Why don’t women volunteer to give blood? A study of knowledge,attitude and practice of women about blood donation,Yazd, Iran, 2005

The most important aim of all blood transfusion centres is to recruit blood donors from low-risk groups of society to donate blood voluntarily and regularly. In the city of Yazd, Iran, only 5% of blood donors are women. The aim of this study was to assess barriers of donation of blood by women and the level of knowledge, attitude and practice regarding blood donation. In this cross-sectional study, 1602 women were selected by cluster sampling method and asked to fill a specially formatted questionnaire. Data were analysed by ANOVA and the t-test. Levels of knowledge were different between the various groups. Illiterate women and housewives had the least levels of knowledge. Fifteen per cent of the women had donated blood at least once in the past. The most important motivational factor was sense of moral duty with a spiritual reward and the most important barriers for donating blood were anaemia, fear, lack of time and difficulty in access to donation sites. A significant percentage of women had false beliefs about blood donation. Increase in the level of knowledge of women and correction of false beliefs should be the topmost priority. Further studies are needed to determine whether addressing anaemia and women's health can tend to increase the number of female blood donors.     

Why do young people sniff? An exploratory study of adolescent inhalant abuse from north India

Background: Inhalant abuse among adolescents is a growing problem worldwide including developing countries like India. It is important to understand the nature of adolescent inhalant abuse behaviour in order to counter the emerging problem.Aims: 1. To assess sociodemographic profile of treatment-seeking adolescents with inhalant abuse. 2. To explore inhalant abuse behaviour among treatment-seeking adolescents.Method: A 6-month long explorative study on 23 consecutive male adolescents seeking treatment for inhalant abuse (aged 13–18) in a tertiary de-addiction centre of India was conducted using a semi-structured questionnaire and a checklist to inquire about the perceived effect of inhalant abuse.Results: All adolescent males [mean age 16 (SD = 1.86) years] belonged to urban area and enjoyed adequate social support. “Sniffing” was the commonest route of inhalant abuse. Experimentation and peer pressure were the commonest reasons reported by adolescents for initiation (65.21%), whereas boldness (56%) was the commonest perceived effect of inhalant abuse.Conclusions: While experimentation and peer pressure contribute in initiation, perceived effects like boldness contribute in continuation of adolescent inhalant abuse in India. Increase in confidence and boldness is a much-desired effect in growing adolescents, and the abuse of inhalants reinforces the same.     

From tall poppies to squashed weeds*: why don’t nurses pull together more?

AIMS: To develop a conceptual framework to account for interpersonal conflict in nursing. To extend the boundaries of debate on the causes of interpersonal conflict in nursing. BACKGROUND/RATIONALE: In nursing, attempts to offer an explanation for staff conflict or, as it is traditionally referred to, horizontal violence, have, nearly always, been influenced by oppression and feminist theories. Such macrolevel analyses avoid discussing the details of individual acts of aggression in favour of considering nurses' alleged disempowerment in relation to other perceived dominant groups, especially male doctors, and the violence these groups inflict in terms of the denial of power, control, and access to rewards - material or otherwise. METHODOLOGY: A critical analysis of an extended literature review adapted from a doctoral dissertation. DISCUSSION: While the oppression and feminist perspectives can be insightful they are also limiting in that they omit the finer grained-analysis necessary for a fuller understanding of staff conflict. At least three levels of explanation can be offered to account for poor staff relationships - a macrolevel, which focuses on nurses' relationships vis-à-vis dominant groups, a mesolevel analysis, which concentrates on organizational structures, including workplace practices - many of which are controlled by nurses themselves, and a microlevel analysis, which emphasizes the interactional nature of interpersonal conflict. CONCLUSIONS: It is contented that it is not only the alleged misogyny intrinsic to oppression theory that shackles and impedes nurses, but nurses themselves, who in their everyday work and interpersonal interactions, act as insidious gatekeepers to an iniquitous status quo.     

How efficient is the orienting of spatial attention to pain? An experimental investigation

This study investigated how efficient spatial attention was oriented to pain in 2 experiments. Participants detected whether painful (pain group) or nonpainful (control group) somatosensory stimuli were delivered to the left or right hand. Each stimulus was preceded by a visual cue presented near to the stimulated hand (valid trial), the opposite hand (invalid trial), or centrally between hands. To examine both exogenous and endogenous orienting of attention, the spatial predictability of somatosensory targets was manipulated. In the first experiment, visual cues were nonpredictive for the location of the pain stimulus, as a result of which, orienting was purely exogenous, i.e., resulting from the occurrence of the visual cue at the location of somatosensory input. In the second experiment, visual cues were spatially predictive, as a result of which, endogenous control was added, i.e., attention driven by expectations of where the somatosensory target will occur. The results showed that only in experiment 1 was spatial attention oriented more efficiently to painful compared with nonpainful somatosensory stimulation. This effect was due to faster responses on valid relative to baseline trials (engagement), rather than slower responses on invalid relative to baseline trials (disengagement), and was significantly correlated with self-reported bodily threat. In experiment 2, prioritization of the pain location was probably overridden by task strategies because it was advantageous for participants' task performance to attend to the cued location irrespective of whether stimulation was painful or not. Implications of these findings for theories of hypervigilance and attentional management of pain are discussed.     

