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Creative programs, such as a clinical externship for employment of nursing students, can be successfully created using a program planning logic model. The planning, implementation, and evaluation components of a clinical extern program will be demonstrated using logic model. The use of the logic model was instrumental to the success of the program.
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Public health practice has been a part of schools of public health for a long time and yet it is still an emerging field of scholarship. Practice faculty often are isolated in their schools and not part of the mainstream. This article explores the elements of culture that are necessary to support a practice focus in a school of public health.
Within many schools of public health, substantial ambiguity surrounds the process of defining and rewarding faculty contributions to practice-oriented scholarly activities. Ernest L. Boyer introduced a powerful and compelling new paradigm for assessing the core domains of scholarship: the scholarships of discovery, integration, teaching, and application. This article draws on Boyer's domains and his colleagues, Charles E. Glassick, and others' criteria for evaluating them in introducing a framework for assessing practice-oriented scholarship within schools of public health. The article presents concepts, content, and defining criteria of practice-oriented scholarship and identifies the principles that might guide tenure and promotion decisions related to it.
The increasing prevalence and incidence of diabetes and its long-term complications in sub-Saharan Africa (SSA) could have devastating human and economic toll if the trends remain unabated in the future. Approximately 90% or majority of patients with diabetes belongs to the adult onset, type 2 diabetes category while 10% have type 1 diabetes in SSA. However, because of the paucity of metabolic and clinical data, a clear understanding of the natural history of both diseases and the classification of diabetes subtypes has been hampered. Nevertheless, we have attempted to provide a concise review of the pathophysiology of both type 1 and type 2 diabetes as well as phenotypic and clinical variations in patients residing in SSA. The limited metabolic data, (albeit increasing), from high-risk and diabetic individuals in the SSA, have contributed significantly to the understanding of the pathogenetic mechanisms of diabetes and the variations in the presentation of the disease. Sub-Saharan African patients with type 1 diabetes have essentially absolute insulin deficiency. In addition, patients with type 2 diabetes in SSA region also manifest severe insulin deficiency with varying degrees of insulin resistance. Although the exact genetic markers of both diseases are unknown, we believe studies in patients of SSA origin who reside in diverse geographic environments (African diaspora) could potentially contribute to our understanding of the genetic and environmental mediators of both diseases. However, many intrinsic, individual and societal obstacles such as poor education and illiteracy, low socio-economic status and lack of access to health care make uncertain the translation of diabetes research in SSA. In this regard, effective management and/or prevention of diabetes in SSA individuals should adopt multidisciplinary approaches. Finally, innovative health care delivery and educational models will be needed to manage diabetes and its long-term complications in SSA.
Serious, widespread problems exist in the quality of U.S. health care: too many patients are exposed to the risks of unnecessary services; opportunities to use effective care are missed; and preventable errors lead to injuries. Advanced practitioners of industrial quality management, like Motorola and General Electric, have committed themselves to reducing the frequency of defects in their business processes to fewer than 3.4 per million, a strategy known as Six Sigma Quality. In health care, quality problems frequently occur at rates of 20 to 50 percent, or 200,000 to 500,000 per million. In order to approach Six Sigma levels of quality, the health care sector must address the underlying causes of error and make important changes: adopting new educational models; devising strategies to increase consumer awareness; and encouraging public and private investment in quality improvement.
This article discusses the modeling of a categorical variable for which subjects can select any number of categories. For c categories, the response variable consists of a cross-classification of c binary components, one pertaining to each category. Using data from a survey (Loughin, T. M. and Scherer, P. N., 1998, Biometrics, 54, 630 637) in which Kansas farmers indicated their primary sources of veterinary information, we discuss simultaneous logit modeling of the binary components of the multivariate response. The use of maximum likelihood or quasi-likelihood fitting provides chi-squared tests with degrees of freedom df = c(r - 1) for testing the independence between each of the c response components and an explanatory variable with r categories. These tests are alternatives to the weighted chi-squared test and the bootstrap test proposed by Loughin and Scherer for this hypothesis.
