. Subjects reported considerable variation in the amount of sex education, but the majority received little or none. This student sample held relatively conservative attitudes towards love, sex, and marriage and this was particularly true for females and for regular churchgoers. In addition, attitudes towards homosexuality were negative (particularly among regular churchgoers). Attitudes towards contraception were more positive than expected among Catholic subjects, and few indicated that they would refuse to use contraceptives on principle. Responses to items about AIDS were highly uniform, suggesting that much of the information made available to the public has been absorbed. However, the lack of uniformity of response to more general items about sex, relationships, and contraception may indicate that fundamental changes in sexual behavior are unlikely to be brought about by influencing a rather narrowly defined set of attitudes about AIDS.     

Gender in medicine – an issue for women only? A survey of physician teachers' gender attitudes

Background  

During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes.     

Patients’ attitudes towards patient involvement in safety interventions: results of two exploratory studies

Background In recent years, patient‐focused interventions have been introduced aimed at increasing patient involvement in safety‐related behaviours. However, patients’ attitudes towards these interventions and comfort in participating in the recommended behaviours remain largely unexplored. Objective To evaluate patients’ attitudes towards a video and leaflet aimed at encouraging patient involvement in safety‐related behaviours. Design Two exploratory studies employing a within‐subjects mixed‐methods design. Setting Six hospital wards on an inner‐city London teaching hospital. Participants Medical and surgical inpatients: 80 patients in study 1 (mean age 55; 69% men) and 80 patients in study 2 (mean age 52; 60% men). Intervention Patients watched the PINK patient safety video (study 1) or read the National Patient Safety Agency’s ‘Please Ask’ about staying in hospital leaflet (study 2). Main outcome measures Perceived comfort in participating in safety‐related behaviours; attitudes towards the video or leaflet. Results Both video and leaflet increased patients’ perceived comfort in engaging in some (but not all) safety‐related behaviours (P < 0.05). In both studies, the majority of patients questioned whether the intervention could help to reduce medical errors in health care. Suggestions on how the video/leaflet could be improved mainly related to content and layout. Conclusion Video and leaflet could be effective at encouraging patient involvement in some safety‐related behaviours. Further in‐depth research on patients’ attitudes towards different educational materials is required to help inform future policies and interventions in this very important but under‐researched area.     

The Attitudes of Medium-Secure Unit Staff Toward the Sexuality of Adults with Learning Disabilities

The attitudes of staff toward the sexuality of adults with learning disabilities within a medium-secure hospital within the United Kingdom were examined using qualitative research methods. Four interviews were conducted with staff members of both sexes from differing occupations. Interviews were transcribed and analyzed using a method adapted from Worthen and McNeill (1996). The analysis revealed that staff members generally held liberal attitudes with respect to the sexuality and masturbation. However, with respect to sexual intercourse, homosexual relationships, and the involvement of adults with learning disabilities in decisions regarding their own sexuality, less liberal attitudes were detected. Concern was also noted with respect to the attitudes of female staff members towards the sexuality of adults with learning disabilities who have committed sexual offences. Training issues were also identified and implications for the service were discussed.     

Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes

BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.     

Mixed gender wards: what does the evidence indicate?

Would adoption of a mixed gender ward policy at the University Health Network accelerate the admission of patients to a ward bed, thereby positively influencing patient care and improving patient satisfaction? Would reducing transfers positively impact staff satisfaction by eliminating an onerous burden? How would patients and staff react to the idea of mixed gender rooms? Would eliminating transfers have a positive financial impact on the organization?     

Outcomes of three different models for sex education and citizenship programs concerning knowledge, attitudes, and behavior of Brazilian adolescents

Three different school-based sex education and citizenship programs in public schools in Rio de Janeiro, Belo Horizonte, and Salvador, Brazil, were evaluated in a cross-sectional study comparing knowledge, attitudes, and practices in sexuality, citizenship, and gender issues among adolescents participating in the programs' activities as compared to adolescents enrolled in schools without such programs (controls). Results showed that Salvador's program achieved good results, with significant changes in knowledge on sexuality and reproductive physiology, attitudes regarding citizenship, and current use of modern contraceptives; Rio de Janeiro's program succeeded in improving students' knowledge of reproductive physiology and attitudes towards sexuality; Belo Horizonte's participants showed greater knowledge of reproductive physiology and STI/HIV prevention but had less positive attitudes towards gender issues, while reporting greater sexual activity. The main difference between Salvador's program and the others was the focus on creative and cultural activities; Belo Horizonte's main difference was its lack of interaction with health services and professionals. However, after the evaluation Belo Horizonte reframed its educational strategies and launched a scaling-up process in a joint effort with the health and school systems.     

