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1.
JMIR Cancer ; 7(4): e26226, 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34612832

RESUMO

BACKGROUND: With the increasing number of older cancer survivors, it is imperative to optimize the reach of interventions that promote healthy lifestyles. Web-based delivery holds promise for increasing the reach of such interventions with the rapid increase in internet use among older adults. However, few studies have explored the views of middle-aged and older cancer survivors on this approach and potential variations in these views by gender or rural and urban residence. OBJECTIVE: The aim of this study was to explore the views of middle-aged and older cancer survivors regarding the features of web-based healthy lifestyle programs to inform the development of a web-based diet and exercise intervention. METHODS: Using a qualitative descriptive approach, we conducted 10 focus groups with 57 cancer survivors recruited from hospital cancer registries in 1 southeastern US state. Data were analyzed using inductive thematic and content analyses with NVivo (version 12.5, QSR International). RESULTS: A total of 29 male and 28 female urban and rural dwelling Black and White survivors, with a mean age of 65 (SD 8.27) years, shared their views about a web-based healthy lifestyle program for cancer survivors. Five themes emerged related to program content, design, delivery, participation, technology training, and receiving feedback. Cancer survivors felt that web-based healthy lifestyle programs for cancer survivors must deliver credible, high-quality, and individually tailored information, as recommended by health care professionals or content experts. Urban survivors were more concerned about information reliability, whereas women were more likely to trust physicians' recommendations. Male and rural survivors wanted information to be tailored to the cancer type and age group. Privacy, usability, interaction frequency, and session length were important factors for engaging cancer survivors with a web-based program. Female and rural participants liked the interactive nature and visual appeal of the e-learning sessions. Learning from experts, an attractive design, flexible schedule, and opportunity to interact with other cancer survivors in Facebook closed groups emerged as factors promoting program participation. Low computer literacy, lack of experience with web program features, and concerns about Facebook group privacy were important concerns influencing cancer survivors' potential participation. Participants noted the importance of technology training, preferring individualized help to standardized computer classes. More rural cancer survivors acknowledged the need to learn how to use computers. The receipt of regular feedback about progress was noted as encouragement toward goal achievement, whereas women were particularly interested in receiving immediate feedback to stay motivated. CONCLUSIONS: Important considerations for designing web-based healthy lifestyle interventions for middle-aged and older cancer survivors include program quality, participants' privacy, ease of use, attractive design, and the prominent role of health care providers and content experts. Cancer survivors' preferences based on gender and residence should be considered to promote program participation.

2.
Nurs Open ; 8(3): 1005-1022, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482649

RESUMO

AIM: To provide a systematic review of the literature from 1997 to 2017 on nursing-sensitive indicators. DESIGN: A qualitative design with a deductive approach was used. DATA SOURCES: Original and Grey Literature references from Cochrane Library, Medline/PubMed, Embase, and CINAHL, Google Scholar Original and Grey Literature. REVIEW METHODS: Quality assessment was performed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: A total of 3,633 articles were identified, and thirty-nine studies met the inclusion criteria. The quantitative assessment of investigated relationships in these studies suggests that nursing staffing, mortality, and nosocomial infections were the most frequently reported nursing-sensitive indicators. CONCLUSION: This review provides a comprehensive list of nursing-sensitive indicators, their frequency of use, and the associations between these indicators and various outcome variables. Stakeholders of nursing research may use the findings to streamline the indicator development efforts and standardization of nursing-sensitive indicators. IMPACT: This review provides evidence-based results that health organizations can benefit from nursing care quality.


Assuntos
Cuidados de Enfermagem , Pesquisa em Enfermagem , Recursos Humanos de Enfermagem , Estudos Transversais , Humanos , MEDLINE
3.
JMIR Ment Health ; 8(5): e26746, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042606

RESUMO

BACKGROUND: Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information. OBJECTIVE: This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs. METHODS: We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews. RESULTS: A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (ß=.382; P=.01) and trust (ß=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information. CONCLUSIONS: Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.

