Nurses'' Beliefs about Nuclear War Avoidance

A questionnaire survey of 156 nurses from western New England institutions of health care and education was conducted to explore their beliefs regarding the avoidance of nuclear war. Twenty-five questions from the Voter opinion on nuclear arms policy manual were adapted to express the dimension of the health belief model (HBM) and analyzed to determine relationships among these dimensions, nurses' belief in action to avoid nuclear war, and demographic characteristics of the sample. A strong negative correlation existed between the susceptibility and severity dimensions of the model, which characterized two distinct beliefs about action to avoid nuclear war. A high score on the susceptibility dimension reflected a belief that the respondents felt vulnerable to consequences of nuclear war but believed in the efficacy of personal action. A high score on the severity dimension was related to a belief in the potential catastrophic nature of nuclear war and was associated with perceptions of strong barriers to taking action. The demographic characteristics of membership in a professional organization, opinion of the role of professional nursing organizations in opposing nuclear war, and parental status were not predictive of actions taken to avoid nuclear war.     

Academic nursing clinic: impact on health and cost outcomes for vulnerable populations.

The purpose of this study was to examine selected health and cost outcomes of clients who used an academic nursing clinic (ANC) located in a high-rise public housing facility for low-income citizens. Service use, health promotion and screening, quality of care, satisfaction and costs were examined. Health outcomes were improved. Estimated cost savings were about $36,000 during the first year with reduced paramedic and police calls, hospitalizations, and emergency room visits. Findings show that advanced practice nurses can positively influence health outcomes by providing cost-effective quality health care.     

Mothers' health beliefs and use of well-baby services among a high-risk population

The relationship between mothers' health beliefs and use of well-baby services among a poor, minority, high-risk population is reported. Data were collected from 61 black mothers attending a maternal-child clinic by interviews at the first and sixth months after the birth of their infants. The analysis focused on four health beliefs (susceptibility, severity, benefits, and efficacy) and two health behaviors (clinic visits and immunizations during the first 6 months). Although mothers' health beliefs were not predictive of clinic visits, health beliefs at the sixth month accounted for 30% of the variance in the number of immunizations. This relationship was dominated by perceived efficacy of immunizations and perceived benefits of well-baby services. The findings indicate a need to consider the nature and extent of possible changes in relationships between health beliefs and health behaviors over time.     

Mental illness and Egyptian families

ABSTRACT:  People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians' beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians' experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others' beliefs, values, and practices.     

The cultural aspects of the practice of Community Health Agents in rural areas

The daily practice of Community Health Agents (CHAs) is permeated with educational interventions aimed at preventive care and health promotion. The sociocultural universe of these professionals can affect the dynamics of their practice within the community, particularly in rural areas, where there is evidence that the population expects to obtain information relative to their health and/or disease by means of cultural rites. Based on a case study, we sought to analyze the influence of the cultural practices of the agents working in a rural area in the interior of the state of Minas Gerais. The analysis revealed the presence of a strong connection between the culture and their activities. Religious beliefs and knowledge developed from the fusion of biomedical information and values based on family tradition regarding the health-disease process have a direct effect on their practices. It is emphasized that they have an important role as facilitators in the practice of health care, with a positive effect stemming from the similarity of their life experiences and inherited cultures with those of the clients, thus making it possible to develop effective interventions.     

Prenatal health promotion content and health behaviors

To improve the effectiveness of prenatal care, there is a need to understand the association between health promotion content and health behaviors during pregnancy. The purpose of this study was to determine the association between prenatal health promotion content and health behaviors during pregnancy among low-income African American and Mexican American women. Twenty-two recommended health promotion topics and their related health behaviors were measured. Structured interviews on health promotion topics and health behaviors were conducted with 159 pregnant women receiving prenatal care at a low-risk urban clinic. Wide variation was found in the number of health promotion topics discussed. Bivariate and regression analyses examined the association between content topics and behaviors. Healthier behaviors were associated with women's reports of discussing more health promotion topics, using fewer substances prepregnancy, and having a more positive attitude toward pregnancy. Data suggest that increasing prenatal health promotion content during routine visits might improve the effectiveness of prenatal care.     

Patient exposition and physician explanation in initial medical interviews and outcomes of clinic visits

To replicate an earlier study and explore associations between verbal behaviors in patient-physician interactions and outcomes of care, 102 visits to a medicine walk-in clinic were tape-recorded, transcribed, and coded according to the Verbal Response Mode (VRM) system. Questionnaires given before and after the clinic visit and telephone interviews 1 week and 4 weeks after the visit were used to measure patient satisfaction, compliance, and change in symptoms. Data were collected on patients' sociodemographic characteristics, illness characteristics, and health beliefs. Two verbal exchanges were examined: in the medical history, the Patient Exposition exchange, which was measured as the frequency with which patients make statements about their illnesses in their own words; and in the conclusion, the Physician Explanation exchange, which was measured as the percentage of physician statements that are factual. These verbal indexes showed correlations with patient satisfaction, thus replicating the earlier study, but no significant correlations with compliance. Analysis of variance showed that the association between verbal exchanges and patient satisfaction remained after controlling for physician differences and for patient age, education, and belief in the controllability of the illness.     

