Does Health Status Affect Perceptions of Factors Influencing Dignity at the End of Life?

ContextMore people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity.ObjectivesTo investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics.MethodsA subsample (n = 2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics.ResultsThe percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity.ConclusionHealth status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early.     

Does God Determine Your Health? The God Locus of Health Control Scale

Although perceptions of internal control havebeen related to physical and psychosocial outcomes inchronic illness,less attention has been paid toperceptions of external sources of control and theirimplications for adaptation. One reason for this has beenthe dearth of adequate measures for assessing specificexternal control constructs. The God Locus of HealthControl (GLHC) scale was developed to assess the extent of an individual's belief that God controls hisor her health status. The GLHC was designed as anadjunct to the widely used Multidimensional Health Locusof Control (MHLC) scales. Initial studies of the psychometric properties of the GLHC scale insamples of persons with two rheumatic diseases,rheumatoid arthritis and systemic sclerosis, provideevidence of the scale's reliability andvalidity.     

Does an educational intervention improve the usefulness of the Health of the Nation Outcome Scales in an acute mental health setting?

The purpose of the current study was to measure the effect of an educational intervention on the Health of the Nation Outcome Scales (HoNOS) completion rates. Additionally, interrater reliability and accuracy amongst nurses completing the instrument was assessed. We used a pre‐ and post‐intervention design with videoed vignettes providing the basis for the educational intervention. Mental health nurses were assessed four times: at baseline, immediately after the intervention, 1 week later and again, 2 months after the intervention. There was a non‐statistical increase in the number of patients assessed on admission using the HoNOS from 12.5% to 22.6%. Interrater reliability was low and did not improve through the course of the study. Intraclass correlation coefficients ranged 0.41–0.48. Accuracy was poor when discrete scoring between 0–4 was analyzed but improved when scores were dichotomised to reflect a clinically significant cut‐off of 2 or more. The intervention improved completion rates marginally but interrater reliability and accuracy were low and did not improve over the study period. Opportunities for improvement were identified.     

Does Similarity in Educational Level Between Health Promotion Volunteers and Local Residents Affect Activity Involvement of the Volunteers?

ABSTRACT Objectives: This study examined whether similarity in educational level, as a socioeconomic background factor, between health promotion volunteers (HPVs) and residents in the district where HPVs work encourages the volunteers' involvement in providing activities. Design and Sample: Cross‐sectional questionnaire survey. A total of 512 HPVs in a Japanese city with 5 districts. Measures: We focused on the number of activities related to working as an HPV as an aspect of involvement in the HPV role. HPV individual educational level was collected from a questionnaire. District educational level was obtained from the Japanese census database. Results: Of 512 questionnaires, 363 were returned and used for the analysis. Multiple regression analysis stratified by district educational level indicated that a higher educational level in HPVs was significantly associated with a greater number of self‐motivated activities in the districts with a higher educational level, although the association between a lower HPV educational level and more activity involvement was not found in districts with a lower educational level. Conclusions: It is important to consider similarity in educational level, as a socioeconomic status factor, between HPVs and the districts in which they will work when recruiting new members and when allocating HPVs to work areas.     

Patients’ Perceptions of What Makes a Good Doctor and Nurse in an Israeli Mental Health Hospital

The aim of this study was to identify inpatients’ expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients’ expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients’ individual needs.     

Occupational Therapists’ Perceptions of Environmental Influences on Practice at an Inpatient Stroke Rehabilitation Program: A Pilot Study

ABSTRACT

Aims: To better understand occupational therapists’ clinical decision making processes as they selected which rehabilitation environment to work in, and how the therapists perceived the environment impacted their choice of intervention. Methods: Focus group and individual interviews were conducted following observation of three occupational therapists providing interventions for 16 months with 12 clients following a stroke at an inpatient rehabilitation hospital stroke unit. Therapists could chose from three different environments for interventions: a therapy gym, homelike space, or a combination space. Results: Three themes emerged that revealed therapists’ habits influenced their clinical reasoning; the environment influenced therapists’ intervention choices; and therapists felt safer treating in the gym environment. Conclusion: The environment influenced the therapists’ intervention choices as well as their clinical reasoning. Rehabilitation services on an inpatient stroke program may be improved if therapists increase their awareness of the influence of the environment on interventions.     

Recovery as a Model of Care? Insights from an Australian Case Study

The terms “model of health care,” “service model.” and “nursing model of practice” are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.     

Perceptions of the Relationship Between Mental Health Professionals and Family Caregivers: Has There Been Any Change?

