Home About us Contact
|
Home About us Contact | ||
|
|
||
Improved Communication (improved + communication)
Selected AbstractsTracheostomy management in Acute Care Facilities , a matter of teamworkJOURNAL OF CLINICAL NURSING, Issue 9-10 2010Vicki Parker Aim., Implement and evaluate an inter-disciplinary team approach to tracheostomy management in non-critical care. Background., Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patient's destination after ICU. Design., A mixed method evaluation incorporating quantitative and qualitative approaches. Method., Data collection included pre-implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis. Results., Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50,27 days (p < 0·0001) and an increase in the number of tracheostomy patients transferred to non-critical care wards in the postgroup (p = 0·006). The number of wards accepting patients from ICU increased from 3,7 and there was increased staff knowledge, confidence and awareness of the team's role. Conclusion., The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes. Relevance to clinical practice., This study highlights the importance of inter-disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter-disciplinary practice, supported by communication and data management that can be replicated across other patient groups. [source] Strategies for Successful Marine Conservation: Integrating Socioeconomic, Political, and Scientific FactorsCONSERVATION BIOLOGY, Issue 6 2005CAROLYN J. LUNDQUIST áreas marinas protegidas; planificación de conservación; reservas marinas Abstract:,As the process of marine-protected-area design and implementation evolves, the incorporation of new tools will advance our ability to create and maintain effective protected areas. We reviewed characteristics and approaches that contribute to successful global marine conservation efforts. One successful characteristic emphasized in most case studies is the importance of incorporating stakeholders at all phases of the process. Clearly defined goals and objectives at all stages of the design process are important for improved communication and standardized expectations of stakeholder groups. The inclusion of available science to guide the size and design of marine protected areas and to guide clear monitoring strategies that assess success at scientific, social, and economic levels is also an important tool in the process. Common shortcomings in marine conservation planning strategies include government instability and resultant limitations to monitoring and enforcement, particularly in developing nations. Transferring knowledge to local community members has also presented challenges in areas where in situ training, local capacity, and existing infrastructure are sparse. Inaccessible, unavailable, or outdated science is often a limitation to conservation projects in developed and developing nations. To develop and maintain successful marine protected areas, it is necessary to acknowledge that each case is unique, to apply tools and lessons learned from other marine protected areas, and to maintain flexibility to adjust to the individual circumstances of the case at hand. Resumen:,A medida que evoluciona el proceso de diseño e implementación de áreas marinas protegidas, la incorporación de nuevas herramientas mejorará nuestra habilidad para crear y mantener áreas protegidas efectivas. Revisamos las características y enfoques que contribuyen a los esfuerzos exitosos de conservación marina global. La importancia de incorporar a los actores en todas las fases del proceso es una característica exitosa enfatizada en la mayoría de los estudios de caso. Es importante que haya metas y objetivos claramente definidos para todas las etapas del proceso de diseño para mejorar la comunicación y estandarizar las expectativas de los grupos interesados. La inclusión de la ciencia disponible para guiar el tamaño y diseño de áreas marinas protegidas y para guiar las estrategias de monitoreo que evalúa el éxito a nivel científico, social y económico también son herramientas importantes en el proceso. Defectos comunes en las estrategias de planificación de conservación marina incluyen la inestabilidad gubernamental y las resultantes limitaciones para el monitoreo y vigilancia, particularmente en países en desarrollo. La transferencia de conocimiento a miembros de la comunidad local también ha enfrentado retos en áreas donde el entrenamiento in situ, la aptitud local y la infraestructura existente son escasos. La ciencia inaccesible, no disponible u obsoleta a menudo es una limitación para los proyectos de conservación en países desarrollados y en desarrollo. Para desarrollar y mantener áreas marinas protegidas exitosas, es necesario reconocer que cada caso es único, aplicar herramientas y lecciones aprendidas en otras áreas marinas protegidas y mantener la flexibilidad para ajustarse a las circunstancias individuales de cada caso. [source] Exploring the implications for health professionals of men coming out as gay in healthcare settingsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2006Bob Cant MA Abstract Coming out as gay is a social process which redefines the relationship between the persons who have decided