4.
J Clin Nurs ; 29(21-22): 4148-4160, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32757394

RESUMO

AIMS AND OBJECTIVES: To explore how workplace bullying influences nurses' abilities to provide patient care. BACKGROUND: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. DESIGN: Qualitative descriptive study. METHODS: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. RESULTS: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. CONCLUSIONS: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. RELEVANCE TO CLINICAL PRACTICE: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

5.
Am J Nephrol ; 51(2): 147-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31838480

RESUMO

BACKGROUND: Nephrology research is expanding, and harnessing the much-needed information and data for the practice of evidence-based medicine is becoming more challenging. In this study, we used the natural language processing and text mining approach to mitigate some of these challenges. METHODS: We analyzed 17,412 abstracts from the top-10 nephrology journals over 10 years (2007-2017) by using latent semantic analysis and topic analysis. RESULTS: The analyses revealed 10 distinct topics (T) for nephrology research ranging from basic science studies, using animal modeling (T-1), to dialysis vascular access-related issues -(T-10). The trend analyses indicated that while the majority of topics stayed relatively stable, some of the research topics experienced increasing popularity over time such as studies focusing on mortality and survival (T-4) and Patient-related Outcomes and Perspectives of Clinicians (T-5). However, some research topics such as studies focusing on animal modeling (T-1), predictors of acute kidney injury, and dialysis access (T-10) exhibited a downward trend. CONCLUSION: Stakeholders of nephrology research may use these trends further to develop priorities and enrich the research agenda for the future.


Assuntos
Pesquisa Biomédica , Mineração de Dados , Nefrologia , Publicações Periódicas como Assunto/estatística & dados numéricos , Editoração/estatística & dados numéricos , Publicações Periódicas como Assunto/normas
6.
J Adv Nurs ; 76(2): 725-740, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31012146

RESUMO

AIMS: To reach consensus among experts on global health competencies for baccalaureate nursing students in the USA. DESIGN: A three-round modified Delphi study using a mixed methods research approach. METHODS: In the first round, the original list of competencies (Wilson et al., 2012, Journal of Professional Nursing, 28, 213-222) was revised based on prior research, a review of literature and the Nursing Global Health Competencies Framework developed by the fist author. Nine global health domains and 52 competencies were identified in Round One. In Round Two, two surveys were conducted for validation of the revised list of global health competencies using a group of six nurses with expertise in global health and baccalaureate nursing education, which produced modifications in the competencies used for the third phase of the study. In Round Three, 41 participants completed a survey to rate the extent to which they thought the competencies obtained in Round Two were essential for baccalaureate nursing education in the United States. Data collection took place from May 2017 - January 2018. RESULTS: A group of experts in global health and baccalaureate nursing education from the United States achieved consensus that 40 global health competencies were essential for baccalaureate nursing education in the United States. CONCLUSION AND IMPACT: The domains and competencies derived in this study can be used to guide undergraduate nursing curriculum development in global health and provide a framework for both clinical instruction and evaluation of global health student experiences.


Assuntos
Competência Clínica/estatística & dados numéricos , Competência Clínica/normas , Bacharelado em Enfermagem/estatística & dados numéricos , Bacharelado em Enfermagem/normas , Docentes de Enfermagem/estatística & dados numéricos , Saúde Global/educação , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Idoso , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Educação de Enfermagem , Estados Unidos , Adulto Jovem
7.
Ann Am Thorac Soc ; 16(8): 1024-1033, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31039003

RESUMO

Rationale: Little direction exists on how to integrate early palliative care in chronic obstructive pulmonary disease (COPD).Objectives: We sought to identify patient and family caregiver early palliative care needs across stages of COPD severity.Methods: As part of the Medical Research Council Framework developmental phase for intervention development, we conducted a formative evaluation of patients with moderate to very severe COPD (forced expiratory volume in 1 s [FEV1]/FVC < 70% and FEV1 < 80%-predicted) and their family caregivers. Validated surveys on quality of life, anxiety and depressive symptoms, and social isolation quantified symptom severity. Semi-structured interviews were analyzed for major themes on early palliative care and needs in patients and family caregivers and across COPD severity stages.Results: Patients (n = 10) were a mean (±SD) age of 60.4 (±7.5) years, 50% African American, and 70% male, with 30% having moderate COPD, 30% severe COPD, and 40% very severe COPD. Family caregivers (n = 10) were a mean age of 58.3 (±8.7) years, 40% African American, and 10% male. Overall, 30% (n = 6) of participants had poor quality of life, 45% (n = 9) had moderate-severe anxiety symptoms, 25% (n = 5) had moderate-severe depressive symptoms, and 40% (n = 8) reported social isolation. Only 30% had heard of palliative care, and most participants had misconceptions that palliative care was end-of-life care. All participants responded positively to a standardized description of early palliative care and were receptive to its integration as early as moderate stage. Five broad themes of early palliative care needs emerged: 1) coping with COPD; 2) emotional symptoms; 3) respiratory symptoms; 4) illness understanding; and 5) prognostic awareness. Coping with COPD and emotional symptoms were commonly shared early palliative care needs. Patients with very severe COPD and their family caregivers prioritized illness understanding and prognostic awareness compared with those with moderate-severe COPD.Conclusions: Patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Cuidados Paliativos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Idoso , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade de Vida , Testes de Função Respiratória , Índice de Gravidade de Doença , Isolamento Social
8.
PLoS One ; 14(3): e0212967, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30865681