Metabolic control in non-insulin-dependent diabetes mellitus: factors associated with patient outcomes

We conducted a cross-sectional study to assess the association of various demographic and medical-care variables with metabolic outcomes in non-insulin-dependent diabetic subjects. The study population was representative of the diagnosed care-seeking diabetic population of a defined geographic community on the Navajo reservation in Arizona. The dependent variable metabolic control was measured as the mean of all random plasma glucose values obtained only at scheduled diabetes clinic visits over 2 yr. Multivariate analysis of the data showed that better metabolic control was most strongly associated with compliance with scheduled appointments. Mode of treatment was also associated with metabolic control. Other variables tested, including source of care, age, sex, duration of diabetes, presence of complications, and weight change, were not associated with metabolic control. The strongest analysis of covariance model with demographic and medical-care variables accounted for 39% of the variance in metabolic control. The analysis suggests that other variables, possibly including several psychosocial variables, need to be assessed for their contribution to metabolic control.     

Health Orientation, Beliefs, and Use of Health Services Among Minority, High-risk Expectant Mothers

This article reports on initial findings of a continuing longitudinal study investigating the relationships of health beliefs as conceptualized by the health belief model and the use of well-baby services among first-time black mothers. The health beliefs of mothers about their babies were measured before the babies were born and during their use of the services at the baby's first and sixth-month visits. Mothers in the sample who became nonusers of the well-baby services were also interviewed. This report describes the results of the first interview of the 662 females who composed the sample for the study, including the following characteristics of a minority, high-risk population: health orientation, health beliefs about their unborn babies, and use of health services. These findings are discussed with implications for community health nursing practice with maternal clients.     

Evaluation of health promotion activities in community nursing practice

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients A cross-sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England Two hundred and fifty-one (83 67%) completed questionnaires were returned by CNs working in primary health care (PHC) Sixty sessions with CNs were observed and 249 interviews were conducted with clients Additionally, as part of the observation 155 clinical records were examined CNs reported involvement in a wide range of opportunistic and organized health promotion activities Lifestyle advice and ill-health prevention were most frequently used by all groups Health visitors (HVs) were involved significantly more in group and community wide activities District nurses (DNs) were mainly involved in opportunistic health promotion Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent Records however showed that this information was rarely recorded The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs 'clients knew what other health promotion activities were available to them and few DNs' clients were aware of any     

The function of home visits in maternal and child welfare as evaluated by service providers and users

This study looks at how public health nurses and clients of maternal and child welfare clinics evaluate the function and meaning of home visits Another concern is with the options available to the service user The data were collected during November and December 1992 from a total of 203 health centres across Finland, responses were obtained from 263 public health nurses and 323 clients The results are presented in the form of frequencies, percentages and cross tabulations According to the results, the clients felt that the most important function of home visits was to have a competent professional examination of the newborn They also attached much importance to the information function, i e learning about the growth and care of small children The public health nurses, on the other hand, felt that the most important function of home visits was to support and encourage parents and to ensure the continuity of care The advantages of meeting in the client's home environment were equally stressed by both sides By contrast, clients and public health nurses had very different views on the options available to the client Almost all nurses said that the client can freely choose between home visits and visiting the clinic, however, only about half the clients felt they could choose the service they best preferred     

A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I

OBJECTIVE: To investigate the primary care, health promotion activities associated with what has historically been called "maintenance care" (MC) as used in the practice of chiropractic in the United States. This includes issues such as investigating the purpose of MC, what conditions and patient populations it best serves, how frequently it is required, what therapeutic interventions constitute MC, how often it is recommended, and what percent of patient visits are for prevention and health promotion services. It also investigates the economic impact of these services. DESIGN: Postal survey of a randomized sample of practicing US chiropractors. The questionnaire was structured with a 5-point ordinal Likert scale (28 questions) and brief fill-in questionnaire (12 questions). The 40-question survey was mailed to 1500 chiropractors selected at random from a pool of chiropractors with active practices in the United States. The National Directory of Chiropractic database was the source of actively practicing chiropractors from which doctor selection was made. The sample was derived by using the last numbers composing the zip codes assigned by the US Postal Service. This sampling method assured potential inclusion of chiropractors from all 50 states, from rural areas and large cities, and assured a sample weighting based on population density that might not have been afforded by a simple random sample. RESULTS: Six hundred and fifty-eight (44%) of the questionnaires were completed and returned. US chiropractors agreed or strongly agreed that the purpose of MC was to optimize health (90%), prevent conditions from developing (88%), provide palliative care (86%), and minimize recurrence or exacerbations (95%). MC was viewed as helpful in preventing both musculoskeletal and visceral health problems. There was strong agreement that the therapeutic composition of MC placed virtually equal weight on exercise (96%) and adjustments/manipulation (97%) and that other interventions, including dietary recommendations (93%) and patient education about lifestyle changes (84%), shared a high level of importance. Seventy-nine percent of chiropractic patients have MC recommended to them and nearly half of those (34%) comply. The average number of recommended MC visits was 14.4 visits per year, and the total revenue represents an estimated 23% of practice income. CONCLUSIONS: Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.     

