Physicians’ and pharmacists’ information provision and patients’ psychological distress

Providing information related to medication has many benefits for patients. However, patients’ conflicting perceptions about medical information provided by physicians and pharmacists may be associated with their psychological distress regarding treatment and medication. This study investigated associations between patients’ perceptions of agreement between physicians and pharmacists about medical information and improvements in their psychological distress. It also clarified the specific relationships of their perceptions with psychological distress. A cross-sectional survey was conducted in Japanese community pharmacy settings. Pharmacists approached 1,500 patients visiting community pharmacies and provided them with questionnaire packages. Patients completed the questionnaires at home and returned them to the researchers by mail. Multivariate logistic regression analysis and signal detection analysis were conducted to examine associations of patients’ perceptions of information agreement with improvement in psychological distress. Measures of improvement in worry and anxiety about disease, improvement in worry and anxiety about medication, and improvement in depressive mood were used to assess alleviation of psychological distress. A total of 645 patients returned the questionnaires; 628 contributed to the data. Multivariate logistic regression analyses clarified that patients’ perceptions of agreement in information regarding need for medication, methods for adverse drug reaction reduction, adverse drug reaction symptoms, coping with forgetting to take medication, and advice for daily life were significantly associated with improvements in psychological distress. Furthermore, signal detection analysis showed that several combinations of patients’ perceptions of agreement between physicians and pharmacists about specific medical information were also significantly associated with improvement in psychological distress. Consistent information provision by physicians and pharmacists could contribute to decreased psychological distress in patients, and consequently to adherence to treatment and taking medication.     

Preschool children’s communication,motor and social development: Parents’ and educators’ concerns

Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing.

Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n?=?275), receptive vocabulary (n?=?131) and language (n?=?274).

Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.     

Postoperative Pain: Nurses’ Knowledge and Patients’ Experiences

The aim of this study was to determine nurses’ knowledge and attitudes regarding postoperative pain and identify postoperative patients’ pain intensity experiences. The assessment and management of acute postoperative pain is important in the care of postoperative surgical patients. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing. A pilot study with an exploratory design was conducted at a large teaching hospital in the eastern United States. The convenience samples included 31 nurses from the gastrointestinal and urologic surgical units and 14 first- and second-day adult postoperative open and laparoscopic gastrointestinal and urologic patients who received patient-controlled analgesia (PCA). The Knowledge and Attitudes Survey Regarding Pain was used to measure nurses’ knowledge about pain management. The Short-Form McGill Pain Questionnaire (SF-MPQ) was used to measure patients’ pain intensity. The nurses’ mean score on the Knowledge and Attitudes Survey Regarding Pain was 69.3%. Patients experienced moderate pain, as indicated by the score on the SF-MPQ. There is a need to increase nurses’ knowledge of pain management.     

Mothers’ and fathers’ involvement in intervention programs for deaf and hard of hearing children

Purpose: Parental involvement in the rehabilitation process of deaf and hard of hearing (DHH) children is considered vital to children's progress. Today, fathers are more likely to be involved in their children’s care. Nevertheless, father involvement has been understudied and relatively little is known about their involvement in families with children who are deaf or hard of hearing. In addition, there are scant data on the correlates of parents’ involvement. This study explored similarities and differences in parental involvement between mothers and fathers in intervention programs for their D/HH children and tested a set of personal and social contextual variables that posited to affect parental involvement in a unique socio-cultural group.

Methods: Thirty Israeli-Arab couples (mothers and fathers) of young D/HH children took part. Each parent completed four self-report measures of parental involvement, parenting stress, parental self-efficacy, and social support.

Results: Mothers were significantly more involved than fathers in their child's intervention. Specifically, they report on higher interest and attendance and overall being more actively engaged with professionals in the child’s intervention. Both mothers and fathers had a rather passive style of involvement in their child's intervention. Parental self-efficacy and informal and formal social support were associated with father involvement. For mothers, only formal social support was associated with involvement.

