Gender differences in fears related to coronary arteriography

OBJECTIVE: To compare levels of fear and the intensity of specific fears in women and men related to coronary arteriography (CA). DESIGN: Prospective survey. SETTING: A 1360-bed university hospital. Data were collected before, during, and after CA, and again 6 months later. SUBJECTS: The sample consisted of 54 women and 166 men undergoing scheduled CA. METHODS: To compare fear levels at different points of evaluation; two analyses of covariance for repeated measures were performed. RESULTS: On average, women had significantly higher mean scores of fear across the points of evaluation on the Visual Analogue Scale than men (P <.001). During the hospital stay, the most intense fear for both women and men was the fear of coronary artery bypass grafting and the uncertainty about the illness, whereas at home it was the fear of myocardial infarction. On average, women reported significantly intense fears more frequently than men across time. On average, men experienced more intensive fear of problems in their sex life than women (P =. 032). The changes in intensity of fears over time were not significantly different by gender, except in fear of pain (P =.013), health care staff not having enough time to care for the patient (P =.039), and health care staff discussing the patient's condition without the patient being present (P =.048). Age and prior CA were found to be significantly related to most of the fears at different points of evaluation, and to the changes of fears over time. CONCLUSION: There existed differences in the tendency to report intensity of fears by gender; however, the intensity of fears changed in a similar way over time. The results suggest that the few gender differences in fears that existed may be explained by the treatment chosen for the patients and the patients' acceptance of it. Therefore, it is important to adapt information and support according to the treatment chosen for the patient.     

Staff perceptions of emotional distress in paitents with burn trauma.

Objective: To compare staff and patient perceptions of patients' emotional distress after acute burn trauma. Design: Staff ratings of patients' psychological states on 6 dimensions of emotional functioning were compared with patient self-report. Results: Staff as a whole and by discipline tended to overestimate depression and underestimate optimism in patients. Moreover, the more experienced (more than 2 years of burn care experience) nurses and occupational/physical therapists were less accurate in estimating depression and optimism than their less experienced counterparts. Conclusion: Consistent with results from spinal cord injury research, findings from the current study indicate a distinct tendency on the part of burn care staff to overestimate their patients' emotional distress and underestimate their positive outlook, supporting the notion that staff may be imposing a "requirement for mourning" on their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A team approach to geriatric case management

Monash Medical Centre, a large major hospital in Melbourne Australia, recently opened a high dependency unit (HDU) at its Moorabbin campus. The present study was designed to examine two patient groups admitted to the unit after major and non-major surgical procedures. Another aim in the study was to describe the services required by these patients and to compare the two groups with regard to length of stay in the HDU, severity of illness, and pain control. The results of this study indicate that the HDU provided a valuable and needed service to a population of patients who have been identified as at risk of postoperative complications. The findings appear to agree with other research which suggests that nurses consistently rate patients' pain as less severe than patients' own ratings of pain indicate. Thus nurses appear to overestimate patients' perception of pain control. This study again indicates that even though it is generally recognised by nurses that patients are in pain the management of it is such that pain continues to be inadequately controlled.     

Predictors of patient outcomes following interactions with nurses

A research and theory-based model was used to identify outcome predictors of hospitalized patients' perceptions of caring and support by nurses. The model tested the effects of cogent personal characteristics of patients (general level of self-esteem and need for control while hospitalized) on their perceptions of humanistic caring and support from nurses and, in turn, considered the effect of these variables on situational appraisal, coping strategies, psychological distress, and coping effectiveness. The 120 hospitalized adult patients indicated that the moderate amount of humanistic caring they received was beneficial. Several factors influenced caring ratings. Higher positive ratings were received from younger patients; however, people with low self-esteem and those desiring more control over their care or reporting a high degree of pain tended to perceive more threat and psychological distress as a results of their encounters with nurses. Following positive caring experiences with nurses, patients with higher self-esteem levels reported effective coping. Overall, positive caring experiences, along with coping strategies and decreased psychological distress levels, explained 40% of the variance of hospitalized patients' ability to cope effectively following their encounters with nurses.     

