Browsing by Subject "Attitude of Health Personnel"
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Item Assessing the relationship between medical residents’ perceived barriers to SBIRT implementation and their documentation of SBIRT in clinical practice(Elsevier, 2014-08) Agley, J.; Gassman, R. A.; Vannerson, J.; Crabb, D.; Department of Medicine, Division of General Internal Medicine, IU School of MedicineItem Dietetic Interns’ Perceptions and Use of Evidence-Based Practice: An Exploratory Study(2018-01-01) Hinrichs, Rachel J.Objective: To explore dietetic interns’ perceptions and knowledge of evidence-based practice (EBP), their use and observation of EBP principles during their clinical rotations, and their intentions to use EBP in their career. Methods: A mixed methods design combining a survey and focus group was employed. Dietetic interns (n=16) from a large Midwestern university were recruited in person and via email to participate in the survey, focus group, or both. Perceptions and experiences of EBP were analyzed through the focus group (qualitative), and EBP knowledge and clinical practice behaviors were analyzed through the survey (quantitative). The focus group discussion was recorded, transcribed, and analyzed using thematic analysis. Results: Four major themes emerged from the focus group data: 1) observations of EBP in clinical practice; 2) use of EBP during clinical rotations; 3) barriers to EBP; and 4) perceived use of EBP as future registered dietitians. Interns considered EBP as important for their profession and future career. They struggled, however, with the discrepancies between current research and practice and highlighted differences they observed and barriers experienced across different clinical settings. Conclusions: This exploratory study is the first to examine dietetic interns’ perceptions of and experiences with EBP in the clinical setting. Future research is needed to identify how dietetics educators, librarians, and preceptors can address the barriers interns perceive in applying EBP in their internship.Item Discussing Sudden Unexpected Death in Epilepsy (SUDEP) with Patients: Practices of Health-Care Providers(Elsevier, 2014-03) Miller, Wendy R.; Young, Neicole; Friedman, Daniel; Buelow, Janice M.; Devinsky, Orin; IU School of NursingItem Finding the elusive balance between reducing fatigue and enhancing education: perspectives from American residents(Springer (Biomed Central Ltd.), 2014) Hanna, John; Gutteridge, Daniel; Kudithipudi, Venu; Department of Medicine, IU School of MedicineDuty hour restrictions for residency training were implemented in the United States to improve residents' educational experience and quality of life, as well as to improve patient care and safety; however, these restrictions are by no means problem-free. In this paper, we discuss the positive and negative aspects of duty hour restrictions, briefly highlighting research on the impact of reduced duty hours and the experiences of American residents. We also consider whether certain specialties (e.g., Emergency Medicine, Radiology) may be more amenable than others (e.g., Surgery) to duty hour restrictions. We conclude that feedback from residents is a crucial element that must be considered in any future attempts to strike a balance between reducing fatigue and enhancing education.Item Hospice in the nursing home: perspectives of front line nursing home staff(Elsevier, 2014-12) Unroe, Kathleen T.; Cagle, John G.; Dennis, M. E.; Lane, Kathleen A.; Callahan, Christopher M.; Miller, Susan C.; Department of Medicine, IU School of MedicineOBJECTIVE: Use of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff toward hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers toward hospice care in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: We conducted a survey of 1859 staff from 52 Indiana nursing homes. MEASUREMENTS: Study data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: (1) makes their job easier; (2) is responsive when a patient has symptoms or is actively dying; (3) makes care coordination smooth; (4) is needed; (5) taught them something; and (6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never. RESULTS: A total of 1229 surveys met criteria for inclusion. Of the respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was 'patient/family appreciate added care' (84%); the lowest was 'hospice makes my job easier' (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (P = .03 and P = .05, respectively). CONCLUSIONS: A majority of staff responded favorably regarding hospice care in nursing homes. About one-third of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement.Item Implicit and explicit stigma of mental illness: attitudes in an evidence-based practice(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2013-12) Stull, Laura G.; McGrew, John H.; Salyers, Michelle P.; Ashburn-Nardo, Leslie; Department of Psychology, School of ScienceThe extent to which explicit and implicit stigma are endorsed by mental health practitioners using evidence-based practices is unknown. The purposes of the current study were to a) examine implicit and explicit biases among Assertive Community Treatment (ACT) staff and b) explore the extent to which biases predicted the use of treatment control mechanisms. Participants were 154 ACT staff from nine states. Overall, the participants exhibited positive explicit and implicit attitudes toward people with mental illness. When modeled using latent factors, greater implicit, but not explicit, bias significantly predicted greater endorsement of restrictive or controlling clinical interventions. Thus, despite overall positive attitudes toward those with mental illness for the sample as a whole, individual differences in provider stigma were related to clinical care. Mental health professionals, and specifically ACT clinicians, should be educated on types of bias and ways in which biases influence clinical interventions.Item Implicit and Explicit Stigma of Mental Illness: Attitudes in an Evidence-Based Practice(2013) Stull, Laura G.; McGrew, John H.; Salyers, Michelle P.; Ashburn-Nardo, LeslieItem Provider Expectations for Recovery Scale: Refining a measure of provider attitudes(2013) Salyers, Michelle P.; Brennan, Madeline; Kean, JacobObjective: The purpose of this study was to refine and test the psychometric properties of a scale to measure provider attitudes about recovery. Method: This was a secondary data analysis that combined survey data from 1,128 mental health providers from 3 state hospitals, 6 community mental health centers, and 1 Department of Veterans Affairs (VA) medical center. Rasch analyses were used to examine item-level functioning to reduce the scale to a briefer, unidimensional construct. Convergent validity was assessed through correlations with related measures. Results: The Provider Expectations for Recovery Scale had strong internal consistency, was related to education and setting in expected ways, and was associated with lower levels of burnout and higher levels of job satisfaction. Conclusions and implications for practice: A 10-item scale of Provider Expectations for Recovery appears to be a useful tool to measure an important construct in recovery-oriented care. The process of refining the measure also highlights potential factors in how providers view recovery.Item Sexuality talk during adolescent health maintenance visits(AMA, 2014-02) Alexander, Stewart C.; Fortenberry, J. Dennis; Pollak, Kathryn I.; Bravender, Terrill; Davis, J. Kelly; Østbye, Truls; Tulsky, James A.; Dolor, Rowena J.; Shields, Cleveland G.; Department of Pediatrics, Indiana University School of MedicineIMPORTANCE: Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality. OBJECTIVE: To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents. DESIGN, SETTING, AND PARTICIPANTS: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area. MAIN OUTCOMES AND MEASURES: Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation. CONCLUSIONS AND RELEVANCE: Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01040975.Item The Thrill Is Gone: Burdensome Electronic Documentation Takes Its Toll on Physicians’ Time and Attention(Springer, 2019-04-22) Flanagan, Mindy E.; Militello, Laura G.; Rattray, Nicholas A.; Cottingham, Ann H.; Frankel, Richard M.; Medicine, School of MedicineExam room computing has become ubiquitous in outpatient clinic visits as electronic health record (EHR) documentation requirements for “meaningful use” are adopted. Despite its initial promise, EHRs have created several unanticipated consequences, not the least of which is that physicians’ attention during patient visits being split between delivering care and completing EHR documentation tasks. Even with real-time documentation in the exam room, the majority of physicians spend additional time after hours completing EHR-related tasks.1 In a recent survey, physicians who reported inadequate time for documentation and “excessive” use of the EHR at home had higher rates of burnout.