to disclose their homosexuality and their listeners. This paper, drawing upon Bakhtin's (1984) theories of dialogue, the coming-out literature of gay men and lesbians and contemporary literature on doctor,patient communication, explores the coming-out experiences of gay men with their general practitioners and sexual health clinic staff. The findings are based upon a study of 38 gay men and 12 health service managers in London. The informants were recruited purposively to reflect some of the diversity of the London setting; recruitment was carried out through the channels of gay voluntary organisations and through snowballing. Semi-structured interviews were conducted and a grounded-theory approach was adopted. It was found that coming out in general practice was often/mostly followed by silence/noncommunication on the part of the practitioner; coming out could, however, result in an improvement in communication if the patients were well supported and assertive. If coming out in sexual health clinics did not result in improved communication, the informants in this study were likely to change clinics until they did find improved communication. This paper raises questions about the communication and training needs of general practitioners. It also raises questions about inequalities of access to ,respectful' sexual health clinics; while men who are articulate about the narratives of their lives as gay men are able to exercise informed choices, there were grounds for concern about the choice behaviours of men who are less articulate about their life narratives. [source] Using therapeutic community principles to improve the functioning of a high care psychiatric ward in the UKINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2002Willm Mistral ABSTRACT: The effects of interventions within a high-care psychiatric ward, based upon the principles of a therapeutic community, were evaluated. Interventions included an enhanced physical environment, improved communication, clear rules and aims, and improved safety procedures. A Ward Atmosphere Scale, an Attitude Scale, and interviews with staff indicated improvements in ward atmosphere and staff attitudes. Ward records showed a substantial reduction in the use of seclusion for aggressive patient behaviour, and a 62% reduction over 2 years in short-term staff illness. The authors conclude that similar interventions could be used to improve the functioning of other psychiatric wards. [source] ASH Position Paper: Adherence and Persistence With Taking Medication to Control High Blood PressureJOURNAL OF CLINICAL HYPERTENSION, Issue 10 2010Martha N. Hill RN J Clin Hypertens (Greenwich). 2010;12:757-764. © 2010 Wiley Periodicals, Inc. Nonadherence and poor or no persistence in taking antihypertensive medications results in uncontrolled high blood pressure, poor clinical outcomes, and preventable health care costs. Factors associated with nonadherence are multilevel and relate not only to the patient, but also to the provider, health care system, health care organization, and community. National guideline committees have called for more aggressive approaches to implement strategies known to improve adherence and technologies known to enable changes at the systems level, including improved communication among providers and patients. Improvements in adherence and persistence are likely to be achieved by supporting patient self-management, a team approach to patient care, technology-supported office practice systems, better methods to measure adherence, and less clinical inertia. Integrating high blood pressure control into health care policies that emphasize and improve prevention and management of chronic illness remains a challenge. Four strategies are proposed: focusing on clinical outcomes; empowering informed, activated patients; developing prepared proactive practice teams; and advocating for health care policy reform. With hypertension remaining the most common reason for office visits, the time is now. [source] School nurse perceptions of barriers and supports for children with diabetesJOURNAL OF SCHOOL HEALTH, Issue 4 2005Laura Nabors These youth often do not receive the support needed to manage their diabetes during or after school. Nurses (n = 110) from 3 states responded to a survey examining perceptions of barriers to and supports for diabetes management during school and after school activities. Results indicated that adolescents need more support at school. Support could be facilitated by education of school staff; improved communication among youth, parents, school nurses, teachers, and physicians; and more communication from adolescents to others about what they need to manage well in school. Open-ended questions allowed nurses to provide recommendations for supporting youth and ideas for addressing barriers to management at school. Future studies should address ways to enable adolescents to communicate about their diabetes and ways to educate the school team. (J Sch Health. 