‘You do know he’s had a stroke,don’t you?’ Preparation for family care‐giving – the neglected dimension

? Countries throughout the developed world have introduced a policy of community care for older people to reduce costs to the state and maintain quality of life. ? In reality community care is largely family care and recognition of the need to support family carers is being promoted through the notion of partnership with professional carers. ? Such a partnership calls for a more complete understanding of how carers’ needs change over time and how professional support can be most effective. ? Support is particularly important at the start of care‐giving in order that carers can exercise free choice and be adequately prepared for their role. ? This paper provides an overview an ongoing longitudinal study and reports specifically on the findings of data from a preliminary study in which a convenience sample of seven experienced carers of stroke survivors who attended a stroke and carers club were interviewed in their own homes. ? Based on initial data from a longitudinal study of stroke victims, this paper outlines four themes: ‘What’s it all about’, ‘Going it alone’, ‘Up to the job’ and ‘What about me?’ These themes highlight the difficulties carers experience in the immediate aftermath of stroke.     

Why are friends special? Implementing a social interaction simulation task to probe the neural correlates of friendship

Friendships form one of the most proximal contexts with a critical role in mental health and social and psychological development. Yet, the neurobiological basis of this crucial developmental factor is largely uninvestigated. In this study, we tested the hypothesis that the interaction with friends is associated with specific activity increases in brain areas known to be involved in interpersonal phenomena, such as empathy, and in reward expectancy. Using functional magnetic resonance imaging (fMRI), we assessed neural activity in a social interaction simulation task implementing the factors 'type of relationship' (peers vs. familiar celebrities) and 'emotional valence' (positive (liked), negative (disliked), and neutral (neither liked nor disliked)). In this design, all stimuli were selected individually for each of the 28 participants and positive peers constituted the friends. Participants were asked to approach a stimulus, to avoid it, or remain neutral. Behavioral results confirmed the expectations in the sense that the participants approached positive stimuli more often than they approached neutral, which were also more often approached than negative stimuli. Moreover, peers were more often approached than celebrities were. Imaging results revealed, among others, three regions of particular interest as selectively more strongly activated when subjects interacted with their friends than with other peers and celebrities: the amygdala and hippocampus, the nucleus accumbens, and the ventro-medial prefrontal cortex. These results might highlight the role of empathy and reward-related processes in friendship. Thus, we may have identified a potential mechanism by which friendships exert such a critical role in development and mental health.     

Emergency medicine in India: Why are we unable to ‘walk the talk’?

The largest democracy on earth, the second most populous country and one of the most progressive countries in the globe, India, has advanced tremendously in most conventional fields of Medicine. However, emergency medicine (EM) is a nascent specialty and is yet to receive an identity. Today, it is mostly practised by inadequately trained clinicians in poorly equipped emergency departments (EDs), with no networking. Multiple factors such as the size of the population, variation in standards of medical education, lack of pre-hospital medical systems and non-availability of health insurance schemes are some of the salient causes for this tardy response. The Indian medical system is governed by a central, regulatory body which is responsible for the introduction and monitoring of all specialties--the Medical Council of India (MCI). This organisation has not recognized EM as a distinct specialty, despite a decade of dogged attempts. Bright young clinicians who once demonstrated a keen interest in EM have eventually migrated to other conventional branches of medicine, due to the lack of MCI recognition and the lack of specialty status. The Government of India has launched a nationwide network of transport vehicles and first aid stations along the national highways to expedite the transfer of patients from a crash site. However, this system cannot be expected to decrease morbidity and mortality, unless there is a concurrent development of EDs. The present article intends to highlight factors that continue to challenge the handful of dedicated, full time emergency physicians who have tenaciously pursued the cause for the past decade. A three-pronged synchronous development strategy is recommended: (i) recognise the specialty of EM as a distinct and independent basic specialty; (ii) initiate postgraduate training in EM, thus enabling EDs in all hospitals to be staffed by trained Emergency physicians; and (iii) ensure that EMs are staffed by trained ambulance officers. The time is ripe for a paradigm shift, since the country is aware that emergency care is the felt need of the hour and it is the right of the citizen.     