A number of international studies have highlighted family caregivers' (FCGs') dissatisfaction with their relationship with mental health professionals (MHPs) when providing care for mentally ill family members. However, few studies have explored the mental health professionals' perspective of this relationship. This study explored both FCGs' and MHPs' perspectives. Semi-structured interviews were conducted with seven FCGs and seven MHPs from two different geographical areas of New Zealand. Thematic analysis of these interviews revealed four distinct MHP themes and five FCG themes. The themes illuminate incongruence between MHPs' intentions to form a positive working relationship with families and the FCGs' mainly negative experiences of this relationship.     

Does Public Health Nurse Home Visitation Make a Difference in the Health Outcomes of Pregnant Clients and Their Offspring?

Abstract Public health nurses (PHNs) at Lincoln‐Lancaster County Health Department have used the Care Pathway tool to track client progress. Conceptually similar to critical pathways used in hospital settings, the Care Pathway is used by the PHN to document milestones of progress by trimester of pregnancy. Data for this research was gathered from chart review of 55 prenatal clients. Study results demonstrate that subjects who had from five to nine home visits by a PHN during pregnancy showed a higher average hemoglobin for the mothers and a higher average birthweight for the babies than those visited four or fewer times. None of the low birthweight babies was born to mothers in the “more visits” category. Furthermore, more breastfeeding was recorded for those who had received more PHN visits. This documentation enabled us to describe better the referent population and to begin to estimate the effect of PHN home visitation on the health outcomes of clients. In essence, we addressed the questions: (1) “Does PHN home visitation make a difference in health outcomes of clients and their families?” and (2) “If so, how can effects be measured?”     

Health Promotion Practices in Two Chiropractic Teaching Clinics: Does a Review of Patient Files Reflect Advice on Health Promotion?

Purpose:

To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes.

Methods:

Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion.

Results:

Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised.

Conclusion:

Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention.Key Indexing Terms: Cardiovascular System, Chiropractic, Health Promotion, Hypertension, Obesity     

Does Implementation of Biomathematical Models Mitigate Fatigue and Fatigue-related Risks in Emergency Medical Services Operations? A Systematic Review

Abstract

Background: Work schedules like those of Emergency Medical Services (EMS) personnel have been associated with increased risk of fatigue-related impairment. Biomathematical modeling is a means of objectively estimating the potential impacts of fatigue on performance, which may be used in the mitigation of fatigue-related safety risks. In the context of EMS operations, our objective was to assess the evidence in the literature regarding the effectiveness of using biomathematical models to help mitigate fatigue and fatigue-related risks. Methods: A systematic review of the evidence evaluating the use of biomathematical models to manage fatigue in EMS personnel or similar shift workers was performed. Procedures proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology were used to summarize and rate the certainty in the evidence. Potential bias attached to retained studies was documented using the Cochrane Collaboration's Risk of Bias tool for experimental studies. Results: The literature search strategy, which focused on both EMS personnel and non-EMS shift workers, yielded n = 2,777 unique records. One paper, which investigated non-EMS shift workers, met inclusion criteria. As part of a larger effort, managers and dispatchers of a trucking operation were provided with monthly biomathematical model analyses of predicted fatigue in the driver workforce, and educated on how they could reduce predicted fatigue by means of schedule adjustments. The intervention showed a significant reduction in the number and cost of vehicular accidents during the period in which biomathematical modeling was used. The overall GRADE assessment of evidence quality was very low due to risk of bias, indirectness, imprecision, and publication bias. Conclusions: This systematic review identified no studies that investigated the impact of biomathematical models in EMS operations. Findings from one study of non-EMS shift workers were favorable toward use of biomathematical models as a fatigue mitigation scheduling aid, albeit with very low quality of evidence pertaining to EMS operations. We propose three focus areas of research priorities that, if addressed, could help better elucidate the utility and impact of biomathematical models as a fatigue-mitigation tool in the EMS environment.     

Does recognition of the dying phase have an effect on the use of medical interventions?

During the dying phase, patients often receive interventions that are not aimed at promoting their comfort. We investigated how recognition of the dying phase affects the use of interventions by comparing patients for whom the dying phase had been recognized with patients for whom it had not been recognized. We included 489 of 613 patients (80%) who died either in a hospital, nursing home, or primary care setting between November 2003 and February 2006. After the death of patients, nurses filled in questionnaires, and patient records were searched for information about therapeutic and diagnostic interventions applied during the dying phase. Caregivers had recognized the dying phase of 380 patients (78%). The number of patients who had received diagnostic interventions during the last three days of life was significantly lower when the dying phase had been recognized (39% vs. 57%) (p = 0.00). Therapeutic interventions were used in similar frequencies in both groups. We conclude that recognition of the dying phase reduces the number of undesirable diagnostic interventions.     

Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review

Objective

To systematically review the literature to determine if preoperative psychological health affected hospital length of stay among adults following primary unilateral total knee arthroplasty.