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PubMed2003

Infection control practices among tattooists and body piercers in Sydney, Australia.

BACKGROUND: Tattooing and body piercing have a long history, and both have become increasingly fashionable worldwide. There is an association between tattooing/body piercing and hepatitis B and C infections. METHOD: We undertook an observational study to examine the prevalence and predictors of infection control practices among tattooists and body piercers in Sydney, Australia. Within each premise, data were obtained from owners/mangers and nominated staff completion of a knowledge and attitudes questionnaire, owner/manager demonstration of key infection control procedures, and an inspection of the premises. RESULTS: Consent to participate was obtained in 41 of 44 premises (93.2%). A low proportion of owners/managers and staff gave the correct answer for the purpose of disinfection (52.8%/26.9%) and sterilization (50%/53.8%). About one third of owners/managers (38.8%) and 56% of staff reported that their infection control compliance could be improved. Approximately one quarter of owners/managers reported that the frequency of inspections was inadequate. Even though the majority of demonstration and inspection items were complied with, deficiencies were observed concerning washing of hands, wearing of gloves, and sterilization procedures. CONCLUSION: There is a continuing need to improve infection control performance among tattooists and body piercers. The effectiveness of intervention approaches designed to achieve this should be explored.

Adult↗
PubMedDate not supplied

[Survey of satisfaction among health center users].

OBJECTIVES: To find out the satisfaction's level of the Nazaret (Valencia) Health Center's users; To detect the deficiencies in the areas under study; To find out whether or not there are differences with previous studies in primary care. DESIGN: Transversal study, results evaluation with no equivalent control group. SETTING: (site). Primary health care. Neighborhood of Valencia with 6749 people. With a regressive Sundbarg index, and the 42.6% of the population that are older than nine years are illiterate or with incomplete primary education, the income level index by neighborhood in 1986 is -5.6 (range: 13.4; -8.1). PARTICIPANTS TARGET POPULATION: all the Nazaret Health Center users. The inclusion criteria were: 1. Eighteen years old (or older) users. 2. That had contacted previously for whatever reason (administrative or sanitary) with the health center at least in one occasion during the prior 6 months. The random sample was selected for a 5% maximum error, a 95.5% confidence level, and a p < or = 30% for the negative answers from the scale, its size was 323 patients, with a 20% increase for forecasted no cooperation/no answers (n = 388). INTERVENTION AND RESULTS: The average age of the interviewed was 42 years. The total adding score was 98.1 (theoretical range: 27-135). The score by areas (theoretical range 9-45) was: personal quality area 35.5 professional competence 32.4 and the relationship cost-comfort 30.5. A total (overall) satisfaction item had an average of 7.2 on a 1 to 10 scale, with P10 = 5, P50 = 7, P90 = 10. The analysis of variance shows that satisfaction increases with age, with the attachment to the same doctor, with feminine sex, with unemployment and, with low educational level, being more critic the young people and the people with educational level (not significative difference). CONCLUSION: We consider that users have a good degree of satisfaction, that the ratio cost-comfort should be improved, there is a significative improvement compared with previous studies done with the former primary health care model.

Adolescent↗
PubMedDate not supplied

[Measurement of health care satisfaction: Andalucia 1984-1992].

Attitude scales are a useful tool measure satisfaction with health services and to detect its main aspects. This paper describes a satisfaction study carried out in Andalusia in 1992 which is based on attitudes of users toward three areas: personal qualities, professional competence and cost/convenience. Results are compared to those obtained in a similar survey carried out in 1984, when competences on Health Services were transferred from the Central Government. The average level of satisfaction measured in 1992 is 59.8, over a 100 points scale; this score is slightly higher to that measured in 1984, which was, 58.8. In both surveys the aspects related to organization and management are the worst rated.

Humans↗
PubMed2003

Teachers' views on curriculum development in health promotion in two Finnish polytechnics.

This study describes teachers' views on how to improve the health promotion element in the curricula of two health care polytechnics in Finland. The theoretical background of this study draws on curriculum development in nursing education and how to promote a human- or resource-centred approach in health promotion. The research data were collected by interviewing 10 teachers from both the schools involved in nursing or public health nursing education since August 1997. The data were analysed using content analysis. The findings showed that most of the teachers interviewed were involved in local curriculum development. This work was impeded by lack of time and real commitment, as well as the teachers' desire to protect their own teaching domains. In both polytechnics, they regarded the curriculum mainly as a document guiding their own and students' work. Teachers in one of the polytechnics emphasised the importance of national guidelines in ensuring professional competence, but no one stressed the importance of their school as a regional educational institution. Almost all agreed that health promotion was adequately included in their curriculum. The project "Health for all by year 2000" was taken as the basis for the curriculum in both schools, but some teachers expressed a need for an additional study unit. The findings revealed teachers' traditional views on health promotion in curricula and that there was no evidence of a new approach being adopted.

