A prospective analysis of pain experience, beliefs and attitudes, and pain management in a cohort of Danish surgical patients.

Background: 

Management of obesity: attitudes and practices of Australian dietitians

OBJECTIVE: To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs.

DESIGN: Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia.

SUBJECTS: 400 dietitians (66% of those surveyed).

MEASURES: Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced.

RESULTS: Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support.

CONCLUSIONS: This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.

Obesity management: Australian general practitioners' attitudes and practices

Objectives: To document general practitioners’ (GPs) attitudes and practices regarding the prevention and management of overweight and obesity.

Research Methods and Procedures: A cross-sectional survey of a randomly selected sample of 1500 Australian GPs was conducted, of which 752 questionnaires were returned. The measures included views on weight management, definitions of success, views regarding the usefulness of drugs, approaches to and strategies recommended for weight management, and problems and frustrations in managing overweight and obesity.

Results: GPs view weight management as important and feel they have an important role to play. Although they consider themselves to be well prepared to treat overweight patients, they believe that they have limited efficacy in weight management and find it professionally unrewarding. GPs view the assessment of a patient's dietary and physical activity habits and the provision of dietary and physical activity advice as very important. The approaches least likely to be considered important and/or least likely to be practiced were those that would support the patient in achieving and maintaining lifestyle change.

Discussion: There remains considerable opportunity to improve the practice of GPs in their management of overweight and obesity. Although education is fundamental, it is important to acknowledge the constraints of the GPs’ existing working environment.

Should I and Can I?: a mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

Background
Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.

Methods
A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.

Results
Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.

Conclusion
PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Family presence during management of acute deterioration: clinician attitudes, beliefs and perceptions of current practices

BACKGROUND: The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration. AIM: To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients. METHODS: Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. RESULTS: Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience. CONCLUSIONS: Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration.

Towards a multicultural world : identifying work systems, practices and employee attitudes that embrace diversity

The research program described focuses on identifying the role of organisational culture, as reflected in workplace systems and practices, and employee and group attitudes in the outcomes of interactions among dissimilar parties. A systematic, theory-testing approach underlies the program, which aims to both develop and validate the diversity openness construct. The Perceived Dissimilarity-Openness Moderator Model developed from the research asserts that the affective, cognitive and behavioural consequences of diversity depend in part upon the perception of difference and subsequent quality and magnitude of the response to the perceived dissimilarity. When individuals or social systems (groups or organisations) are diversity-closed, outcomes are predicted to be less positive than when they are diversity-open.

Wildlife management in Australasia : perceptions of objectives and priorities

The aim of this study was to examine the values and attitudes held by Australasian wildlife managers as they relate to wildlife management issues, and to gain some insight into possible future directions and priorities for Australasian wildlife management. During December 2002 – February 2003, 138 questionnaires were completed by members of the Australasian Wildlife Management Society (AWMS) and registrants of the 2002 AWMS annual conference. Threatened species management, threatened communities/habitats, and management of introduced species were the issues rated as needing the highest priority for the Australasian Wildlife Management Society. Issues such as animal rights, genetically modified organisms and timber harvesting on public lands were the lowest-rating issues. Respondents expressed a strong belief in managing and controlling wildlife to achieve wildlife management objectives, a strong belief that wildlife should be protected and that wildlife managers should minimise the pain and suffering of individual animals, and a belief that resources should be directed towards conserving wildlife populations rather than protecting individual animals from non-threatened populations. While respondents held a strong belief that it is important to consult the community when developing wildlife management policies and programs, there was little support for a comanagerial approach where the community has a significant role to play in decision-making processes.

Attitudes and perceptions of workers to sexual harrassment

The authors investigated how individual factors (age, gender, gender role, past experiences of sexual harassment) and organizational factors (gender ratio, sexual harassment policies, the role of employers) related to workers' attitudes toward and perceptions of sexual harassment. In Study 1, participants were 176 workers from a large, white-collar organization. In Study 2, participants were 75 workers from a smaller, blue-collar organization. Individuals from Study 2 experienced more sexual harassment, were more tolerant of sexual harassment, and perceived less behavior as sexual harassment than did individuals from Study 1. For both samples, organizational and individual factors predicted workers' attitudes toward and experiences of sexual harassment. Individual factors—such as age, gender, gender role, past experiences of sexual harassment, and perceptions of management's tolerance of sexual harassment—predicted attitudes toward sexual harassment. Workers' attitudes, the behavioral context, and the gender of the victim and perpetrator predicted perceptions of sexual harassment. The authors discussed the broader implications of these findings and suggested recommendations for future research.

Gender differences in the perceptions of wildlife management objectives and priorities in Australasia

It is now well established that men and women often differ significantly in their attitudes and responses to workplace situations, challenges and policies. The aim of this study was to examine the effect of gender on perceptions and priorities held by Australasian wildlife managers. Data were collected via a questionnaire distributed during December 2002 – February 2003 to members of the Australasian Wildlife Management Society (AWMS) and registrants of the 2002 AWMS annual conference. The results show that there are now significantly more female AWMS members than there were in the early 1990s, a possible indication of a change in the wider wildlife management profession in Australasia. Consistent with previous research, male respondents held different views from female respondents about wildlife and wildlife management. In particular, male respondents were significantly more likely to express the ‘management/consumptive use of wildlife’ perspective than female respondents. Interestingly, this gap was observed only in the 18–30-year age category. The paper examines what these differences might mean for the future of wildlife management in Australasia.

