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PubMed2003

Influences on compliance with standard precautions among operating room nurses.

BACKGROUND: Occupational exposures of health care workers occur because of inconsistent compliance with standard precautions. The purpose of this study was to develop national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses (specifically, scrub nurses) in Australia and to assess variables that influence compliance. METHODS: A descriptive correlation design was used to investigate relationships between variables and compliance, using a theoretical framework, the Health Belief Model, to give meaning to the variables. Data collection was done through mail-out surveys to members of the Australian College of Operating Room Nurses. RESULTS: This article reports the results of compliance with the following 2 specific self-protective behaviors: double-gloving and wearing adequate eye protection. Mean compliance rates were 55.6% with always double-gloving during surgical procedures and 92% with always wearing adequate eye protection. In addition, the variable that had the most influence on compliance was the perception of barriers to compliance, specifically, that adhering to standard precautions interfered with duties. CONCLUSION: These results have implications for the development of multifaceted perioperative infection control programs, including strategies for prevention, education, and policy development, to improve practices aimed at reducing occupational exposures among this high-risk group.

Adult↗
PubMed2003

The SAZA study: implementing health financing reform in South Africa and Zambia.

This paper explores the policy-making process in the 1990s in two countries, South Africa and Zambia, in relation to health care financing reforms. While much of the analysis of health reform programmes has looked at design issues, assuming that a technically sound design is the primary requirement of effective policy change, this paper explores the political and bureaucratic realities shaping the pattern of policy change and its impacts. Through a case study approach, it provides a picture of the policy environment and processes in the two countries, specifically considering the extent to which technical analysts and technical knowledge were able to shape policy change. The two countries' experiences indicate the strong influence of political factors and actors over which health care financing policies were implemented, and which not, as well as over the details of policy design. Moments of political transition in both countries provided political leaders, specifically Ministers of Health, with windows of opportunity in which to introduce new policies. However, these transitions, and the changes in administrative structures introduced with them, also created environments that constrained the processes of reform design and implementation and limited the equity and sustainability gains achieved by the policies. Technical analysts, working either inside or outside government, had varying and often limited influence. In part, this reflected the limits of their own capacity as well as weaknesses in the way they were used in policy development. In addition, the analysts were constrained by the fact that their preferred policies often received only weak political support. Focusing almost exclusively on designing policy reforms, these analysts gave little attention to generating adequate support for the policy options they proposed. Finally, the country experiences showed that front-line health workers, middle level managers and the public had important influences over policy implementation and its impacts. The limited attention given to communicating policy changes to, or consulting with, these actors only heightened the potential for reforms to result in unanticipated and unwanted impacts. The strength of the paper lies in its 'thick description' of the policy process in each country, an empirical case study approach to policy that is under-represented in the literature. While such an approach allows only a cautious drawing of general conclusions, it suggests a number of ways in which to strengthen the implementation of financing policies in each country.

Decision Making, Organizational↗
PubMed2001

Rationalising chances of success in intersectoral health policy making.

OBJECTIVE: It is generally accepted that a wide range of factors determine the health of a population, many of which are beyond the remit of the Ministry of Health. The aim of intersectoral health policy is to influence these factors. Success depends on a multi-stage process. This paper aims to provide support for the first stage of this process in the form of a quick scan for appraising the feasibility of intersectoral health policy. DESIGN: The content of the quick scan for intersectoral health policy was derived from a literature review. To determine the usefulness of this quick scan, the study looked at two examples in the policy sectors of education and safety. MAIN RESULTS: The quick scan distinguishes between three factors: (1) the availability of evidence, (2) the degree of support, and (3) the availability of tools for implementation. The quick scan made it possible to review the two policy sectors systematically in a relatively short time and to obtain sufficient information for priority setting in intersectoral health policy. The examples in this paper suggest that intersectoral health policy for community safety is more feasible than intersectoral policy for psychosocial problems in secondary education. However, specific information is required for a more precise assessment of feasibility. CONCLUSIONS: There are many ways of improving health through intersectoral health policy. The proposed quick scan may provide systematic support for setting priorities before developing policies of this kind.

Adolescent↗
PubMed2005

Human resources for emergency obstetric care in northern Tanzania: distribution of quantity or quality?