The influence of gender on student willingness to engage in peer physical examination: the practical implications of feminist theory of body image

CONTEXT: Previous research has consistently found a relationship between students' attitudes towards peer physical examination (PPE) and their gender. Male students are more comfortable with PPE than females and students are more comfortable with same- rather than mixed-gender PPE. Despite these findings, previous research has not discussed the gender-attitude relationship in any meaningful depth. OBJECTIVES: This discussion paper examines why a relationship exists between student attitudes towards PPE and student gender using insights from feminist body image theory. DISCUSSION: According to the feminist theory of objectified body consciousness, females experience their bodies differently from males. Females may be less comfortable with PPE because they have higher levels of body shame and body surveillance than males. They may also be more likely than males to fear critical and teasing comments and sexual objectification by the opposite sex. CONCLUSIONS: Capitalizing on what we already know about psychoeducational and activism approaches to the prevention and change of negative body image, I recommend that body image issues are discussed as part of students' PPE and professionalism programmes. Further research is needed to examine medical students' body image alongside their attitudes towards PPE.     

Knowledge, attitudes and practices regarding smoking cessation among Chinese affiliates of women's organisations in Hong Kong

Volunteers and staff of women's organisations who are highly active in engaging and providing community service can be recruited to motivate female smokers to quit. We described the knowledge and attitudes regarding tobacco control and smoking cessation among these affiliates in Hong Kong and identified factors associated with the practices of cessation interventions. Eight of 14 women's organisations joining the Women Against Tobacco Taskforce agreed to participate. All staff, volunteers, and members of the eight organisations were invited to complete a self-administered anonymous questionnaire during July and August 2006. A total of 623 out of 771 (80.8%) affiliates responded. Their knowledge on smoking and health (mean = 3.91, SD = 1.44 on a range of 0-7), smoking related diseases (mean = 2.91, SD = 0.97 on a range of 0-4), and women-specific diseases (mean = 2.93, SD = 1.87 on a range of 0-6), was considered to be inadequate. They had positive attitudes towards tobacco control (mean = 3.31, SD = 0.55) and their own role in smoking cessation counselling (mean = 3.19, SD = 0.56) on a 4-point Likert scale and 39.3% reported had attempted to offer quitting advice. Logistic regression analysis found that participants having direct contact with smokers who had a positive attitude towards their own role in smoking cessation counselling (OR = 2.57; 95% CI = 1.67-3.95) and better knowledge of smoking and smoking-related diseases (OR = 1.35; 95% CI = 1.06-1.71) were more likely to provide cessation counselling after controlling for gender; knowledge on smoking and health, and women-specific diseases; attitude towards tobacco control, negative and positive attitudes towards female smokers, and perceived self-efficacy in smoking cessation counselling. Women's organisations showed limited support towards tobacco control and their affiliates had a limited knowledge on smoking and health but had positive attitudes. Appropriate training, capacity building and establishing rapport with women's organisations are needed to promote smoking cessation and to support tobacco control in the community.     

Outcome measurement in rural mental health care: a field trial of rooming-in models

ABSTRACT: The main objectives of this project, in rural Western Australia, were to collect information, compare and evaluate the functioning of novel types of psychiatric services, including rooming-in facilities, using outcome measurement tools, and to assess the attitude of mental health professionals towards routine outcome measurement. For the first time in rural health services, two outcome measurement tools were used for this purpose: the Health of the Nation Outcome Scales and the World Health Organization Short Disability Assessment Schedule. While staff at 11 rural sites were trained in the use of outcome measurements, only staff from three sites were able to participate in the data collection that spanned for a year and shed information on 39 patients. Two of these sites were rooming-in facilities with different models of care and patient characteristics. Shortage of staff, lack of adequate local information technology support on sites and technical difficulties limited participation. The assessment of staff attitudes towards routine outcome measurement revealed a need to provide staff with reasons and incentives for incorporating outcome measurement into routine practice, in addition to provision of a thorough and on-going training and support in time and resources from management.     

Discrepancy between self-reported and observed hand hygiene behaviour in healthcare professionals

Hand hygiene behaviour in 71 healthcare professionals was observed on hospital wards for a total of 132 h, encompassing 1284 hand hygiene opportunities. Questionnaires completed by the participants were used to compare actual behaviours with self-reported behaviours, as well as intentions and attitudes towards hand hygiene. Observed practice showed very poor rates of adherence to guidelines and indicated that staff failed to take account of risk, even with patients colonized with meticillin-resistant Staphylococcus aureus. Observed practice was unrelated to carers' intentions and self-reported behaviour. The results suggest that hand hygiene interventions that target changes in attitudes, intentions or self-reported practice are likely to fail in terms of changing behaviour, and consideration is given to how this could be remedied.