Conclusion: For the Israeli-Arab population, the findings underscore the differences between mothers’ and fathers’ multiple dimensions of involvement in the intervention program of their D/HH children and their predictors. The results suggest important avenues for prevention and intervention activities when working with families of children who are D/HH.

• Implications for rehabilitation

• Parental involvement in intervention programs for children who are deaf or hard of hearing (D/HH) is vital to children's progress and an essential component of implementing family-centered service provision.

• Understanding of both mothers and fathers multiple dimensions of involvement and the factors that facilitate or hinder their parental involvement in their children’s intervention programs, will equip professionals to better support parents of D/HH children aligned with the principles of family centered care service delivery.

• Mothers and fathers style of involvement reflects on gaps between the goals of family centered care and their implementation in the realities of everyday practice.

• The experiences and behaviors of mothers and fathers should not be seen as interchangeable.

     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Nurse Practitioners’ and Nurse Practitioner Students’ LGBT Health Perceptions

Nurse practitioner (NP) and NP student perceptions of adult lesbian, gay, bisexual, and transgender (LGBT) health needs were qualitatively explored. One overreaching theme, “We need to do better. We have a lot to do,” and four key themes were identified: (1) same basic health needs as straight people; (2) a little more risk, a little more help, a little extra care; (3) breaking down that trusting, honest provider relationship; and (4) society sucks and social media and politics play a major role. Results support the need for future research exploring NP and NP student understanding of LGBT health needs.     

A descriptive study on emergency department doctors’ and nurses’ knowledge and attitudes concerning substance use and substance users

AimThe aim of this study was to determine emergency department doctors’ and nurses’ knowledge and attitudes regarding problematic substance use and substance users.MethodsData were collected using an adapted survey questionnaire and the Substance Abuse Attitude Survey (SAAS). By means of convenience/opportunistic sampling all emergency department doctors and nurses (N = 145) working in three university teaching hospitals in Ireland were asked to fill out the knowledge and attitudes questionnaire.ResultsA response rate of 46%, N = 66 was achieved. Results indicate that participants’ current level of knowledge about alcohol and drug misuse in general, is satisfactory. A particular knowledge deficit in relation to intervention strategies, and other substances was identified. The majority of participants have never received any specific training regarding substance use and this suggests that substance using patients are managed inadequately. The SAAS results indicate that participants exhibited near-optimal attitudes for constructive working with substance using patients.ConclusionThere is an urgent need for further in-service training programmes and the development of standard protocols/guidelines for the identification and management of substance using patients who present in the emergency department.     

Survey of pharmacists’ and physicians’ perceptions of therapeutic interchange

Therapeutic interchange has long been an integral part of drug formulary management, but physicians’ and pharmacists’ attitudes toward such programs are relatively unknown. This survey was undertaken to determine pharmacists’ attitudes, physicians’ potential response to a hypothetical interchange, and how well pharmacists predicted physicians’ responses. A survey that described a drug interchange program and several potential responses to the proposed switch was provided to 300 staff physicians at a 512-bed community facility in southwest Florida; the survey was also mailed to pharmacy directors or clinical pharmacy coordinators at 42 southwest Florida hospitals. Responses were obtained from 98 physicians and 95 pharmacists. Most physicians would not cooperate with an interchange if they were not familiar with the proposed drug; 16% would continue to prescribe the original drug, knowing that the new agent would be provided; and 58% would switch to another agent with which they had clinical experience. Only 26% of physicians would follow the interchange program. In contrast, 48% of pharmacists believed that physicians would continue to order the original therapy, 32% believed that physicians would order the new agent, and only 20% believed that physicians would switch to an alternative drug (P < .005 vs physician responses). Clearly, pharmacists’ expectations of physicians’ response to a therapeutic interchange differ significantly from the physicians’ expected behavior. This difference has potentially important implications for actual versus projected cost savings of therapeutic interchange. This paper was presented as a poster at the American Society of Health System Pharmacists Clinical Meeting and Exhibits in New Orleans, Louisiana, December, 1996. (Work completed while employed by Manatee Memorial Hospital in Bradenton, Florida.)     