BACKGROUND: Health care agencies report that the major limiting factor for implementing effective health policies and reforms worldwide is a lack of qualified human resources. Although many agencies have adopted policy development and clinical practice guidelines, the human resources necessary to carry out these policies towards actual reform are not yet in place. OBJECTIVES: The goal of this article is to evaluate the current status of human resources quality, availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. The article also discusses the usefulness of distribution indicators for describing equity in the decision-making process. METHODS: We conducted a quantitative facility survey in six districts of Northern Tanzania. We collected data from all 129 facilities that provide delivery services in the study area. The data includes information on the emergency obstetric care indicators, as described by the WHO/UNICEF/UFPA guidelines for monitoring the provision of obstetric care. The inventory also includes information on the numbers of qualified health personnel at the basic and comprehensive emergency obstetric care level. We analysed the distribution and workload of the available human resources in a wider policy context with a particular focus on equity, use and quality, by means of descriptive statistics and the Spearman's correlation test. RESULTS: We determined that there are adequate human resources allocated for health care provision in Tanzania, according to national standards. Compared to similar countries however, Tanzania has a very low availability of health care staff. Most qualified staff are concentrated in a few centralized locations, while those remaining are inequitably and inefficiently distributed in rural areas and lower-level services. Rural districts have restricted access to government-run health care, because these facilities are understaffed. In fact, voluntary agency facilities in these districts have more staff than the government facilities. There is a statistical correlation between availability of qualified human resources and use of services, but the availability of qualified human resources does not automatically translate into higher availability of qualified emergency obstetric care services. CONCLUSION: National guidelines for human resources for health care in Tanzania require focused revisions in order to reflect the quality indicators more adequately when monitoring and setting criteria for HR distribution. Availability of qualified personnel as well as institutional management and capacity determine the quality of emergency obstetric care services and personnel. The current wide distribution of staff of inadequate quality should be reconsidered. The use of distribution indicators alone is not useful to properly monitor equity. This article suggests increasing access to high-quality health care instead of distributing low-quality services widely.

Journal Article↗
PubMed2003

Relationships between families and registered nurses in long-term-care facilities: a critical analysis.

Although much has been written about the relationship between families and nurses, little systematic analysis has been undertaken of this dyadic relationship in long-term care (LTC). Using a critical ethnographic approach, the researchers conducted separate in-depth interviews with 17 family-nurse dyads caring for residents with Alzheimer disease or a related disorder in one LTC setting. Analysis of interview transcripts and fieldnotes revealed 4 types of family-nurse relationships--conventional, competitive, collaborative, and "carative"--each reflecting the roles of nurse and family, negotiating strategies, and consequences. In addition, it became apparent that intrinsic and extrinsic factors influence the development of certain types of relationships. The findings have implications for nursing practice, policy development, and further research within LTC settings.

Adult↗
PubMed2001

Conversation with Les Drew.

In this occasional series we record the views and personal experiences of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Dr Drew is an Australian psychiatrist who has made substantial contributions to drug and alcohol policy development in his country.

Australia↗
PubMed1998

Firearm-related injury surveillance. An overview of progress and the challenges ahead.

Firearm-related injuries pose a serious public health problem in the United States and are increasingly the focus of public health concern. Despite the magnitude of this problem, ongoing and systematic collection of data on firearm-related injuries to help guide research and policy development has been lacking. The further development of firearm-related injury surveillance systems can provide an objective source of information for policy. Beginning in the mid-1980s, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control began to support the development of firearm-related injury surveillance systems by augmenting existing national- and state-level data collection systems and establishing cooperative agreements with state and local health departments to identify optimal firearm-related injury surveillance practices. Some progress has been made in improving the capacity to undertake firearm injury surveillance at national, state, and local levels for mortality, morbidity (including disability), and risk/protective factors, but much work remains to be done. The development of state and local firearm-related injury surveillance systems provides the clearest potential for linking basic information on firearm-related injuries to action, given the critical role that states have in both public health surveillance and regulation of firearms. Broader application of external cause-of-injury codes, increased standardization and validation of definitions and data-collection instruments, improved methods for identifying firearm characteristics and types, and the identification of efficient techniques for linking health and criminal justice data sources are among the key challenges we face as we try to build a more uniform system for monitoring firearm-related injuries in the United States.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

How to develop local physical activity promotion programmes with national support: the Finnish experience.

Stimulated by recent research findings regarding the health effects of physical activity, an extensive policy development for sports and for health took place in Finland in the early 1990s resulting in two national programmes. The 'Finland on the Move' programme's aim was to stimulate new local projects by financial support, training and consultation services, and media promotion. The evaluation of the programme listed several general characteristics of successful local projects. The ongoing 'Fit for Life' programme is based on the experience gained from the previous programme, but is focused mostly on the 40-60-year-olds as a target group, and utilises a more intensive mass media approach. It is concluded that the two programmes have been successful in creating plenty of new local initiatives and increasing population participation related to physical activity. The Finnish experience demonstrates that deliberate efforts to communicate scientific knowledge can lead to a better acceptance of physical activity on the national level and that well-planned and sensitive state-level support of grassroots activities can succeed.

