Care Experience (care + experience)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Families of Origin, Foster Care Experience, and the Transition to Adulthood

Donna Dea Holland
ABSTRACT The rising number of young adults transitioning to adulthood from the foster care system has been a focus of prior research. The current study explored foster care youths transitions to adulthood to identify factors that contribute to or inhibit prosocial adult outcomes. Structured data derived from interviews with foster care-experienced adults and child welfare professionals as well as focus groups with foster care-experienced adults and foster parents were analyzed using content analysis to examine the transition to adulthood from foster care. Positive or negative life outcomes resulted from two key mechanisms: a) issues related to family of origin (inadequate parenting, abuse); and b) foster care experiences (including a pattern of "drift"). We explore disidentification, a new social psychological concept. Throughout, key players provide policy recommendations for the child welfare system. [source]

Behavioral response to methylphenidate challenge: Influence of early life parental care

Veronika Engert
Abstract Rat studies have shown that pups subjected to suboptimal rearing conditions exhibited permanently dysregulated dopamine activity and altered behavioral responses to dopamine stimulation. In humans, heightened stress-induced mesoaccumbens dopamine release in adults reporting low maternal care experience has been shown. We explored the relationship between quality of parental care and behavioral responsivity to reward and 20,mg of the dopamine agonist methylphenidate (MPH). Forty-three male university students accomplished a monetarily rewarded card-sorting task in a placebo controlled between-subjects study design. In participants scoring above the cut-off score for high parental care as assessed by the Parental Bonding Inventory, MPH decreased performance accuracy in the reward condition of the task. Contrarily, reward-induced performance accuracy of low care participants was enhanced with MPH. Activity measures in response to reward and MPH were uninfluenced by parental care. This is the first human study to reveal that the behavioral MPH response interacts with early life parental care experience. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 408,416, 2009. [source]

Mortality after care among young adult foster children in Sweden

Bo Vinnerljung
This exploratory study looks at mortality after care among 13,100 former Swedish foster children, placed before their teens. Sources used are two national databases, on child welfare interventions and causes of death. Risk ratios of death for foster children are compared with those of their peers in the general population and with a comparison group, consisting of 10,668 young adults from adverse home backgrounds, who never entered foster family care before their teens. Both ex-foster children and the comparison group were young adults (19,26 years old) at time of follow-up. Results show a moderately elevated risk ratio for both groups compared with peers in the general population, mainly due to more frequent unnatural deaths, especially suicides. Time at first placement was not related to mortality among men, but there was a weak tendency of a higher risk ratio for girls placed at age 7,12. Information on time spent in care is used with caution, due to possible problems with reliability. Almost all comparisons between the foster care and the comparison group fell short of statistical significance. For foster children who had spent more than five years in care, the risk ratio tended to be higher than for foster children with shorter care experience, and similar to that of the comparison group. Foster children who had been in care for less then six years thus tended to have a lower risk ratio than the comparison group. [source]

Nursing and midwifery research in Scotland: from partnership to collaboration

T. Fyffe mmed ed
Nurses and midwives form the workforce that provides the greatest proportion of direct care to service users. They have the ability to make a significant impact not only on the quality and outcomes of patient care, but also on service users' and carers' perceptions of the care experience. It is therefore vital that nursing and midwifery practice has a robust knowledge and evidence base. The Scottish Executive Health Department, in partnership with other key stakeholders, launched in 2004 an £8 million funding package for research and development capacity and capability initiatives for nursing, midwifery and the allied health professions. This article seeks to describe the process of engagement and partnership building that enabled this scheme to be developed. It will attempt to illustrate how the convergence of political, policy and professional agendas has provided the opportunity for nurses and midwives to set a direction of travel for research and development that will enable them to become key players within multidisciplinary research at United Kingdom and international levels. [source]

Emotional outcome after intensive care: literature review

Janice E. Rattray
Abstract Title., Emotional outcome after intensive care: literature review. Aim., This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. Background., Being a patient in intensive care has been linked to both short- and long-term emotional and psychological consequences. Data sources., The literature search was conducted during 2006. Relevant journals and databases were searched, i.e. Medline and CINAHL, between the years 1995 and 2006. Review methods., The search terms were ,anxiety', ,depression', posttraumatic stress', ,posttraumatic stress disorder' and ,intensive care'. Results., Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow-up clinics and patient diaries. Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient's intensive care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. Conclusion., Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group. [source]

