Health Care Professionals' Perceptions of Child Life Specialists

The hospital environment presents many stressors for ill children and their families. For this reason, the child life profession focuses on the psychosocial care of hospitalized children and their families. However, little is known about perceptions of the child life profession in the medical setting. Thus, the purpose of this study was to examine the perceptions of child life specialists by members of the health care profession. Results indicated several discrepancies between child life professionals' perceptions of their responsibilities and other health care professionals' perceptions of child life responsibilities. Child life specialists were viewed as important for patient psychosocial well-being, although perceived as having little power in the health care team. Child life specialists can use this information to educate other professionals in the medical field about their responsibilities, including patient and family support, advocacy, and patient psychological preparation.     

Application of Theory to Family-Centered Care: A Role for Social Workers

Family-centered care is an emerging trend in health care settings today. An explanation, principles, and a definition of family-centered care are offered and discussed. A theoretical framework, Balance Theory of Coordination, which can be utilized by social workers to develop and enhance family-centered care practices, is explained and discussed. Various family-centered care practices are examined within the context of Balance Theory of Coordination as examples.     

高血压患者实施以家庭为中心的健康教育对改善其自我效能感的作用分析

目的探讨高血压患者实施以家庭为中心的健康教育的效果。方法将医院2016年1月—2017年1月90例高血压患者按照随机数字表法分组为对照组与观察组,每组各45例;其中对照组采用常规药物治疗;观察组于对照组药物治疗基础上实施以家庭为中心的健康教育。比较两组患者治疗前后血压情况,采用自我效能量表评价两组干预前后自我效能评分,调查两组生活质量情况。结果两组患者治疗后收缩压和舒张压均明显低于治疗前,观察组治疗后收缩压和舒张压明显低于对照组,P0.05;两组患者干预后日常生活、遵医行为、健康行为、严格服药及自我效能总分明显高于干预前,观察组各项指标得分明显高于对照组,P0.05。观察组各项生活质量指标得分明显高于对照组,P0.05。结论采用药物治疗可有助于改善患者血压,提高其自我效能及生活质量,但辅以家庭为中心的健康教育可进一步提升药物治疗效果,因此值得推荐。     

Knowledge and practices in breastfeeding promotion by Family Health teams in Montes Claros, Brazil

The Family Health Strategy has been implemented in Brazil with the aim of reorganizing the health care system with an emphasis on promotion and prevention. Thus, encouragement for breastfeeding is one of the most important activities by family health care teams. The objective of this study was to assess knowledge and practices by family health care teams in relation to breastfeeding. In addition to a questionnaire on health professionals' characteristics, a specific knowledge test on breastfeeding was conducted with 41 physicians and nurses and another test on the same subject was given to 152 community health workers. Scores were above 80% on the advantages of breastfeeding in all the teams, but knowledge on practical issues concerning technique and management of the main problems encountered in breastfeeding was not uniform among the health professions. Nurses scored better than physicians, and community health workers had the lowest scores. Practical activities to promote breastfeeding were not developed uniformly among health care professionals. There is a need for systematic and ongoing training in breastfeeding management in the family health teams.     

Parent Assessment of Family-Centered Care Practices in a Children's Hospital

A study was undertaken at British Columbia's Children's Hospital to assess parents' views on the adequacy and extent of family-centered care practices. The study's 2 main objectives were to determine the feasibility of carrying out a detailed survey of parental attitudes toward family-centered care following a child's acute admission to hospital and to identify areas of practice where improvement was needed. The tool used was a survey comprising 125 structured and open-ended questions, conducted by telephone several weeks after discharge. Although limitations to the study were recognized, the survey proved to be a catalyst for multidisciplinary action to improve aspects of family-centered care.     

Perceptions of primary health care among users and health professionals: a comparison of units with and without family health care in Central-West Brazil

This study analyzes perceptions of performance by primary health care facilities with and without the Family Health Program in municipalities with more than 100,000 inhabitants. Questionnaires from the Primary Care Assessment Tool developed by John Hopkins University and adapted to Brazil, contemplating eight dimensions of primary health care, were applied to users and professionals from a sample of 36 family health care facilities and 28 traditional primary care facilities. Thirty health professionals with university education, 207 with secondary education, 490 adult users, and 133 family members answered the questionnaires. The overall result did not show significant differences between perceptions of family health care facilities as compared to traditional primary health care facilities, but perceptions of health professionals were consistently more favorable than those of users. Comparing the scores for each dimension, family health care facilities always scored better (with the exception of level of access), but the difference in scores between facilities with and without the Family Health Strategy was only statistically significant for all three categories of respondents in relation to the items "family focus" and "community orientation".     

