Mistaken identity: the effect of badges on EMT recognition

INTRODUCTION: Many emergency medical services (EMS) providers wear badges with their uniforms. This study was undertaken to determine whether emergency medical technicians (EMTs) who wear badges with their uniforms are more likely to be mistaken for law enforcement personnel than are those who do not wear badges. HYPOTHESIS: Emergency medical services providers who wear badges are more likely to be mistaken for law enforcement personnel than are those who do not wear badges. METHODS: High school students, college students, civic organizations, and church groups were shown slides of different uniforms and badges/insignia and asked to identify the person portrayed. Responses were categorized as "EMS," "law enforcement," or "other." Frequency of responses for each uniform and insignia were compared with chi-square analysis. RESULTS: Fifty-nine percent of the uniforms with badges were identified as law enforcement personnel. Only 5.5% of the uniforms with badges were identified as "EMS," compared with 74% of the uniforms with a Star of Life (p < 0.001). CONCLUSION: Individuals wearing uniforms with badges are more likely to be identified as law enforcement personnel than are EMS personnel. Emergency medical services providers who do not wish to be mistaken for law enforcement personnel should wear the Star of Life, not a badge, with their uniform.     

Treatment and career attitudes of prehospital care providers associated with potential exposure to HIV/AIDS

Career and treatment attitudes related to potential human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) exposure are reported based on a survey of 1,228 Maryland career and volunteer prehospital care providers trained to provide basic (BLS) and advanced (ALS) life support. Sixty-five percent stated potential exposure to HIV/AIDS was a major occupational stressor. Ninety-two percent stated they would treat HIV/AIDS patients if protected. Given a choice, 38% would avoid providing treatment to HIV/AIDS patients. Eighteen percent considered resigning from emergency medical services (EMS) work. An attitudinal scale (AIDSTRESS) was developed to evaluate overall treatment and career reactions. Respondents with significantly higher (more negative reactions) AIDSTRESS scores were: BLS providers, men, paid providers, personnel with more than 3 years of field experience, those working in urban areas, personnel with no formal education beyond high school, and those who stated that their HIV/AIDS training was inadequate. Implications of the findings for quality of care, career decision making, and inservice education are discussed.     

Providers, co-providers, commercial entities, and sponsors: keeping them straight

There is considerable confusion among continuing education providers about the terms "provider," "co-provider," "commercial entity," and "sponsor." This column address the differences and why they are important.     

Why study pain? A qualitative analysis of medical and nursing faculty and students' knowledge of and attitudes to cancer pain management

Although effective means for pain management have long been available, cancer pain remains widely undertreated. Surveys of medical personnel have revealed knowledge deficits and attitudinal barriers to pain management, but have not determined why such attitudes persist and how they may be addressed in medical and nursing curricula. This paper presents findings from a qualitative study of the beliefs and attitudes toward pain and cancer pain management held by medical and nursing students and faculty who participated in the Cancer Education Module for the Management of Pain (CEMMP) project. Analysis centered on informants' prioritization and knowledge of pain and cancer pain management and on the meanings informants assigned to pain in a clinical context. Themes in prioritization included the importance of learning about pain versus cancer pain and the responsibility of primary care providers versus specialists for pain and cancer pain management. Themes in informants' knowledge of pain included knowledge deficits about medications and adjunct therapies and the presence of pain management in the curriculum, and the role of knowledgeable faculty members and mentors in the dissemination of information about pain management. Themes in the meanings informants' assigned to pain included opioidphobia, and the (inter-)subjectivity of pain. The discussion focuses in particular on tensions within the prioritization, knowledge and meanings of pain that must be resolved before students can be appropriately educated for optimal pain management.     

Poised for next-century politics?

From management hierarchies, to leveraging "who you know," to shared governance, organizational politics have changed over the years. Best bets for the future: Be a good leader, don't get hung up on titles, and value your employees.     

