Technology training: knowledge is power.
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Computer User Training↗
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Common countertransference issues related to inpatient/residential psychiatric treatment of children.
The contemporary conception of countertransference as potentially useful therapeutically is presented within a Sullivanian -interpersonal framework. A typology of countertransference is outlined with illustrations common within inpatient/residential treatment settings for children. Several clinical vignettes follow which demonstrate the therapeutic application of countertransference. Finally, guidelines are provided for inservice training programs to promote staff understanding and therapeutic management of countertransference in the treatment setting.
Child↗
Altered medication orders in medical records.
A 1-month study was conducted at a teaching hospital to determine how often medication orders in a medical record are improperly altered after orders have been written. This was determined by comparing the pharmacy copy of the physician order, which is removed from the medical record as the orders are written, with the medical record after the patient has been discharged. Five percent of the discharged patients whose records were examined had a record which had been improperly changed. This was ascertained by examining 1,125 individual medication orders, of which 4 were found to be altered. The altered records are shown. A policy statement is presented on how to properly correct an entry in a medical record. Inservice training and adequate orientation must be provided for all those who make entries in the medical record.
Documentation↗
Sexuality of nurses: correlations of knowledge, attitudes, and behavior.
In a study of relationships among knowledge, attitudes, and statements of nursing behavior about sexuality, degree of comfort with sexual situations was measured with a Professional Sexual Role Inventory (PSRI), using ridit analysis. The PSRI and the Sex Knowledge and Attitude Test were administered in groups to 107 professional family planning nurses and 64 senior nursing students. The major hypothesis--the more knowledge a nurse has of human sexuality, the more favorable will be her attitude toward it and the more comfortable she will be in professional situations with sexual overtones--was supported. Significant positive correlations between sexual knowledge and attitudes and written responses indicated comfort in handling sexual situations. Analyses of variance of the test scores--by age, race, marital status, religion, religiosity, frequency of church attendance, and urbanization--demonstrated areas of sexuality which might be incorporated into nursing inservice training and education.
Adult↗
The use of the Paediatric Standard Treatment Book by clinic and health centre staff.
The study assessed the self-reported frequency and quality of use of the Paediatric Standard Treatment Book by staff in urban clinics and rural health centres. 61 of the 88 nursing officers and 44 of the 89 community health workers in 9 urban and 4 rural health settings completed written questionnaires on their use of the Standard Treatment Book. The survey participants were also assessed on the management of three case scenarios of common clinical conditions. Whilst 69% of the participants reported daily use of the book, only 51% indicated that they always followed the guidelines. Performance in the case scenarios was poor. Although 87% made a correct diagnosis in the most straightforward case, only 38% indicated complete treatment and only 36% indicated complete and correct advice. In two more complex scenarios less than 30% of the participants made correct diagnoses and less than 10% indicated complete treatment and advice. 75% of the study group wanted inservice training on the use of the book; the majority of these said that doctors should give this training. 79% thought that the book could be improved. Many of the participants felt that more topics and more flow charts should be included. Whilst nursing officers and community health workers regard the Standard Treatment Book (STB) as important, many do not make optimal use of it. Knowledge of appropriate advice to give parents regarding their child's illness was particularly poor. Given the low scores of health workers on case scenarios involving children with more than one presenting problem, the use of the STB appears to be essential for management of most severely ill children presenting to health facilities in Papua New Guinea. Doctors, especially paediatricians, have an important role to play in stressing the importance of the book, in teaching health workers to use it correctly and in emphasizing an integrated approach to the management of sick children. The study incorporated an assessment of health facility infrastructure and equipment. All facilities needed maintenance work, and more than half had significant deficiencies in equipment and drug availability. Medical staff supervision and support of primary health staff is important and should include increasing and improving the use of the Standard Treatment Book. Such support should also aim to improve the working environment and health facility resources. This would substantially improve the service provided.
Child↗
Sex education and counseling program on a spinal cord injury service.
A sex education and counseling program was designed for spinal cord-injured patients and their partners, and alternative approaches are briefly reviewed. Also notable is the importance of inservice training for staff working with the cord-injured.
Counseling↗
The development of rural laboratory services in Papua New Guinea.
The health service of Papua New Guinea is targeted at village level primary health care, through aid posts and health centres. There is an increasing demand for providing these facilities with basic diagnostic laboratory services at the health centre level. To accomplish this, an inservice training program has been established to train existing health workers in specific laboratory skills. A management support scheme has also been instigated to ensure that the most effective use is made of these laboratory-trained staff. This has created a team of rural laboratory workers to support the clinical management of patients in rural locations throughout Papua New Guinea.
Community Health Services↗
Environmental concerns in surgery in the 1990s.