Patients' perceptions of nursing care in the hospital setting

Lee A. Schmidt PhD RN
Background., Patient satisfaction and patient satisfaction with nursing care data are routinely collected as an indicator of the quality of services delivered. Despite the widespread collection and reporting of these data, the theoretical basis of patient satisfaction and patient satisfaction with nursing care remains unclear. Without a clear theoretical base, interpretation of patient satisfaction findings is hampered and the entire line of patient satisfaction research is of questionable validity. It has been suggested that, to understand patient satisfaction, patient perceptions of their care must first be understood. Aim., The aim of this study was to discover patients' perceptions of the nursing care they receive in the hospital setting. Method., Grounded theory method was used in this study of eight medical,surgical patients recently discharged from an academic medical centre in the south-eastern United States of America (USA). Participants were interviewed and the verbatim transcripts analysed using the constant comparative method. Findings., Four categories of patient perceptions of their nursing care emerged from the data. ,Seeing the individual patient' captures the unique nature of the nursing care experience for each patient. ,Explaining' represents the informal explanations given by nursing staff as they provide care. ,Responding' refers to both the character and timeliness of nursing staff's responses to patient requests or symptoms. ,Watching over' represents the surveillance activities of nursing staff. Conclusions., The categories identified in this study may be used in efforts to further develop a formal theory of patient satisfaction with nursing care. These categories should also be tested with patients possessing a wider range of characteristics, to assess the transferability of the findings. [source]

Emergency nurses' knowledge of perceived barriers in pain management in Taiwan

Feng-Ching Tsai MS
Aims and objectives., To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Background., Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses' knowledge of and perceived barriers to pain management in Taiwan. Design and methods., Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. Results., The overall average correct response rate for the knowledge scale was 49·2%, with a range of 4·8,89·2% for each survey question. The top barrier to managing pain was identified by these nurses as ,the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Conclusions., Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. Relevance to clinical practice., The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses. [source]

The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain

PAIN MEDICINE, Issue 3 2003
Carmen R. Green MD
ABSTRACT context. Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. objectives. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. evidence. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. conclusions. Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities. [source]

Critical management in patients with severe enterovirus 71 infection

Abstract Objective: The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection. Methods: A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison. Results: The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2 ± 5.0 vs 4.9 ± 1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%). Conclusion: Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management. [source]

Treatment of Breast Cancer in Medically Underserved Women: A Review

Lisa C. Richardson MD
Abstract: Women at risk of being undertreated for breast cancer include women who are older, from minority groups, from lower socioeconomic backgrounds, and those without health insurance or insured by Medicaid. Recent reviews of the cancer care experience of medically underserved populations indicate that breast cancer care may be even less optimal for these populations than the majority of women. These are the same women who may experience difficulty obtaining access to medical care once they are diagnosed with breast cancer. Indirect proof of problems with access is manifested as higher recurrence rates of breast cancer and differences in breast cancer-specific survival among medically underserved women. Multiple factors have been shown to affect access to medical care, and therefore quality of care, including patient-level factors, provider-level factors, and health system factors. This article reviews the current state of these factors in explaining breast cancer care in medically underserved women. [source]

Personal stigma and coping strategies in families of patients with schizophrenia: Comparison between Japan and Korea

Setsuko Hanzawa PhD
Abstract Introduction: It has been extensively documented that caregivers of persons who have serious and persistent mental disorders must successfully cope with many challenging problems in order to provide good care. However, little is known about the relationship between family stigma and strategies for coping with patients with schizophrenia. Therefore, the present study compared the personal stigma and coping strategies of families of patients with schizophrenia by examining the socio-cultural factors that affect the care experience of families in Northeast Asian countries. Methods: Two self-rating scales were used to compare personal stigma and coping strategies regarding family members of patients with schizophrenia in 47 Japanese and 92 Korean families. Respondents reported their personal attitudes (personal stigma) with respect to a case vignette that described a person with chronic schizophrenia. Results: Analysis revealed the following: 1) although no differences in coping strategies were observed between the countries, the personal stigma of families was significantly higher in Korea than in Japan; 2) coping strategies, such as positive communication, coercion, and avoidance, were significantly associated with personal stigma in Korean families; however, in Japanese families, resignation was significantly associated with personal stigma. Discussion: The present findings suggest that personal family stigma was higher in Korea than Japan, and the features associated with coping strategies differ between countries. It is important to determine the features of personal stigma that are associated with schizophrenia. Furthermore, education and support programs for families with schizophrenia based on trans-cultural considerations must be emphasized in both countries. [source]