HIV prevalence in older adults

The "overlooked epidemic," "silent risk group" and "forgotten population" are phrases used when referring to HIV/AIDS and the population group aged 50 and older Health Canada reports that almost 12 per cent of the positive HIV test reports in Canada since the epidemic began are among those 50 and older. Despite the availability of this information, older adults (and those who care for their health) are often not aware of the risk in this group. Older adults are often stereotyped as asexual beings and health-care providers frequently omit a sexual history as part of their assessments. Symptoms of AIDS such as fatigue and memory loss can be dismissed as part of the normal aging process and this may lead to the fact that older people frequently present with AIDS at the same time they are diagnosed with HIV. Research, prevention and education programs are typically geared toward younger adults. Multiple intervention programming must be designed and implemented specifically for older adults in order to reduce HIV transmission in this group. The nursing community is in a strategic position to intervene. The authors discuss various strategies for action.     

The difficult choice of chemotherapy in patients with unresectable non-small-cell lung cancer

 The aims of this study were: to assess the attitude of non-small-cell lung cancer (NSCLC) patients to being treated with chemotherapy, determining whether and how much it differs from that expressed by patients with benign diseases or by healthy people; and to investigate how the information received about the treatment may influence the patients' decisions. A three-item self-assessment questionnaire measuring willingness to be treated with chemotherapy and presented according to three different scenarios (with an optimistic, neutral, and pessimistic physician's presentation) was administered to 104 NSCLC patients, 129 other patients with respiratory diseases (RDP), 140 health care providers (HCP) and 120 students (STU). Guttman's coefficient of reproducibility confirms the hierarchical structure of the three scenarios ranging from an optimistic to a pessimistic view. Relative to the other groups, cancer patients showed: (a) a consistently higher degree of uncertainty about whether to accept or reject chemotherapy; (b) the lowest acceptance rate in the optimistic and neutral scenario and, in contrast, the highest in the pessimistic scenario; (c) the highest percentage of constant answers, independently of the scenario presented, particularly as regards the answers "I don't know" (NSCLC=25%, RDP=9%, HCP=2%, STU=5%) and "Yes, I accept" (NSCLC=29%, RDP=31%, HCP=19%, STU=16%). Answer patterns differed markedly between cancer patients, the HCP, and the STU group, and in most cases the difference was statistically significant at a confidence level of 0.001. The differences between NSCLC and RDP patients were less marked, and not always statistically significant. The choice between accepting and rejecting chemotherapy is very difficult for patients with NSCLC, much more so than for healthy people, and it is often independent of the way the information is provided. Published online: 10 March 2000     

Pediatric powered wheelchairs: results of a national survey of providers

A national survey of providers of pediatric powered wheelchairs was conducted to collect background data on these professionals and to develop a "model" of their current assessment and recommendation practices. Data collected in the survey included provider demographics, frequency of powered wheelchair provision to young children, common reasons for not recommending a powered wheelchair, reasons why a child who is recommended a powered wheelchair does not receive one, current pediatric powered wheelchair assessment and recommendation practices, and subjective data regarding the efficacy of these practices and the impact of powered wheelchairs on children. Respondents rated the frequency with which they performed various wheelchair assessment and recommendation practices, and these ratings were analyzed to determine activities that were performed frequently. These activities were then combined into common "factors" using factor analysis, and the results of the factor analysis were used to create a model of current pediatric powered wheelchair assessment and recommendation practices. A total of 140 surveys were received from providers in 46 states. Of these providers, 54% were clinicians (e.g., physical therapists, occupational therapists), and 46% were suppliers (e.g., Rehabilitation Technology Specialists), representing a variety of geographic locations and facility types. The 3 major reasons for not recommending a powered wheelchair included cognitive, physical, and behavioral factors. The 3 major reasons why a child who is recommended a powered wheelchair does not receive one included funding issues, lack of family support, and transportation issues. The model of current pediatric powered wheelchair provision includes 4 assessment factors: Preliminary Clinical Assessment, Intake, Advanced Clinical Assessment, and Consideration of Other Factors. Typical recommendations include both therapeutic and nonclinical interventions. A modified version of this model, which addresses some issues identified in the survey that limit wheelchair recommendations, is currently being tested at 4 clinical sites.     

Perspectives of women with disabilities on reaching those who are hard to reach.

