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The perioperative specialist practitioner: developing and evaluating a new surgical role.

INTRODUCTION: This paper describes the design, implementation and evaluation of a new professional role in surgery. The role of the perioperative specialist practitioner (PSP), conceived as a response to the Working Time Directive, provides integrated preoperative and postoperative care to patients undergoing surgery in hospital. METHODS: A 1-year training programme was designed, dealing with a wide range of knowledge, skills and attitudes. Effective communication was a key component. Nine intensive 5-day modules at Imperial College London (London, UK) alternated with supervised experience of the surgical team at each participant's home trust. Detailed evaluation of the role and the training programme was provided by an independent research team, using an interview-based qualitative approach. Observational data were provided by the project team. Data were analysed using standard qualitative methods. RESULTS: 27 PSPs across 12 National Health Service trusts took part in two PSP training programmes. A total of 124 interviews (94 individual and 30 group) were carried out with PSPs and their colleagues. Overall, the role was seen as successful and positive, with great potential for dealing with reductions in junior medical cover. Each site encountered different opportunities and problems. Lack of mentorship was a key issue, and the role provoked considerable opposition in trusts. The training programme was viewed as highly successful. DISCUSSION: PSPs can provide high levels of expertise, but within clear limits. Our training programme has been effective and is perceived to be of high quality. However, introducing a new role requires time and sensitivity if opposition is to be minimised.

Adult↗

Retention and recruitment: reversing the order.

This excerpt, chapter 12 from the book Nursing Management: Principles and Practice, edited by Mary Magee Gullatte, RN, MN, ANP, AOCN, FAAMA, is part of a series of clinically relevant reprints that appear periodically in the Clinical Journal of Oncology Nursing.

Attitude of Health Personnel↗

Research priorities for surge capacity.

The 2006 Academic Emergency Medicine Consensus Conference discussed key concepts within the field of surge capacity. Within the breakout session on research priorities, experts in disaster medicine and other related fields used a structured nominal-group process to delineate five critical areas of research. Of the 14 potential areas of discovery identified by the group, the top five were the following: 1) defining criteria and methods for decision making regarding allocation of scarce resources, 2) determining effective triage protocols, 3) determining key decision makers for surge-capacity planning and means to evaluate response efficacy (e.g., incident command), 4) developing effective communication and information-sharing strategies (situational awareness) for public-health decision support, and 5) developing methods and evaluations for meeting workforce needs. Five working groups were formed to consider the above areas and to devise sample research questions that were refined further by the entire group of participants.

Disaster Planning↗

Independence through organized self-development.

There is a need for nurses to continuously develop themselves. Self-development supported by the organization is one means of developing a more involved and adaptable workforce. This article describes the introduction of such a scheme in a medical unit.

Career Mobility↗

Enhancing reference services with the support of your colleagues.

The expertise of colleagues and experience gained through professional organizations is an overlooked resource for adding value to reference service. Collegial networks must be nurtured. They deserve the support and investment of the institution.

Interinstitutional Relations↗

Academic mentorship: an effective professional development strategy for medical reference librarians.

Academic mentorship is a professional development strategy that enables fledgling professionals to take advantage of the skills and expertise of the senior members for professional growth. Although widely practiced in many other professions, academic mentorship has not been widely reported in medical librarianship. Drawing upon personal experience, the author reports the success story of an academic mentorship program implemented in an academic medical library and argues for academic mentorship to be widely adopted in academic medical libraries. This paper first reviews the literature on the concept of mentoring in an academic setting, and then describes the background, rationale, methods, and results of the mentorship programs the author has experienced. Lastly, based upon an analysis of several surveys and studies on coping skills for quality job performance of health sciences reference librarians, the paper discusses mentorship as one effective means to ease a new medical reference librarian's transition from his/her pre-service experience to the professional world of medical librarianship. It calls on other health sciences librarians to consider developing their own mentorship programs to promote their professional development and personal growth.

Humans↗

Reinventing a health sciences digital library--organizational impact.

What is the organizational impact of becoming a digital library, as well as a physical entity with facilities and collections? Is the digital library an add-on or an integrated component of the overall library package? Librarians see sweeping environmental and technological changes. The staff members feel exhilarated and challenged by the pressures to adapt quickly and effectively. Librarians recognize that a Web presence, like other technology components, must be continuously enhanced and regularly re-engineered. The Health Sciences Library, University of North Carolina at Chapel Hill, is reinventing its digital presence to better meet the needs of the community. This paper provides a case study focusing on major changes in planning processes, organizational structure, staffing, budgeting, training, communications, and operations at the Health Sciences Library.

Computer Communication Networks↗

Myco-Ed: Mycological curriculum for education and discovery.