RESUMO

AIMS: Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver's role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. METHODS: Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. FINDINGS: Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient's partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported "fair" or "poor" health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients' upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient's treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing "what if" scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. CONCLUSIONS: These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.


Assuntos
Cuidadores/psicologia , Tomada de Decisões , Relações Familiares , Família/psicologia , Neoplasias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Pesquisa Qualitativa
9.
Prog Transplant ; 29(2): 164-172, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845889

RESUMO

INTRODUCTION: Studies demonstrate that family notification is much less frequent in African Americans than in Caucasians. Familial notification of one's decision to become a registered organ donor (ROD) is important to ensure adherence to the decedent's donation decision and to disseminate prodonation attitudes. The purpose of this study was to explore the experiences of familial notification among recent African American RODs and to identify intervention strategies to overcome potential barriers to the notification process. METHODS/APPROACH: The study used a qualitative focus group approach. An inductive thematic analysis identified common categories and themes in the recorded and transcribed discussions. FINDINGS: The focus groups consisted of 50 African American participants who had recently visited Alabama Department of Motorized Vehicles and made the voluntary decision (yes or no) about becoming an organ donor. Three major themes describing the African American experiences with notifying their family members about their decision to become a ROD emerged. These themes were as follows: motivation for the notification, notification conversation, and promoting familial notification. Specific discussions centered upon the importance of and barriers to familial notification, information, and strategies needed for successful notification. Strategies identified were use of media and social networks to provide enhanced knowledge on the notification process and the importance of health-care, community-provided knowledge about the donation process. DISCUSSION: Findings from this study provide a framework for future interventions designed to assist African American RODs in notifying family members of their status.


Assuntos
Tomada de Decisões , Família , Conhecimentos, Atitudes e Prática em Saúde , Veículos Automotores/legislação & jurisprudência , Doadores de Tecidos/psicologia , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , Alabama , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Obtenção de Tecidos e Órgãos , Adulto Jovem
10.
Clin Transplant ; 32(10): e13402, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30179271

RESUMO

African American (AA) organ donation registration rates fall short of national objectives. The goal of the present study was to utilize data acquired from a quantitative telephone survey to provide information for a future Department of Motorized Vehicles (DMV) intervention to increase AA organ donor registration at the DMV. AAs (n = 20 177) that had visited an Alabama DMV office within a 3-month period were recruited via direct mailing to participate in a quantitative phone survey. Data from 155 respondents that participated in the survey were analyzed. Of those respondents deciding to become a registered organ donor (ROD; n = 122), one-third made that decision at the time of visiting the DMV. Of those who chose not to become a ROD (n = 33), one-third made the decision during the DMV visit. Almost 85% of all participants wanted to learn more about organ donation while waiting at the DMV, preferably via TV messaging (digital signage), with the messaging delivered from organ donors, transplant recipients, and healthcare experts. Altruism, accurate organ donation information, and encouragement from family and friends were the most important educational topics to support AAs becoming a ROD. These data provide a platform to inform future interventions designed to increase AAs becoming a ROD at the DMV.