1. The surgical environment is the sum of the physical and the functional milieu in which surgical operative procedures are carried out in the course of patient care. 2. Although we acknowledge advances in surgical technology that have made possible a whole array of new procedures, we must be concerned with their effects on the surgical environment of the 1990s. These concerns include control of the spread of blood borne diseases and the lagging field of infectious and hazardous waste disposal. 3. The needs are clear for better departmental and institutional master planning, better systems analysis, better inservice training of personnel, and more precise and functional programming and planning. All must be accomplished within a framework of safety, efficiency, and economy.
Environment, Controlled↗
Multidisciplinary adverse drug reaction surveillance program.
Initial experience with a multidisciplinary adverse drug reaction (ADR) surveillance program at a 350-bed community hospital center is described. The pharmacy and quality-review (QR) departments developed a program that was incrementally incorporated into the hospital's overall QR activity. After inservice training, nurses and QR personnel were asked to complete an "alert" card for every suspected ADR and send it to the pharmacy. In addition, medical records were reviewed retrospectively for disease classification codes related to drug toxicity and unspecified adverse effects. Laboratory and utilization-review personnel also conducted retrospective reviews. A pharmacist reviewed all ADR reports and categorized each according to the severity of the reaction and the probability that it was drug related. For each reaction classified as severe, the patient's chart underwent physician peer review for appropriateness of therapy, avoidability of the reaction, and adequate documentation; related patient-care issues were addressed by the medical staff as part of routine quality-review activities. When problems with prescribing were identified, the pharmacy and therapeutics committee intervened with the prescribers or recommended further medical staff review. Drugs repeatedly associated with ADRs became the focus of drug-use reviews. The number of ADR reports increased from 0 to 134 in the first 11 months of the program. A multidisciplinary approach to ADR reporting increased the number and quality of ADR reports.
Drug-Related Side Effects and Adverse Reactions↗
Perioperative autotransfusion. Avoiding donated risks.
Because of the risks associated with donated blood, although slight, intraoperative and postoperative autotransfusion is becoming the wave of the future. "Intraoperative autotransfusion," according to Ken Williamson, MD, of the Mayo Clinic, "is now a medically indicated procedure." Cost effectiveness, once raised as an objection to intraoperative autotransfusion, is no longer considered; disease prevention is paramount. Every OR nurse should become familiar with the operation of the autotransfusion machines and be able to set up such a machine and operate it in an emergency. In our institution, one OR nurse can run two machines in different operating rooms because blood loss into the orthopedic wound is usually slow. Inservice training for nurses is readily available from the manufactures' representative or distributors. All in all, nurses-especially OR nurses-must prepare to be part of the autotransfusion team in the 1990s and beyond.
Blood Group Incompatibility↗
In-hospital bedside blood glucose monitoring: the importance of a quality control program.
This study examined the adequacy of a quality control program to assure accuracy of blood glucose monitoring performed at the bedside by nurses in a general pediatric hospital. A standard quality control program during which all nurses received inservice training and demonstrated proficiency resulted in accuracies (percentage of values within 15% of the laboratory) of only 68.6% and 69.2% over two successive 3-month periods. A standardized refresher course did not improve accuracy. Expansion of the program to include identification and reinstruction of individual nurses who had more than 20% of their blood glucose measurements more than 10% off the laboratory value or any one value more than 40% off the laboratory during the previous quarter resulted in improved accuracies (83%, 78%, and 91%) over three successive 3-month periods. These findings indicate that a systemic quality control program including individual monitoring and remedial retraining is required to improve the long-term accuracy of bedside blood glucose monitoring by nurses in a general pediatric hospital.
Blood Glucose Self-Monitoring↗
Bar-code technology for documenting administration of large-volume intravenous solutions.
The failure to properly document dispensing, administration, charging, and crediting of large-volume plain i.v. solutions in a hospital, along with the potential for using bar-code technology to reduce documentation discrepancies, was investigated. Portable bar-code scanners and preprinted bar-code labels were employed to identify large-volume plain i.v. solutions administered on two selected nursing units of a 1000-bed, private, not-for-profit hospital. Inservice training sessions were conducted to instruct hospital personnel in the use of the scanning equipment. Comparisons of patient statements and medication administration records for large-volume plain i.v. solutions established the level of documentation errors in the study hospital. The causes of these errors were traced to three primary sources: (1) failure to document administration of a solution to a patient (38%), (2) failure to credit patients for i.v. solutions returned to the pharmacy (37%), and (3) administration of a solution to a patient other than the patient for whom the solution was dispensed (25%). Accountability for large-volume plain i.v. solution charges to patients was improved by 19% using bar-code technology. The pharmacy manager desiring to employ bar-code technology should determine convenient methods for applying bar-code labels to solutions and for scanning the bar codes, as well as provide programming that can compensate for erroneous scans.
Documentation↗
Nurses' preparedness for health promotion through linkage with mutual-aid self-help groups.