Fungi are important and hyperdiverse organisms, yet chronically understudied. Most fungal clades have no reference genomes, impeding our understanding of their ecosystem functions and use as solutions in health and biotechnology. Also, opportunities for training in fungal biology and genomics are lacking, creating a bottleneck that hinders the recruitment and cultivation of a talented future mycological workforce. To address these issues, we developed Myco-Ed, an educational program offering training and scientific contributions through genome sequencing and analysis. Myco-Ed empowers students to pursue careers in fungal biology while improving fungal resources. Myco-Ed has been piloted at 12 institutions (15 classrooms) ranging from online e-Campuses to R1 universities, resulting in hundreds of fungal observations and many new high-quality reference genomes.

Curriculum↗

A model for capacity-building in AIDS prevention programs.

This article discusses a collaboratively organizational capacity-building model for agencies engaged in HIV/AIDS prevention. The cooperative training approach (CTA) utilized by the Training and Technical Assistance Program trained participants to incorporate learned skills into their daily work practices, and to become trainers to help disseminate their newly acquired skills, first to others in their own organization and later to other organizations. The CTA was successfully implemented among 285 community-based organizations (CBOs) serving predominantly Hispanics in the U.S.-Mexico border region. The program evaluation demonstrated that it has significantly upgraded the program implementation capability and the organizational infrastructure of the participating organizations resulting in improved delivery of services to their clients. Furthermore, it fostered networking and collaboration for the development of sustainable training and technical assistance networks of agency staff skilled in organizational capacity building. It is suggested that funding agencies examine the feasibility of using this approach to increase the organizational capacity of CBOs involved in HIV/AIDS prevention.

Acquired Immunodeficiency Syndrome↗

The assessment of attention-deficit/hyperactivity disorder in rural primary care: the portability of the American Academy of Pediatrics guidelines to the "real world".

OBJECTIVE: To examine the implementation of a protocol for the assessment of attention-deficit/hyperactivity disorder (ADHD) in rural pediatric practices. The protocol was designed to provide an efficient means for pediatricians to learn and use the ADHD guidelines put forth by the American Academy of Pediatrics (AAP). METHODS: Primary care staff (physicians, nurses, etc) from 2 rural pediatric practices were trained to use the ADHD-assessment protocol. Medical records for 101 patients were reviewed from 1 to 2 years before the introduction of the protocol and for 86 patients during the subsequent 2 to 3 years to assess compliance with the AAP guidelines. In addition, 34% of the scales scored by the staff were rescored to check for scoring accuracy. RESULTS: Before the availability of the AAP guidelines and the implementation of the assessment protocol, neither primary care site was consistently collecting the comprehensive information that is now recommended for an ADHD assessment. Parent and/or teacher rating scales were collected for only 0% to 21% of assessments across sites. When provided with brief training and supporting materials, medical records reflected significant improvement in the ascertainment of clinically necessary ADHD information, with parent and teacher rating scales present 88% to 100% of the time. Staff demonstrated an ability to score rating scales with a high degree of accuracy. The integrity of protocol collection and management was maintained 2 to 3 years after training. CONCLUSIONS: An efficient system for conducting ADHD assessments according to AAP guidelines in rural pediatrics clinics can be initiated and maintained with integrity. Additional research is needed to determine if this system improves diagnostic decision-making and patient outcomes.

Attention Deficit Disorder with Hyperactivity↗

Getting high on performance!

The success of the NICU depends in large part on the manager's ability to continuously identify the high, middle, and low performers on the unit. To retain top performers, the manager must ensure a challenging work environment paired with zero tolerance for substandard performance. Middle performers need positive recognition and the opportunity to stretch for improved performance. Once employees have been categorized, the manager needs to consistently develop performance improvement plans for each one.

Employee Performance Appraisal↗

The Cash and Counseling Demonstration and Evaluation: focus groups inform design of a consumer-directed cash option.

The purposes of the study were to explore consumer preferences for a cash option, to inform the ongoing CCDE survey and program design, and to identify the messages that the CCDE and other states should include when informing consumers about a cash option. The preference study consisted of 3 parts: 11 pre-survey focus groups, a telephone survey in each of the 4 participating states, and 16 post-survey focus groups. This article highlights unique results from pre- and post-survey focus groups. Focus group discussions were audiotaped and videotaped and transcribed. Transcripts were manually coded and text was clustered according to the moderator's guide questions and some new and recurrent themes that emerged. Overall, focus group participants, including elders, expressed positive feelings about the CCDE, especially about having a role in hiring workers and determining the workers' schedules and responsibilities. Focus groups provided important lessons about features to highlight when presenting program information to potential consumers and their families. Program planners must also bear in mind consumer concerns, especially considering that less than 10% of eligible Medicaid consumers volunteered for the cash option. These findings will be useful in guiding other states as they develop new cash and counseling programs, especially those in the current Cash and Counseling replication project.

Aged↗

Growing the field of health impact assessment in the United States: an agenda for research and practice.

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.

Community Health Planning↗