Assuntos
Afro-Americanos/psicologia , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Licenciamento/estatística & dados numéricos , Transplante de Órgãos , Doadores de Tecidos/psicologia , Adulto , Feminino , Humanos , Masculino , Motivação
11.
J Nurs Educ ; 55(8): 433-40, 2016 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-27459429

RESUMO

BACKGROUND: Recruiting and retaining faculty to teach courses is crucial for online nursing programs to succeed. The purpose of this study was to gain a fuller understanding of the benefits and challenges of teaching nursing courses online by exploring the perspectives of faculty, administrators, and instructional designers at three schools of nursing in the southeastern United States. METHOD: This qualitative multiple case study explored perspectives of 21 participants from different stakeholder groups. Researchers used cross-case analysis and determined emerging themes in data collected from interviews, course demonstrations, and course documents. RESULTS: Data analysis revealed themes regarding benefits and challenges for nursing instructors in (a) teaching strategies, (b) instructor availability, (c) training and support, and (d) institutional issues. CONCLUSION: This study found gaps in perspectives between participant groups that indicated a need for institutions to address communication issues, training program objectives, and institutional policies and procedures regarding online course design and delivery to promote faculty success and satisfaction. [J Nurs Educ. 2016;55(8):433-440.].


Assuntos
Atitude do Pessoal de Saúde , Currículo , Educação à Distância , Bacharelado em Enfermagem , Docentes de Enfermagem , Adulto , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Sudeste dos Estados Unidos
12.
J Cancer Educ ; 31(3): 514-21, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26081311

RESUMO

The human papillomavirus (HPV) vaccine could assist in reducing the cervical cancer disparity existing between Black and White women. Understanding factors influencing Black maternal intentions to vaccinate their daughter is essential in improving vaccination uptake. However, existing instruments do not comprehensively assess factors (e.g., culture) influencing maternal intentions. This paper describes the development of the Human Papillomavirus Vaccination Survey for Black Mothers with Girls Aged 9 to 12 (HPVS-BM), the first instrument to measure knowledge, attitudes, subjective norms, and cultural beliefs relating to Black maternal intentions to vaccinate their daughters aged 9 to 12 years against HPV. The items and scales were refined using content review by experts, as well as cognitive interviews and pilot testing with target audience participants. The final version of the HPVS-BM was administered to 242 Black mothers with adolescent daughters. Internal reliability was determined using Cronbach's alpha. An a priori hypothetical model was developed to determine convergent and discriminant validity. All scales of the HPVS-BM had an acceptable internal reliability of 0.70 or higher. The intention scale of HPVS-BM was significantly correlated (p < .05) with perceived benefits, perceived barriers, and subjective norms, supporting strong convergent validity. Moderate discriminant construct validity was also demonstrated. Exhibiting good psychometrics, this instrument could be used by healthcare researchers and professionals to develop programs to increase HPV vaccination among Black adolescent females aimed at reducing the racial disparities in cervical cancer. Further psychometric testing of this survey tool for understanding factors influencing maternal intentions is warranted.


Assuntos
Afro-Americanos/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Adulto , Criança , Feminino , Humanos , Relações Mãe-Filho , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/virologia , Percepção , Inquéritos e Questionários , Vacinação , Adulto Jovem
13.
Disabil Rehabil ; 37(9): 739-49, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25003483

RESUMO

BACKGROUND: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult. PURPOSE: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process. METHODS: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices. RESULTS: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits. CONCLUSIONS: Motivation and resources were important facilitators, including rehabilitation professional's personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them. IMPLICATIONS FOR REHABILITATION: Assistive technology supports successful return to work after SCI. Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members. Patients should be well informed about how to access assistance programs such as vocational rehabilitation.


Assuntos
Reabilitação Vocacional , Retorno ao Trabalho , Traumatismos da Medula Espinal/reabilitação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Motivação , Ocupações , Projetos Piloto , Pesquisa Qualitativa , Equipamentos de Autoajuda , Trabalho
14.
J Pediatr Hematol Oncol ; 37(1): 35-42, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25072367

RESUMO

With the increase in access to medical information, parents can acquire health information from multiple sources. An understanding of parents' reactions to a newborn infant's diagnosis of sickle cell anemia and how they acquire knowledge can identify parent beliefs and preferences about the process of sickle cell education. This study utilized a sequential exploratory mixed methods design. First, qualitative interviews were conducted with 8 parents of infants with sickle cell anemia to understand the process of health education. Second, quantitative surveys were conducted with 22 other parents to test qualitative findings. Parents of infants with sickle cell anemia expressed a high level of fear at the time of notification of a positive screen. Parents desired an understanding of how to identify acute complications of disease and how sickle cell will alter their child's life. Parents actively sought information at the time they were told their child had sickle cell disease. Sickle cell education should begin at time of notification of positive newborn screening results and address identified parent concerns. Health care providers should build trust with parents and provide them with immediate access to educational materials. Hematologists should work with primary care providers to develop complementary educational programs and resources.


