Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception.

Background: Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs. Methods: Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS). Results: Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients. Conclusion: While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.

Pectus excavatum en adolescentes: cuidados de Enfermería en el postoperatorio / Pectus excavatum in adolescents: nursing care during the postoperative period

El pectus excavatum es una deformidad congénita de la pared torácica caracterizada por el hundimiento del esternón. Esta alteración, aparte de ser una cuestión estética, conlleva un impacto psicosocial en el individuo. Se presenta el caso de un varón de 16 años sometido a intervención quirúrgica de pectus excavatum. Se realizó una valoración según las 14 Necesidades de Virginia Henderson y se definió un plan de cuidados individualizado empleando la taxonomía diagnóstica de la North American Nursing Diagnosis Association (NANDA), describiendo los resultados esperados según la Nursing Outcomes Classification (NOC) y enunciado las intervenciones necesarias según la Nursing Intervention Classification (NIC). Se identificaron seis diagnósticos enfermeros NANDA: “[00118] Trastorno de la imagen corporal”, “[00120] Baja autoestima situacional”, “[00053] Aislamiento social”, “[00121] Trastorno de la identidad personal”, “[00132] Dolor agudo”, “[00046] Deterioro de la integridad tisular”. Se identificaron 11 resultados esperados NOC y ocho intervenciones NIC con sus correspondientes actividades enfermeras. La evaluación del plan de cuidados mostró que se alcanzaron las puntuaciones diana de los indicadores de los NOC a excepción de los indicadores “[150303] Interacción con miembros de la familia” y “[150307] Participación en organización de actividades” que se mantuvieron. Además, en algunos como ”[120507] Comunicación abierta” y “[120014] Adaptación a cambios corporales por cirugía” se superó la puntuación diana. En conclusión, el paciente mostró un mayor grado de aceptación de su imagen corporal, y recuperó progresivamente el estado de ánimo y la relación con sus iguales.(AU)

Pectus excavatum is a congenital deformity of the thoracic wall characterized by a caved-in sternum. This alteration, besides being an aesthetic issue, entails a psychosocial impact on the individual. We present the case of a 16-year-old male patient undergoing surgery for pectus excavatum. An assessment was conducted according to Virginia Henderson’s 14 Needs, and an individualized plan of care was defined, using the diagnostic taxonomy by the North American Nursing Diagnosis Association (NANDA), describing the expected outcomes according to the Nursing Outcomes Classification (NOC), and stating the interventions required according to the Nursing Intervention Classification (NIC). Six NANDA nursing diagnoses were identified: “[00118] Body Image Disorder”, “[00120] Situational Low Self-Esteem”, “[00053] Social Isolation”, “[00121] Disturbed Personal Identity”, “[00132] Acute Pain”, “[00046] Impaitment of Skin Integrity”. Eleven (11) expected NOC outcomes were identified, as well as eigh NIC interventions with their relevant nursing activities. The assessment of the plan of care showed that the target scores for the NOC indicatiors were reached, except for “[150303] Interacts with Family Members” and “[150307] Participates in Organized Activities”, which were sustained. Besides, the target score was exceeded in some indicators such as ”[120507] Open Communication” and “[120014] Adjustment to Body Changes due to Surgery”. In conclusion, patients showed a higher level of acceptance of their body image, and recovered gradually their mood and relationship with peers.(AU)

Analysis of needs and processes: social skills program for unemployed people with disabilities / Análise de necessidades e processo: programa de habilidades sociais para desempregados com deficiência / Análisis de necesidades y proceso: programa de habilidades sociales para desempleados con discapacidad

This study evaluated indicators of needs and processes in a social skills program for unemployed people with physical disabilities. The needs assessment - measured via self-reporting instruments - indicated the importance of preparing participants for job interviews and improving some social skills related to work, which would serve as a basis for the definition of the program's objectives. The skills developed in the program were as follows: civility, feedback, communication, empathy, offering help, citizenship, assertiveness, dealing with criticism, problem solving, job interview performance, and expressing positive feelings. For the process evaluation, the program's sessions were filmed and analyzed using indicators such as task performance. This study showed the importance of planning a program that considers the characteristics of the participants and of continuously monitoring its application to ensure the suitability of the intervention and the achievement of its objectives. (AU)

Este estudo avaliou indicadores de necessidades e de processo em um programa de habilidades sociais para pessoas com deficiência física, desempregadas. A avaliação de necessidades, mensurada por meio de instrumentos de autorrelato, indicou a importância de preparar os participantes para entrevistas de emprego e de aprimorar algumas habilidades sociais relacionadas ao trabalho, servindo como base para a definição dos objetivos do programa. As habilidades desenvolvidas no programa foram: civilidade, feedback, comunicação, empatia, oferecer ajuda, cidadania, assertividade, lidar com críticas, resolução de problemas, desempenho em entrevista de emprego e expressão de sentimento positivo. Para a avaliação de processo, as sessões do programa foram filmadas e analisadas por meio de um registro que continha indicadores como desempenhos nas tarefas. Este estudo mostrou a importância de planejar um programa considerando as características dos participantes e monitorar continuamente sua aplicação para garantir a adequação da intervenção e o alcance de seus objetivos. (AU)

