Outpatients' attitudes regarding advance directives.

BACKGROUND. Although many bedside ethical dilemmas can be avoided if patients discuss their wishes regarding the use of life-prolonging treatment and aggressiveness of care, many physicians are reluctant to raise this issue with their patients. Physicians may wait for such discussions until a patient is ill or elderly or until the patient raises the issue first. METHODS. Three hundred adult patients visiting their family physician's office were asked to complete a 19-item questionnaire. In addition to providing demographic information, they were asked whether they had discussed their wishes regarding life-prolonging treatments with their physician; what their attitude was toward having these discussions in various situations; whom they wanted to initiate the discussion, and with whom else they had discussed their wishes. RESULTS. Of the respondents who had not previously discussed their wishes with their physician, 68% wanted the physician to initiate the discussion. Only 11% did not want their physician to bring up the subject. A majority of respondents in all age groups thought it was somewhat or very important to discuss this matter both when healthy and when very ill. CONCLUSIONS. Very few patients would be upset if their physician raised the issue of life-prolonging treatment even if he or she did so during an initial patient visit. To avoid problems later, physicians should take an active role by raising these questions early in the patient-physician relationship rather than waiting for the patient to do so.     

Knowledge and attitudes towards influenza vaccination of health care workers in emergency services

Annual vaccination rates among French health care workers (HCWs) are in decline even in Emergency Services to which patients at highest risk of influenza complications are admitted, and in which HCWs have the greatest risk of exposure to influenza from patients. We aimed here to identify knowledge and attitudes towards influenza vaccination of HCWs in Emergency Services. We collected 344 self-administered questionnaires of 1060 HCWs. Only 18% of HCWs were vaccinated against influenza. Physicians were vaccinated more often (55%) than nurses (16%) or aid nurses (11%). The most important barriers to vaccination were reported as being a lack of time (33%), lack of safety of the vaccine (31%), fear of contracting influenza due to vaccination (29%), and lack of effectiveness (23%). Being vaccinated was significantly related to a higher knowledge score based on epidemiological influenza items (OR (95% CI)) (1.63 (1.08–2.46)) and vaccine features items (2.36 (1.36–4.10)).     

Knowledge,attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations

Objectives

Immunization of healthcare workers (HCWs) is a major issue for infection control in healthcare facilities. The aim of this study was to evaluate knowledge regarding occupational vaccinations, HBV, varicella and influenza vaccination rates and attitudes towards influenza vaccine among HCWs.

Design and setting

A cross-sectional survey was conducted in two wards (Medicine and Paediatrics) of a 1182-bed teaching hospital in Paris, France.

Methods

A standardized, anonymous, self-administered questionnaire was used.

Results

Of 580 HCWs, 395 (68%) completed the questionnaire. Knowledge about the occupational vaccinations of HCWs was low. HBV (69%), tuberculosis (54%) and influenza (52%) were the most cited vaccinations. Paediatric staff was more aware of influenza and pertussis immunizations (p < .05). HBV vaccination rate was 93%, among whom 65% were aware of their immune status. Influenza vaccination rate for 2006–2007 was 30% overall, ranging from 50% among physicians to 20% among paramedical staff (p < .05). Physicians based their refusal on doubts about vaccine efficacy, although paramedics feared side effects. Influenza vaccination was associated with knowledge of vaccine recommendations [OR = 1.75, 95% CI: 1.13–2.57] and contact with patients [OR = 3.05, 95% CI: 1.50–5.91].

Conclusions

Knowledge of recommended occupational vaccinations is insufficient in HCWs, except for HBV and influenza. Although the HBV vaccine coverage of HCWs is satisfactory, a large proportion of them is unaware of immune status. Influenza vaccine coverage remains low, especially among paramedical staff because of fear of side effects. As vaccine coverage is associated with knowledge, educational campaigns should be strengthened to increase the adhesion of HCWs to vaccinations.     

Knowledge and attitudes in multicultural health care

Health professionals' knowledge of ethnic minority cultures and lifestyles was assessed to determine whether the respondents' cultural background and experience of working with ethnic minorities affected the health care delivered by them and to assess the need for training. Improving access to health services for ethnic minorities requires continuing education and training of all health professionals.     