Healthcare needs of women with disabilities are often neglected, even for women who are well connected to the community and to the healthcare system. So-called "hard-to-reach" women, whose degree of disability impedes use of community resources, have even greater difficulty obtaining health care. The purpose of this study was to gain insight into the perceptions of women with mobility and sensory limitations about several healthcare issues that may affect them: barriers to obtaining care, sources of information about health issues, ways to improve access to care, and ways to help hard-to-reach women overcome barriers to health care and health information. Researchers conducted six focus groups, comprising 43 women with limitations of mobility, hearing, or vision. To validate the women's input, researchers conducted two additional focus groups: the first comprised female physicians with special interest in the health care of women with disabilities, and the second included professional administrative staff of agencies that provide services for people with disabilities. In several cases, members of the physician and agency focus groups were themselves women with disabilities. In addition, 16 women with disabilities participated in an online survey; their responses were used to validate the findings of the face-to-face focus groups. Transcribed data were content analyzed and 10 themes identified. Seven of those themes are discussed in this article: communication barriers; lack of knowledge and awareness among healthcare providers; access issues; working the system; system issues; outreach to healthcare providers; and reaching hard-to-reach women. The findings of this study can provide direction to development of more effective outreach to hard-to-reach women with disabilities, resulting in better integration of healthcare services for this population.     

"I saw it in a different light": international learning experiences in baccalaureate nursing education

Health care providers in the United States are faced with delivering care to an increasingly diverse population. Nursing leaders and their respective organizations long have recognized the need to prepare nurses who understand the effects of the growing global community. Inclusion of cultural content in theory courses and clinical assignments in diverse settings are two ways to increase student nurses' cultural competency. This study explored the experiences of nursing students and faculty mentors who sought to increase their cultural competence through participation in a short-term immersion learning project in Central America. Analysis of data gathered through interviews and journal entries identified three themes--being "other," "I was already a nurse," and expanding my worldview.     

The epidemiology, clinical manifestations and health-maintenance needs of women infected with HIV.

The growing epidemic of HIV infection poses a serious threat to women's health in the United States and abroad. In the United States, HIV disproportionately affects African-American and Hispanic-American woman. Primary care providers will be faced with an increasing need to provide counseling and clinical services to these women. It is not yet clear whether gender affects the natural history of HIV infection; differences in survival rates may reflect lack of access to care rather than true biologic differences. Opportunistic infections among women with HIV infection are similar to those found among men with AIDS who use injection drugs. Unique expressions of HIV disease associated with women's reproductive tracts include persistent vaginal candidiasis, human papillomavirus infections and cervical dysplasia. Women with HIV infection should receive thorough gynecologic screening, including Pap smears, every six months. Women who know they are HIV positive may choose to become pregnant; these clients require extensive prenatal care and state-of-the-art HIV management.     

Trauma outreach education: assessing the needs of rural health care providers

Trauma centers find it a challenge to provide appropriate, cost-effective outreach education. A needs assessment of rural health care providers was conducted to determine "what," "how," and "where" was preferred. The results showed that multidisciplinary rural providers were consistent with their preferences, that they considered case reviews the most effective method, that weekday evenings were the most convenient time, and that their lack of experience was their greatest barrier to learning.     

Teens' perceptions about attention deficit/hyperactivity disorder and medications.

This qualitative study describes teens' perceptions about attention deficit/hyperactivity disorder (AD/HD) and medications. The four modes of adaptation of the Roy Adaptation Model were the framework for this study. Data were collected through semistructured interviews with 15 high school teens aged 14-17 with parent-reported AD/HD. An inductive analysis identified four themes: (1) physiologic (medication)--"Medications are a hassle, but they work"; (2) role function--"I do better in school when I take the meds"; (3) interdependence-"With meds things are better with my family, and friends don't know I am any different"; and (4) self-concept/group identity--"I'm just an everyday teenager, pretty much." The composite main theme was, "Meds help me." School nurses can use this information to guide interventions for families and teens with AD/HD and in working with health care providers, teachers, staff, and communities in a multidisciplinary effort toward an adaptive educational experience for teens.     

Evaluation of services for people with HIV/AIDS in an inner-city health authority: perspectives of key service providers

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers It is the service provider data which will be presented here Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/ AIDS in the Camberwell Health District Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer) However, they also identified a number of problems which were either unique or more severe for people with the virus Services for people with HIV/AIDS were generally felt to be poorly coordinated and a number of areas of overlap and gaps in service provision were identified     

Long-term nonprogressors with HIV disease.