2005;75(4):119-124) [source] Parental communication and children's behaviour following diagnosis of childhood leukaemiaPSYCHO-ONCOLOGY, Issue 4 2005Sally-Ann Clarke Many parents find decisions about what to tell their child with cancer difficult. Open communication is generally considered the best policy and most health care professionals encourage parents to talk openly and honestly about the illness. However, parents differ in their views about what to tell the child. In this study 55 parents of children (36 boys and 19 girls, mean age = 7.33 years) newly diagnosed with acute lymphoblastic leukaemia (ALL) were interviewed about (i) the child's reactions and behaviour following diagnosis, (ii) their views about what to tell their child and (iii) factors influencing parents' communication with the child. Interviews were analysed using thematic analysis. Most children showed behavioural and mood difficulties after diagnosis. Older children were given more information. In addition, parents' perceptions of childhood cancer affect the way they communicate with their child. These findings may be used to inform training packages in order to facilitate improved communication amongst health professionals. Copyright © 2004 John Wiley & Sons, Ltd. [source] Auditory Brainstem Implantation in Patients with Neurofibromatosis Type 2,THE LARYNGOSCOPE, Issue 12 2004Seth J. Kanowitz MD Abstract Objectives: Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) and schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA), regardless of hearing loss (HL). The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. This study aims to review the surgical and audiologic outcomes in 18 patients implanted by our Skull Base Surgery Team from 1994 through 2003. Study Design: A retrospective chart review of 18 patients with ABIs. Methods: We evaluated demographic data including age at implantation, number of tumor resections before implantation, tumor size, surgical approach, and postoperative surgical complications. The ABI auditory results at 1 year were then evaluated for number of functioning electrodes and channels, hours per day of use, nonauditory side effect profile and hearing results. Audiologic data including Monosyllable, Spondee, Trochee test (MTS) Word and Stress scores, Northwestern University Children's Perception of Speech (NU-CHIPS), and auditory sensitivity are reported. Results: No surgical complications caused by ABI implantation were revealed. A probe for lateral recess and cochlear nucleus localization was helpful in several patients. A range of auditory performance is reported, and two patients had no auditory perceptions. Electrode paddle migration occurred in two patients. Patient education and encouragement is very important to obtain maximum benefit. Conclusions: ABIs are safe, do not increase surgical morbidity, and allow most patients to experience improved communication as well as access to environmental sounds. Nonauditory side effects can be minimized by selecting proper stimulation patterns. The ABI continues to be an emerging field for hearing rehabilitation in patients who are deafened by NF2. [source] Prospects for the Survival of the Navajo Language: A ReconsiderationANTHROPOLOGY & EDUCATION QUARTERLY, Issue 2 2002Professor Bernard Spolsky What is the role of schools in the loss of indigenous languages? A study 25 years ago of prospects for the survival of Navajo placed most of the blame for the spread of English on increasing access to schools. Reconsidering that evidence and recent developments, the central role of the introduction of Western schooling is seen still to be highly relevant. But other factors have worked through the school, the major effect of which has been the ideological acceptance of English. Vernacular literacy, traditional or introduced religion, and political structure all have failed to establish a counterforce. Economic changes also led to new living patterns that, together with improved communication, broke down isolation and supported the threat to the survival of language. This study confirms the importance of seeing language and education in the full social, cultural, religious, and political context recognized by educational anthropology. [source] The implications of improved communications for participatory forest management in TanzaniaAFRICAN JOURNAL OF ECOLOGY, Issue 2009Elizabeth J. Z. Robinson Abstract Following the 1998 National Forest Policy and Forest Act of 2002, participatory forest management (PFM) is being introduced in Tanzania. PFM has two key objectives: to reduce forest degradation thereby increasing ecosystem services, and to improve the livelihoods of local villagers. A unique data set collected in 2006 suggests that significant challenges remain with respect to communicating the new forest policies if the objectives of PFM are to be achieved. First, villagers as a group are much less well informed than other stakeholders, and their knowledge is often inaccurate. Second, women are less likely than men to have heard of the changes. Third, how PFM will contribute to poverty reduction (a key objective of PFM) is not always clear. Fourth, environmental degradation may not be reduced as much as anticipated , without alternatives sources, villagers often continue to cut trees for charcoal and firewood in the protected forests. Finally, several mismatches in perceptions are identified that could lead to difficulties in implementing PFM. [source] | |||||||||||||