浙江省宁波市卫生类高职院校新生心理发展现状调查

目的了解卫生类高职院校新生心理发展现状。方法自编《大学生心理发展特征量表》,对2049名卫生类高职新生进行心理发展现状的调查。结果卫生类高职院校新生心理发展总体呈中等偏上水平,学业与考试焦虑、时间管理问题2个维度的平均得分相对偏低(3分以下),男生在学业与考试焦虑维度的平均得分上要显著高于女生;女生在自我认同问题、人际生活满意、压力感受和大学生网络问题4个维度的平均得分上要显著高于男生。在生涯与人生整合维度上,护理类专业新生的平均得分要显著高于相关医学类和健康服务类专业新生的平均得分,在人际生活满意维度上,护理类专业新生的平均得分要显著高于相关医学类专业新生的平均得分。结论有针对性地开展卫生类高职新生入学心理适应教育,尤其要关注男生的心理发展,构建心理和职业教育相融合的思政教育体系。     

Saying 'goodbye' to single-handed practices; what do patients and staff lose or gain?

BACKGROUND: The practice setting is, next to the GP and staff, an important determinant of the quality of care. Differences between single-handed practices and group practices in practice management and organization could therefore provide clues for improvement. An explorative, cross sectional survey was conducted in 766 general practices in The Netherlands comparing single-handed practices with group practices. OBJECTIVE: The study is looking for answers on aspects of the organization and management that are lost or gained when single-handed GPs and practices are replaced by group practices. METHODS: Between 1999 and 2003 GPs and their practices were assessed using a validated practice visit method (VIP) consisting of 303 indicators describing 56 dimensions of practice management. Instruments used consisted of questionnaires for patients, GPs, practice assistant and a direct observer in the practice. Single-handed practices (1 GP) were compared to group practices or health centres (>2.0 GPs) comparing raw scores on dimensions of practice management. In addition, data were analysed in a regression model with specific aspects of practice management as dependent variables using a general linear model procedure. Independent variables included 'single-handed/group practice', 'rural/ urban' 'part-time/full-time' and 'male/female'. RESULTS: Group practices scored better on nearly all aspects of infrastructure except those rated by patients. Patients gave single-handed practices higher marks for service, accessibility and even for the facilities. In single-handed practices GPs reported that they worked more and experienced higher levels of job stress. They delegated less of the medical technical tasks but there is no difference in delegation of preventive tasks/treatment of chronic diseases. Group practices had more computerized medical information and more quality assurance activities, but gave less patient information. Single-handed practices spent more hours on continuous medical education. DISCUSSION AND CONCLUSION: The quality of the practice infrastructure and the team scored better in group practices, but patients appreciated the single-handed practice better. The advantages of single-handed practices could be a challenge for group practices to give better personal, continuous care and to put the patient perspective before organizational considerations. This is underlined by the better score on patient information of single-handed practices. Single-handed practices can reduce their vulnerability and openness to high demand by opening up to the requirements of organised primary care.     

Evolving Models of Family-Centered Services in Neonatal Intensive Care

The article examines the evolution of midels for providing family-centered servies in neo- natal intensive one settings Child-focused par- ent-infant interactin and ecological models are presented and discussed One specific eco- logical model the family-centered care model is examined in details While most current pro- grams endorsed family-centered care (FCC) as I best practice for develpmental interven- tion with infants few were found that imple mented these prectices Most utilized only lim- ited componets of FCC Instead programs operating in NICU settings had features di- tected toward child care staff training family support an transition to community Either than impacting the philosophy of cart ind/on service delivery system in the NICU Suggestions for working toward FCC in NICU setting the given and barriers are discussed.     

Health literacy and health-related knowledge among persons living with HIV/AIDS

BACKGROUND: Functional health literacy is associated with illness-related knowledge, understanding, and treatment perceptions for several chronic illnesses. This study examined health literacy in relation to knowledge and understanding of HIV/AIDS. METHODS: Persons living with HIV/AIDS recruited from AIDS service organizations and HIV clinics completed the Test of Functional Health Literacy for Adults (TOFHLA) reading comprehension scale and measures of health status, knowledge and understanding of health status, perceptions of primary care givers, and perceptions of anti-HIV treatments. RESULTS: Eighteen percent of the sample scored below the cutoff for marginal functional health literacy on the TOFHLA. Controlling for years of education, persons of lower health literacy were significantly less likely to have an undetectable HIV viral load, somewhat less likely to know their CD4 cell count and viral load, and lower health-literacy persons who knew their CD4 count and viral load were less likely to understand their meaning. Lower health literacy was also related to misperceptions that anti-HIV treatments reduce risks for sexually transmitting HIV and beliefs that anti-HIV treatments can relax safer-sex practices. CONCLUSIONS: Poor health literacy creates barriers to fully understanding one's health, illness, and treatments. Misperceptions of treatment in the case of HIV infection creates danger for potentially transmitting treatment-resistant strains of HIV. These results have implications for patient education and treatment programming for people who have poor health-literacy skills and are living with HIV/AIDS.     

Journey toward a patient-centered medical home: readiness for change in primary care practices

Context: Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient‐centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation. Methods: We used a comparative case study design to assess primary care practices’ readiness for PCMH implementation in sixteen practices from twelve different physician organizations in Michigan. Two major components of organizational readiness, motivation and capability, were assessed. We interviewed eight practice teams with higher PCMH scores and eight with lower PCMH scores, along with the leaders of the physician organizations of these practices, yielding sixty‐six semistructured interviews. Findings: The respondents from the higher and lower PCMH scoring practices reported different motivations and capabilities for pursuing PCMH. Their motivations pertained to the perceived value of PCMH, financial incentives, understanding of specific PCMH requirements, and overall commitment to change. Capabilities that were discussed included the time demands of implementation, the difficulty of changing patients’ behavior, and the challenges of adopting health information technology. Enhancing the implementation of PCMH within practices included taking an incremental approach, using data, building a team and defining roles of its members, and meeting regularly to discuss the implementation. The respondents valued external organizational support, regardless of its source. Conclusions: The respondents from the higher and lower PCMH scoring practices commented on similar aspects of readiness—motivation and capability—but offered very different views of them. Our findings suggest the importance of understanding practice perceptions of the motivations for PCMH and the capability to undertake change. While this study identified some initial approaches that physician organizations and practices have used to prepare for practice redesign, we need much more information about their effectiveness.     

长沙市高校新生健康素养调查结果分析

目的揭示高校新生健康素养水平和健康素养相关信息获取的基本现状,为高校健康教育的内容和方式提供参考依据。方法根据中国疾控中心的问卷进行修改,对2270名新生进行问卷调查。结果社会性别对健康素养水平某些方面的影响有统计学意义。高校类别对健康素养水平的影响有统计学意义(P0.05)。高考生源地对健康素养水平的影响有统计学意义(P0.05)。不同户口类型对健康素养水平的影响有统计学意义(P0.05)。父母受教育文化程度及职业对健康素养水平的影响有统计学意义(P0.05)。结论调查对象的健康素养水平相对较低,影响健康素养水平的因素有很多,但本研究仅限人口统计学变量,如性别、父母受教育文化程度和职业等,其他研究因素还有待进一步探讨。     

Perceptions of good medical practice in the NHS: a survey of senior health professionals.

OBJECTIVES: To categorize senior health professionals' experience with poor medical practice in hospitals and in general practice, to describe perceptions which senior NHS staff have of good medical practice, and to describe how problems of poor medical practice are currently managed. DESIGN: A postal questionnaire survey. The questionnaire sought perceptions of good medical practice, asked participants to characterise deviations from good practice, and to describe experience with managing poor performance at the time of the introduction of the General Medical Council (GMC) performance procedures. SETTING: A range of NHS settings in the UK: hospital trusts, health authorities/boards, local medical committees, community health councils. SUBJECTS: Senior health professionals involved in the management of medical professional performance. MAIN MEASURES: Perceptions of what constitutes good medical practice. RESULTS: Most respondents considered that persistent problems related to clinical practice (diagnosis, management, and outcome and prescribing) would require local management and, possibly, referral to the GMC performance procedures. Informal mechanisms, including informal discussion, education, training, and work shifting, were the most usual means of handling a doctor whose performance was poor. Many took a less serious view of deficiencies in performance on manner and attitude and communication, although consultation skills rather than technical skills comprised the greatest number of complaints about doctors. CONCLUSIONS: Senior NHS professionals seem reluctant to consider persistently poor consultation skills in the same critical light as they do persistently poor technical practice. These attitudes may need to change with the implementation of clinical governance and updated guidance from the GMC on what constitutes good medical practice.     

Factors Associated With Family-Centered Involvement in Family Practice—A Cross-Sectional Multivariate Analysis

The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians’ family-centered involvement and expected patient receptiveness, perceived impact of the family’s influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family’s influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.     

Stretched rating scales cause guided responding

Decision making by policymakers, public health professionals, and health care providers is often guided by the extent to which individuals feel at risk for certain adverse health events. Such health risk perceptions can be assessed in surveys using different types of probability rating scales. It has recently been suggested that rating scales that offer decomposed numeric values at the lower end of the scale (stretched scales) improve the accuracy of estimates of small risks. However, the authors suggest that respondents use the differentiated small numeric values as cues to guide them to the correct response. Study 1 supports this proposition by showing that response distributions are substantially skewed toward the lower end of stretched rating scales and have restricted variances as compared with equal-interval scales. Study 2 provides experimental evidence that scores on the stretched scale are a result of guided responding. The results show that scores on stretched rating scales are not a valid reflection of respondents' risk perceptions, but, instead, guide responses to the end of the scale that has been stretched. The findings suggest that stretched rating scales result in biased risk estimates, which may hinder effective communication about health risks between decision- and policymakers as well as between individuals and their health care providers.     

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.     

Reforms in pharmacy education and opportunity to practise clinical pharmacy

The impact on 357 newly licensed pharmacists, graduates of two colleges, of efforts to turn pharmacy into a clinical profession, was examined by way of a self-administered questionnaire. Perceptions and expectations about work, differences in consulting practices, relationship between practice and attitudes, and the presence or absence of an identifiable general value orientation (which could account for specific perceptions and attitudes), were examined. Results indicated that hospital practice was more likely to be associated with clinical pharmacy and clinical pharmacy practice was more likely to meet the expectations of recently graduated pharmacists. In addition, 52 per cent of the community-based pharmacists were found to engage in patient counseling, as compared with 39 per cent of hospital-based pharmacists. Newly licensed pharmacists are deepening the existing divisions in the profession, while moving toward a revision of their place in the health care delivery system.