This descriptive study of a sector of the Canadian nursing population aimed to identify attitudes, knowledge, and roles regarding mutual-aid self-help groups. Questionnaires were mailed to 200 randomly selected hospital nurses and to all 177 community health nurses working in the Nova Scotia metropolitan centre; 74 completed questionnaires were returned. Only half of the respondents considered themselves educationally well prepared for work with self-help groups. Almost all respondents viewed their relevant level of knowledge as only fair, and the most commonly cited reason for non-referral was lack of information. Most desired pertinent inservice training, a directory and continuing-education sessions. Twice as many nurses attended group meetings to increase their familiarity with groups as served initiator, speaker, consultant or non-professional member roles. The majority held positive attitudes regarding the effectiveness, merits and functions of lay help groups, professional linkage with self-help groups and future personal involvement. Reoriented educational mechanisms were recommended to overcome knowledge deficits.
Attitude of Health Personnel↗
Paying for clinical education: fact or fiction?
Changes in the health care system, brought on by cost control measures, are expected to have an impact on clinical education opportunities in allied health. There has been speculation that clinical facilities, upon which academic programs depend for clinical education, will begin charging fees for allowing students to rotate through their facilities. A survey was conducted of 43 schools and colleges of allied health, comprising 274 programs in 46 different disciplines to ascertain the extent to which programs were paying for clinical education. Two basic research questions were addressed: (1) to what extent are academic institutions supporting direct costs for clinical education of students and (2) to what extent are academic institutions exchanging resources with clinical facilities in which their students are receiving clinical education? Data were collected on cash payments made to clinical facilities, payment of preceptors, academic faculty in direct supervision of students in the clinics, tuition credit bank for clinical supervisors, university provision of inservice training for the clinical faculty, and university provision of equipment for use by students in the clinical facility. Results indicate that very few programs are making cash payments--2.2% in academic health centers and 10.6% in non-academic health centers (four-year colleges). In lieu of cash payments, a number of resource exchanges take place between educational institutions and clinical facilities.
Academic Medical Centers↗
Conceptual systems and teacher attitudes toward regular classroom placement of mildly mentally retarded students.
The effects of a teacher personality construct (abstract vs. concrete conceptual system) and two pupil variables (race, school behavior) on 454 regular classroom teachers' attitudes toward mainstreaming were determined. Following administration of the Conceptual Systems Test, teachers were randomly assigned a profile of a mildly mentally retarded student that held pupil IQ and school achievement constant while varying pupil's race and school behavior. Subjects responded on an integration inventory comprised of three subscales: social-psychological classroom environment, self-actualization, and classroom cohesiveness. Results revealed a significant main effect on the behavior variable and a significant Personality X Race interaction on all inventory dimensions, suggesting that these teachers perceived maladaptive behavior of mainstreamed retarded students as a significant threat to a conducive instructional atmosphere and the capability of nonretarded students to achieve to their potential. These results have implications for inservice training for teachers based on the pupil race and teacher conceptual system findings.
Black or African American↗
Ancillary staff in general practice.
The results of a questionnaire answered by 70 secretary-receptionists in general practice are analysed. Variations in their rates of pay are described. Lack of inservice training appears to result more from paucity of opportunity than lack of enthusiasm of the secretaries themselves.
Family Practice↗
Providing individualized nutritional care in a state institution for the mentally retarded.
The dietary department at Fernald is responsible for providing quality nutritional care to 900 residents with varying dietary needs. Faced with a complex food service system, a diverse population, and an objective to provide quality nutritional care to all the clients, the dietary department assigns each of 7 dietitians the clinical responsibility for approximately 125 to 130 clients housed in several residential buildings. The dietitians' primary responsibilities are clinical. As a liaison between the residential buildings and the dietary department, the dietitians provide important feedback to the food service director on acceptability of menu items. Inservice training of staff is also provided as needed.
Adolescent↗
Meeting the child care needs of the female alcoholic.
The agency partnership described in this article has been satisfying to both the clients involved and the staffs of both agencies. The foster parents reported greater satisfaction from these fostering relationships than many others because of the short-term nature of the placement and their feeling that they were an instrumental force in healing and reuniting a family. The staffs of both agencies have enjoyed the exchange of professional information provided by the direct case contact, as well as inservice training designed to educate both staffs about the other's area of expertise. The total number of clients served has been low by original estimates. It is difficult to determine how much this has to do with client need versus the need for improved marketing of the child care option: the female alcoholic may underutilize the resource in her effort to deny the need for treatment. Further evaluation is needed. The strength of the partnership between the two agencies lies in its program flexibility, facilitated by reduced financial investment for either agency. The initial proposal was designed as a new continuum of service. The program can be adapted to meet the child care needs of the female alcoholic client as the needs change and/or become more defined.
Alcoholism↗