El presente estudio evaluó indicadores de necesidades y proceso en un programa de habilidades sociales para personas con discapacidad física y desempleadas. La evaluación de necesidades, medida por instrumentos de autoinforme, señaló la importancia de preparar los participantes para entrevistas de empleo y mejorar algunas habilidades sociales relacionadas con el trabajo, sirviendo como base para la definición de los objetivos del programa. Las habilidades desarrolladas en el programa fueron: civilidad, feedback, comunicación, empatía, ofrecer ayuda, ciudadanía, asertividad, lidiar con críticas, solución de problemas, desempeño en entrevistas de empleo y expresión de sentimiento positivo. Para evaluación de proceso, las sesiones del programa fueron filmadas y analizadas mediante un registro que contenía indicadores como el desempeño en las tareas. Este estudio mostró la importancia de planear un programa considerando las características de los participantes y controlando su aplicación para garantizar la adecuación de la intervención y el alcance de sus objetivos. (AU)

Cancer patients treated with intravenous chemotherapy for the first time. What are their needs? What do they lack? A qualitative-quantitative mixed approach.

INTRODUCTION: The announcement of cancer coupled with initiation of its treatment impacts patients' psychological and physical states as well as their lifestyles. The objective of this study was to identify and confirm the needs of patients starting off on anticancer chemotherapy treatment. METHODS: This study was based on a qualitative-quantitative mixed method. In 2009, a qualitative study was conducted at the Lucien Neuwirth Cancer Institut for cancer patients undergoing intravenous chemotherapy for the first time. Exploratory and semi-directed interviews were carried out by a sociologist. In 2014, a questionnaire was hetero-administered to 100 patients starting off on chemotherapy. RESULTS: Forty patients were interviewed in 2009. Ninety-seven patients answered the questionnaire in 2014. Food was a theme that was identified by a majority of patients in 2009 (13/40) and confirmed in 2014: 63% needed help in identifying favorable food and 67% in identifying those that had to be avoided. The other needs identified were those linked to better understanding of the treatment, of how it may affect the couple, its side effects, hygiene and beauty, and knowledge about other treatments. These needs were confirmed in 2014. New needs were elicited in 2014: activities and leisure (33%), psychological needs (32.6%), and family relations (29.9%). CONCLUSION: This study enabled us to identify, confirm, and enrich our knowledge of the needs of cancer patients starting off on intravenous chemotherapy. These results led to the modification of an existing patient education program for these patients, in order to fulfill their needs in an updated and tailored manner.

Assessment of Decisional Conflict about the Treatment of Trigger Finger, Comparing Patients and Physicians.

BACKGROUND: As an early step in the development of a decision aid for idiopathic trigger finger (TF) we were interested in the level of decisional conflict experienced by patients and hand surgeons. This study tested the null hypothesis that there is no difference in decisional conflict between patients with one or more idiopathic trigger fingers and hand surgeons. Secondary analyses address the differences between patients and surgeons regarding the influence of the DCS-subcategories on the level of decisional conflict, as well as the influence of patient and physician demographics, the level of self-efficacy, and satisfaction with care on decisional conflict. METHODS: One hundred and five hand surgeon-members of the Science of Variation Group (SOVG) and 84 patients with idiopathic TF completed the survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). RESULTS: On average, patients had decisional conflict comparable to physicians, but by specific category patients felt less informed and supported than physicians. The only factors associated with greater decisional conflict was the relationship between the patient and doctor. CONCLUSIONS: There is a low, but measurable level of decisional conflict among patients and surgeons regarding idiopathic trigger finger. Studies testing the ability of decision aids to reduce decisional conflict and improve patient empowerment and satisfaction with care are merited.

Trigger finger: assessment of surgeon and patient preferences and priorities for decision making.

PURPOSE: To test the null hypothesis that there are no differences in the priorities and preferences of patients with idiopathic trigger finger (TF) and hand surgeons. METHODS: One hundred five hand surgeons of the Science of Variation Group and 84 patients with TF completed a survey about their priorities and preferences in decision making regarding the management of TF. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. RESULTS: Patients desired orthotics more and surgery less than physicians. Patients and physicians disagreed on the main advantage of several treatment options for TFs and on disadvantages of the treatment options. Patients preferred to decide for themselves after receiving advice, whereas physicians preferred a shared decision. Patients preferred booklets, and physicians opted for Internet and video decision aids. CONCLUSIONS: Comparing patients and hand surgeons, there were some differences in treatment preferences and perceived advantages and disadvantages regarding idiopathic TF-differences that might be addressed by a decision aid. CLINICAL RELEVANCE: Information that helps inform patients of their options based on current best evidence might help them understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making.