Adult↗
PubMed1991

Homelessness in the United States. An ecological perspective.

This article presents an ecological perspective on homelessness that emphasizes the context in which homeless people live and the complex interactions between personal, social, economic, and service system resources that affect their well-being. The ecological perspective encourages researchers and program developers to assess the problems of homelessness at multiple levels of analysis, to view homelessness as a result of contextual factors that interact with individual and family vulnerabilities, and to assess carefully the social contexts in which researchers and program developers operate. Four ecological principles are described as a heuristic for research, intervention, and policy development. The implications of an ecological perspective for psychologists who wish to get involved in dealing with homelessness are discussed.

Adaptation, Psychological↗
PubMed2006

Political dynamics promoting the incremental regulation of secondhand smoke: a case study of New South Wales, Australia.

BACKGROUND: The history of governmental responses to the accumulation of scientific evidence about the harms of secondhand smoke (SHS) presents an intriguing case study of incremental public health policy development. Australia has long been considered a world-leader in progressive tobacco control policies, but in the last decade has fallen behind other jurisdictions in introducing SHS legislation that protects all workers. Bars, clubs and pubs remain the only public indoor spaces where smoking is legally permitted, despite SHS exposure in the hospitality industry being higher and affecting more people than in any other setting after domestic exposure. This paper examines the political dynamics that have shaped this incremental approach to SHS. METHODS: In-depth interviews with 21 key stakeholders in the state of New South Wales (NSW), including politicians, their advisors, health officials and tobacco control advocates, were conducted and subjected to thematic content analysis. Interviewees' comments provided insights into the dynamics surrounding the debates and outcomes of SHS legislative attempts and the current political environment, and about how to progress SHS legislation. RESULTS: SHS restrictions have been delayed by several broad factors: the influence of industry groups successfully opposing regulation; issue wear-out; and political perceptions that there is not a salient constituency demanding that smoking be banned in bars and clubs. Interviewees also provided suggestions of strategies that advocates might utilise to best overcome the current political inertia of incremental compromises and achieve timely comprehensive smoking bans. CONCLUSION: Advocates concerned to shorten the duration of incremental endgames must continue to insist that governments address SHS fundamentally as a health issue rather than making political concessions to industry groups, and should broaden and amplify community voices calling on governments to finish the job. Publicity to the growing number of state and national governments that have successfully implemented total bans over the past decade is likely to make incrementalism an increasingly unattractive political option.

Air Pollution, Indoor↗
PubMed1992

Deciding on access and levels of care: a comparison of Canada, Britain, Germany, and the United States.

Americans view universal coverage as a reality only if a minimum benefit package is explicitly defined, and discussions about expanding access take place under the slogan of minimum benefits. The policy environment is different in Canada, Britain, and Germany. There, health care costs are controlled and benefits provided under universal coverage plans. Yet the medical services provided in these countries result not from difficult decisions about rationing care at a "minimum" benefit level but from difficult political decisions about the structure of the health care system. Institutional factors rather than explicit policy influence the implicit health priorities in these countries. The United States, in contrast, develops policies that explicitly designate a minimum level of benefits.

Canada↗
PubMedDate not supplied

Pathways to access: health insurance, the health care delivery system, and racial/ethnic disparities, 1996-1999.

We examine the roles that insurance coverage, the delivery system, and external factors play in explaining persistent disparities in access among racial and ethnic groups of all ages. Using data from the 1996-1999 Medical Expenditure Panel Surveys and regression-based decomposition methods, we find that our measures of health care system capacity explain little and that while insurance clearly matters, external factors are equally important. Employment, job characteristics, and marital status are key determinants of disparities in access to insurance but are difficult for health policy to affect directly. Much of existing disparities remains unexplained, presenting a challenge to developing policies to eliminate them.

Black or African American↗
PubMed2002

Laboratory services regulations carry HIM implications.

This is Part 1 of a two-part article on national coverage and policies for clinical diagnostic laboratory services payable under medicare Part B. Part 1 concentrates on the administrative policies. Part 2, which will appear in the October issue of the Journal, will focus on the national coverage policies developed for individual clinical diagnostic laboratory tests. For additional information regarding the new administrative policies, see the Centers for Medicare & Medicaid Services (CMS) Program Memorandum AB-02-030, which was issued to all Medicare contractors on March 5, 2002.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Crafting mental health policy.

