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Developing Best Practice in Ascertaining LMP in Adolescent Patients. Ami Cook Dr Christine Ferris. Why focus on LMP?. Biohazards from ionising radiation Teenage pregnancies (12-18 years) Variable understandings of patients Parent reaction Lack of national guidelines.
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Developing Best Practice in Ascertaining LMP in Adolescent Patients Ami Cook Dr Christine Ferris
Why focus on LMP? • Biohazards from ionising radiation • Teenage pregnancies (12-18 years) • Variable understandings of patients • Parent reaction • Lack of national guidelines
Context of the limping child • Any imaging of the Pelvis or Hips • Female patient of child-bearing age • LMP required
Key issues from theory • Communication • Sex Education - religion & culture • Blanket Testing (surgical approach)
Communication (theory) • Stereotypes • Skills variable between ages of adolescence • Urban/ rural variation regarding sexual activity • "Subjects thought it was improper to ask them about their sexual activity"
Sex education (theory) • Religion/culture • Age - mainly delivered at age 14 • Negative perceptions • Variable standard of teaching
Blanket Testing (theory) • Validity of response • Ethical issues - consent for pregnancy test • Religious issues • Privacy issues • Professional responsibility of giving test results
Method • Qualitative approach • Semi structured interview • Open ended questions derived from theory • Opportunities for identifying issues throughout the interview • Final year students • Thematic analysis of data
Advantages and limitations • Captures people's experiences and views • Allows expression in own words important as tacit area of practice • Identify issues • Does not give an indication on spread of practice
Parental Presence Key theme highlighted by negative responses received by participants. Issues described: • Emancipated minors • Confidentiality • Social and religious influences
Parental Presence Data from study: • "difficult" • "parents reluctant to leave" • "parents cause an issue when asked to leave" Findings from literature • Some patients will withheld information if they thought it would get back to parents • 12 - 15 years olds prefer no parental presence • "Every effort should be made to respect a child's privacy
Religion/culture Participants identified this as an issue and one with little training help: • Amending practice • Lack of understanding • Changing policy and legal framework • Language barriers
Religion/culture Data from study: • "taboo subject in some cultures" • "guardian would not leave the room" • "religion is an issue but I don't know how to change my practice" • "language barriers" Findings from literature: • Professionals should recognise barriers of different cultures • Not adapting care can be deemed discriminatory • Adjusting policy could cause religion induced conflict
Sex of Radiographer Female participants spoke of their own preferences and male participants spoke on reflection of own experiences: • Patient preference • Discussing sexual activity • Age of patient
Sex of Radiographer Data from study: • "makes a difference" • "important to younger girls" • "does affect the response" • "young girl with a young male radiographer plus the undignified nature of radiography" Findings from literature: • Some patients feel more comfortable with professionals of the same sex • Do not feel comfortable discussing sexual activity
Inconsistent documentation • Currently no standard – participants described variation between clinical placements • Creating a standard form would promote consistency • Radiographers can be too relaxed • Confusion can cause lack of documentation
Inconsistent documentation Data from study: • "dates should be recorded and not just a signature" • "signature's not concrete evidence for a legal case" • "trusting the theatre staff" Findings from literature: • No policy will guarantee 100% detection • Standardized form would promote continuity • Question the validity of spoken confirmation
Training needs Participants were asked if they felt University could prepare them for this aspect of practice: • Communication with age-group not taught • Little understanding of different religions and cultures • Scenario-based teaching would be beneficial
Training needs Data from study: • "scenario based sessions" • "go over the LMP dates and understand the basics" • "Uni don't prepare" Findings from literature: • Communication is not taught • Healthcare should be age-specific • Understanding of religion and culture
Conclusions • National Policy, Local Policy or Professional Guidance • Standardization between trusts • Educational needs met – communication, religion/culture, scenario-based
Further Research • Look into the views of qualified Radiographers and compare issues raised • Develop training needs of the student Diagnostic Radiographer
Thank You for Listening Any Questions?