Comparing patients’ and physiotherapists’ views of professionalism and professional standing: an Australian perspective

Background: Professionalism in health care comprises adherence to professional values and ethical codes, discipline-specific standards of practice and competencies, and specific expectations about appearance and social standing. Specialisation in a particular area of practice further increases expectations of professionalism and competency-based standards.

Objective: To investigate, in an Australian setting, patients’ and physiotherapists’ perceptions of the features and value of professionalism in specific physiotherapy practice contexts.

Major Findings: The professional standing of physiotherapists was similar to that of chiropractors, with judges, general practitioners and solicitors more highly regarded by both patients and physiotherapists. Participants had similar views about the importance of several elements of professionalism. In response to questions about professional appearance, both patients and physiotherapists preferred business attire for male physiotherapists, whereas opinions varied for female physiotherapists. Patient/therapist views diverged regarding the link between specialisation and professionalism. Patient participants presented with a list of physiotherapists with differing nomenclature/titles to treat their back pain indicated they were more likely to select a physiotherapist with a special interest in back pain and factors such as location of the physiotherapy service and recommendations from a friend influenced their choice of physiotherapist. In contrast, physiotherapist participants responded that postgraduate qualifications, years of experience and facilities were more important in the choice of a physiotherapist.

Conclusions: Patients and physiotherapists share some views on professional behaviours and values, professional appearance and standing within the community. They differ with regard to perceptions of specialisation and how extra qualifications add to their perception of trust and professionalism.     

Incidence of chemotherapy-induced nausea and vomiting in Taiwan: physicians’ and nurses’ estimation vs. patients’ reported outcomes

Background The major objective of the study was to determine the incidence and prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) among patients receiving chemotherapy and assess the accuracy with which medical providers perceive the incidence of CINV in their practice.Methods Specialists, residents and nurses (medical providers) from two cancer centers in Taiwan estimated the incidence of acute and delayed CINV. Chemotherapy-naïve patients from the same centers then completed a 5-day nausea and vomiting diary following highly and moderately emetogenic chemotherapy (HEC and MEC) to determine the actual incidence of acute and delayed CINV. Daily nausea ratings were recorded on a 100-mm visual analogue scale (VAS). No nausea was defined as a nausea VAS score <5 mm. Vomiting episodes were also recorded. Nausea and vomiting were defined as acute and delayed based on whether they occurred during the first 24 h after chemotherapy, or during days 2–5 after chemotherapy, respectively.Results In the two oncology centers, 37 medical providers (13 specialists, 4 residents, 20 nurses) and 107 patients were enrolled. The mean patient age was 49.2 years with 76% female and 74% having breast cancer. Of the 107 patients, 39% received HEC and 61% received MEC, and 77% received a 5-HT3 receptor antagonist and 94% received dexamethasone. There were no significant differences between patients with acute CINV and delayed CINV in terms of demographics, chemotherapy treatment or antiemetic treatment. The proportion of patients without alcohol use was significantly higher among patients with delayed CINV than among those with non-delayed CINV. Good control of CINV during the acute period correlated with the control of delayed emesis. There were no significant differences between specialists, residents, and nurses estimations of the incidence rates of CINV. For HEC given to chemotherapy-naïve patients, the medical providers estimated acute CINV to be 44/41% and delayed CINV to be 61/53%, respectively. However, patient diaries revealed acute CINV to be 43/21% and delayed CINV to be 64/60%, respectively. For MEC given to chemotherapy-naïve patients, medical providers estimated acute CINV to be 39/36% and delayed CINV to be 44/39%, respectively. However, patient diaries revealed acute CINV to be 55/18% and delayed CINV to be 74/55%, respectively.Conclusions Medical providers significantly overestimated the incidence of acute vomiting by 20% and 18% in HEC and MEC patients, respectively. While they correctly estimated the rate of delayed vomiting in HEC patients, they underestimated it by 16% in MEC patients. With respect to nausea, medical providers correctly estimated rates of both acute and delayed nausea in HEC patients, but significantly underestimated rates of acute and delayed nausea by 16% and 30%, respectively, in MEC patients.     

