The Development of a Scale to Assess the Training Needs of Professionals in Providing Sexuality Rehabilitation Following Spinal Cord Injury

The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.     

Validation of the Knowledge,Comfort, Approach,and Attitudes Towards Sexuality Scale for Use with Rehabilitation Counseling Students: An Exploratory Factor Analysis

Sexuality and Disability - As research on sexuality and disability in the field of rehabilitation counseling increases, having a validated measure to assess knowledge, comfort, and attitudes...     

Allied health professional students' perceived level of comfort in clinical situations that have sexual connotations

This study examined the anticipated level of comfort of 1,132 higher education students enrolled across physical therapy, occupational therapy, medical radiation sciences, rehabilitation counseling, leisure and health sciences, and behavioral health science professional courses. Participants were asked to indicate their anticipated level of comfort for a range of clinical interactions that have sexual implications. More than half of the students anticipated that they would not feel comfortable in dealing with the issues raised in 9 of the 19 sexually themed items. Significant gender differences were identified for some of these items. These gender differences should be taken into account when developing sexuality curricula. Feelings of discomfort when interacting with clients could impede appropriate therapeutic interventions. Further research investigating the nature and cause of discomfort in clinical settings is required. Studies that examine the usefulness of sexuality education programs in increasing practitioner comfort also should be carried out.     

Addressing Sexuality as Standard Care in People with an Upper Limb Deficiency: Taboo or Necessary Topic?

The purpose of this paper is to analyze whether professionals who work with people with an upper limb deficiency (ULD) received questions about sexuality from their patients and whether they addressed sexuality themselves, and to analyze their knowledge and comfort level, approach and attitudes towards sexuality. An online questionnaire, including questions on self-perceived sexological competence and the Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) was used to asses these aspects. One out of three professionals had received a question about sexuality from their patients. Nearly one out of five professionals had addressed sexuality themselves. Professionals who received a question about sexuality from patients or addressed this issue themselves had significantly higher scores on self-perceived knowledge about sexuality and on self-perceived conversation skills compared to professionals who did not. The scores on the KCAASS Knowledge and Comfort of professionals who received a question about sexuality or addressed the issue of sexuality were significantly higher than those of professionals who did not. Sexuality is thus only scantly discussed by professionals working with patients with an ULD. Professionals indicated they do not feel confident nor comfortable enough to address this issue. They also experience a lack of appropriate knowledge to address sexuality with patients. Professionals reported a need for courses and training on both knowledge and conversation skills concerning sexuality. In addition, a protocol and necessary facilities need to be provided for the team working with people with an ULD in order to be able to address sexuality systematically.     

Enhancing practice improvement by facilitating practitioner interactivity: new roles for providers of continuing medical education

Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships, such as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may explain in part the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects. Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.     

Developing leadership in healthcare administration: a competency assessment tool

Despite the many graduate programs that specialize in health administration, healthcare leaders and practitioners have expressed concern about the quality of preparation of health administration graduates. The purpose of this study was to facilitate one part of an integrated approach to leadership development that spans academic and practitioner settings. The approach was to design a competency assessment tool for early careerists who have two to five years of postgraduate experience and who aspire to fill senior leadership positions in complex, provider-based healthcare organizations. Open-ended interviews with key informants and a comprehensive review of relevant literature were done to identify and categorize a set of competencies relevant to early careerists. Based on data from key informants, specific work experiences and academic courses were mapped to each competency, indicating where and how such competencies might be developed. A simple rating system was then added to assess each competency, which resulted in the completion of the tool. Finally, the tool was piloted in a practitioner setting at the Massachusetts General Hospital Administrative Fellowship Program and in an academic setting at the Yale University Health Management Program. The resulting tool includes 52 competencies categorized into four domains: (1) technical skills (operations, finance; information resources, human resources, and strategic planning/external affairs); (2) industry knowledge (clinical process and healthcare institutions); (3) analytic and conceptual reasoning; and (4) interpersonal and emotional intelligence. Early experience with the tool suggests that it can facilitate career planning among graduate students, early careerists, and their mentors. Further, the tool can help directors of both academic and practitioner programs identify strengths and gaps in their existing curricula or training programs. By offering specific competencies linked to work experiences and graduate courses, the tool is an initial step toward promoting collaborative efforts between academic and practitioner programs.     