Family stigma and care burden of schizophrenia patients: Comparison between Japan and Korea

Setsuko Hanzawa PhD
Abstract Introduction: In the present study, we compared the care burden and stigma experienced by families of patients with schizophrenia in Japan (Niigata) and Korea (Seoul and Daegu) to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in East Asia. Methods: Factors such as care burden (evaluated using the eight-item short version of the Zarit Caregiver Burden Interview [ZBI-8]), stigma, and social distance were evaluated in members of support groups for families of mentally ill individuals in Japan (n=47) and Korea (n=92) using an interview questionnaire. Interviewees reported their personal attitudes (personal stigma and social distance) and perceptions of the attitudes of others in the community (perceived stigma) with respect to a case vignette. These vignettes described a person with chronic schizophrenia. Results: The data analysis revealed the following: (i) feelings of care burden (according to ZBI-8), perceived stigma, and social distance were significantly stronger in Japan compared to Korea, and (ii) feelings of personal stigma were significantly stronger in Korea than in Japan. Discussion: The care burden and stigma experienced by families of patients with schizophrenia differed between Japan and Korea. The present findings suggest that to provide effective support for reducing family stigma and care burden, the necessity of such support must be emphasized in both countries. [source]

Satisfaction and Use of Prenatal Care: Their Relationship Among African-American Women in a Large Managed Care Organization

BIRTH, Issue 1 2003
Arden Handler DrPH
ABSTRACT:Background: Although many more mothers of almost all ethnic groups began prenatal care in the first trimester during the last decade, a significant number of low-income and minority women still fail to obtain adequate care in the United States,a failure that may be related to their dissatisfaction with the prenatal care experience. This study sought to examine the relationship between satisfaction with care and subsequent prenatal care utilization among African-American women using prospective methods. Methods: A sample of 125 Medicaid and 275 non-Medicaid African-American adult women seeking care through a large Midwest managed care organization were interviewed before or at 28 weeks' gestation at one of two prenatal care sites. Women were interviewed about personal characteristics, prenatal care experience, and ratings of care (satisfaction). Information about subsequent use of prenatal care was obtained through retrospective medical record review after delivery. Univariate and multivariable analyses examining the relationship between women's satisfaction and prenatal care use were conducted using a dichotomous measure of satisfaction and a continuous measure of utilization. Results: Women were highly satisfied with prenatal care, with an overall mean satisfaction score of 80.3. Non-Medicaid women were significantly (p < 0.05) less satisfied with their prenatal care (mean score, 79.1) than Medicaid women (mean score, 82.8), and the latter had significantly fewer visits on average than the former subsequent to the interview. Analyses showed no significant difference in subsequent utilization according to whether a woman had a high versus low level of satisfaction at the prenatal care interview. Conclusions: This study challenges the assumption that improving a woman's satisfaction with care will lead to an increase in the adequacy of her prenatal care utilization. Since this study was limited to African-American women and is the first prospective study of women's satisfaction with care and prenatal care utilization, the negative findings do not yet settle this area of inquiry. Monitoring women's satisfaction with prenatal care in both managed care and fee-for-service settings and working to improve those aspects of care associated with decreased satisfaction is warranted. (BIRTH 30:1 March 2003) [source]

Sleep behaviour in preterm children from birth to age 10 years: A longitudinal study

Abstract Aim: To study clinically relevant aspects of sleep behaviour in preterm children in comparison to term children. Methods: Longitudinal sleep behaviour data were collected prospectively by structured interviews in 130 preterm and 75 control term children from birth to age 10 y. Results: No significant differences in sleep duration (time in bed per 24 h), bedsharing, night wakings, bedtime resistance and sleep-onset difficulties were found between preterm and term children. Conclusion: Sleep behaviour does not differ between preterm and term children from birth to age 10 y, indicating that prematurity or neonatal intensive care experience does not significantly affect sleep in the first 10 y of life. [source]