Self-esteem and depression in men who present with erectile dysfunction

Erectile dysfunction always has a psychologic component in addition to the underlying physical cause. The extent of depression and reduced self-esteem in patients who present with erectile dysfunction are explored in this study. Suggestions are given for how urologic nurses can overcome patients' fears and concerns.     

A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status

The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.     

A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children.

The development, reliability, and validity of a new instrument, the Social Phobia and Anxiety Inventory for Children (SPAI-C), is described. The results indicate that the SPAI-C has high test–retest reliability and internal consistency. In addition, an assessment of concurrent and external validity indicates statistically significant correlations with commonly used self-report measures of general anxiety and fears and parental reports of children's anxiety and social competence. The results of a factor analysis indicate that the scale consists of three factors: Assertiveness/General Conversation, Traditional Social Encounters, and Public Performance. Finally, scores on the SPAI-C successfully differentiate socially anxious and non-socially-anxious children. The instrument appears to be a reliable and valid measure for childhood social anxiety and fear and may prove useful for improving clinical assessment and documenting treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family caregiving of hospitalized patients. Caregiver and nurse perceptions at admission and discharge

To ensure patients will be discharged to stable, health-promoting home environments, nurses must understand family caregivers' perceptions of the patients' needs and problems in caring for them. At the time patients were admitted to and discharged from the hospital, there was little agreement between family caregivers and nurses about the kinds of things caregivers needed to care for older patients or about problems that might prevent the continuation of caregiving. There was slightly more overall agreement between family care-givers and admission nurses than discharge nurses, despite the fact that discharge nurses reported spending more time with patients and being more knowledgeable about them. Future discharge planning models should build opportunities for nurses to communicate with other health care colleagues who can contribute to a more accurate and complete picture of patients' and family caregivers' needs and problems in the transition from hospital to home.     

Staff nurses' ability to assess community patients: a study

This article describes a project to evaluate the effectiveness of staff nurses undertaking patients' first assessment, within the community setting. District nurses selected appropriate groups of patients to delegate to the staff nurses and remained accountable for care throughout the project. Patient documentation, patient satisfaction, and GP, district nurse and staff nurse satisfaction were all audited at the end of the study period. The authors found that while the district nurses remained essential to the management of care, some work could be delegated appropriately to selected staff nurses. The standard of care was not adversely affected by the alteration in working practice.     

Nurse and patient reactions to social displays of depression.

Examined the interpersonal responses of 27 nurses and 27 hospitalized patients with chronic medical conditions to a target who appeared either to have a chronic physical impairment or to be able-bodied, and who enacted either a depressed or nondepressed role. It was predicted that while nurses and patients would have negative reactions to the depressed targets, patient reactions to the depressed target with a physical impairment would be less negative than nurse reactions on the basis of perceived similarity. Results indicated that both groups had negative perceptions of the depressed targets. The similarity hypothesis, however, was not explicitly supported. The reactions of health-care staff to depressed medical patients may reinforce the patients' depressive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents

We sought to compare self-assessment of preoperative anxiety levels and selection of worst fears by surgical patients with the assessments made by the anesthesia and surgery residents providing intraoperative care for those patients. One hundred inpatients at a Veterans Affairs hospital (Group 1) and 45 patients at a University hospital (Group 2) were asked to complete a brief questionnaire; the residents were asked to complete the same questionnaire. Group 1 results showed that median patient visual analog scale (VAS) scores were lower for anxiety about anesthesia compared to surgery (16 vs 22, P < or = 0.05). Anesthesia resident VAS scores were higher than patient or surgery resident scores. Neither type of resident was able to predict their individual patient's VAS score (Kendall's tau). The fear chosen with the greatest incidence by Group 1 patients and residents was "whether surgery would work". A significant number of residents (34%, anesthesia or surgery, P < or = 0.05) matched their patient's fear choice. Residents commonly chose fears related to their specialty (e.g., anesthesia residents chose anesthesia-related fears more often than surgery residents, 50% vs 28%, P < or = 0.001). In Group 2, residents demonstrated an improved ability to predict patient scores. For instance, both surgery and anesthesia residents were able to predict individual University patient VAS scores (P < or = 0.01). The fear chosen with the greatest frequency by Group 2 patients was "pain after the operation". Sixty percent of anesthesia residents matched their patients' fear choice (P < or = 0.001). This study indicates a variable ability of anesthesia and surgery residents to predict patient anxiety and fear which may be due, in part, to difficulty in understanding a Veterans Affairs hospital patient population.     