BACKGROUND: Although biomedical research is being conducted on long-term nonprogressors with HIV disease, there is relatively little research on the psychosocial factors influencing this phenomenon. OBJECTIVE: To describe the perceptions of long-term nonprogressors of their HIV disease and its course. METHOD: A naturalistic study design was used to elicit information from 25 men and women who were long-term nonprogressors (HIV positive for 7 or more years, CD4 count > 500, and free of opportunistic infections and/or AIDS-defining illnesses). Audiotaped interviews were transcribed verbatim, and content analysis and constant comparison were used to elicit themes. RESULTS: Themes include viewing HIV as a manageable illness, taking care of my physical health, human connectedness, taking care of my emotional/mental health, and spirituality. Specific ways of adapting to HIV are identified within each theme. CONCLUSIONS: The results of this study can be used by nurses who work with HIV positive individuals in an effort to help them adopt strategies that may assist them in maintaining their health. However, longitudinal studies that follow this group over time and that include biomedical markers of disease progression would provide knowledge that would assist in the refinement of these interventions.     

Nurse practitioner, nurse midwife and physician assistant attitudes and care practices related to persons with HIV/AIDS

Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals.     

Motivation and adult learning: a survey among hospital personnel attending a CPR course

AIM OF THE STUDY: A massive cardiopulmonary resuscitation (CPR) training programme is continued in most hospitals to make hospital personnel ready to take action in cases of cardiac arrest. Motivated course participants learn more and perform better than unmotivated course participants. This study investigates whether hospital personnel are motivated to participate in CPR courses and whether motivation correlates with important assumptions in adult learning. MATERIALS AND METHODS: A survey measuring learning motivation via the MSLQ instrument was performed among 361 hospital personnel before attending a CPR course. Assumptions of adult learning were identified and data were analysed in relation to these assumptions. RESULTS: Hospital personnel are generally motivated for learning CPR. Respondents who had been prepared for the course, who had participated in the decision about attending the course, who were working in high-risk area for cardiac arrest or were nursing personnel working in long-time close contact with patients were more motivated to CPR training than other hospital personnel. It seems like motivation correlates with adult learning assumptions such as the learners need to know, the learners self-concept, readiness to learn and orientation to learning. CONCLUSION: This study supports the assumption that CPR training should be based on an adult learning model. As preparedness, participation, readiness and relevance seem to be key factors, we may want to include these factors when training hospital personnel in CPR skills.     

Concerns and needs of children with epilepsy and their parents

PURPOSE: Having epilepsy often interferes with a child's and his or her family's quality of life, but specific concerns have not been explored. The purpose of the study was to explore in-depth the self-reported concerns and needs of children with epilepsy and their parents. METHOD: A focus group methodology was used with 2 child groups and 2 parent groups. DATA ANALYSIS: Themes were independently identified by each investigator, who then met to discuss the themes until 100% agreement was reached. RESULTS: Child themes included "talking at my level" and "feeling different from others." Parent themes included "difficulties, struggles and problems," "need for information," and "fears and concerns." CONCLUSION: Findings from this study suggest that attention needs to be directed to assessing informational and emotional support needs during the diagnostic process. Ongoing assessment is also necessary because children and parents have continuing needs beyond the initial encounter with healthcare professionals.     

Integrating health care for women diagnosed with HIV infection, substance abuse, and mental illness in Detroit, Michigan.

This article describes the evolution of Personalized Nursing, a comprehensive nursing practice model of care. Findings from several nursing research studies contributed to the development of Personalized Nursing. The model includes a practice model of the art of nursing care based on nursing theory and a specific nursing process that directs nursing care delivery. The process of care delivery includes location of hard-to-reach clients; linkage to health care providers; integration of care among providers for clients diagnosed with HIV, mental illness, and substance abuse; and strategies to promote retention in health care. Use of Personalized Nursing is designed to assist clients to improve their well-being and increase positive health-related behaviors. Personalized Nursing has been used in urban landscapes to serve multiply diagnosed clients at risk for HIV infection. The model is currently being used in a study targeting multiply diagnosed women who are lost to follow-up from medical care.