Attitude of Health Personnel↗
PubMed2003

Continuous professional development along the continuum of lifelong learning.

AIM: To identify what factors influenced motivation to participate in continuous professional development (CPD), among a group of qualified nurses, occupational therapists and physiotherapists. METHOD: Ninety-four nurses, 38 occupational therapists and 50 physiotherapists participated. They completed a questionnaire derived from research literature. Views on the concepts of lifelong learning (LLL) and CPD were sought. RESULTS: One hundred and eighty-two questionnaires were returned from 300 giving a response rate of 60.6%. Professional knowledge was reported as the prime motivator to seek CPD. Other motivators, which featured in the top four most important factors included updating existing qualifications, increasing the status of the profession as a whole and demonstrating that an individual was professionally competent. These factors overlapped with respondents reasons for CPD and a general consensus of opinion was reached among respondents on the meanings of LLL and CPD. CONCLUSION: In conclusion there were no observable differences between the professions and seeking CPD is intrinsically driven.

Adult↗
PubMed1997

National Kidney Foundation report on dialyzer reuse. Task Force on Reuse of Dialyzers, Council on Dialysis, National Kidney Foundation.

The Council on Dialysis of the National Kidney Foundation convened an expert panel to evaluate the current practice and literature related to the reuse of hemodialyzers. The panel reviewed and evaluated literature related to reuse since the last report of the National Kidney Foundation recommendations on reuse was published in 1988. The group sought to develop a consensus concerning the effect of reuse of hemodialyzers on mortality; the efficiency of delivered hemodialysis when reused hemodialyzers are used in the clinical setting; the clinical effects of reused dialyzers as compared with dialyzers not reused on intradialytic symptoms; infections in patients using reused dialyzers; and the effect of reused dialyzers on complement activation, cytokine production, and beta2-microglobulin metabolism and clearance. In addition, the panel reviewed the literature on the potential toxicity of germicides used in the processing of dialyzers for reuse as well as recent changes in federally mandated regulations concerning labeling of dialyzers for reuse, the monitoring of the reuse process, and the effectiveness of reused dialyzers to achieve a prescribed delivered clearance as estimated by urea kinetic modeling or by percent urea reduction. The National Kidney Foundation takes no position for or against dialyzer reuse. The principal reason for the practice of reuse is economical. In view of the uncertainties related to the safety and biological impact of reuse procedures, the task force recommends that a full discussion of the issue of reuse and its potential beneficial and detrimental effects be undertaken with each patient. There is no conclusive evidence to substantiate the notion that either morbidity or mortality associated with single use or reuse is different. Microbial contamination of the water used for dialyzer reprocessing increases patient morbidity. The chemical quality of water used for dialyzer reprocessing should, at least, fall within the same standards as those recommended for product water intended for hemodialysis. Dialyzers should not be reprocessed from patients who have tested positive for hepatitis B surface antigen. The effects of reprocessing high-flux dialyzers on beta2-microglobulin clearance are dependent on the reprocessing technique, the number of reuses, and the nature of the dialyzer membrane used. There are insufficient data on the effects of reuse on beta2-microglobulin behavior to make uniform recommendations. Untoward effects of reused dialyzers may still occur in spite of rigorous adherence to the AAMI guidelines. For example, use of the total cell volume method for assessing changes in small molecule clearances will not show the loss of performance attributable to dialysate shunting. For this reason, the measurement of Kt/V for urea as recommended by the AAMI or the determination of the urea reduction ratio (URR) is strongly recommended at least monthly to gauge the adequacy of the dialysis procedure. Given the significant fall in dialyzer efficiency for urea removal that can occur after repeated uses of a dialyzer, dialysis prescriptions in units practicing reuse should be designed to deliver a Kt/V or URR value that exceeds the dose used for patients treated with single-use dialyzers to make allowance for any possible reuse-induced reduction in dialyzer efficiency. Technicians and other personnel responsible for the reprocessing of dialyzers should receive proper training. These health care providers should be certified in reprocessing by an examining body so that professional competency can be assured.

Bacterial Infections↗
PubMed2005

Therapists' perspectives on the management and delivery of occupational therapy and physical therapy services.

The impact of resructuring healthcare services on the day-to-day practice of occupational therapists and physical therapists was examined. Four main issues emerged: limited understanding of scopes of practice; absence of a rehabilitation perspective at decision-making tables; lack of a career ladder; and barriers to the maintenance and enhancement of professional competence. This article describes the reported impact of these issues on patient care specifically and on the healthcare system in general. Recommendations for an improved structure within an interdisciplinary management paradigm that would ensure effective and efficient use of healthcare resources are provided.

Allied Health Personnel↗
PubMed1990

Conceptual models of the professions and their implications for the professionalization of health administration.