全科服务团队开展社区康复模式的实践

目的评价全科服务团队开展社区康复的工作模式。方法对本团队责任区内1344名≥60岁老年人进行筛查，有康复需求的43名慢性病患者开展家庭、站点的康复训练。结果经过1年多康复训练，有效率83％。结论全科服务团队开展社区康复是一种方便、可行、有效、能被患者接受的康复模式。     

Survey on International Health Professional Training and Attitudes on Sexuality After Traumatic Brain Injury

Traumatic brain injury (TBI) is associated with a range of deficits that may negatively impact sexuality. Few studies have explored how professionals respond to sexuality issues among individuals with TBI. The present study aimed to examine the attitudes and level of training of international health professionals working with individuals with TBI and whether guidelines exist in their work settings related to sexual issues. A survey composed of 53 questions was developed to evaluate attitudes, professional training, and assessment related to sexuality among health professionals working with individuals with TBI. The sample consisted of 324 self-identified health care professionals. During their training, 83% of professionals reported not taking any specific courses, and 61% reported not taking any type of clinical practice related to sexuality issues after TBI. Approximately 70% reported knowing little information about sexuality issues related to TBI and believed it affected the way in which they address the topic with their patients. Professionals believed sexual expression among both cognitively intact (100%) and cognitively impaired (90%) patients was healthy. Sixty-nine percent reported their work setting had no guidelines to determine if an individual with TBI can consent to sexual activity or not. Sixty-six percent of professionals believed that a patient with severe TBI could consent to sexual activities; however 58% believed it is not their responsibility to determine that. Results demonstrated a need for enhanced educational curriculums with specific courses related to sexuality after TBI. Furthermore, institutions should develop guidelines for the assessment of capacity to consent to sexual activity.     

Development and evaluation of a sexuality and disability course for the helping professions

A study was undertaken to develop and evaluate a graduate level course dealing with sexuality and disability for students in the helping professions. The course was structured from reportedly successful elements of previous sexuality programs, and both empirically based measures and subjective reports were utilized in the evaluation. The results indicate that a comprehensive course can be effective in enhancing attitudes and knowledge levels, as well as increasing comfort in dealing with sexual matters. Limitations of the study and areas for additional concern are discussed.     

Operationalizing the Concept of Sexuality Comfort: Applications for Sexuality Educators

Thirty-two high school and college sexuality educators participated in a study designed to operationalize the concept of sexuality comfort. Research questions asked were: “What is the nature of sexuality comfort?” and “Can the concept, of sexuality comfort be defined operationally?” An interview guide developed with input from an expert panel of health/sexuality educators and semanticists facilitated data collection. Data were categorized and tabulated through a systematic process. This coding process, performed by independent coders, yielded 97.2% reliability. Based on the results, an operational definition of sexuality comfort was delineated. Because an operational definition is one which tells what to do to experience the thing defined,¹ the operational definition of sexuality comfort has immediate practical applications to preparation programs for prospective sexuality educators as well as those currently working in the field.     

Domestic violence: a comparative survey of levels of detection, knowledge, and attitudes in healthcare workers

The objective of this study was to compare the knowledge, attitudes, responses and levels of detection of domestic violence among a variety of healthcare workers in different specialities.Self-administered questionnaires were sent to community and hospital based healthcare workers in Oxfordshire working in primary care, obstetrics and gynaecology, mental health and accident and emergency. These comprised all principal general practitioners and general practitioner registrars, 50% of practice/district nurses and health visitors in each practice, and all healthcare workers in obstetrics and gynaecology, community mental health teams and accident and emergency in one trust.The amount of domestic violence detected in different healthcare settings was far less than indicated by anonymous surveys and crime figures. Knowledge about many of the issues surrounding domestic violence was inconsistent and there were fundamental deficiencies. The attitudes of healthcare workers to domestic violence were generally sympathetic and supportive. Women, nurses and community mental health workers reported significantly better knowledge and more positive attitudes than other respondents. Gender, role and speciality were independently associated with more positive attitudes and the latter two were independently associated with good knowledge. The response that healthcare workers make when they uncover domestic violence is confused and often inappropriate.In conclusion, most healthcare workers accept that domestic violence is a healthcare issue but lack fundamental knowledge about the issues surrounding domestic violence itself and appropriate agencies that can offer help. They also lack skills in identifying and discussing this issue with patients/clients. A large, unfulfilled training need has been identified.     

