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This study was an investigation of the Ball State University Counseling Practicum Clinic in terms of client expectation, client satisfaction, and the relationship between client personality characteristics and client satisfaction. Specifically, this study attempted to (1) identify and compare the expectations in the cognitive and affective domains that clients have when they come for counseling within the three clinic counselor assignment groups, (2) determine the extent of satisfaction in the cognitive and affective domains within the three clinic counselor assignment groups as a result of counseling, (3) investigate whether or not there is a significant relationship between client personality characteristics and client satisfaction in the cognitive and affective domains within each of the three clinic counselor assignment groups, (4) analyze the responses of the Client Satisfaction Questionnaire, and (5) describe client demographic characteristics within the three clinic counselor assignment groups in the cognitive and affective domains.Subjects in this study were volunteer clients seeking psychological counseling at the Ball State University Counseling Practicum Clinic during the Winter Quarter, 1975-1976, and the first five weeks of Spring Quarter, 1976.The data collected for each subject came from the following sources: (1) the Client Expectancy Inventory (CEI), (2) the Inventory of Fulfillment of Client's Expectancy (IFCE), (3) the California Psychological Inventory (CPI), and (4) the Client Satisfaction Questionnaire (CSQ).The data were treated by one-way multivariate analysis of variance, multiple regression analysis, and descriptive techniques. No differences were detected in either client expectations or client satisfactions within the three clinic counselor assignment groups in the cognitive and affective domains. Also, no significant association between cognitive and affective domain satisfaction scores and group membership was detected nor did any of the CPI scale scores provide a significant amount of additional explained variation in the client satisfaction scores. The clients within the three clinic counselor assignment groups indicated that their counseling experience had been moderately to slightly satisfactory. And, client demographic characteristics did not offer any significant information in predicting client satisfaction.Under the constraints of the study, the following conclusions were drawn.1. There was no significant difference in expectations among the clients in the cognitive and affective domains who were assigned to counselors with various levels of supervised training. 2. No association was found between entering expectations of clients and the extent of client reported satisfaction in the three clinic counselor assignment groups in the cognitive and affective domains.3. Clients of the advanced and post-advanced counselor groups reported the same level of satisfaction in the cognitive and affective domains as did the less severe clients who werecounseled by counselors with less supervised training.4. No association was found between a subset of premeasured personality characteristics and client reported satisfaction in the cognitive and affective domains.5. No association was found between group membership and client reported satisfaction in the cognitive and affective domains.6. Clients reported that their counseling experiences had been from moderately successful to successful. Also clients reported that they were either somewhat satisfied or satisfied with their counseling experience at the Ball State University Counseling Practicum Clinic. The above conclusions hold true irregardless of the (1) sublevel of the demographic characteristic investigated, (2) clinic counselor assignment group, or (3) cognitive or affective domain to which clients were classified.5

Class of 2012 Abstract / Specific Aims: To explore whether publishing requirements for human-centered randomized control trials, particularly the CONSORT criteria, have any relationship to impact as measured by the Journal Citation Reports TM Impact Factor. Methods: A worksheet was used to evaluate a methodically selected list of journals, including types of articles published, requirements of authors for human-focused randomized control trials, JCR Impact Factor and other JCR metrics for each specific journal title. A worksheet was filled out for each journal by each member of the research team and answers combined for consensus. Group means and SDs were calculated and the Student’s t-Test applied to values for selected journals. Main Results: 50 candidate pharmacy journals were identified and 41 met the criteria for publishing human-centered randomized control trials. Journals were grouped according to whether they required CONSORT or had other reporting requirements for human RCTs, or had no requirements for such studies. Few (6; 15%) pharmacy journals required authors to use CONSORT; and additional 15 (37%) journals provided as least some author guidelines similar to CONSORT. Pharmacy journals using CONSORT or other guidelines had a higher average impact factor (3.5; SD = 1.5) than did journals without guidelines (2.4; SD = 0.9; p = 0.007). Conclusions: There appears to be a statistical difference in average JCR metrics between journals which require specific RCT guidelines and those which do not. The use of reporting guidelines, such as CONSORT, by pharmacy journals is associated with increased impact as represented by JCR influence measures.

Background: More people than ever before are now seeking refuge from war and terror in other countries (UNHCR, 2016). This has as a consequence that the health care in many Western countries faces new patient categories which don’t speak the language and are culturally different from what health professionals are familiar with. Ethical considerations are important, since being misunderstood and not met with dignity or respect can cause care-related suffering. This may increase the suffering already experienced due to loss of security, family and friends. Aim: To illustrate refugees’ experiences in the contact with health care. Method: This is a literature-based, qualitative study. 15 articles were selected to investigate refugees’ experiences of health care. The analysis resulted in 2 themes, each containing 3 subthemes. Results: The main themes that emerged were: Feeling acknowledged and respected, and Overcoming language and cultural barriers. The result mainly reveals that language barriers are common, and that refugees consider it important to be seen as individuals, which is not always the case in health care. Conclusion: The challenge in caring for refugees as a nurse consists in ensuring there is a common understanding. While being aware of a patient’s history, it is also important to see the individual in a person-centered approach. / Att bryta upp från familj och allt man känner sig trygg med försätter människan i en utsatt position. Den vilsenhet detta medför skapar ett lidande. Som sjuksköterska är det viktigt att vara medveten om detta. Författarna till detta litteraturbaserade arbete har studerat 15 vetenskapliga artiklar där flyktingars perspektiv av olika vårdmöten står i fokus. Resultatet visar att flyktingar upplever språket som det största problemet i mötet, men att även deras kultur och religion spelar in i vad de tycker är en bra vård. I många fall känner flyktingar sig förbisedda eller diskriminerade. Detta har i många fall att göra med att de inte blir bemötta som individer utan ses som en del av en annan kultur. För att undvika problem med språkförbistringar är det att föredra att anlita tolk. Detta är emellertid inte helt problemfritt. Tolkar påverkar mötet på olika sätt beroende på vem patienten är. Studiens resultat visar att många flyktingar föredrar en tolk av samma kön. Det bidrar till att de lättare kan öppna upp sig och att intima situationer, exempelvis avklädning, inte blir så svåra att hantera. Samma förhållanden råder när det gäller kön på vårdpersonal. Att undersökas av någon av motsatt kön kräver att detta upplevs som ofrånkomligt och väl förankrat. De upplevelser som har med kultur och religion att göra varierar mellan flyktinggrupper och enskilda personer. De berör hur man vill bli bemött och behandlad. Det visar sig att patienterna i många fall är ovana vid ett personcentrerat förhållningssätt. Att utveckla ett sådant förhållningssätt är dock viktigt, eftersom brister i detta gör att flyktingarna känner sig diskriminerade och förbisedda. Det kan även leda till att de går miste om viktig information om sin sjukdom och rekommenderade behandling. Om sjuksköterskor tillämpar personcentrerad vård där patientberättelsen och partnerskap ligger till grund kan vårdlidande undvikas.

This thesis is the result of my work with the Military Nature-Centered community. The first thing is does it examine some of the distinctive features of the population, such as its history, sense of community, magical consciousness. It then presents the military Nature-Centered community as an emergent tradition.

Thesis advisor: Judith A. Vessey / Purpose: The purpose of this study was to elucidate changes in parents' perceptions of health related quality of life (HRQOL), functional status, and caregiver burden in children with severe cerebral palsy (CP) following extensive orthopedic surgery and to determine the amount of nonmedical out-of-pocket expenses (NOOPEs) incurred during hospitalization. Background: CP is the most common cause of childhood physical disability. Children with severe non-ambulatory CP have multiple complex medical problems and frequently develop hip dislocations and neuromuscular scoliosis; these require extensive orthopaedic surgical interventions to prevent progression. The surgical trajectory is costly, resource intensive, and complications are common. Decision-making needs to extend beyond anticipated physical and radiographic improvements to include patient-centered outcomes including HRQOL, functional status, caregiver impact, and financial burden. Currently, research on this second group of outcomes does not exist. Methods: A single group prospective cohort study (N=48) design was used to measure changes pre- and post- surgery. NOOPEs were collected on a daily basis from parents during their child's hospitalization. A linear mixed-model regression analysis for longitudinal data, incorporating serial patient measurements over one year, was used to assess changes in HRQOL, functional status, and caregiver impact using measures normed for this population (i.e., CPCHILD, ACEND). NOOPEs were calculated using descriptive statistics. Results: Significant declines in HRQOL and functional status were noted at six weeks post-operative with return to baseline at three months. Long-term significant (p = .005) improvements, however, were noted beginning at six months. Caregiver impact did not change significantly over time. The total NOOPEs for the inpatient ranged from $59.00-$6977.50 (Median = $479.30) with 1971.5 missed hours from work. Conclusion: Children with severe CP who undergo extensive orthopaedic surgery and their families experience improvements across a variety of patient-centered outcomes in the long-term following surgery. Nursing has a critical role in assisting families in decision-making around surgery and providing anticipatory guidance and support. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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The period of transition from high school is challenging for most adolescents. There are a substantial number of life-changing decisions that transpire during this time. Choices must be made regarding career paths, continued education, future residence, and avenues for social activities and general integration in the community. Person-centered planning provides a structure for addressing these questions, with the interests and aspirations of the individual at the forefront. While much has been written about person-centered planning, there is still a sparse evidence base to support its use and no formal examination of the fidelity of implementation of these programs. This study utilized a multiple-baseline single subject design to assess the effects of structured meetings with performance feedback on fidelity of implementation of participants' action plan steps in their person-centered plan. Analysis of the results suggests a strong functional relation between the use of structured follow-up with performance feedback and activity related to the person-centered plan action plan. Quality of life data were also gathered prior to planning and prior to and following the performance feedback intervention, with little change in the scores across the three points in time. Social validity was also assessed. The implications of these findings are discussed.