Cancer Caregivers’ Prognostic and End-of-Life Communication Needs and Experiences and their Impact

ContextFamily caregivers of patients with advanced cancer are integrally involved in communications regarding prognosis and end-of-life (EOL) planning and care. Yet little research has examined caregivers’ communication experiences or the impact of these experiences on patients and caregivers at EOL.ObjectivesInvestigate cancer caregivers’ communication experiences and potential impact on patient and caregiver outcomes.MethodsSemistructured interviews with bereaved family cancer caregivers (N=19) about their communication needs and experiences as their loved one approached EOL and died. Audiotaped interviews were transcribed and thematically analyzed for communication-related themes.ResultsCaregivers described fulfilling many important communication roles including information gathering and sharing, advocating, and facilitating—often coordinating communication with multiple partners (e.g., patient, family, oncology team, hospital team). Caregivers reported that, among the many topics they communicated about, prognosis and EOL were the most consequential and challenging. These challenges arose for several reasons including caregivers’ and patients' discordant communication needs, limited opportunity for caregivers to satisfy their personal communication needs, uncertainty regarding their communication needs and responsibilities, and feeling unacknowledged by the care team. These challenges negatively impacted caregivers’ abilities to satisfy their patient-related communication responsibilities, which shaped many outcomes including end-of-life decisions, care satisfaction, and bereavement.ConclusionCaregivers often facilitate essential communication for patients with advanced cancers yet face challenges successfully fulfilling their own and patients’ communication needs, particularly surrounding prognostic and end-of-life conversations. Future research and interventions should explore strategies to help caregivers navigate uncertainty, create space to ask sensitive questions, and facilitate patient-caregiver discussions about differing informational needs.     

Oral mucositis: a phenomenological study of pediatric patients’ and their parents’ perspectives and experiences

Goal  The purpose of this qualitative phenomenological study was to describe children’s and their parents’ lived experiences of oral mucositis (OM) and to explore their needs in relation to OM. Materials and methods  Individual semistructured interviews were conducted with 22 children who had experienced WHO grade ≥ 2 OM during chemotherapy within the previous 6 months. Parents from each family were also interviewed in the same way. Interviews were audio recorded and fully transcribed verbatim. Data were analyzed using inductive content analysis. Results  The mean ages of the children and parents were 12 and 41 years, respectively. Regarding gender, 55% of the children were boys, and 95% of the parents were mothers or grandmother. Forty-one percent of the children were diagnosed with acute lymphoblastic leukemia, and 36% were treated with methotrexate. The findings illustrated that the experience of OM impacted on the lives of the children and their parents. Five themes, which subsumed a number of categories, were constructed: “Symptoms experienced,” “Negative emotional outcomes,” “The dilemma of eating (or not eating),” “Challenges in oral care,” “Health care needs.” Mouth and throat pain were found to cause a number of severe consequences in daily life. Many children experienced turmoil characterized by a panoply of emotions. All parents described psychological distress on various levels which they attributed to the burden of care and the suffering of their children. OM can present a difficult dilemma to patients: on the one hand, children found it too painful to chew and swallow food, while on the other hand they felt very hungry. Children were aware of the significance of oral care. Discomfort associated with oral care forced some children to neglect oral care. Parents also described oral care as a stressful event for their children and for them. Children needed more activities coordinated by the ward to distract them from their OM, as well as psychological support from the health care professionals. Parents indicated the need for more information about the process of OM and food selection. Conclusion  Findings from this study illustrate the complex biopsychosocial impact of chemotherapy-induced OM on children and their parents. Optimal OM pain management guidelines and holistic supportive care strategies should be developed in conjunction with OM strategies in the future. This study was supported by the Lee Hysan Foundation Research Grant of United College of the Chinese University of Hong Kong. The abstract of this paper was partially presented at the 2nd Annual Mucositis Research Workshop of the 2008 MASCC/ISOO International Symposium, Houston, 24 to 28 June 2008.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background

: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation.