George A. Nowacek

Influencing the personal meaning of diabetes: research and practice.

Diabetes patient education involves the cognitive, psycho motor, and affective domains. This paper focuses on the influence diabetes patient education has on how people feel about having diabetes and what it means to them. Our research suggests that diabetes patient education can contribute to more positive attitudes about diabetes and that diabetes educators should address the affective domain directly. Strategies for influencing the personal meaning of diabetes are presented and discussed.

Assessment of Adaptive Transportation Technology: A Survey of Users and Equipment Vendors

In order to define the state of adaptive transportation equipment, wheelchair users with spinal cord injury (SCI) and equipment vendors were surveyed about equipment, funding, maintenance, and repair. SCI registries from two states, Virginia and Arkansas, were used to create the sample pool of users and 225 responses were received. A list of equipment vendors and vehicle modifiers was compiled from several national resources, and 123 responses were received from 36 states. User respondents were generally satisfied with their adaptive equipment, which typically required only minor inexpensive (<

Providing Free Samples of Baby Items to Newly Delivered Parents An Unintentional Endorsement

100) repairs, if any. Personal or family money was used by over 90% of the respondents for equipment funding. Vendors reported that a substantial amount of custom modification or fabrication of equipment is required to meet the needs of their clients. Lifts, external controls, and six-way power seats were cited by vendors as the equipment requiring the most frequent repair. The survey results provide an examination of the opinions and experiences of users and vendors of adaptive transportation equipment, which should prove useful to those involved in evaluating equipment, equipment availability, and the need for industry-wide standards.

An Item Bank of Diabetes-Related Test Questions

Recent studies have suggested that providing free sample packs of baby items to newly delivered parents may adversely influence parental health behavior. To determine the extent of this practice in Virginia, the head nurses of all 68 newborn nurseries and a random sample of 200 pediatricians were surveyed. Formula samples were being distributed at all hospitals. Formula packs were given to breast-feeding mothers at 65 (95%) hospitals although only 66 percent of the surveyed pediatricians approved of this practice. Samples of baby items other than formula (e.g., baby powder) were being distributed at 66 (97%) hospitals. Some physicians (18%) objected to the distribution of these non-formula samples, and others were not familiar with the content of these packs. In most instances, the hospital medical staff had not voted to approve the distribution of these packs. Parents were being informed only rarely about the source and intent of the packs. The provision of sample packs to newly delivered parents affects approximately 3,000,000 babies each year in the United States. The short- and long-term effects of providing these packs have been inadequately explored. Physicians should make an active decision whether to distribute sample packs. Those physicians choosing to dispense these samples may wish to review and edit the content of the packs and to enclose in the pack a brief note explaining that the provision of the products does not constitute a medical endorsement.

A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language

Most published tests of knowledge and skill do not fit the instructional content, setting, and audience of specific diabetes education pro grams, so diabetes education program direc tors must develop their own. A computerized item bank of diabetes test questions can save the program director time in constructing appro priate tests by taking advantage of computers and compatible software for entering, sorting, and retrieving test questions; analyzing results; revising items; and printing a master copy of the test for reproduction. Such an item bank of diabetes- related test questions is described, and procedures for requesting test ques tions from the item bank are included.

Outpatient pediatric diabetes—I. Current practices

Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland.

52 CURRENT STATUS AND GOALS OF THE COMMUNITY HOSPITAL PERINATAL SERVICE AS DETERMINED BY A SELF - INVENTORY

A survey of pediatric diabetologists in the U.S. was made in an attempt to define current outpatient practices in diabetes subspecialty clinics. Survey questions addressed clinic organization, health care team members, content of histories and physical examinations, use of laboratory studies, patient education, therapeutic recommendations, self-management practices and screening procedures used to identify early diabetes-related complications. The results of the survey suggested similar clinic organization and operation in most settings; a high degree of reliance on glycosylated hemoglobin determinations; a preference for the use of NPH insulin; and a lack of credence given urinary glucose determinations. Additionally, screening tests for the development of complications are not performed with regularity.