Health beliefs: a cultural division?

Uptake of preventive health programmes seems to be related to people's underlying motivations, attitudes and beliefs about health and illness. Current theories used to account for variance in behaviours by social group (such as the health belief model and locus of control model) explain only some of the variance in these motivations and attitudes, and have not been adequately tested on women from different ethnic minority groups. Health beliefs have important implications for nursing given the role of the nurse in health promotion and patient teaching. This paper identifies and compares the health beliefs of women of Asian origin and white indigenous women living in an inner-London borough, through in-depth semi-structured interviews, and considers the findings in relation to health promotion practices and the role of the nurse. The Asian women rated their health as worse than the white women; this requires further study. Comments and views gathered about the causes of various diseases indicated that it may be unrealistic to fit a person's health beliefs into a distinct model. Beliefs about disease appeared to be culturally sensitive; health education, therefore, must also be culturally sensitive.     

Promoting the mental health of elderly African Americans: a case illustration

Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.     

Factors at first diagnosis of tuberculosis associated with compliance with the Directly Observed Therapy (DOT) in the Limpopo Province,South Africa

The aim of this study is to compare and contrast health beliefs, demographic and socio-economic variables, causative beliefs, knowledge, health-seeking behaviour and health provider-patient interaction of compliant and non-compliant tuberculosis patients. The sample included 219 consecutive new sputum-smear and/or culture positive pulmonary tuberculosis patients registered between October 1999 and March 2000 in three hospitals in the Limpopo Province of South Africa. The patients were 144 (65.8%) men and 75 (34.2%) women in the age range of 18 to 79 years (M age 35.9 yr., SD = 12.6). The consultation at first diagnosis was observed and tape-recorded. Thereafter an interview was conducted and a questionnaire was face-to-face administered with the patient including knowledge, causative beliefs, health seeking, and Health Belief Model items. Discriminant analysis between compliant and non-compliant groups after six months follow-up showed that the quality of the health practitioner-patient interaction and causative belief were associated with compliance behaviour whereas knowledge, onset of TB, sociodemographic variables, health care seeking, and health beliefs were not associated.     

手部肌腱修复术后患者健康信念与康复治疗依从性相关性分析

目的:了解肌腱修复术后患者的健康信念及其与康复治疗依从性的关系.方法:对228例手部肌腱修复术后患者进行调查,内容包括患者的基本情况、健康信念和治疗依从性等.采用SPSS 11.0统计软件对资料进行分析.结果:228例手部肌腱修复术后患者治疗依从性总得分为(35.32±6.95)分;术后患肢功能康复治疗依从性与健康信念及其各维度的相关分析中,显示患者的健康信念与治疗依从性呈显著正相关.肌腱修复术后患者越能认识到治疗行为的益处及必要性,维护身体健康的动机越强,其治疗依从性越高;而认为术后功能康复治疗有害、没有必要治疗者其依从性较差.结论:手部肌腱修复术后患者的健康信念影响着患者术后的功能康复治疗依从性.为提高护理质量,有助于术后康复训练和减少肌腱粘连,护士应关注手部肌腱修复术后患者的健康信念及其对治疗依从性的影响,使护理干预措施更加系统化.     

Patient and clinic factors predictive of missed visits and inactive status in a multicenter clinical trial. The Macular Photocoagulation Study Group.

Obtaining complete patient follow-up in clinical trials is important for the analysis of treatment results and for good patient care. Incomplete data can introduce bias into study results and can alter conclusions concerning treatment efficacy. The purpose of this study was to explore in a case-control design patient and clinic factors that may be associated with missed visits or inactive status within three clinical trials conducted as part of the Macular Photocoagulation Study. All inactive patients, all patients with any missed visits, and a random sample of patients with no missed visits were selected for interview. A total of 175 patients (60% of 292 selected) participated in the study. Two factors were found to be significantly associated (P less than .05) both with inactive status and with having any missed visits: health problems and travel costs. Several patient and clinic factors were found to be associated only with inactive status. These included change in marital status since joining the study, retirement since study entry, unsatisfactory interactions with the study physician or clinic coordinator, too little time spent with the study physician, and patient's belief that participants should be paid to participate in clinical trials. Distance from the clinic greater than 100 miles, in addition to health problems any time during follow-up and problems with travel costs, was found to be associated only with having any missed visits. This study emphasizes the importance of maintaining good patient-staff interactions and sensitivity to the events in a patient's life in order to obtain complete patient follow-up.