This study assessed the appropriateness of advice given by teletriage nurses to patients in northern Ontario. Assessments used audiotapes and printed records of 73 calls, selected from approximately 350 calls based on sound quality, completeness, and consent of caller and teletriage nurse. Audits were conducted independently by one family physician, one nurse practitioner, and one registered nurse with teletriage experience. In 56% of the 73 calls, all three auditors judged the nurse's advice as "appropriate." In 92% of the 73 calls, at least two of the three auditors judged the teletriage nurse's advice as "appropriate." All calls were rated as "appropriate" by at least one auditor. If not "appropriate," then auditors were three times more likely to rate the advice as "overly-cautious" rather than "insufficient." The percentage of calls with the same rating varied from 62% to 86% with an outlier of 33%. Nurse practitioners tended to rate the appropriateness of the advice slightly, but significantly lower than the rating given by family physicians or registered nurses. Interestingly, nurse practitioners tended to rate aspects of the nurse-caller interaction advice as slightly and significantly better than the rating chosen by family physicians or registered nurses. The teletriage service was providing appropriate advice, but the generalizability of these results may be limited because of the selection of calls.
The extent of rehabilitation services is adequate, but little feedback is available on these services and service users. This paper is based on a client feedback survey of physiotherapy services conducted in Spring 2000. The purpose of the paper is to compare patients' perceptions of the physiotherapy instruction they received in a private outpatient facility and in a public physiotherapy facility. The results of the study showed that physiotherapy clients were satisfied with the therapy and instruction they received. They felt they received an adequate amount of instructions and advice. The rehabilitee's strong commitment to care, high motivation and a support network are important to independent rehabilitation in the future. As for the point of contact, the majority of clients in the private physiotherapy facility were gainfully employed while the health centre had almost as many retired clients. Client instruction was not dependent on the point of contact.
The aim of this study was to investigate and interpret ideas inherent in sleep and diet consultations concerning infants in Swedish child health services. Data were obtained through semi-structured interviews of professionals employed in these services. A qualitative method with a phenomenological approach was applied to analyse the data. The results indicate that professionals have underlying conceptions. They considered that when parents force food on their child, this is a violation of the child's integrity. This view is based on the idea that such actions restrict the child's right to self-determination. In the participants' opinions, when the child is forced to sleep well, this is not regarded as a violation of the child's integrity, but is perceived as support of the child's autonomy. An underlying theoretical view may be that parents' time can be saved if the child becomes independent of the parents at as early an age as possible.
Counseling by experienced midwives is offered to women with childbirth fear in most obstetric clinics in Sweden, but information about the content of such counseling is lacking.
To study comprehensiveness, content and organization of the midwife-led counseling for childbirth fear in all obstetric clinics in Sweden.
In this cross-sectional study, data were collected using a questionnaire sent to all obstetric clinics in Sweden (n?=?45); a total of 43 clinics responded. Descriptive and one-way ANOVA was used in the analysis.
All responding obstetric clinics in Sweden offer midwife-led counseling to women with childbirth fear. Major differences were found regarding the time allocated to counseling, with a range between 5.7 and 47.6 minutes per childbirth. Supplementary education for midwives and the availability of treatment options varied at the different clinics and were not associated with the size of the clinic.
The midwife-led counseling conducted at the different Swedish obstetric clinics showed considerable disparities. Women with childbirth fear would benefit from care on equal terms irrespective of place of residence. Consequently, it would be valuable to develop a national healthcare program for childbirth fear.
This article describes the derivation of an instrument (Empowering Speech Practices Scale) for assessing the empowerment of dyadic counseling, the evaluation of the validity and reliability of the ESPS and the results acquired with the instrument from hospital counseling.
ESPS was constructed on the basis of empowerment theory and foregoing conversation analytic research. Nurses and patients assessed the same counseling session by way of parallel statements. Structure and reliability of the scale were evaluated with Cronbach alpha, percentage of agreement, factor analysis and logistic regression analysis.
According to these preliminary results, ESPS described the realization of empowerment, directing attention to patient participation. By means of the scale, we assessed 127 counseling sessions and found evidence of the realization of empowering counseling. According to the results, nurses were the most successful in constructing a positive emotional atmosphere and in giving information.
We found evidence that nurses need to improve the active mutuality of the counseling relationship by asking for patients' opinions and views, by facilitating the patients' assessment of their personal health and their participation in decision-making and coming up with options for their individual treatment.
The developed scale can be utilized, in addition to assessing the quality in hospital care, for improving nursing education programs. Further study is needed to evaluate the usability of the scale and to examine its stability and validity.
To characterize the recommendations of the medical directors of North American poison information centres for gastrointestinal decontamination of a hypothetical poisoned patient, and to examine the extent to which those recommendations agree with the advice previously issued by their poison information centres for the same scenario.
The medical directors of 72 poison centres in the United States and Canada were contacted and invited to participate in a survey. Each participant was asked to provide specific advice for gastrointestinal decontamination of a hypothetical patient presenting 1 h after a potentially life-threatening ingestion (32.5 g) of enteric-coated acetylsalicylic acid. The directors were then presented with the recommendation their poison centres had previously issued for the same overdose scenario. The main outcome measures were perceived agreement with their own centre's recommendation and director-centre concordance for each method of gastrointestinal decontamination.
Sixty-seven of 72 (93%) medical directors participated in the survey. They issued 30 different management suggestions for our hypothetical patient, and were in full agreement with their own centres 27% of the time. Concordance was moderate for recommendations on syrup of ipecac (k=0.468, P
Numerous groups of health professionals have undertaken the task of defining core competencies for their profession. The goal of establishing core competencies is to have a defined standard for such professional needs as practice guidelines, training curricula, certification, continuing competency and re-entry to practice. In 2006, the Canadian Association of Genetic Counsellors (CAGC) recognized the need for uniform practice standards for the profession in Canada, given the rapid progress of genetic knowledge and technologies, the expanding practice of genetic counsellors and the increasing demand for services. We report here the process by which the CAGC Practice Based Competencies were developed and then validated via two survey cycles, the first within the CAGC membership, and the second with feedback from external stakeholders. These competencies were formally approved in 2012 and describe the integrated skills, attitudes and judgment that genetic counsellors in Canada require in order to perform the services and duties that fall within the practice of the profession responsibly, safely, effectively and ethically.