Assuntos
Anemia Falciforme/psicologia , Educação em Saúde , Pais/psicologia , Viés , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pesquisa Qualitativa , Tamanho da Amostra
15.
Anesthesiology ; 119(6): 1261-74, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24005578

RESUMO

Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model.


Assuntos
Prática Clínica Baseada em Evidências/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Assistência ao Paciente/normas , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Perioperatória/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Estudos de Coortes , Controle de Custos , Prática Clínica Baseada em Evidências/economia , Guias como Assunto , Humanos , Modelos Organizacionais , Avaliação de Processos e Resultados em Cuidados de Saúde , Assistência ao Paciente/economia , Segurança do Paciente , Assistência Centrada no Paciente/economia , Assistência Perioperatória/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do Tratamento
17.
J Dent Educ ; 76(12): 1600-14, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23225679

RESUMO

This article describes a mixed methods conceptual framework for evidence-based dentistry to enhance the curriculum at the University of Alabama at Birmingham School of Dentistry. A focus of recent curriculum reform has been to prepare students to integrate evidence-based dentistry into clinical practice. The authors developed a framework consisting of four conceptual phases to introduce curriculum innovation: 1) exploration of the phenomenon; 2) development of two new instruments; 3) data collection, analysis, outcomes, and evaluation; and 4) application to curricular reform. Eight sequential procedural steps (literature review; focus group discussions; development of themes; survey design; internal review; data collection, analysis, and evaluation; development of recommendations with external review; and implementation of recommendations for curricular enhancement) guided the curricular enhancement. Faculty members supported the concept of teaching evidence-based dentistry to facilitate major curriculum reform, and course directors incorporated evidence-based teaching to prepare scientist-practitioners who meet dental performance standards. The new curriculum implemented following completion of the study is in its third year. Much of its structure is based on evidence-based teaching methodologies, and approximately one-third of the content consists of small groups researching clinical problems with applied science and discussing the findings. The framework described in this article proved useful to guide revision of predoctoral clinical education at one dental school and may be useful in other settings.


Assuntos
Currículo , Pesquisa em Odontologia/educação , Educação em Odontologia/métodos , Odontologia Baseada em Evidências/educação , Alabama , Humanos , Modelos Educacionais , Avaliação de Programas e Projetos de Saúde
18.
Fam Med ; 36(9): 651-9, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15467943

RESUMO

BACKGROUND AND OBJECTIVES: While content, navigability, and usability are essential qualities of effective Web sites, the health care literature contains limited discussion of these issues. This article describes how knowledge gained through focus groups, Web site searches, and individual interviews were used to develop and improve a health-related Web site. METHODS: We conducted 10 focus groups and searches of existing Web sites in preparation for developing a Web site about colorectal cancer (CRC) screening. We conducted 30 in-depth interviews to assess content, navigation, and usability of a new CRC Web site, using participants recruited from Michigan communities with a low incidence of CRC testing. Targeted participants were 50-70 years of age, had no prior experience with CRC testing, and had variable comfort levels with Internet use. RESULTS: Existing CRC screening Web sites uniformly use user-directed navigation and have little variation in content. Our study participants stimulated revisions in content, navigation, and usability. Revised content factors included comprehension, utility, and appeal. Navigation changes focused on logical transition between sections. Usability changes included user focus and clarity of graphics/ text. CONCLUSIONS: We found focus groups, Web site searches, and individual interviews useful in developing and testing content, navigation, and usability of a CRC screening Web site. These steps provide methodological procedures for developing and revising health-related Web sites.


Assuntos
Neoplasias Colorretais/diagnóstico , Internet , Educação de Pacientes como Assunto , Atenção Primária à Saúde , Idoso , Diagnóstico Precoce , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde
19.
Ann Fam Med ; 2(1): 7-12, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15053277

RESUMO

BACKGROUND: Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. METHODS: We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. RESULTS: Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. DISCUSSION: We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.


Assuntos
Atenção Primária à Saúde , Projetos de Pesquisa , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Modelos Teóricos , Pesquisa Qualitativa
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