PURPOSE: This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). METHODS: One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. RESULTS: Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. CONCLUSIONS: There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. CLINICAL RELEVANCE: Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Patients' and carers' perception of needs in a Polish sample.

BACKGROUND: The assessment of patients' needs is an essential element of psychiatric health care planning and evaluation. Not much interest has been paid to the study of psychiatric patients' needs in Poland so far. AIMS: To assess the relation between inpatients' and their key carers' perception of needs in a Polish sample. METHODS: Out of 324 inpatients invited to take part in the study, 60 sets were finally included. Patients and their carers were examined by means of CANSAS to rate patients' and carers' perception of needs. RESULTS: The mean number of general needs indicated by patients themselves was 7.11 (± 2.98), and those indicated by carers equalled 9.53 (± 3.92). The more unmet needs identified by the patient, the more met and general needs of the patient identified by their carer (r = .27, p = .03; r = .38, p = .02, respectively). The more general needs perceived by the patient themself, the higher the indicator of unmet and general needs scored by their carer (r = .32, p = .01; r = .39, p = .001, respectively). CONCLUSIONS: There is a significant association between the inpatients' and their carers' perception of needs. Patients' perspective should serve as a high priority in developing treatment plans.

Classification of patients seen at a hemodynamics unit according to the degree of dependence on nursing care / Classificação de pacientes atendidos em uma unidade de hemodinâmica segundo o grau de dependência dos cuidados de enfermagem

OBJECTIVE: To classify patients in a hemodynamics healthcare unit, according to the degree of dependence on nursing care. METHODS: Cross-sectional study performed in June/2005 at the Hemodynamics unit of a university hospital. Data were collected during the first hour post-procedure, using Perroca's instrument of patient classification. RESULTS: Among 164 patients, 52% were female, aged 60 ± 14.8 years. The average score of classification was 31.9 ± 4.8, rated as intermediate. As for instrument indicators, patients submitted to gastroenterological procedures presented a significant difference regarding their level of consciousness (P<0.0001); as for motility, patients submitted to cardiologic procedures presented higher dependence scores (P<0.0001); there were no differences for locomotion between the different specialties. CONCLUSION: The dependence profile of patients seen in the hemodynamics unit was considered intermediate. Further studies may add more information when planning the size of hemodynamics units.

OBJETIVO: Classificar pacientes em uma unidade de hemodinâmica segundo o grau de dependência dos cuidados de enfermagem. MÉTODOS: Estudo transversal, realizado em junho/2005 na hemodinâmica de um hospital universitário. A coleta de dados foi na primeira hora pós-procedimento, com o instrumento de classificação de pacientes de Perroca. RESULTADOS: Dos 164 pacientes, 52% eram do sexo feminino, com média de idade de 60 ± 14,8 anos. O escore médio da classificação foi de 31,9 ± 4,8 pontos, categorizado como intermediário. Quanto aos indicadores do instrumento, pacientes submetidos a procedimentos gastroenterológicos apresentaram diferença significativa quanto ao nível de consciência (P<0,0001); quanto à motilidade, pacientes submetidos a procedimentos cardiológicos apresentaram escores maiores de dependência (P<0,0001); a locomoção não apresentou diferença entre as especialidades. CONCLUSÃO: O perfil de dependência dos pacientes atendidos na hemodinâmica foi de grau de dependência intermediário. Novos estudos poderão agregar mais informações para o planejamento de dimensionamento em unidades de hemodinâmica.

OBJETIVO: Clasificar pacientes en una unidad de hemodinamia según el grado de dependencia de los cuidados de enfermería. MÉTODOS: Se trata de un estudio transversal, realizado en junio/2005 en la unidad de hemodinamia de un hospital universitario. La recolección de datos se llevó a cabo en la primera hora después del procedimiento, con el instrumento de clasificación de pacientes de Perroca. RESULTADOS: De los 164 pacientes, 52% eran del sexo femenino, con un promedio de edad de 60 ± 14,8 años. El puntaje medio de la clasificación fue de 31,9 ± 4,8 puntos, clasificado como intermedio. En cuanto a los indicadores del instrumento, los pacientes sometidos a procedimientos gastroenterológicos presentaron diferencia significativa en cuanto al nivel de conciencia (P<0,0001); en cuanto a la motilidad, los pacientes sometidos a procedimientos cardiológicos presentaron puntajes mayores de dependencia (P<0,0001); la locomoción no presentó diferencia entre las especialidades. CONCLUSIÓN: El perfil de dependencia de los pacientes atendidos en la unidad de hemodinamia fue de grado de dependencia intermedia. Estudios nuevos que se realicen podrán agregar más información para la planificación de acciones en las unidades de Hemodinamia.