Why is change a challenge in acute mental health wards? A cross‐sectional investigation of the relationships between burnout,occupational status and nurses’ perceptions of barriers to change

Changes in UK psychiatric wards have been difficult to implement. Specific areas of nursing staff resistance remain unclear. Previous healthcare research suggests that burnout is common and that managers’ regard changes more positively than direct care staff. We will therefore examine whether burnout and workforce characteristics influence psychiatric nurses’ perceptions of barriers to change. Psychiatric nurses (N = 125) completed perceptions measures of ‘barriers to change’ (VOCALISE: subscales included ‘powerlessness, confidence and demotivation’); and ‘burnout’ (Maslach Burnout Inventory: subscales included ‘emotional exhaustion, personal accomplishment and depersonalization ‘). Staff characteristics, such as length of employment, occupational status, education, ethnicity, gender and age, were also collected. Correlations between these measures informed random‐effects regression models, which were conducted to predict the barriers to change score and to explore differential effects in the subscales of VOCALISE. Perceptions of barriers to change (VOCALISE) were correlated with burnout (r = 0.39), occupational status (r = ?0.18) and age (r = 0.22). Burnout (Coef. β: 10.52; P > 0.001) and occupational status (Coef. β: ?4.58; P = 0.05) predicted VOCALISE. Emotional exhaustion (Coef. β: 0.18; P < 0.001) and low personal accomplishment (Coef. β: 0.21; P = 0.001) predicted powerlessness. Emotional exhaustion predicted low motivation regarding changes (Coef. β: 0.11; P = 0.005). Low confidence predicted high levels of depersonalization (Coef β: 0.23; P = 0.01). Direct care staff expressed significantly more powerlessness (Coef. β: ?2.60; P = 0.02) and significantly less confidence (Coef. β: ?3.07; P = 0.002) than managers. For changes to be successful in psychiatric wards, burnout will need to be addressed. Future change strategies may consider involving direct care staff to improve perceptions of barriers to change.     

Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’

The care programme approach (CPA) was introduced in the United Kingdom in 1991 to ensure that the needs of people with mental health problems are met appropriately. Many community psychiatric nurses (CPNs) act as 'key workers' under the CPA. Recent evidence suggests that the CPA is not particularly effective at meeting the needs of this vulnerable group, but it might be possible to enhance the CPA by introducing a more 'needs-led' approach to the planning of nursing care. 'Needs feedback' is a technique for enhancing the CPA. Needs feedback begins with a standardized assessment of patients' psychiatric and social needs by a nurse specialist. The patient's CPN is then provided with information on: (a) the needs identified; (b) why these needs have been identified; (c) the interventions required to meet the identified needs; and (d) how these interventions may be obtained. In the pilot study reported in this paper, 20 patients with severe mental disorder were evaluated before and after their CPN received needs feedback. All patients were living in the community and being managed by CPNs under the CPA. Outcome was assessed 6 months after the feedback in terms of: mental state, social behaviour and number of 'unmet' needs. Needs feedback was found to be compatible with the CPA in that it proved acceptable to CPNs and patients. Significant improvements were seen in the number of 'unmet' needs and the level of anxious/depressive symptoms. Improvements approaching significance were seen for social functioning and negative psychiatric symptoms, but not for positive psychiatric symptoms. This pilot study suggests that needs feedback may improve the quality of nursing assessment and care planning within the CPA. Further controlled investigations of needs feedback are justified.     

In whose best interests? An examination of the ethics of the UK government's White Paper ‘Reforming the Mental Health Act’

Throughout history the legislative framework for the treatment of the mentally ill has reflected societies' attitudes, and the proposals in the United Kingdom (UK) government's White Paper 'Reforming the Mental Health Act' are no exception. This paper examines some of the fundamental ethical issues invoked by the proposals, particularly the concept of paternalism and use of risk assessment in determining 'best interests'. The issue of power in relation to the mentally ill is also examined, alongside the impact of the change on nurses' ethical decision making. As will be seen, the proposed Act will require high standards of professional practice to ensure the ethical application of care, particularly in the case of individuals diagnosed as suffering from 'dangerous and severe personality disorders'. Nurses need to ensure that the interventions used are of the highest quality and are indeed in the patient's 'best interests'. If they are not, then again nurses need to be very clear as to why the profession should be involved at all. Nurses should demonstrate vigilance and high professional standards to ensure they are maintaining rigorous safeguards to promote the public interest. Although relating specifically to UK legislation the underlying ethical dilemmas posed by this proposed legislation are relevant to all mental health nurses, as they challenge fundamental assumptions regarding the role of nurses in supporting mental health legislation that may have a social, rather than therapeutic, function.     