495 SELF-INSTRUCTIONAL PROGRAM FOR PERINATAL EDUCATION

Regional perinatal care is often criticized because local personnel are uninvolved in determining their “level” category. To intensify local input, we developed a self-assessment inventory of desired care practices and existing resources. The inventory includes a list of 48 high-risk conditions to be classified as requiring local care or referral and a list of 179 items for hospital equipment and staffing. 21 obstetricians (O), 16 pediatricians (P), 16 family physicians, and 84 perinatal nurses from 8 rural hospitals completed the inventories. The results of the inventory were compared with data obtained from 3-day site visits to the hospitals.O and P consistently felt that over 80% of Level II and III prenatal conditions should be managed locally, but they disagreed about referring neonatal conditions (O=46% refer; P=76% refer). 10.6% of the resources required for desired level of care were stated as not present in the hospitals. These results were 96% consistent with site visit observations. There were conflicting responses on 17.1% of the 179 items (i.e., some responders did not know many of their own resources).We conclude that 1) patient care goals frequently are not consistent with available resources and 2) the self inventory can replace site visits, identify discrepent patient care goals, accurately assess hospital facilities, and identify existing hospital resources not being utilized.

494 ATTITUDES TOWARD PERINATAL CARE IN COMMUNITY HOSPITALS

Perinatal regionalization encourages regional centers (RC) to provide educational programs for community hospitals (CH). We have developed a program with the following novel approaches: (1) Each hospital defines its own equipment and personnel needs by completing an inventory; (2) The same self-instructional program is completed by all perinatal nurses and physicians, thus facilitating uniformity of care and improving nurse-physician communication; (3) The RC trains 2 nurses from the CH who subsequently direct an intensive 4 month program entirely in their hospital and with minimum intervention by the RC. The program consists of 5 self-instructional books (575 pages) covering 17 perinatal subjects and 17 skills. The program was revised through 3 field trials and critiqued by 7 national experts. 55 physicians, 173 nurses and 107 supporting personnel representing 81% of the perinatal professionals from 9 CH participated in the program.For the units completed by all hospitals to date, pre vs. post test scores increased from a mean of 70% to 87% respectively (p<.001). Critical incident data suggested that the program resulted in improved patient care and staff morale. Pre-transport conditions of referral babies showed a 34% increase in quantity of stabilizing activities. Chart reviews are now underway to evaluate care practice changes.We conclude that a self-instructional, locally-based and coor-dinated program of this type is an effective, well accepted, and efficient means of training personnel in the CH.

Improved Perinatal Knowledge and Care in the Community Hospital Through a Program of Self-Instruction

At the time of on-site observations of the perinatal services of 9 community hospitals, interviews and discussions were held with nursing personnel. Unexpectedly, these interviews suggested that hospital personnel held fatalistic attitudes that could potentially interfere with optimal perinatal care.From these interviews, 51 statements regarding perinatal attitudes were written. The items were condensed to 32 statements through a pilot study and the resulting attitude survey was administered to 435 perinatal physicians, nurses, and support personnel from community hospitals. The data from the survey were subjected to a principle components factor analysis with squared multiple correlations in the diagonal and a Varimax rotation. The factors to be rotated were selected by Kaisers criterion and the following were identified as general attitudes: (1) it does little good to anticipate perinatal problems; (2) some babies are predestined to be unhealthy; (3) some sick babies survive only because they have a “will to live”. These respective attitudes were expressed by 12.1%, 9.4% and 38.2% of the individuals. The survey was readministered after a 4 month educational program. Preliminary results show a statistically significant shift toward less fatalistic attitudes following the program.We conclude that (1) non-facilitating attitudes toward perinatal care exist in community hospitals and (2) these attitudes can be favorably influenced by an educational program.