The multicompetent practitioner: a needs analysis in an urban area

This study examined the concept of the multicompetent practitioner - the health care worker trained in more than one specialty - as one way of meeting the changing needs of the health care system. Seventy-four hospital administrators, 74 directors of nursing, 14 directors of community health organizations, and 12 private physicians from the Philadelphia metropolitan area were surveyed to explore the feasibility of developing and using multicompetent practitioners at their participating institutions. The results indicated that multicompetent practitioners are already working in some institutions and that there is a willingness to hire this new type of health care worker. How the multicompetent practitioner fits into the institution, the level of education required beyond the original area of skill, and the question of salary were included in the survey. Findings also indicate positive support for the development of multicompetent practitioner training within allied health educational programs.     

Effectiveness of educational strategies preparing physician assistants,nurse practitioners,and certified nurse-midwives for underserved areas.

A study of physician assistant, nurse practitioner, and certified nurse midwifery programs was undertaken to identify and assess the effectiveness of recruitment, educational, and deployment strategies that programs use to prepare practitioners for medically underserved areas. The 51 programs studied were those having mission statements or known track records relating to this goal. A total of 170 interviews were conducted with faculty, students, graduates, and employers from 9 programs visited on-site and 42 programs surveyed by telephone. All programs had some recruitment and training activities in underserved sites. Only about half of the programs were able to submit data on their graduates'' practice settings and specialties. These data suggest that older students who have backgrounds in underserved areas and clearly identified practice goals are more likely to practice in underserved areas. Programs that actively promote service to the underserved do so through publicly stated missions and recruitment and educational strategies that complement these missions. Such programs also are more likely to evaluate and document their success than programs that lack strategies.     

The nurses' knowledge and attitudes about epilepsy

This study aimed at the assessment of the nurses' knowledge and attitudes towards epilepsy. A sample consisting of 273 nurses working in different hospital departments, at three University hospitals in Tanta, Menoufiya and Zagazig was chosen. The results revealed a deficiency in the nurses' knowledge about epilepsy. However, they had a moderately positive attitude towards epilepsy. Although more than half of them considered epilepsy a mental illness, they agreed that epileptics must learn in special schools. It is recommended that all in-service training programs for nurses should emphasize epilepsy management, rehabilitation of epileptics, and how to change public attitudes towards epilepsy.     

The Effectiveness of a Sexuality Training Program for the Interdisciplinary Spinal Cord Injury Rehabilitation Team

While there is evidence to support consideration of client sexuality needs in the provision of rehabilitation services to people with spinal cord injury (SCI), the interdisciplinary team rarely receives training in this area. The current study aimed to examine the effectiveness of a consumer-driven sexuality training program in improving staff knowledge, comfort (general and personal) and attitudes. Using a local needs assessment to identify training needs and the Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model as a training framework, a sexuality training program was developed in one Australian SCI service. A randomized controlled trial was conducted and significant improvement was found in all domains for the treatment group – Knowledge(χ²= 46.141, p< 0.001), Comfort (χ²= 23.338, p< 0.001), Approach(χ²= 23.925, p< 0.001) and Attitude (χ²= 15.235, p< 0.001) compared to the control group. Changes were found to be maintained at three month follow-up – Knowledge (Z=−5.116, p< 0.001), Comfort (Z=−3.953, p< 0.001), Approach (Z=−4.103, p< 0.001) and Attitudes (Z=−2.655, p< 0.001). These results support the use of an individualized needs-based sexuality training program in fostering staff knowledge, comfort and attitudinal change in an interdisciplinary SCI rehabilitation service.     

Correlates of attitudes toward the sexuality of the disabled person in selected health professionals