The extent to which health administration can be considered a profession is examined in the context of the five major models of the professions in the literature (historical, trait, functional, economic and power). A synthesis of the various models into a proposed integrative model, or typology of occupations, is also presented. Control over entry and control over conduct are identified as the two major dimensions by which the professional status of various occupations is measured. Health administration is seen as a profession in this context, and the prospects for further professionalization are discussed.

Canada↗
PubMed2003

Assessment of the indoor environment: evaluation of mold growth indoors.

Much attention has been focused on indoor molds; resulting in modest amounts of new research. There is strong evidence of respiratory effects. Although mechanisms are disputed, some of the effect (but not all) is likely to be allergy related. There is some evidence that atopic individuals may be more affected, but many nonatopic individuals also are affected. This area needs more general research and specific research on exposure measures (such as what fungal components should be measured) and on health-effect mechanisms. It is worthwhile to emphasize the practical knowledge that is readily available. Buildings should be designed, built, operated, and occupied so that the buildings stay dry. When this situation does not occur, the environmental and clinical aspects that are observed by competent professionals should both be considered when determining causal relationships.

Air Pollution, Indoor↗
PubMed1997

Ethical decision-making in intensive care: are nurses suitable patient advocates?

According to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) code of conduct (1992), nurses in Britain are expected to act as patient advocates. An advocate is someone who 'pleads for another' (Concise Oxford Dictionary 1982). However, it has been shown that advocacy is a complex issue and it is debatable as to whether or not it is a legitimate attribute of the role of the nurse (Gates 1995). Mallik (1997) also finds that advocacy can be a risky career option. Professional codes of conduct spell out duties, but do not give moral guidance. Phrases such as 'promote and safeguard the well-being of the patient' (UKCC 1992) are used, but although undoubtedly well-intentioned, this is platitudinous and these codes commonly shed little light on how to define an action that is to the patient's benefit or detriment. It is tempting to suggest that they are used as a drunken man uses a street lamp; more for support than illumination. Castledine (1981) identified a number of factors that would make a nurse an inappropriate advocate and these will be discussed within the context of intensive care units (ICUs).

Critical Care↗
PubMed1996

The impact of a high dependency unit continuing education program on nursing practice and patient outcomes.

Most evaluation studies of continuing education (CE) programs have concentrated on the assessment of learner knowledge and satisfaction and/or learner perceptions of change in professional competence and patient care, rather than on actual changes in nursing practice and patient outcomes. This study aimed to measure and compare frequency of nursing interventions and patient outcomes before and after a high-dependency (HD) CE program. A retrospective review of all HD patient records (n = 92) over the same 2-month periods in 1994 (n = 39) and 1995 (n = 53) was undertaken. Outcome variables were measured by assessing the incidence of cardiorespiratory complications, HD patient admission rates to critical care areas and process measures of nursing interventions with predetermined practice patterns. The before and after groups of patients were similar in age (mean 69 years), severity of illness (mean APACHE II = .12) and HD length of stay (mean 2.6 days). While the average number of critical events per patient was similar in both groups (before 2.03; after 1.96), complications resulting from critical events were 8 per cent fewer in the after group. The implementation and documentation of appropriate nursing interventions improved by 30 per cent following the introduction of the CE program (chi 2 = 25.53, df = 1, p < 0.001, 95 per cent CI 0.1804 to 0.4196, point estimate 0.3). The study revealed that there was a strong association between implementing the HD CE program and improved nursing practice. This may be related to the observed improvement in patient outcomes.

Activities of Daily Living↗
PubMed2002

The administration of school-based mental health services.

Challenges and proposed solutions in the administration of school-based mental health services have been addressed. Differences depend on whether the services are provided by the mental health component of an SBHC or by an ISBMHP. Seven common elements relevant in developing and administering school-based mental health services, whether in an SBHC or ISBMHP, have been identified: funding, assessment and resources, program structure, staffing and training, partnership and collaboration, quality assurance, and evaluation. How these elements are addressed varies from school district to indivdual school to individual principal to agencies providing services to specific clinicians. One of the most important lessons learned is that the ecosystem of each school is different; one size does not fit all. When external agencies enter a school, they are in the best case guests, in the worst case foreigners or invaders. Agencies and their clinicians must be respectful, adaptable, flexible, and competent professionals. With such attributes, the chance for an effective collaboration is enhanced. Contributions of school-based mental health services to the child and adolescent mental health delivery system include (1) access to services for disadvantaged and underserved youth, (2) system-wide collaboration, (3) prevention of acute psychiatric intervention, (4) gate-keeper role for more acute or specialized care, (5) systematic program evaluation in a "naturalistic" setting, (6) professional training in working with a range of systems and cultures, and (7) outreach and community-based care. With the emphasis on partnership and collaboration, school-based programs have the potential to benefit the children and families, schools, communities, and managed care organizations. The provision of access and early intervention is cost effective in the long run, and findings indicate that school-based mental health service is as effective as that of a central clinic. With the emphasis on collaboration, partnership, and bridging systems and cultures, the provision of school-based mental health care may be able to offer tools and experience to create integrated systems of care. This is a reciprocal process and an ongoing dialectic, however. Providers and planners of a school-based mental health programs, schools, and managed-care leaders can learn from one another, and all have major contributions to make to the overall delivery system. Schools and mental health service providers contribute knowledge and skills in working with this population; managed care organizations bring administrative and fiscal expertise and a focus on and mandate for quality and cost-effective care. For-profit and not-for-profit agencies must enter into a dialogue to educate and understand each other so that they may become collaborators in the underutilized service for children and youth.