Medication knowledge and self-management by people with type 2 diabetes

Objective: To explore medication knowledge and self management practices of people with type 2 diabetes.

Design: A one-shot cross sectional study using in-depth interviews and participant observation.

Setting: Diabetes outpatient education centre of a university teaching hospital.

Subjects: People with type 2 diabetes, n=30, 17 males and 13 females, age range 33-84, from a range of ethnic groups.

Outcome measures: Ability to state name, main actions and when to take medicines. Performance of specific medication-related tasks; opening bottles and packs, breaking tablets in half, administering insulin, and testing blood glucose.

Results: Average medication use > or = 10 years. Respondents were taking 86 different medicines, mean 7 +/- 2.97 SD. Dose frequency included two, three and four times per day. All respondents had > or = 2 diabetic complications +/- other comorbidities. The majority (93%) were informed about how and when to take their medicines, but only 37% were given information about side effects and 17% were given all possible seven items of information. Younger respondents received more information than older respondents. Older respondents had difficulty opening bottles and breaking tablets in half. Twenty per cent regularly forgot to take their medicines. Increasing medication costs was one reason for stopping medicines or reducing the dose or dose interval. The majority tested their blood glucose but did not control test their meters and 33% placed used sharps directly into the rubbish.

Conclusion: Polypharmacy was common. Medication knowledge and self management were inadequate and could lead to adverse events.

Perceptions and attitudes of land managers in multi-tenure reserve networks and the implications for conservation

Multi-tenure reserve networks aim to connect areas managed for biodiversity conservation across public and private land and address the impacts of fragmentation on both biotic and social systems. The operation and function of Australian multi-tenure reserve networks as perceived by their land managers was investigated. Overall, the conservation of natural assets was the most frequently reported primary reason for involvement in a network. The perceived aims of the respective networks largely reflected the response identified for involvement and management. Over 88% of managers considered their involvement in multi-tenure reserve networks to be a positive or very positive experience. A lack of resources and time for management were considered major limitations of these networks. The majority (80%) of private land managers within networks were willing to be included in a national reserve system of conservation lands. As the Australian National Reserve System currently incorporates mostly public land, these findings have important and potentially positive implications for a greater role for protected private land.

Multiple-criteria decision analysis for integrated catchment management

Implementation of integrated catchment management (ICM) is hampered by the lack of a conceptual framework for explaining how landowners select farming systems for their properties. Benefit–cost analysis (a procedure that estimates the costs and benefits of alternative actions or policies) has limitations in this regard, which might be overcome by using multiple-criteria decision analysis (MCDA). MCDA evaluates and ranks alternatives based on a landowner's preferences (weights) for multiple-criteria and the values of those criteria. A MCDA approach to ICM is superior to benefit–cost analysis which focuses only on the monetary benefits and costs, because it: 1) recognizes that human activities within a catchment are motivated by multiple and often competing criteria and/or constraints; 2) does not require monetary valuation of criteria; 3) allows trade-offs between criteria to be measured and evaluated; 4) explicitly considers how the spatial configuration of farming systems in a catchment influences the values of criteria; 5) is comprehensive, knowledge-based, and stakeholder oriented which greatly increases the likelihood of resolving catchment problems; and 6) allows consideration of the fairness and sustainability of land and water resource management decisions. A MCDA based on an additive, multiple-criteria utility function containing five economic and environmental criteria was used to score and rank five farming systems. The rankings were based on the average criteria weights for a sample of 20 farmers in a US catchment. The most profitable farming system was the lowest-ranked farming system. Three possible reasons for this result are evaluated. First, the MCDA method might cause respondents to express socially acceptable attitudes towards environmental criteria even when they are not important from a personal viewpoint. Second, the MCDA method could inflate the ranks of less profitable farming systems for the simple reason that it allows the respondent to assign non-zero weights to non-economic criteria. Third, the MCDA might provide a better framework for evaluating a landowner's selection of farming systems than the profit maximization model.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Corporate ethics in TQM: management versus employee expectations and perceptions

Purpose – The objective of this research is to develop and describe a conceptual framework of corporate ethics in total quality management (TQM).

Design/methodology/approach – The research is based on a summarised in-depth and longitudinal case illustration. The summarised case describes corporate ethics in an intra-corporate relationship.

Findings – TQM requires human resources and failing to care for them will affect accordingly the success of TQM. The case description illustrates the evolution of management versus employee expectations and perceptions of corporate ethics. It has an emphasis on the human resources of a company that strives towards TQM. As the quality of corporate ethics decreases the outcome of TQM is also affected (i.e. directly or indirectly). The case is initialised in an atmosphere of management and employee optimism and positivism of corporate ethics, which is a requisite from both parties in order to ensure prosperous TQM. The successive change towards pessimism and negativism of corporate ethics in the intra-corporate relationship concludes the in-depth case description.

Research limitations/implications – Four parameters of corporate ethics are used to incorporate corporate ethics into TQM, namely management versus employee expectations and perceptions. Internal corporate quality management should always be regarded as dependent upon the achieved equilibrium between management and employee perceptions. It is also dependent upon the derived equilibrium between management and employee previous expectations.

Practical implications – An important insight of this research is that TQM requires the continuous attention to the management versus employee expectations and perceptions inherent in corporate ethics of internal business operations. Furthermore, corporate ethics is complementary to business ethics.

Originality/value – The case description has shown that TQM may be running well and accomplishing the hard goals. However, TQM is not only about figures, profits and costs. It is also a business approach that should penetrate all activities inside and outside that are related to the company, including the soft issues.