Strengthening women's health visiting work with women

AIMS: The aim of the paper is to show how life events contributed to ways in which health visitors related to women in their professional work. BACKGROUND: Health visiting work has been labelled 'invisible' and since, 'invisibility' is an issue in feminist literature, this concept was explored in relation to health visiting. METHODS: A qualitative research design was developed, with a conceptual framework based in feminist and educational literature. Semi-structured, tape-recorded interviews were conducted with a purposeful sample of 35 women health visitors. A systematic approach to data analysis took place, through which key themes and analytic categories were identified. FINDINGS: The findings showed three levels of interaction between health visitor and client that overlapped in the working relationship. First, the public face of the work is exemplified in the planned purposes of the health visiting contact. Secondly, during this contact, health visitors may draw on their lay knowledge of 'life events', that is, their private knowledge of the situation being described by the client. Thirdly, and at the same time, health visitors manage hidden personal feelings that arise within the interaction. CONCLUSIONS: The invisible private knowledge gained in life events can have a transforming effect for both health visitors and clients. However, there is no educational model which legitimizes private and personal knowledge as a resource for use by health visitors. Understanding women's own position as 'women in a gendered society' would enhance the way in which health visiting is conducted and could lead to more productive outcomes in public health work.     

Enhancing interprofessional education and practice: Development and implementation of a new graduate-level course using the international classification of functioning,disability, and health

Since the introduction of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), there is increasing awareness among health professionals to consider a biopsychosocial approach to patients’ health and functioning. Although diffusion of the ICF as a concept is widely recognized, application of the ICF within health education and practice requires attention, training, and support. This article describes the development and implementation of a new graduate-level course using the ICF to assist health professionals and graduate trainees in rehabilitation. The innovation behind this course is its focus on application of the ICF in research and practice through a combination of peer support and instructor mentorship. The value of the ICF for interprofessional education, research, and practice includes promotion of a broad perspective to health, application of theory in practice, and enhanced communication and collaboration in healthcare.     

Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework

Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure‐process‐outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2‐part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.     

Symptom status and health-related quality of life: clinical relevance

BACKGROUND: Nursing continues to struggle to identify outcomes that measure quality of care. Health-related quality of life (HRQOL) has been identified as an outcome indicator that is sensitive to health-care interventions. However, clinicians remain skeptical about its relevance. AIM: This article discusses the conceptual issues surrounding HRQOL research and provides an example that demonstrates how symptom status can serve as a clinically relevant and measurable dimension of HRQOL. METHODS: The study sample (n = 99) were patients presenting to the emergency department of an academic medical centre in the United States of America (USA) between July 1997 and March 1999 with the diagnosis of gastrointestinal bleeding. The mean age was 57.86 (17.52) years and 62.6% of the sample was male. The Short Form-12 (SF-12) (measurement used for HRQOL) and a 15-item symptom checklist were administered within the first 24 hours following the emergency department visit and by phone 1 month after discharge. RESULTS: Regression analysis controlling for age, gender, haematocrit and comorbidities was used to examine the relationships between symptom status and HRQOL. The analysis suggests that symptom status is a key predictor of HRQOL. STUDY LIMITATIONS: The sample was a relatively small convenience sample from one emergency department in the USA. CONCLUSIONS: Nurses are concerned with improving patients' HRQOL. Certainly, symptoms are amenable to nursing interventions. We provide one example that demonstrates the relationship between symptom status and HRQOL. By tracking and studying trends in the number of symptoms over time we can begin to track HRQOL as an outcome of care. Thus, we conclude that by helping patients manage their symptoms their overall HRQOL would improve.     

Three Conflict Levels

The use of the self-state metaphor requires careful attention to changes in a patient's subjectivity that may go unnoticed by the patient. Affect, fund of knowledge, beliefs, worldview, idiosyncratic behaviors, physiologic state, and other aspects of subjective experience may vary from self-state to self-state. These shifts are especially visible when “not-me” self-states are present. Changes in self-state in the analyst in resonance with similar shifts in the patient provide avenues of inquiry and insight that are far reaching and make the most of the use of the analyst's self in an analysis of enactment. Not-me self-state experience is especially challenging to uncover and is often the focal point of the patient's or analyst's resistance to knowing his own mind. Intense overwhelming affects are often at the core of this resistance. Attention to these focal points may open the not-me self-state to view as a subject for analysis. Distinguishing these complex dissociative processes from psychotic process is of critical importance and requires alert consciousness for the mechanisms of dissociative experience.     

Alcohol and the self: An interpretative phenomenological analysis of the experience of addiction and its impact on the sense of self and identity

This article presents an in-depth study illuminating how experiences of addiction and accompanying feelings, thoughts and expressions appear to the participant in the context of her life. It focuses on the participant's engagement with alcohol as an experience of flux and instability and how it impacts on her sense of self. The study reports data from semi-structured interviews with a female participant, analysed using interpretative phenomenological analysis (IPA). The results are considered in relation to relevant literature, including research on addiction and recovery, works on self and identity and theory and use of metaphor. It is suggested that IPA provides an opportunity to build up a rich picture of subjective-felt experience, and thus to contribute to existing psychological research a subjective perspective not often addressed in psychological accounts of addictive behaviour.     

Conceptual abilities of children with mild intellectual disability: Analysis of Wisconsin Card Sorting Test performance

Abstract

Background The ability to generate and flexibly change concepts is of great importance for the development of academic and adaptive skills. This paper analyses the conceptual reasoning ability of children with mild intellectual disability (MID) by their achievements on the Wisconsin Card Sorting Test (WCST).

Method The sample consisted of 95 children with MID aged between 10 years and 13 years 11 months. The following variables from the WCST were analysed: number of categories completed, initial conceptualisation, total number of errors, non-perseverative errors, perseverative errors, number of perseverative responses, and failures to maintain set.

Results The observed WCST predictive variables account for 79% of the variability in the number of categories completed (p < .000). The total number of errors was the most significant predictor of performance on the WCST.

Conclusion We can conclude that there is a significant progress of conceptual abilities between the age of 13 years to 13 years 11 months, compared to other assessed age groups. The results of our research suggests that the development of mental set flexibility is the basis of progress in conceptual abilities, thus intervention programs should offer specially designed activities that vary in their attentional demands, content, conceptual patterns, and actions required.