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All wheelchair cushions have a limited life and need regular checking to provide a reliable degree of assistance in prevention of sores cheap 20 mg forzest otc. Clothes made of natural fibres are preferable because many patients sweat excessively; clothing should not be tight otherwise there is risk of skin damage resulting in pressure sores. It should also be noted that hard seams and pockets which cross over the ischial tuberosities, trochanters, or coccyx may cause pressure marks on the skin. It is recommended that shoes should generally be one size larger than previously worn because of a tendency of the feet to swell during the day. The patient should be assessed individually to ascertain the appropriate mattress for their long-term needs. Patients are encouraged to contact the pressure clinic for information and advice regarding any aspect of their care. In addition, the community liaison staff while visiting the patient in the community are able to reinforce educational aspects. Bladder care Patients are taught the most effective method of bladder emptying (see chapter 7). Although men with high tetraplegia can often tap over the bladder to induce a detrusor contraction, they may require help to apply a sheath and to fit Figure 12. In women with high tetraplegia the bladder is often assess pressure distribution, which helps to prevent skin breakdown. Patients whose bladder emptying method • Intermittent self-catheterisation is preferred method for those involves an indwelling catheter are taught to regularly use a with acontractile bladders catheter valve (which can be opened and closed), to maintain • Condom sheath drainage in contractile bladders bladder volume and compliance. Intermittent clean self- • If indwelling catheter, suprapubic catheter is preferable to urethral catheter, to avoid urethral damage. Use catheter valve to catheterisation is the preferred method for most women and maintain bladder compliance and capacity men with paraplegia and some with low tetraplegia.

EXAMPLES OF QUALITATIVE RESEARCH METHODOLGIES Action research Some researchers believe that action research is a re- search method 20 mg forzest otc, but in my opinion it is better under- stood as a methodology. In action research, the researcher works in close collaboration with a group of people to improve a situation in a particular setting. The researcher does not ‘do’ research ‘on’ people, but instead works with them, acting as a facilitator. There- fore, good group management skills and an under- standing of group dynamics are important skills for HOW TO DECIDE UPON A METHODOLOGY / 17 the researcher to acquire. This type of research is pop- ular in areas such as organisational management, com- munity development, education and agriculture. Action research begins with a process of communica- tion and agreement between people who want to change something together. Obviously, not all people within an organisation will be willing to become co-researchers, so action research tends to take place with a small group of dedicated people who are open to new ideas and willing to step back and reflect on these ideas. The group then moves through four stages of planning, acting, observing and reflecting. This process may hap- pen several times before everyone is happy that the changes have been implemented in the best possible way. In action research various types of research meth- od may be used, for example: the diagnosing and eval- uating stage questionnaires, interviews and focus groups may be used to gauge opinion on the proposed changes. Ethnography Ethnography has its roots in anthropology and was a popular form of inquiry at the turn of the century when anthropologists travelled the world in search of remote tribes. The emphasis in ethnography is on describing and interpreting cultural behaviour. Ethnographers im- merse themselves in the lives and culture of the group being studied, often living with that group for months on end. These researchers participate in a groups’ activ- ities whilst observing its behaviour, taking notes, con- ducting interviews, analysing, reflecting and writing 18 / PRACTICAL RESEARCH METHODS reports – this may be called fieldwork or participant ob- servation.

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Tom did not have access to any computing facilities purchase 20 mg forzest otc, so he decided to analyse the questionnaires by hand. He conducted a count of gender, age, occupation, postcode area of residence and reason for attending or telephon- ing the centre. From this information, members of staff at the centre were able to find out that their main custo- mers were women over the age of retirement. This meant that they were able to arrange more activities which sui- ted this age group. Tom found out also that one of the main reasons for contacting the centre was for more in- formation on disability benefits. A Braille booklet and a cassette recording containing all the relevant informa- tion was produced and advertised locally. It took Tom one month to design and pilot the question- naire, another month to administer the questionnaire and two months to analyse the results and write the re- port. Often you will need to find out if there is a connection between one variable and a number of other variables. For exam- ple, a researcher might want to find out whether there is a connection between watching violent films and aggressive behaviour. In multivariate analysis the researcher is interested in ex- ploring the connections among more than two variables. For example, a researcher might be interested in finding out whether women aged 40-50, in professional occupa- tions, are more likely to try complementary therapies than younger, non-professional women and men from all categories. MEASURING DATA Nominal scales To move beyond frequency counts, it is important to un- derstand how data is measured. In nominal scales the re- spondent answers a question in one particular way, choosing from a number of mutually exclusive answers. Answers to questions about marital status, religious af- filiation and gender are examples of nominal scales of measurement. The categories include everyone in the sam- ple, no one should fit into more than one category and the implication is that no one category is better than another.

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All the information required seems commonsense and indeed it is generic forzest 20mg with amex, but when you are anxious about speaking to a more senior doctor whom you may not know, it is easy to forget to give or ask the most important details. This is particularly the case in the adrenaline rush of speaking to a senior whom you have woken up or who seems annoyed that you have bothered them. Examination findings at presentation and provisional diagnosis What treatment have you given? Examination findings now Finally: What would you like them to do – see the patient now, later or just give advice? Specialist Specialist opinion Take over care Provide joint care investigation or management of the patient of the patient Figure 10. Referring and Requesting 63 Often,if you have woken someone up,they will be half asleep too and forget to ask you important information you have forgotten to volunteer. The patient had presented with an acute‘asthma attack’in the early hours of the morning. The medical SHO was dealing with an unwell patient on the ward and was tired. He accepted the referral without protest and left the unwell patient on the ward for the A&E department, thinking that the patient with the asthma attack would be more unwell and therefore take priority. On arrival in the A&E department he dis- covered the patient sitting up talking in full sentences, having been managed through the acute phase by the A&E staff. He rapidly returned to the ward without consequence to the other patient, but cursed himself for having left the ward without asking the vital question of‘how the patient was now’, not‘how were they on arrival’. The lesson here is that the A&E SHO did not refer the patient properly and the med- ical SHO did not‘take’the referral well. When these basic day-to-day tasks become second nature the job gets much easier, but hopefully if you have read this you will be well ahead of the game. These referrals may be urgent (patient seen within two weeks) or routine (patient not usually seen within at least six to eight weeks of referral). Out-patient clinics are run by a clinic manager (usually a senior sister or nurse who has taken on a part managerial, part clinical role).