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Introduction: Many individuals suffer from chronic or complex wounds that can be very difficult to heal and cause severe pain and hardship. In the absence of any evidence based local information on the topic, this study explored the lived experiences of Jamaican hospital patients with delayed wound healing using physiological, psychological, socio-cultural, developmental and spiritual perspectives. Methods: A qualitative descriptive study design with a purposive sampling method was used to select five patients, two males and three females (aged 33 years old to 56 years old) from a regional hospital in western Jamaica, who were recruited into the study. They each had a single chronic ulcer on an extremity. Following ethical approval and informed consent, individual interviews were conducted and thematic analyses were done on the data. Results: Diabetes mellitus and infection were the etiologic factors in their delayed wound healing. All of the participants experienced social isolation, low self-esteem, “frustration”, job loss/loss of man hours, financial dependence and impaired physical mobility. They desired improved communication with healthcare personnel, more supportive and caring attitudes from family and caregivers; as well as enhanced learning experiences to acquire the self-care skills needed for all aspects of diabetes control and wound care. Conclusions: The patients’ lived experiences and stated needs should be noted by all caring health professionals. Future interventions and care plans should address all the perspectives experienced and described by these patients.

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45% reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4% reported being on a "special diet". Only 16.5% reported not taking any sugar. Self-care scores were inversely related to HbA1c% (p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23% had blood glucose controlled to HbA1c < or = 6.5%. In women, HbA1c% levels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Kingston Regional Hospital's Accident and Emergency Department (AE), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8%) of the total population (n = 33) of health personnel working in the AE. The participants were 15 (53.6%) doctors, eight (28.6%) registered nurses and five (17.8%) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the AE was three years, range 0.5-22 years. Eighteen (60%) rated the AE as "stressful". The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p0.05). The number of behavioural symptoms experienced was associated with age (p0.05). The majority (89.2%) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and "extracurricular" activities in buffering the effects of stress. Nurses were more likely to be "burned out" than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful.

Compliance with treatment is a fundamental prerequisite for therapeutic benefit. The aim of this study is to determine the level of knowledge of hypertension, compliance with recommended antihypertensive therapy, and current blood pressure status in women with hypertension attending a Type V health centre. A pre-tested questionnaire with 37 in-depth items was administered to 30 (37.5%) women, selected by quota sampling, from a population of 80 women with hypertension, on four consecutive regular clinic days in May/June 2001. Weights and the mean of two blood pressure measurements were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 7.5. The median age and weight of the respondents was 57 years (range 36-85 years) and 80.3 kg (range 66.8-150 kg). Median duration of hypertension was five years. Fifty per cent of the sample were diabetic. The longer the patient had been hypertensive, the greater the compliance with medication (p0.05). Twenty per cent of non-diabetics were controlled to blood pressureor = 140/90 mmHg and 13% of the diabetics were controlled to blood pressureor = 135/85 mmHg. Twenty per cent reported ill effects from medication; 60% used "folk remedies" such as garlic. Only 27% of patients were fully compliant with medication. Sixty per cent did no exercise, 73% did less than one hour of exercise per week. Diabetics took more exercise than non-diabetics (Z = -2.1, p0.05) and were more compliant with medication than non-diabetics (Z = -2.3, p0.05). All respondents included salt in their diets and consumed fruits and vegetables only "sometimes". One third believed that hypertension could be "cured". The overall median knowledge score and median compliance score were 50% (range 16.7%-100%) and 31% (range 13%-60%) respectively. This group had inadequate knowledge of hypertension, poor compliance with recommended antihypertensive therapy (JNCVI) and limited BP control. Counselling of these patients in the areas of medication, diet, exercise and weight control is recommended. Further research, using randomized samples, to inform interventions to improve the knowledge, compliance and self-care management of patients with hypertension is indicated.

The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies (UHWI), between January 4 and March 29, 1999, with blood pressure140/90 mmHg (n = 80), were randomly divided into Group 1, cases (n = 42) and Group 2, controls (n = 38). A 40-item pretested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyle and knowledge data. Group 1 attended monthly structured interventions for six months. Except for diastolic blood pressure among male controls, diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p0.01). Knowledge improved among the male patients (p0.01). Among the female patients, activity scores were significantly increased (p0.01), weight (p0.05) and BMI (p0.05) were significantly reduced. There were no differences in these variables among the controls. This intervention had a benefit in blood pressure control.