The attitudes of health professionals toward sexuality and disability have recently been under much scrutiny. These attitudes have been characterized as essentially negative. This study was undertaken in an attempt to clarify the relationship between attitudes toward sexuality, attitudes toward disability and attitudes toward the sexual behavior of the disabled.Fifty-three health professionals from three rehabilitation centers served as subjects. Subjects completed a research packet that included theAttitude Toward Disabled Persons Test, Sex Knowledge and Attitude Test and a researcher-designed Attitude Toward Sexual Behavior of the Disabled semantic differential.It was found that attitudes toward disability did not correlate with sex knowledge, attitudes or with attitudes toward the sexual behavior of the disabled. Attitudes toward the sexual behavior of the disabled is best predicted by attitudes toward premarital and extramartial sex and attitudes toward autoeroticism.The data indicate that attitudes toward the sexual behavior of the disabled are associated more with fundamental sex attitudes than with attitudes toward disability. Sex knowledge is not related to attitudes toward sexual behavior of the disabled. It was recommended that programs designed to change attitudes toward sexual behavior of the disabled should focus on attitudes as opposed to knowledge.She is also project director for the Sexual Adjustment Counseling Services project at George Washington University.The original research was conducted under the support of the University of North Carolina Medical School, Department of Allied Health Professions. Preparation of this article was supported by Department of Health, Education & Welfare Grant #RSA 15-P-57882/3-03.The author wishes to extend personal thanks to Debra Cornelius and Elaine Makas for their assistance in preparing this article.     

The Long-term Effects of Human Sexuality Training Programs for Public School Teachers

The current study evaluated long-term effects of a training model in human sexuality on public school teachers' knowledge and attitudes. The data indicated that, although significant changes were found from the pretest to posttest assessment of knowledge and attitudes on two standardized measures, attitudinal changes for teachers could not be maintained over time. In addition, knowledge decreased with most drastic changes occurring in the educator who, while trained, did not teach the material in a classroom setting. The results of this model staff development program suggest factors that may alter sex education training effects for professionals who work in public school settings.     

Exploration of occupational therapists' comfort with client sexuality issues

Sexuality is manifest in nearly every aspect of our daily behaviour and is crucial to self-image. It follows, then, that issues of sexuality are important to consider when providing health care. When an individual experiences ill health, every aspect of that individual needs to be recognized and included in the overall intervention; this includes the client's sexuality. Literature indicates that clients' need for recognition of their sexuality within health care is not often met. Some writers suggest that this need is not being met partly because health professionals, including occupational therapists, are not comfortable with situations involving sexuality, due to a lack of knowledge, experience and positive attitudes. The purpose of this research was to explore these and other factors that might contribute to the comfort level of occupational therapists when they deal with situations involving sexuality. To explore this area, six clinical scenarios involving issues of sexuality were developed from the literature and the authors' experience. Occupational therapists and final year occupational therapy students were asked to review and comment on these situations. Analyses of this data together with data from a focus group, the authors' clinical education placements and informal interviews suggests that, in addition to knowledge, experience and attitudes, there are other factors worthy of further consideration. These factors include: the therapist's perception of his or her role and issues of power and control. This study highlights the need for further innovative inquiry into this interesting and important area.     

Sexuality Education: A More Realistic View of its Effects

Sexuality education has been proffered as a partial solution to a variety of adolescent sexual problems. Research demonstrates that programs increase knowledge, but have little direct impact on values and attitudes, actual sexual behavior, use of birth control, and teen-age pregnancy. This article compares the effects of sexuality education programs with the results of other educational programs and discusses why sex education programs may increase knowledge, but may not effectively change behavior. Finally, good reasons to offer sexuality education are discussed.     

Attitudes of Swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption

AIMS: To explore the attitudes of Swedish general practitioners (GPs) and nurses to secondary alcohol prevention (early identification of, and intervention for, alcohol-related problems) and compare it to their attitudes to other important lifestyle behaviours such as smoking, stress, exercise, and overweight. METHODS: An adjusted version of The WHO Collaborative Study Questionnaire for General Practitioners was posted to all GPs and nurses in the County of Skaraborg, Sweden; 68 GPs and 193 nurses responded. RESULTS: The importance of drinking alcohol moderately, counselling skills on reducing alcohol consumption and perceived current effectiveness in helping patients change lifestyle behaviours ranked lower than working with all the other lifestyle behaviours. The nurses rated their potential effectiveness in helping patients change lifestyle higher than that of GPs for all the lifestyle behaviours. Nurses receiving more alcohol-related education had more positive attitudes than nurses with less education. For alcohol, the GPs assessed their role adequacy, role legitimacy and motivation higher than that of the nurses. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify problem drinkers who have no obvious symptoms of excess consumption. CONCLUSION: GPs and the nurses estimated their alcohol-related competence as lower than working with many other health-related lifestyles. These results can be explained by lack of practical skills, lack of training in suitable intervention techniques, and unsupportive working environments. All these elements must be considered when planning secondary alcohol prevention programs in primary health care.