Although family centered care and natural environment services have been heralded as the ideal model in early childhood intervention and have been mandated by Part C of IDEA, research demonstrates that family centered principles are still not adhered to in many early childhood programs. Previous research in this area is lacking with regard to the limited diversity of participants (i.e., white, middle-class woman) and perspectives (i.e., childcare providers). This dissertation reports the results of a study that took into account perspectives of multiple stakeholders in early intervention including families, service providers, and program directors in order to understand the full range of difficulties and supports experienced when providing family centered care in the natural environment. This qualitative study used grounded theory methods to analyze information gathered through semi-structured interviews to elaborate the barriers and facilitators experienced in family centered care and natural environment services. The core theme identified in the data was the tension between the resources available to early intervention and the ideals of best practice. This core finding was supported by three themes regarding facilitators and barriers to service provision. Two of these, the need for theoretical buy-in to the model and the challenges of negotiating roles in family centered care, emerged as either facilitators or barriers, depending on service provider roles. The third theme was common across the data and indicated that the major barrier to natural environment services was the management of scarce resources.

In a teaching clinic, healthcare students and their supervisors talk with their patients in the examination room and they talk about their patients during teaching consultations outside the examination room. Effective doctor-patient communication helps to establish management plans that are appropriate for both doctors and their patients. Amid a pressure to provide more patient-centered care, communicating effectively with older adult patients is particularly crucial because the occurrence of health problems and the likelihood of age-based communication barriers and negative attitudes increase with age. This project is a qualitative, collective case study of eye examinations, case presentations and participant interviews. This study took place in the Primary Care Clinic at the University of Waterloo, School of Optometry. Participants included 8 fourth-year optometry students, 5 supervising optometrists, and 10 patients between 60 and 85 years of age. The study involved audio-recording and analyzing eye examinations of older adult patients, case discussions about these patients, and interviews of older adult patients, optometry students and their optometrist supervisors. Data were analyzed using a constant-comparative approach, consistent with grounded theory. This study identified some of the discursive features of and reflections about patient-centered communication during the talk with and about older adult patients. During the eye examinations, optometry students incorporated five types of verbal communication that were consistent with a patient-centered model: Patient Agenda, Social Talk, Analogies, Patient Agency, and Health Promotion & Prevention. Although these successful attempts to incorporate patient-centered communication strategies were evident in the talk with patients, optometry students routinely engaged in seven other verbal strategies that challenged this patient-centered ethos: Closed-Ended Questions, Biomedical and Technical Language, Patient as a Problem, Unacknowledged Patient Voice, Patient Understanding, Doc Talk, and Caregiver Agency. Two types of discursive strategies related to patient-centered care were identified in the talk about older adult patients during novice case presentations: Voice of Optometry and Voice of Patient. The Voice of Optometry incorporated field-sanctioned language strategies including three subcategories: Biomedical, Technical and Judgment. In contrast, the Voice of Patient represented various levels of patient agency: Passive Recipient, Negotiated Agency and Patient Agency. According to their interviews, optometry students received limited explicit training, in both classroom and clinic instruction, on how to talk with and about patients. During their interviews, optometry students and their supervisors made clear distinctions between patient–centered and doctor-centered care. Most of the students and supervisors believed that the optometry profession and the optometry school promoted patient-centered care. Elements of patient voice were represented in the eye examinations, the case presentations and the post-examination patient interviews. During novice case presentations patient voice was often fragmented into sound bytes of the original patient statements or translated into field-sanctioned language. Although many instances of patient education and counselling were evident throughout the eye exams, limited discussion occurred in the novice case presentations between students and their instructors about what to say to patients, In addition, the majority of topics addressed during educational and counselling moments were not discussed during the novice case presentations. Additionally, post-examination patient recall regarding education and counselling was generally limited. Throughout this study, talk about age appeared in four ways: 1) caregivers used age to make clinical decisions during case presentations, 2) caregivers referenced age during counseling and education to explain eye and vision changes, 3) patients commented on the impact of age on themselves, and 4) caregivers spoke about how they considered age when speaking to their patients. While the caregivers generally valued a patient-centered approach, the talk with and about patients was skewed towards strategies that may limit the ability to support this ethos. It is questionable what audience (i.e. patient or supervisor) optometry students value and how this affects their ability to adopt patient-centered communication strategies. Findings from this study suggest that caregivers and their patients might benefit from some changes in the way patient-centered practice is taught and practiced in this optometry teaching clinic. As a greater understanding develops of the strategies of and challenges to patient-centered practices in optometry, it is my hope that optometry training programs as well as optometry professional organizations will further embrace patient-centered practices.