Learning needs of congestive heart failure patients

Congestive heart failure (CHF) affects approximately one-half million Canadians and five million Americans. Patient education is a vital component of nursing care of this population, with the goals of improving the CHF patient's quality of life, minimizing symptoms and hospital admissions, and reducing length of hospital stay. A review of the literature related to the educational needs of CHF patients reveals minimal research. The purpose of this study was to compare the perceived learning needs of CHF patients by patients and nurses, and to identify existing gaps between their perceptions. Fifty (50) CHF patients and 47 cardiac nurses were surveyed using a modified version of the CHF Patient Learning Needs Inventory developed by Hagenhoff et al. This instrument measured the importance of specific learning topics within the categories of anatomy and physiology, medications, diet, risk factors, activity, psychological factors, and other pertinent information. The results indicated that both groups found most information "moderately" to "very" important to learn. The patients generally rated all information items higher than nurses did. The most significant finding was that the nurses rated the diet category as second in importance, while the patients rated it last. The results from the study will be incorporated into a needs-based educational program for CHF patients.     

Perception of causes of omissions in the assessment of patients with chest pain

There is growing evidence that errors and omissions often occur in the nursing assessment and care of patients. As yet, the impact of audit has been insufficient to correct these deficiencies, possibly because audit does not primarily focus on the causes of deficiencies. The purpose of this study was to examine the perceived causes of omissions in the assessment of patients with chest pain and to compare these with omissions detected in an audit of the assessment records. The type of attributions nurses used to explain the causes of the omissions was also investigated. Following an audit of the assessment records of patients with chest pain, 88 nurses were invited to answer a 51-item questionnaire relating to the types of omissions which occurred in the assessment of patients with chest pain. The results showed a marked discrepancy between the frequency of reported omissions and those found in the assessment records. The most common causes of omissions reported by the nurses were patients' condition, work overload, lack of time, poor assessment documentation, not realizing that the assessment had not been fully carried out and different nurses being involved in the assessment of patients. Nurses overwhelmingly attributed the causes of omissions to external or environmental factors rather than internal ones such as lack of knowledge or fatigue, which have implications for the types of strategies that might be used to improve care.     

Psychological factors influencing the surgical patients' consent to regional anaesthesia

To investigate the preoperative attitude of surgical patients to regional anaesthesia, 162 subjects scheduled for elective surgery were studied. On the day before operation, patients were interviewed by an anaesthesiologist, using a semi-structured schedule. Topics investigated were sociodemographic variables and clinical correlates, such as past anaesthetic experience, information about anaesthesia and surgery, as well as questions and fears related to anaesthesia. Subjects were assessed for personality characteristics and emotional symptoms by Eysenck's Personality Questionnaire (EPQ), Zung's Self-rating Anxiety and Depression Rating Scales, Schalling-Sifneos' Personality Scale and the 43-item Life Events Inventory of Holmes and Rahe. Seventy-one patients (44%) consented to regional anaesthesia. Consent to regional anaesthesia was associated with advanced age, low neuroticism and high extroversion score in the EPQ, as well as longer duration of illness. The deniers of consent asked more questions and expressed more fears about anaesthesia. It is suggested that the patients' characteristics influence their preference, acceptance or refusal of regional anaesthesia.     

A Chinese cultural perspective of nursing care behaviours in an acute setting

This study carried out in Hong Kong, identified 29 Chinese patients' perceptions of the importance of nursing care behaviours in an acute setting using a Chinese language translated version of the CARE-Q instrument. Patients ranked items concerned with 'giving the patients' treatments and medication on time' as the most important and 'sits down with the patient' as the least important. Comparisons are made with the results from other cultures and specific Chinese cultural interpretations are drawn to provide direction for nursing care of Chinese patients in Hong Kong and worldwide.