Are nurses’ assessments of their workload affected by non‐patient factors? An analysis of the RAFAELA system

Aims To identify (1) the contribution of non‐patient factors to patient classification systems and (2) the explanatory power of nursing care intensity and non‐patient factors to Professional Assessment of Optimal Nursing Care Intensity Level workload. Background In the Rainio, Fagerström and Rauhala (RAFAELA) patient classification system, nursing care intensity per nurse is measured daily by the Oulu Patient Classification/Qualisan instrument. The optimal nursing care intensity is determined using Professional Assessment of Optimal Nursing Care Intensity Level instrument. However, nurses’ workload may be affected by factors other than nursing care intensity. Therefore, RAFAELA contains 12 non‐patient questions. Methods A retrospective study of all 22 somatic wards of a secondary healthcare hospital in Finland. Results Non‐patient questions were answered in 26% of 4870 questionnaires. They added to workload in 62%. Eight questions were grouped into four factors: administration; staff resources and mental stress; co‐operation within and between units. The explanatory value between Oulu Patient Classification/Qualisan and Professional Assessment of Optimal Nursing Care Intensity Level had a median of 0.45. Including the non‐patient questions raised it to 0.55. Conclusions Non‐patient factors affect the nurses’ assessments of their workload, but less than nursing care intensity. They contribute valuable information on the functioning and problems of wards.     

‘But what about the really ill,poorly people?’ (An ethnographic study into what it means to nurses on medical admissions units to have people who have harmed themselves as their patients)

In the UK, someone dies by suicide every 2 hours. An increasing number are also harming themselves. Many of these people are admitted to Medical Admissions Units of General Hospitals. Department of Health guidelines now recommend that anyone who harms him or herself should have a psychosocial and risk assessment. This means that they have to stay in hospital until they are assessed and this renders them 'different' from other patients. This study uses an ethnographic approach to search for the meaning to nurses of having this group of patients on the ward, using participant observation and semistructured interviews with four nurses. Three themes were isolated through analysis of the data: the busy quality of such wards (busyness) how this group of clients impede the busy quality and the strategies which nurses use to cope with the difficulties. Analysis of the data revealed that the research participants found difficulty in understanding why people harm themselves and that they felt that they did not have the requisite skills to deal with this group of people. This appears to leave them with a sense of frustration and helplessness which perhaps mirrors that of this client group.     

Why is recruitment to trials difficult? An investigation into recruitment difficulties in an RCT of supported employment in patients with severe mental illness

BackgroundUnder-recruitment to randomised controlled trials (RCTs) is often problematic and there may be particular difficulties in recruiting patients with severe mental illness.AimTo evaluate reasons for under-recruitment in an RCT of patients with severe mental illnessMethodsQualitative study during the recruitment phase of an RCT of supported employment. Trial staff and recruiting clinicians were interviewed. Data were analyzed thematically using constant comparative techniques.ResultsRecruitment rates were low. Five main reasons for recruitment difficulties were found. These included: (i) misconceptions about trials, (ii) lack of equipoise, (iii) misunderstanding of the trial arms, (iv) variable interpretations of eligibility criteria, (v) paternalism.ConclusionReasons for recruitment difficulties in trials involving patients with severe mental illness include issues that occur in trials in general, but others are more specific to these patients. Clinician and patient involvement in the study design may improve recruitment in future similar trials.     

Can blood pressure responses to tests unmask future blood pressure trends and the need for antihypertensive medication? Ten years of follow‐up

An exaggerated blood pressure (BP) response to test may unmask the subjects who have a high risk of developing hypertension. In this prospective 10 years of follow-up, we examined whether the predictive value of casual BP measurements on future BP level and need for antihypertensive medication could be improved by using BP responses to different physical tests. At baseline, BP was recorded by casual measurements and intra-arterial monitoring. During the intra-arterial BP recording, standardized postural and exercise tests were performed on 97 healthy, untreated men (34 normotensive, 29 borderline hypertensive, and 34 mild hypertensive). After 10 years of follow-up, 87 of them (90%) returned for casual and non-invasive 24-h BP measurements. At follow-up, 20 (23%) of the men had antihypertensive medication. The prediction of casual systolic blood pressure (SBP) was best improved by SBP at 10 min after the dynamic exercise test (adj. R2 = 0.448; adj. R2 = 0.356 for casual SBP alone). The prediction of casual diastolic blood pressure (DBP) was most improved by DBP at 10 min after the dynamic exercise test (adj. R2 = 0.282; adj. R = 0.259 for casual BP alone). SBP in the supine test best improved the prediction of 24-h SBP (adj. R2 = 0 448; adj. R2 = 0.275 for casual SBP alone). DBP in the standing test best improved the prediction of 24-h DBP (adj. R2 = 0.252; adj. R2 = 0.214 for casual DBP alone). Pre-exercise DBP and casual SBP were the best predictors of the need for antihypertensive medication (Cox-Snell R2 = 0.256; Cox-Snell R2 = 0.164 for casual SBP alone). In conclusion the prediction of future BP and need for antihypertensive medication can be improved by using BP measurements during postural and exercise tests. Future SBP is more predictable than DBP.