Allied health workers’ role in patient education in the United States

Introduction: Patient education (PE) has been traditionally seen as the role of nurses and physicians, while allied health workers (AHWs)-who make up the biggest population of the US healthcare workforce-are sometimes reduced to providing supportive roles. This article reviews the available literature on the role of AHWs in providing PE in the US.Methods: This review was based on a search of the databases Academic Search Ultimate; Health Source-Consumer Edition; Health Source-Nursing/Academic Edition and MEDLINE initially conducted between January 10 and February 3, 2021, and later re-done between December 20 and December 22, 2021. This review applied guidelines for narrative reviews (Ferrari 2015). The search looked at papers published between 2001 and 2021, which discussed allied health professions relevant to the US health system.Results: The review derived 18 articles from the search and two articles from the reference lists of the 18 articles. The review found that AHWs seldom performed PE, although the profession of physical therapy made efforts to formalize participation in PE. It also found that expansion of roles for AHWs was warranted, although additional training may be required to develop effective PE competencies among AHWs. Finally, it found existing challenges such as interprofessional rivalries and time limitations that affected the incorporation of AHWs in PE.Conclusions: AHWs have untapped potential to contribute more to the US health system through delivery of effective PE. Policy adjustments are needed to maximize the input of AHWs in PE. Increased interprofessional collaboration in the US health system is needed to facilitate the extension of PE roles to AHWs. Further research is needed to better understand the factors limiting AHWs’ involvement in PE

Linking patient satisfaction with nursing care: the case of care rationing -a correlational study

Abstract Background: Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses' perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses' perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels

Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor)

To assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs).Open pragmatic parallel group randomised controlled trial.Primary care in UK.Adults (aged ≥18) registered with general practitioners, recruited by postal invitation.Patients were randomised with computer-generated random numbers to access the intervention website (intervention) or not (control). The intervention tailored advice about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help.Primary: National Health Service (NHS) contacts for those reporting RTIs from monthly online questionnaires for 20 weeks. Secondary: hospitalisations; symptom duration/severity.3044 participants were recruited. 852 in the intervention group and 920 in the control group reported 1 or more RTIs, among whom there was a modest increase in NHS direct contacts in the intervention group (intervention 37/1574 (2.4%) versus control 20/1661 (1.2%); multivariate risk ratio (RR) 2.25 (95% CI 1.00 to 5.07, p=0.048)). Conversely, reduced contact with doctors occurred (239/1574 (15.2%) vs 304/1664 (18.3%); RR 0.71, 0.52 to 0.98, p=0.037). Reduction in contacts occurred despite slightly longer illness duration (11.3 days vs 10.7 days, respectively; multivariate estimate 0.60 days longer (-0.15 to 1.36, p=0.118) and more days of illness rated moderately bad or worse illness (0.52 days; 0.06 to 0.97, p=0.026). The estimate of slower symptom resolution in the intervention group was attenuated when controlling for whether individuals had used web pages which advocated ibuprofen use (length of illness 0.22 days, -0.51 to 0.95, p=0.551; moderately bad or worse symptoms 0.36 days, -0.08 to 0.80, p=0.105). There was no evidence of increased hospitalisations (risk ratio 0.25; 0.05 to 1.12; p=0.069).An internet-delivered intervention for the self-management of RTIs modifies help-seeking behaviour, and does not result in more hospital admissions due to delayed help seeking. Advising the use of ibuprofen may not be helpful.ISRCTN91518452

Epidemiology of ATTRV30M neuropathy in Cyprus and the modifier effect of complement C1q on the age of disease onset.

BACKGROUND: ATTRV30M amyloidosis is a lethal autosomal dominant sensorimotor and autonomic neuropathy caused by amyloid deposition composed of aggregated misfolded TTR monomers with the V30M mutation. The age of onset in patients with ATTRV30M varies in different foci and the mechanism behind it is still unknown. METHODS: The tertiary neurology center following all ATTRV30M patients in Cyprus was used to collect demographic data to estimate; prevalence, incidence, penetrance, anticipation, time from disease onset to diagnosis and transplantation. Ocular, cardiac and leptomeningeal involvement in transplanted patients was explored. Correlation of C1q tagging SNPs with age of disease onset was carried out. RESULTS: Prevalence and incidence for ATTRV30M neuropathy in Cyprus are 5.4/100,000 and 0.3/100,000 respectively. Mean age of onset is 40.6 years and anticipation is 8.3 years. Penetrance reaches 51% and 75% by the ages of 50 and 80 years respectively. In liver transplanted patients rates of ocular, cardiac and leptomeningeal involvement were estimated to be 60%, 20% and 16%, respectively. C1q polymorphisms correlated with age of disease onset. CONCLUSIONS: ATTRV30M neuropathy has a rising prevalence in Cyprus due to improved survival of patients. Late onset complications are becoming a major problem. Complement C1q appears to be a modifier in this disease

Identifying the theoretical components and technical characteristics of a prototype intervention to support and promote self-care for cold and flu symptoms