Research sensitivities to palliative care patients

J. Addington-Hall phd
Research sensitivities to palliative care patients This paper considers the methodological challenges of researching the health care experiences of palliative care patients and their families. Difficulties in defining a ,palliative care patient' are highlighted, and the question of whether there are specific ethical issues when researching palliative care explored. Methodological issues are discussed, including the negotiation of access via health professionals, the choice of appropriate data collection methods and tools, the consequences of high attrition rates and the use of retrospective surveys of bereaved relatives. Key areas for research are identified. These include patients' and families' experiences of research participation, the impact of being approached on those who decline, how the characteristics of those who participate differ from those who do not and the likely impact of this on findings. Research is also needed into patient and family motivations for participation, and whether and how these change as the disease progresses. To ensure that the voices of palliative care patients and their families are heard by both service providers and policy-makers, research in this area needs to address the methodological challenges raised in this paper, as well as continuing to explore users' views. [source]

Evaluation of negative emotional care experiences in burn care

Björn Wikehult MSc
Aim and objective., To assess recollection of negative emotional experiences during burn care. Background., Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences. Design., Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face-to-face interview. Methods., Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms. Results., Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post-traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent. Conclusions., Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction. Relevance to clinical practice., Although relatively uncommon, negative emotional care experiences should be monitored more closely during care. [source]

Youth Voices as Change Agents: Moving Beyond the Medical Model in School-Based Health Center Practice

Leslie A. Mandel
Freshmen were recruited to participate in a Youth Advisory Board Project that included weekly afterschool meetings. Adult supervision was provided by SBHC staff that included 2 clinical social workers and 1 youth empowerment specialist. Through this effort, students were (1) trained in nonprofit board development and governance structures; (2) urged to identify gaps in services; (3) taught to select, prioritize, and implement action projects; and (4) offered clinical support around personal issues. Students brought a wealth of life experiences, knowledge of teen attitudes, information regarding trends in risk-taking behaviors, and feedback about experiences in the SBHC. In addition, their increased awareness of the SBHC service elements led to identification of obstacles to youth participation in care, feedback regarding positive and negative health care experiences within the SBHC, as well as with external health care providers, and ideas about unrecognized needs leading to gaps in services. This experience demonstrated that young health care consumers, with support, can focus their attention and begin to utilize analytical thinking skills to shape health outcomes and inform service delivery. (J Sch Health. 2005;75(7):239,242) [source]

Families of Origin, Foster Care Experience, and the Transition to Adulthood

Donna Dea Holland
ABSTRACT The rising number of young adults transitioning to adulthood from the foster care system has been a focus of prior research. The current study explored foster care youths transitions to adulthood to identify factors that contribute to or inhibit prosocial adult outcomes. Structured data derived from interviews with foster care-experienced adults and child welfare professionals as well as focus groups with foster care-experienced adults and foster parents were analyzed using content analysis to examine the transition to adulthood from foster care. Positive or negative life outcomes resulted from two key mechanisms: a) issues related to family of origin (inadequate parenting, abuse); and b) foster care experiences (including a pattern of "drift"). We explore disidentification, a new social psychological concept. Throughout, key players provide policy recommendations for the child welfare system. [source]

Fostering self-esteem: exploring adult recollections on the influence of foster parents

Nikki Luke
ABSTRACT Foster parents are in a unique position to improve the self-esteem of children in their care, which may be lower than that of their non-fostered peers. According to Harter's dual-influence model, both general support or attachment and domain-specific support contribute to self-esteem. The current study used this model to explore the ways in which foster parents had influenced the self-esteem of a sample of five adults with differing foster care experiences. Retrospective interviews were used to gather memories of high self-esteem from time spent in foster care. A thematic analysis of the interview transcripts supported Harter's model, and provided a number of examples of ways in which foster parents could boost children's self-esteem. The model was further extended to show the importance of ,normality' and inclusion for this sample of fostered adults. Further research on this topic is recommended with a view to widening the scope of foster carer training beyond attachment theory. [source]