The 1990s has brought a heightened interest in policy and, more specifically, health policy development. This article gives the reader an overview of the principles of crafting public policy, the components of basic policy at a national level, the techniques and pitfalls of policy formation, and the refinement needed for application of skills to mental health policy. Nurses will be able to discuss elements of and the process for policy acceptance and implementation.

Health Policy↗
PubMed2002

Pesticide environmental indicators and environmental policy.

A current concern in many European countries is the environmental impact of agricultural pesticide usage and appropriate policy development to reduce impact. Currently, relatively hazardous pesticides that might be targeted for replacement by other products or management practices are not positively identified, with consequently few incentives for farmers to choose the least environmentally-risky chemicals. There is a lacuna in terms of widely-agreed operational environmental indicators, and an urgent need for comparative environmental assessment tools for pesticides, for use by both agriculturists and policy-makers. Such a system could, for example, provide a basis on which to differentiate an eco-tax according to the environmental threats posed by each product, and thus improve policy effectiveness. The heterogeneity of pesticide chemicals should be taken into account more explicitly in policy design. Through a comparison of different approaches covered in the literature on pesticide environmental classifications, this paper assesses the feasibility of developing environmental banding to improve the effectiveness of pesticide policy. A more pragmatic approach lies in the development of pesticide groupings rather than a continuous scale of environmental burden, i.e. focusing on broad similarities and differences rather than precise individual ordering. In particular, hazard indicators should be considered further, as a first stage in progress towards comprehensive environmental impact measures.

Agriculture↗
PubMed2002

Access rights for outdoor recreation in New Zealand: some lessons for open country in England and Wales.

Access opportunities for outdoor recreation in New Zealand and England and Wales are classified according to their conformity with collective, citizenship or exclusion rights and their degrees of permanence. Alternative criteria for the apportionment of access rights are considered in the context of this classification. Different criteria for rights apportionment are found to be appropriate according to different circumstances in the context of pluralist provision. Policy developments in New Zealand are compared with those in England. After 150 years of a dominance of collective rights in New Zealand current policy is shifting provision towards exclusionary rights. In England, there is a policy shift in the other direction, towards collective rights. Lessons for the development of collective rights in England are drawn from the New Zealand experience in relation to styles of governance, public preferences, public cost, insurance liability and the potential of markets.

Civil Rights↗
PubMed1993

Guidelines for the transfer of critically ill patients. Guidelines Committee of the American College of Critical Care Medicine; Society of Critical Care Medicine and American Association of Critical-Care Nurses Transfer Guidelines Task Force.

OBJECTIVE: The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. DATA SOURCES: A task force of experts in the field of patient transport drawn from the membership of the Society of Critical Care Medicine and the American Association of Critical-Care Nurses provided the personal experience and published literature from which these guidelines were developed. STUDY SELECTION: Study design was not a factor in selecting the literature to validate the experts' personal experience. The lack of well-designed clinical outcome studies was an important factor in determining the method of practice policy development we utilized. DATA EXTRACTION: The expert task force met and developed a draft of these guidelines based on their experiences and the available literature. This draft document was then reviewed by an additional group of experts whose input was used by the task force to develop this final consensus report. DATA SYNTHESIS: Each hospital should have a formalized plan for intra- and interhospital transport that addresses the following elements: pretransport coordination and communication, transport equipment, accompanying personnel, monitoring during the transport, and documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined by the continuous quality improvement process. CONCLUSION: The available data have allowed us to develop an evidence-based practice policy for the intra- and interhospital transport of the critically ill.

Algorithms↗
PubMed1993

Guidelines for the transfer of critically ill patients. Guidelines Committee, American College of Critical Care Medicine, Society of Critical Care Medicine and the Transfer Guidelines Task Force.

OBJECTIVE: The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. DATA SOURCES: A task force of experts in the field of patient transport drawn from the membership of the Society of Critical Care Medicine and the American Association of Critical-Care Nurses provided the personal experience and published literature from which these guidelines were developed. STUDY SELECTION: Study design was not a factor in selecting the literature to validate the experts' personal experience. The lack of well-designed clinical outcome studies was an important factor in determining the method of practice policy development utilized. DATA EXTRACTION: The expert task force met and developed a draft of these guidelines based on their experiences and the available literature. This draft document was then reviewed by an additional group of experts whose input was used by the task force to develop this final consensus report. RESULTS OF DATA SYNTHESIS: Each hospital should have a formalized plan for intra- and interhospital transport that addresses the following elements: pretransport coordination and communication, transport equipment, accompanying personnel, monitoring during the transport and documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined by the continuous quality improvement process. CONCLUSION: The available data has allowed the authors to develop an evidence-based practice policy for the intra- and interhospital transport of the critically ill.

Algorithms↗