The primary aim of this thesis was to present the development of the prototype of a theory-based web intervention aiming to support decision-making of the general adult population on whether to seek professional help or self-care for acute respiratory tract infections. The thesis comprised of a systematic review, two qualitative studies, one survey, and a step-by-step development of the intervention. All the empirical studies aimed to identify the theoretical and technical components that could improve the intervention. The systematic review of 18 trials aimed to identify the effectiveness of health educational materials in improving health outcomes for minor ailments such as physical health and health service use. There was mixed evidence regarding the factors that influence primary care consultations; providing educational information outside consultation appeared to be most effective. The piloting of the intervention elicited feedback, via 21 interviews, regarding the content of the intervention e.g. reducing the length of the information, making screening questions clearer, and clarifying when they need to seek professional help. Comments about the format included improving the navigation and aesthetics of the materials by adding more pictures and colour as well as reducing the use of jargon language. The second qualitative study aimed to elicit the underlying reasons to consult a clinician. Findings indicated that consultation was linked to uncertainty about the symptoms, severity and the impact on everyday activities, and past antibiotic prescribing. The theories closely identifying with the arising constructs were Social Cognitive theory, the Common Sense of Illness Representations, and the Beliefs about Medication. The last study of thesis, a survey of 323 participants, showed that the most significant factors linked to the decision not to seek professional help were strong beliefs that symptoms can resolve on their own and seeking help from the pharmacist prior seeing the GP. The findings from the empirical studies contributed further into the development of the intervention as a new resource to help individuals decide whether to seek professional help or self-care for their symptoms. Further work for the online version of the intervention, including tailoring of theoretical factors and including more representative sample, can enhance its validity and effectiveness

Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision

Background: it is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms.Methods: in Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis.Results: study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed.Conclusions: educational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they see

Exploring Sensitive Nursing Issues Through Focus Group Approaches

Background: Rationing of nursing care is an important organisational variable that includes omissions in care and appears to be related to patient safety and quality of care. Nursing care rationing is a sensitive issue that raises strong emotions as nurses are not always willing to report omitted or unfinished nursing tasks. Apart from the negative consequences for patients, rationing may add an ethical burden on nurses causing moral distress. Aim: The aim of this paper was to explore some of the methodological issues arising from using focus group interviews as a research method when investigating “sensitive nursing issues”, in this case rationing of nursing care. Material and Method: Methodological issues are discussed in the context of a study examining views of nursing care rationing among registered nurses working in medical and surgical units. Three focus groups were held, between June and September 2011, to identify which areas of nursing care are rationed and the underlying causes of rationing. The groups comprised of a total of seventeen registered nurses. The discussion started based on a scenario describing a regular day in a busy hospital ward and the purpose was to use group dynamics and participant interaction to gain an in-depth discussion of the participants’ views. Results: The security provided by the focus group encouraged the exploration of less conventional positions and facilitated conversation about sensitive events like the admission of rationing nursing care tasks. The group participation has given the nurses the opportunity to listen to colleagues having similar experiences and created an atmosphere of openness and honesty. Conclusions: Focus-group interviews as a data collection strategy for sensitive nursing issues is a rich source of information.http://www.hsj.gr/index.files/Page3698.ht

Social capital and care in the community: a methodological study

Abstract Rationale, aims and objectives: Healthcare reform systems require that individuals with long term and complex health problems to be cared at home by their families making informal caregivers a critical national healthcare resource. Caregiver support may be better understood in the context of the social capital framework that has the capacity to support health and wellbeing for the patient and caregiver through a combination of connections, informal exchange, informal non-family relations and resource acquisition. The aim of the study was to assess the validity and reliability of the Social Capital Questionnaire (SCQ-Greek) amongst Greek-speaking community dwellers in Cyprus. Methods: The SCQ was administered to a total sample of 225 Greek Cypriot community dwellers consisting of 2 groups - a group of family caregivers of patients with dementia (n=76) and a neighborhood-matched control group (n=149). Exploratory factor analysis using Varimax rotation was performed and items with factor loadings greater than 0.4 were retained. Cronbach’s coefficient of internal consistency was calculated for the overall scale and sub-scales. The association of Social Capital and its components (factors) with the socio-demographic characteristics of the participants were investigated in regression analyses. Results: A 6-factor solution with 28 items accounted for 48.3% of the variance. The item-total correlation ranged from 0.20 to 0.49 indicating that each of them contributed to the total score. For the overall instrument, Cronbach’s alpha was 0.83 and ranged between 0.55 and 0.82 for the individual factors. Generally, younger individuals, those with higher educational attainment and higher income tended to report higher levels of social capital. Conclusions: Findings demonstrate that a 28-item version of the SCQ is a reliable and valid tool for the assessment of perceptions of social capital among Greek-Cypriot community residents which included a sample of caregivers of the chronically ill. A tool to measure the perceptions of social capital is important for the understanding and utilizing the broader resources required for the care of the chronically ill in the community.The study has been funded by the Cyprus University of Technology

Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies

Abstract Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.The study was funded by the Cyprus University of Technolog

The hidden ethical element of nursing care rationing

Objective: To explore nurses’ experiences and perceptions about prioritizations, omissions, and rationing of bedside nursing care. Methods: A total of 23 nurses participated in four focus groups. The interviews were based on a semi-structured interview guide; data were analyzed using a thematic analysis approach. Findings: Four themes were developed based on the data: (a) priorities in the delivery of care; (b) professional roles, responsibilities, and role conflicts; (c) environmental factors influencing care omissions; and (d) perceived outcomes of rationing. Discussion: The delivery of nursing care is framed by the biomedical ethos and inter-professional role conflict while the standards of basic care are jeopardized. Organizational and environmental factors appear to exert significant influence on prioritization. Failure to carry out necessary nursing tasks may lead to adverse patient outcomes, role conflict, and an ethical burden on nurses. Conclusion: There is a need for further exploration and possible redesign of the nursing role, scope, and responsibilities, as well as addressing the arising ethical issues of rationing in nursing care