Adolescent↗
PubMed2001

The ethical beliefs and behaviours of Victorian fitness professionals.

A survey based on those employed by Petitpas, Brewer, Rivera, and Van Raalte (1994), Pope, Tabachnick, and Keith-Spiegel (1987), Pope and Vetter (1992), and Tabachnick, Keith-Spiegel, and Pope (1991) was used to investigate the ethical beliefs and behaviours of Victorian fitness professionals. Although there is evidence that Victorian fitness professionals are knowledgeable about some general ethical principles, the results of this study suggest that there is some lack of consensus among Victorian fitness professionals about the ethical appropriateness of a number of complex issues relating to business practices, confidentiality, dual relationships, and personal and professional boundaries. The findings suggest there is a need to improve the professional and ethical education of fitness professionals and to develop comprehensive ethical principles and a code of conduct that is relevant to the individuals working in the Australian fitness profession.

Adult↗
PubMed2002

Undertaking nursing interventions throughout Europe: research activities of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

The working Group on Cardiovascular Nursing is actively involved in international research though the UNITE (Undertaking Nursing Research Throughout Europe) research program, a new initiative for the WGCN. A group of cardiovascular nursing researchers from a number of different European countries committed themselves to a research group that is designed to promulgate international research in the field of cardiac nursing. The first study was a survey on coronary risk factors in a cohort of cardiac nurses from Europe. At this moment four additional studies are planned aimed at the development of the nursing profession in Europe and improvement of care for patients with chronic cardiac disease. If, as hoped, these studies prove to be successful, it will provide the seed for other international collaborations of this type.

Cardiology↗
PubMed2003

Revalidation--are we fixing a system that wasn't broken?

In 10 years, the medical profession in the U.K. has moved from a loose system of self regulation, through reluctant and patchy compliance with recorded continuing medical education (CME) to statutory obligations for 5-yearly revalidation which will control the issuing of a licence to practise for all doctors. The profession initially viewed these changes with dismissive cynicism, but the new rules are now being viewed with trepidation and paranoia. Royal Colleges can still play a central role in the development of the Revalidation process and must work together to develop appraisal as a meaningful tool to be used for the benefit of patient and doctor.

Education, Medical, Continuing↗
PubMedDate not supplied

Faculty and student perceptions of effective clinical teachers: an extension study.

This extension study was conducted to (1) identify which characteristics of the effective clinical teacher are deemed most important by nursing students and faculty; (2) determine whether previous findings remain valid (are transferable); and (3) investigate whether the perception of effective teaching behavior shifts as students advance toward graduation. The research tool, a two-part questionnaire developed by Brown, was circulated among students and instructors at a university college of nursing in southwestern Ohio. The first section listed 20 characteristics of teachers to be rated, using a Likert-type scale, from "of most importance" to "of no importance." The second section required subjects to select and rank in order the five most important characteristics from the list of 20. Descriptive analysis was applied to the data, and findings were compared with those of Brown. The study suggests that both faculty and students favor articulate, knowledgeable clinical instructors who are "objective and fair" in student evaluation. There is a high degree of similarity between the responses of faculty and students, but differences emerge. Both value skills involving the student-faculty relationship over skills centering on the professional or personal attributes of the instructor. However, faculty respondents appear to place a higher value on instructor interest in patients, and students are more concerned with communication-related attributes. Faculty members place a greater value on showing interest in patients than do students. The results, when compared with Brown's findings, appear largely transferable, but significant differences appear. For example, faculty members ranked characteristics dealing with the clinical instructor's relationship with students to be more important than those dealing with professional competence--the opposite of Brown's results. This study shows the need for nursing institutions to implement programs to foster and to promote uniformly identified effective clinical teaching characteristics. Given the special challenges of clinical nursing education, graduate programs should also seek to teach the skills identified as most effective, and persons with the skills perceived as effective should be urged to enter clinical instruction and should be rewarded for success in this important area.

Clinical Competence↗