Reducing children's immunization distress in a primary care setting.

The purpose of this study was to compare two brief, inexpensive distraction techniques for children receiving immunizations during a county-sponsored immunization clinic. Preschool children (n = 80) were assigned to a party blower intervention, a pinwheel intervention, or a control group. Nurses were instructed to use "standard instructions" for the control group, and to simply provide the distracter and encourage use, but not to spend time trying to train the child or force them to use it, for the other groups. Results of planned comparisons indicated significant party blower results in the children's ratings of reduced distress (P < .01) and the parents' ratings of having to hold their child less strongly (P = .04), and showed it to be more distracting than the pinwheel (P < .02). The overall pattern of results on all rating scales supports the efficacy of using a party blower for reducing children's immunization distress, with minimal staff training and no procedural delay.     

Diabetes education in the primary care setting.

Most diabetes education occurs in primary care settings and its effectiveness is often dependent upon a therapeutic patient-provider relationship. Providers must assess the patient's knowledge about and willingness to comply with treatment. A written contract with specific goals and behaviors may facilitate the learning and records of education sessions provide the means to monitor and evaluate progress through the educational process. Recommendations for choosing a formal diabetes education program are also included.     

Teaching the concepts of rehabilitation in a primary care setting.

To teach the concepts of rehabilitation to undergraduates in a clinical, primary-care setting, it is essential to first mobilize student awareness regarding patient dysfunction. After some sensitivity has developed, faculty can focus on rehabilitation theories and processes. This method of teaching is generally accepted positively by students. A daily chart review has proved useful for identifying rehabilitation issues for students and is suggested for other health care agencies as a practical way to promote rehabilitation among primary-care providers.     

Rethinking chronic pain in a primary care setting

Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.     

Screening for substance abuse in a primary care setting

This article addresses the need for the nurse practitioner functioning in nearly any type of primary care setting to appreciate the potential of substance abuse in the client population. The addiction assessment tool serves as a guide for obtaining a precise health history regarding substance abuse. This information can assist the health provider in selecting the appropriate treatment strategy. A brief synopsis of substance abuse treatment modalities summarizes the vast field of research and referral sources which are available to the client. Hallmarks of recovery attempt to direct the nurse practitioner toward a realistic treatment plan.     

The use of hypnosis in a primary care setting

An aware clinician using the modality of hypnosis either themselves or induced by a trained practitioner will find many indications on a daily basis. The application can be used for control of symptoms such as nausea or pain or, in the case of some clinical conditions, as a primary or adjunctive therapy. An overview of the commonly occurring opportunities for the use of hypnosis is presented in this article.     

Diagnosing binge eating disorder in a primary care setting

Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment–seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that it is not merely a subtype of obesity.     

Northern nursing practice in a primary health care setting

BACKGROUND: This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices. AIM: It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities. METHODOLOGY: The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process. RESULTS: The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community. CONCLUSION: The nurses in this study saw building trust to promote health and well-being in communities as very important, yet very difficult to achieve. The difficulty in part stems from the constraining, structural, administrative, historical, cultural and political contextual realities that have shaped northern community nursing.     

Pressure ulcer benchmarking within a primary care setting

Patient-focused benchmarking was initially launched by the Department of Health. This article examines how the tissue viability service of Camden and Islington primary care trusts implemented the pressure of ulcer benchmarking process within the nursing teams of these trusts. This was achieved by: agreeing best practice through examination of local and national guidelines; developing a suitable audit tool for nursing teams to assess their clinical areas against this best practice; nursing teams producing core action plans to facilitate movement towards best practice; disseminating results; reauditing. The results of the audits carried out in October 2003 and February 2004 are presented. A plan for future work is described including: the involvement of other members of the multidisciplinary team and the Patient Advice Liaison Service; linking pressure ulcer benchmarking to the benchmarks of communication, privacy and dignity and record keeping.     

Improving eye care in the primary health care setting

One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO's providing eye care, decentralization of services and the establishment of an eye care committee in the region.