The Public Health Nurse as a Discharge Planner: Patients'' Perceptions of the Discharge Process

The trend toward earlier patient discharges from hospitals has provided new incentives for hospitals and public health nurses to work together to ensure that patients receive uninterrupted quality care after discharge. This study investigated perceptions of the discharge process using a structured telephone interview to survey a sample of 30 adult patients who had been hospitalized for at least 24 hours in a small, rural community, hospital in the upper Midwest. The county public health nursing agency contracted with the hospital to provide discharge planning services. Patients identified discharge needs in 15 different areas, with a mean of 5.8 needs per patient. Twenty-seven percent of the patients received referrals for the services of a public health nurse, homemaker, or both before discharge. One week after discharge 37 percent of the patients continued to need assistance appropriate for referral back to the professionals or agencies with whom they had had initial contact. Elderly patients with chronic illnesses were more likely to have received referrals at the time of discharge than younger patients with acute illnesses. Family and friends were heavily involved in providing support services in the postdischarge period.     

Post-conviction Sex Offender Polygraph Examination: Client-Reported Perceptions of Utility and Accuracy

Post-conviction polygraph testing of adult sex offenders in treatment has been a somewhat controversial subject. This study (n = 95 participants who took 333 polygraph tests) explored how sexual offenders enrolled in outpatient treatment programs perceived their polygraph experience. Participants reported a relatively low incidence of false indications of both deception (22 of 333 tests) and truthfulness (11 of 333) tests, suggesting that clients agreed with examiners opinions 90% of the time. The majority of clients reported that polygraph testing was a helpful part of treatment. Finally, about 5% of participants reported that they responded to allegedly inaccurate accusations of deception by admitting to things they had not done. The data offer encouragement for continued but cautious use of polygraphs by sex offender treatment programs. Implications for practice and research are identified.     

Predictors of Treatment Attrition as Indicators for Program Improvement not Offender Shortcomings: A Study of Sex Offender Treatment Attrition

This study classified potential attrition predictors under the domains of risk, need and responsivity (D. Andrews & J. Bonta, 2003). Non-sexual criminogenic needs (e.g. aggression, rule violating behaviors) and responsivity factors (e.g. lack of motivation and denial) were the two main clusters of predictors that correctly classified 95.3% of program completers and non-completers using discriminant function analysis in a sample of high-risk male sexual offenders treated in an accredited inpatient sex offender treatment program. Rapists were more aggressive than other types of sex offenders and were more likely to drop out of treatment. Some studies of predictors of treatment attrition have used offender problem behaviors or psychopathologies to predict attrition and then use the information to exclude offenders from treatment. Others have argued, and we concur, that results of attrition research should not be used to develop an “attrition profile” to exclude offenders from treatment. Predictors of attrition should be seen as markers for program improvement, rather than shortcomings of the offender. Suggestions for program improvements to reduce the rate of attrition, based on results of research, are presented.     

The Nature of Sexual Offenders' Affective Empathy: A Grounded Theory Analysis

The aim of this research was to investigate the nature of sexual offenders' affective empathy. Thirty-one men participating in a residential treatment program for child abusers constructed victim apology letters as a way of measuring/examining empathy deficits. The task was videotaped, transcribed, and subject to grounded theory techniques. It was discovered that intrafamilial offenders were more likely to minimize their behavior while exhibiting illicit power and control, whereas extrafamilial offenders were more likely to directly blame their victims and exhibit overtly explicit offense detail. From these open-coded categories, the axial categories of self as nonoffender, external blaming, and secondary victimization were derived. These results may have implications for the delivery of victim empathy components of sexual offender treatment programs.     

Human Rights and the Treatment of Sex Offenders

Human rights create a protective zone around persons and allow them the opportunity to further their own valued personal projects without interference from others. All human beings hold human rights and that includes sex offenders, although some of their freedom rights may be legitimately curtailed by the State. In this paper we apply the concept of human rights to sex offenders. First we briefly analyze the concept of human rights, their structure, and justification. Second, we apply our own model of human rights to the assessment and treatment of sex offenders. We conclude that a significant advantage of a human rights approach is that it is able to integrate the value and capability aspects of offender treatment.     

Patient Perceptions of Physician Burden in the Treatment of Chronic Pain

While patient perceptions of burden to caregivers is of recognized clinical significance among people with chronic pain, perceived burden to treating physicians has not been studied. This study examined how people with chronic pain perceived levels of medical evidence (low vs high) and pain severity (4,6,8/10) to influence physician burden and how burden then mediated expected clinical judgments. 476 people with chronic pain read vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity from the perspective of a treating physician, rated the burden that patient care would pose, and made a range of clinical judgments. The effect of pain severity on clinical judgments was expected to interact with medical evidence and be conditionally mediated by burden. Although no associations with burden were found for the pain severity x medical evidence interaction or for pain severity alone, low levels of supporting medical evidence yielded higher burden ratings. Burden significantly mediated medical evidence effects on judgments of symptom credibility, clinical improvement, and psychosocial dysfunction. Results indicate that perceived physician burden negatively influenced judgments of patients with chronic pain, beyond the direct effects of medical evidence. Implications are discussed for clinical practice, as well as future research.Perspective: People with chronic pain expect physicians to view the care of patients without supporting medical evidence as burdensome. Higher burden is associated with less symptom credibility, more psychosocial dysfunction, and less treatment benefit. Perceived physician burden appears to impact how patients approach treatment, with potentially adverse implications for clinical practice.     

Perceptions of Nurse Practitioners as Clinical Leaders in the Military

Health care systems need leaders to address complex challenges. This presents an opportunity for nurse practitioners (NPs). The United States Army is already using NPs as leaders. This study addresses the following 2 research questions: What are Army primary care clinicians’ perceptions of NPs as clinical leaders? and Are there differences in these perceptions? In this study, we used a survey that captured clinicians’ perceptions of NP leadership. Overall, respondents favored NPs as clinical leaders. Over 65% agreed that NPs were qualified as leaders within the Army. This study suggests clinicians perceive NPs as qualified and effective leaders at high levels throughout primary care.     

Rural Dwellers' Cancer Fears and Perceptions of Cancer Treatment

Abstract The purpose of this study was to explore differences in cancer fears and perceptions of cancer treatment among four rural groups: men with cancer, men caregivers, women with cancer, and women caregivers ( N = 590). The four groups differed in their cancer fears. About half or less feared pain, nausea, body disfigurement, and sexual problems from cancer. Over two-thirds were worried about finances and decreases in quality of life. More worried about separation from loved ones than worried about death. The four groups differed only slightly in perceptions of treatment. The majority thought chemotherapy, surgery, and radiation were important treatments. A larger percentage saw nutritional interventions and biologicals as unimportant in cancer prevention or treatment. Nurses need to address fears and perceptions of cancer treatment with persons experiencing cancer and their families. In addition, these persons and their families need support for decisions regarding cancer treatment.     

The Offence Process of Sex Offenders with Intellectual Disabilities: A Qualitative Study

There have been few attempts to build a model of sexual offending for men with intellectual disabilities and hence clarify appropriate intervention. This study examines any commonalities that characterize the offence process of such men. Using a grounded theory approach, qualitative interviews with sex offenders with intellectual disabilities are analyzed to generate a model of the offence process. Data from qualitative interviews with clinicians is used to triangulate offender participants’ data. The subsequent model highlights the importance of individual’s attitudes and beliefs and the impact that they have at all stages of the offence process. It raises issues concerning the variation in the process that is seen within and between offences. Additionally, it identifies a marked lack of awareness of any “decency insult” in these offenders, an inability to empathize with society’s view of sex offending. A clear implication is that thorough assessment and formulation are likely to be the key to successful and appropriate intervention.     

Multicultural Students' Perceptions of Nursing as a Career

Junior year students (=276) at a culturally diverse, urban high school were surveyed to examine how their perceptions of nursing compared with their perceptions of an ideal career. Findings indicate that significant differences exist among cultural and racial groups and between genders. Recommendations are made to increase recruitment of multicultural students into nursing .     

Perceptions of Parenting and Depression-Proneness in the Offspring: Dysfunctional Attitudes as a Mediating Mechanism

This research attempted to clarifythe mechanismthrough which dysfunctional parenting leads todepression in the offspring. Consistent with theorizingbyBeck (1967), we tested a three-stage causal pathway wherein dysfunctional parenting should giverise to dysfunctional attitudes in the offspring which,in turn, should give rise to depression-proneness in theoffspring. Another objective of this study was to further delineate the types of parentingbehaviors that give rise to dysfunctional attitudes inthe offspring. To this end, a large sample of collegestudents (N = 246) completed measures assessing four parenting dimensions (i.e., low care,overprotection, perfectionistic expectations, andcriticalness) as well as measures assessingdysfunctional attitudes, general depression-proneness,and current depression. Support for the depressogenic effects of allfour parenting dimensions was obtained in that eachparenting dimension correlated significantly withdysfunctional attitudes and depression tendencies in the offspring. Moreover, path analyses supportedBeck's three-stage causal model with perfectionistic andcritical parenting playing a particularly prominentrole. Last, after controlling for current depression, the partial correlations among the variables inthe three-stage model remained significant, suggestingthat the present findings were not simply the result ofa mood congruency effect. These findings illuminate additional parenting behaviors that can havedepressogenic effects and indicate that these parentingbehaviors exert their effects, at least in part, by wayof instilling dysfunctional attitudes in the offspring.     

Predictors of Recidivism in Australian Juvenile Sex Offenders: Implications for Treatment

Juvenile sex offenders charged with their first sexual offence were compared with recidivist juvenile sex offenders who had been charged with more than one sexual offence on a number of factors related to sexual offending. Participants were 70 male juvenile sex offenders, aged 13–21 years who were awaiting court disposition. Negative family history, negative family characteristics, school and learning problems, social skill deficits, deviant sexual experiences, deviant sexual fantasies, and cognitive distortions were assessed for their direct and mediating roles in recidivism. Path analysis indicated that poor social skills, learning problems, and deviant sexual experiences were causally related to recidivism of sexual offending. Poor social skills were directly related to recidivism, whereas cognitive distortions and deviant sexual fantasies mediated the role of learning problems and deviant sexual experiences. There was a significant association between deviant sexual experience and learning problems. The findings support the role of cognitive distortions and deviant sexual fantasies in recidivist sexual offending for this sample. The causal role identified for poor social skills and learning problems in recidivism for sexual offending has implications for treatment and therefore deserves further attention.     

Users' Perceptions of the Impact of Electronic Aids to Daily Living Throughout the Acquisition Process

This study investigated the experience of seven new users of a particular type of assistive technology through the stages of anticipating, acquiring, and using an electronic aid to daily living. A mixed methods research approach was used to explore each of these stages. The Psychosocial Impact of Assistive Devices Scale was used to measure the perceived impact of the new assistive technology on users' quality of life, and findings were further explored and developed through open-ended questioning of the participants. Results indicated that preacquisition of the device, users predicted that the electronic aid to daily living would have a positive impact on their feelings of competence and confidence and that the device would enable them in a positive way. One month after acquiring the device a reduced, yet still positive, impact was observed. By 3 and 6 months after acquisition, perceived impact returned to the same positive high level as preacquisition. It is suggested that prior to receiving the device, potential users have positive expectations for the device that are not based in experience. At the early acquisition time, users adjust expectations of the role of the assistive technology in their lives and strive to balance expectations with reality. Three to 6 months after acquiring an electronic aid to daily living, the participants have a high positive view of how the device impacts on their lives based in experience and reality. A model illustrating the electronic aids to daily living acquisition process is proposed, and suggestions for future study are provided.     

Sometimes Jello Helps: Perceptions of Headache Etiology, Triggers and Treatment in Literature

SYNOPSIS
Throughout history writers have attempted to describe the symptoms and evoke the misery of "a dismal headache."Writers from Plato to Stephen King have used the phenomenology of headache to illustrate their work. Lewis Carroll, for example, vividly describes the central scotoma, tunnel vision, phonophobia, vertigo, distortions in body image, dementia and visual hallucinations that often accompany migraine.
Although many authors have discussed the topic seriously, others have addressed the issue in a dismissive and even contemptuous manner, relegating this very real disorder to the status of a medical stepchild. We will examine headache etiology, triggers and treatment and explore the attitudes toward headache and headache sufferers found in literature.
We have recently seen a growing understanding of the physiological basis of headaches. However, this knowledge has not yet reached the level of literature or popular culture. In an age when it seems every Sunday night brings a new "disease of the week" movie, and every human ill is subjected to often intense and numbing scrutiny by the media, the anguish of a chronic migraine sufferer will probably remain unexplored - unless she kills her husband and children during an attack.     

雷米普利治疗原发性高血压左室重构的疗效观察

对比 6 4例原发性高血压 (EH)伴左心室肥厚 (LVH)患者服药前及服药后的血压及心脏彩色超声仪测左室壁厚度(PWT) ,室间隔厚度 (IVST)和左室舒张末期内径 (EDd)。结果服药 6个月后收缩压及舒张压治疗前后均有显著性差异(P <0 .0 1) ,特别是舒张压下降明显。PWT、IVST和EDd治疗前比较也有显著意义。     

Health Care Provider Perceptions of Pain Treatment in Hispanic Patients

Despite increasing numbers of Hispanic patients in the United States, this group continues to face disparities in access and quality of pain treatment. Although previous surveys have examined treatment disparities experienced by minority patients, none have provided a provider‐centric perspective on issues and concerns surrounding pain relief among pain patients of Hispanic/Latino origin. The goal of this study was to assess the relationship between provider characteristics (ie, Spanish fluency, Hispanic caseload size, and experience with Hispanic pain patients) and their perceptions of pain treatment in these patients. One hundred eighty‐seven health professionals completed an online survey. The major findings indicated that: (1) less than 20% of health professionals treating Hispanic pain patients reported Spanish proficiency at an advanced level; (2) surveyed health professionals were involved treating a significant proportion of Hispanic patients in their caseloads, but reported a lack of cultural competence training; (3) Spanish fluency and experience with Hispanic pain patients exerts a strong effect on the use of established pain treatment practices; (4) providers with greater Spanish fluency report a significantly greater effect of patients' cultural beliefs and attitudes on treatment; and (5) providers did not regard cultural or language barriers as significantly impacting opioid prescribing or patient compliance.