Patient counselling and health education最新文献

Patient education is receiving increasing interest from persons interested in improving adherence to regimens and in preventing disease. Yet a number of empirical studies have cast doubts on the notion that patient education actually can influence behavior. This article compares and contrasts two paradigms of patient education, one based on the teaching approach and the other based on a behavioral diagnosis. The behavioral diagnosis is the assessment of influences on the desired patient behavior. It includes consideration of individual, social, environmental, and medical regimen factors that may either impede or facilitate behavior. The process of performing a behavioral diagnosis is presented, and clinical experience using this approach is described.

A follow-up study of Smoke Stoppers participants was conducted at least one year after participation to determine the effectiveness of this approach and to identify the characteristics of those who had remained nonsmokers. The overall program success rate was determined to be 40% at best, but no worse than 32%, depending on the denominator. The following characteristics did not show a statistically significant correlation with stopping smoking: age, education, number of attempts to stop smoking, reasons for wanting to stop, total life stressors, moral support for quitting, companions with whom participants attended classes, number of cigarettes smoked, number of years smoking has continued, and employment with the hospital. Those who stopped smoking had attended significantly more classes and had a greater proclivity to gain weight than did those who resumed smoking, although large weight gains were not a problem.

This exploratory study determined specific educational needs of hysterectomy patients. The study population onsisted of patients who had successfully undergone hysterectomies performed by four gynecologists within the two years prior to the study. A questionnaire was developed, tested, revised, and subsequently returned by 146 women. Most quenstions were designed to elicit information on (1) what patients wanted to know, (2) when they wanted the information, and (3) whenther this information was obtained. Data regarding the first two questions were examined in relation to the demographic variables of age, education, occupation, pregnancy outcomes, and employment. Results showed that hysterectomy patients wanted more explanation of all topics. The topic nost often (92%) rated very important was physical effects of the surgery. Women between 31 and 40 years of age valued as most important the sexuality topics. Ninety-four percent indicated they most wanted the information before hospitalization. Twenty percent reported receiving no information about possible psythological or sexual problems. Conclusions drawn from this study are that there is an urgent need for structured patient education about hysterectomy; that patients have a need for information on the physical, psychological, and sexual aspects of hysterectomy; and that this information is needed before entering the hospital, pre- and postsurgery, and after returning home.

Hypertension is a leading public health problem, which significantly increases the risks of death and disability from cardiovascular and cerebrovascular diseases. Medical treatment is effective for reducing hypertension and the associated risks, but nonadherence to recommendations for treatment has limited the realization of benefits of advances in medical care.

This paper reviews recent attempts to improve adherence to medical regimens for the control of high blood pressure. Adherence to antihypertension regimens is defined as a behavioral problem, which includes a series of steps: participation in screening, entering treatment, continuing treatment, and adhering to the prescribed regimen. In the past decade, a wide range of structural and educational interventions attempting to increase adherence have had varying degrees of success. The interventions, their efficacy, study designs, and populations studied are reviewed, and recommendations for future testing and adoption of strategies for improving management of hypertension are advanced.

Circumcision is an elective surgical procedure performed on male neonates, but a procedure that may be elected by parents and medical personnel on less than adequate information. In this review paper, the authors explore the history of circumcision as a practice, as well as the arguments for and against its continuation as a “routine” practice. The authors conclude that the health and social or personal reasons for circumcision may not be based on sound judgments, nor applicable to the general public. Thus there is a strong case made for careful counselling of parents by health education and professional medical staff members of clinics, hospitals, and other health-care settings.

Volunteers are essential to smaller hospice care programs. These volunteers must be selected and trained to provide these services. The training program has several goals: content acquisition, experiential learning, mutual screening and selection, team building, and public relations. Selection processes avoid persons who have rigid beliefs, unresolved grief, or negative personalities as well as those who talk too much. The training uses many teaching methods to emphasize hospice philosophy, team building, communication skills, death awareness, empathy skills, basic nursing skills, impact of death on family, cancer information, pain control, and physician-care factors. Concrete examples of how each of these themes is accomplished are included in the paper. This program has worked well in preparing a group of volunteers for a rural, home-based hospice program in northern Michigan and represents one example of an effective approach.