Knowledge, attitudes and behaviours of health care workers towards clients of sexual health services in Fiji

A cross-sectional survey was conducted to identify the attitudes and behaviours of health care workers (HCWs) in health care settings (HCS) in Fiji involving 369 participants. Self-rated knowledge of HIV and sexually transmissible infections (STIs) varied depending on whether the HCS was divisional or sub-divisional, and varied between the various national divisions. HCWs with experience in HIV, reproductive health and antenatal clinics had higher self-rated HIV knowledge. A high proportion had a fear of catching HIV from HIV-positive clients. This study found high levels of negative attitudes towards clients from vulnerable groups with regards to the transmission and spread of HIV. Study participants also reported observing differential treatment by their colleagues if a client was known to have or was suspected of having HIV. There is a need for further HIV education of HCWs, with training focussed on occupational risk, and on reducing stigma and discrimination of those living with or vulnerable to HIV in Fiji.     

Knowledge and attitudes of health professionals toward adolescent health care

The rising concern over the competency of health care professionals in the United States to meet the health needs of adolescents was the impetus for a national survey of 3066 physicians, nurses, social workers, nutritionists, and psychologists. The survey explored perceptions of training and competency regarding 16 dimensions of adolescent health care. Major deficits were noted for each discipline. For physicians, self-perceived limitations were in the areas of eating disorders, learning disabilities, chronic illness, and delinquent behavior. The same limitations were also mentioned by nurses. Over half of the psychologists reported deficits related to the psychological sequelae of sexual concerns, sexual orientation conflict, eating disorders, and chronic illness. Many of the same concerns reflected the perceived competencies of social workers. Nearly half of all nutritionists surveyed acknowledged deficits in almost all adolescent food-related concerns. The impact of these low levels of perceived competency is discussed in terms of implications for clinical service.     

Risk perception and attitudes towards HIV in Serbian health care workers

BACKGROUND: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV). AIM: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia. METHODS: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied. RESULTS: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients. CONCLUSIONS: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.     

Incentives and barriers regarding immunization against influenza and hepatitis of health care workers

A meeting of the Viral Hepatitis Prevention Board in Barcelona in November 2012 brought together health care professionals concerned with viral hepatitis and those concerned with other vaccine-preventable diseases (especially influenza) in order to share experiences and find ways to increase the protection of health care workers through vaccination. Despite the existence of numerous intergovernmental and national resolutions, recommendations or published guidelines, vaccine uptake rates in health care workers are often shockingly low and campaigns to increase those rates have been generally unsuccessful.     

Sources of strain between physicians and social workers: implications for social workers in health care settings

This paper analyzes the sources of strain between the professions of medicine and social work. The two professions are compared in relation to (1) the organization and socialization process of professional training; (2) perspectives on patient care, illness and role of the health care professional; (3) attitudes toward knowledge and data; (4) attitudes toward and preparation for team-work; (5) perspectives on the role of the patient; (6) perceptions of social work's function.     

Computerized information systems for social workers in health care

Social workers' contributions to preventive medicine; discharge planning; and effective integration of hospital, family, and community resources are becoming increasingly important within the changing context of health care delivery. Information technology can be a powerful tool for developing efficient, accurate, and comprehensive patient records. In spite of the potential that information technology offers health care social workers, the actual use of computerized patient data has been limited and slow to develop. This article describes the development of a prototype information system that supports the diverse tasks of health care social workers in ambulatory care, shows how a shared computerized database can improve coordination of patient care among multiple health care disciplines, and addresses emerging issues as a growing number of social workers in health care use computerized information systems.     

Caring for persons with AIDS: Knowledge and attitudes of 1,047 health care workers attending AIDS action committee educational programs

Thirty-six educational programs on AIDS for 1047 massachusetts health care providers were evaluated by pre-and post-program questionnaires. Providers' knowledge about modes of transmission and means of preventing transmission were ascertained, as were professional and personal attitudes about persons with AIDS. Providers included 149 who established regulations, 345 supervisors, 468 inpatient care and 85 outpatient care providers. Results suggest 1. a need for provider education; and 2. significant differences among the four groups in knowledge and attitudes, both before and after programs, with regulators having the most accurate knowledge and inpatient care providers the least. Suggestions are made for development of effective education to prevent AIDS among caregivers and to prevent the emotional injuries associated with being an AIDS patient.