Hospitalisation process seen by patients and health care professionals

Appropriate use of hospitalisation is an important concern in most countries. Previous studies have relied on professional opinion regarding the appropriateness of hospital stays, neglecting the patients' point of view. The purpose of this cross-sectional study was to assess the patients' point of view about the appropriateness of their hospital stay and to evaluate agreement with health care providers' opinions. It was undertaken in a medical rehabilitation division of the University Hospitals of Geneva in Switzerland. Patients reported their opinion on the justification of their hospital stay on the day of the interview, the reason why they judged their stay to be appropriate, and the place where they should be if not. The patients' health care providers answered the same questions. Two-hundred and fifty-four patients contributed to the evaluation of 314 days of hospitalisation. Only 20 hospital days (6%) were considered unjustified by patients, compared to 63 (20%) by health care providers (p<0.001). There was no agreement between these two judgements (Kappa=0.00,95% CI: -0.09 to +0.09). Similarly, there was little or no agreement concerning the reasons justifying the stay (Kappa=0-0.47) and concerning discharge planning. These results suggest that the definition of an appropriate hospital stay is complex and depends upon each actor's point of view. Better communication between patients and health care providers about decisions related to the hospitalisation process would be desirable.     

Negotiating skill for health care professionals

Health workers engage in negotiations at work and at home on a daily basis. The ability to negotiate is a vital part of interpersonal skill. The paradigm of negotiation strategy is undergoing a profound shift from power pressure to an egalitarian form of problem solving or value-added approach that is much more likely to result in win/win outcomes. The basic principle of this refreshing innovation is similar to what we learned about brainstorming and creative problem solving.     

Relationship between health care professionals and HIV positive women: a gender approach

This article presents the results of research in 2003 focusing on the relationship between health care professionals from a public clinic and HIV positive women, adopting a gender approach. Ten patients and seven attending professionals were interviewed on the following themes: gender representations; representations of HIV/AIDS in women; and accommodation and resistance strategies to internalized attitudes and values regarding the health professional/patient relationship. According to the results, health professionals attempted to adjust the treatment to the limited resources of both the institution and the patient, endeavoring to offer the most complete care possible. Their social imagery continues to portray the traditional role of woman/mother/wife, perceived as a victim. Meanwhile patients adopted a "fighting woman" image, reinforced by the "modern woman" ideology, produced in both public and private spheres, disguising the effects of the women's double workload. Contrary to the myth of passivity, patients took an active stance towards their treatment, negotiating with health professionals about their own needs and objective possibilities. Despite the material and symbolic limitations, the potential was identified for changes in health care in order to achieve full reproductive rights.     

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.     

Primary health care product defined by health professionals and users

OBJECTIVE: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. METHODS: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. RESULTS: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. CONCLUSION: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.     

Educating allied health professionals to provide care for cancer patients and their families

From 1985 to 1988, a state-wide program of cancer education was offered to community-based allied health professionals (AHPs) at five different program sites in Pennsylvania. During this three-year period, 512 social workers, clergy, dieticians, physical therapists and others received training to increase their knowledge about cancer and counseling, improve their supportive attitude regarding cancer patients and families, and decrease stress related to their work with this population. Overall, the Program was successful in reaching AHPs working with cancer clients who had little formal training in the cancer field. At the beginning of training, it was observed that AHPs with initially higher levels of education and more years of work experience with cancer patients had higher levels of counseling knowledge. Those who were women, worked in hospitals, or had worked with cancer patients longer exhibited higher levels of cancer knowledge. Participants who were women and who had more education had reported lower levels of job stress. Among those AHPs who completed the training courses, cancer knowledge increased by 14 percent. In addition, knowledge related to counseling cancer patients and their families improved by 11 percentage points. Perceived job stress among the AHPs also declined by 10 percent. Finally, participant supportive attitude concerning cancer clients improved.     

Interdisciplinary education for health care professionals.

As the interdisciplinary approach to health care becomes more important, new approaches to interdisciplinary education for health professionals are needed. This article presents objectives for interdisciplinary learning and describes one such course designed to deal with the problem of child abuse.