AIMS: The aim of the paper is to show how life events contributed to ways in which health visitors related to women in their professional work. BACKGROUND: Health visiting work has been labelled 'invisible' and since, 'invisibility' is an issue in feminist literature, this concept was explored in relation to health visiting. METHODS: A qualitative research design was developed, with a conceptual framework based in feminist and educational literature. Semi-structured, tape-recorded interviews were conducted with a purposeful sample of 35 women health visitors. A systematic approach to data analysis took place, through which key themes and analytic categories were identified. FINDINGS: The findings showed three levels of interaction between health visitor and client that overlapped in the working relationship. First, the public face of the work is exemplified in the planned purposes of the health visiting contact. Secondly, during this contact, health visitors may draw on their lay knowledge of 'life events', that is, their private knowledge of the situation being described by the client. Thirdly, and at the same time, health visitors manage hidden personal feelings that arise within the interaction. CONCLUSIONS: The invisible private knowledge gained in life events can have a transforming effect for both health visitors and clients. However, there is no educational model which legitimizes private and personal knowledge as a resource for use by health visitors. Understanding women's own position as 'women in a gendered society' would enhance the way in which health visiting is conducted and could lead to more productive outcomes in public health work.
The current political agenda to adapt mental health services to meet contemporary needs is changing the way that psychiatric rehabilitation is organized and focused. This comparatively new branch of mental health services has over the past 20 years been subject to continual change, both through policy and clinical directive. The author argues that this consistent process of change has destabilized the clarity that is needed to offer the style of care and support that users of rehabilitation services require. Whilst broad aims of rehabilitation remain relatively clear the increasing options of principles and approaches towards rehabilitation have overwhelmed both service users and those working within the service. In this paper, author seeks to resolve these problems by providing an overview of a practice development framework that was applied to eight psychiatric rehabilitation teams over a 4 year period. The paper contains examples of equitable structures that have developed as a result of applying these frameworks. Attention is given to the creation of a representative council of service stakeholders and a paradigm of practice that has become integrated into the philosophical functioning of the teams. The tangible results of the process are ones of increased opportunity and fulfillment for those involved in the study.
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Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.
While millions of dollars are being spent developing the seeds of research to improve the care we give to patients, significant barriers to using empirical evidence by health care professionals and policymakers still exist. The gap between what we know from research and what we use in practice is at the heart of the translation research problem. How do we get empirical knowledge uptake and use by clinicians in the fields of practice? In addition, how do we measure if practice changes are occurring? This article describes a program of translation research in which the intervention, called the Collaborative Research Utilization model, was developed and tested in four clinical studies over 18 years.
OBJECTIVE: The purpose of this study was to investigate the temporal development of the utilization of dental care, in relation to socio-economic factors and also considering perceived oral health, attitudes to dental care, dental anxiety, care organisation and changes in the way that dental care is paid for. A conflict model was used as a theoretical framework. METHODS: In 1992, a mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergotland, as part of a cross-sectional study. This study group numbered 8888 persons. In 1997, the same population was sent a new questionnaire. There were 5363 persons who completed the questionnaire in both 1992 and 1997. Changes in utilization of dental care were analysed. RESULTS: An increase in personal expenditure for care was obvious, 42% paid more in 1997 compared with 1992. In the study, 7% had prolonged their time since most recent visit and 12% had less frequent visits. In regression models, education, occupation, place of residence, country of birth, marital status, gender, dental anxiety, having poor perceived oral health and poor general health were associated with utilization. Care organisation factors showed there was a greater probability of having higher utilization and higher cost of care when private practitioners provided the care. CONCLUSION: Small changes in the utilization of dental care occurred during this study time. Inequality in utilization existed and socio-economic factors affected utilization as well as health perception and dental anxiety. Changes in the cost of care did not affect utilization appreciably, probably because of a selected population with high price elasticity. Having a private care provider compared with one in the public system affected the probability of having higher utilization and higher cost for care.
To address the local health care needs of both patients and primary care providers in Montana, an integrated primary care and behavioral health family practice clinic was developed. In this paper we describe our experience with integrating mental health and substance abuse services into a primary care setting (a community health center) while simultaneously teaching family practice physicians to take the lead in providing these services. The Deering Community Health Center in Billings, Montana, is a Federally Qualified Health Center serving a largely low-income patient population. The medical care at the clinic is provided primarily by the faculty and residents of the Montana Family Medicine Residency. The teaching model was founded on the belief that improved care will result when physicians have increased comfort with, and are able to enjoy the challenges of, patients with mental illnesses. The enhanced longitudinal curriculum incorporates mental health across the 3 years of the family practice residency. Unique characteristics of this model include staffing and the concurrent delivery of a high volume mental health service while teaching family practice resident physicians and the faculty to integrate this competency into their primary care practices.
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This paper presents a three-dimensional model for teaching questioning to those wishing to develop skills in couple and family therapy. The model breaks questions into their component parts of format (the style of the question: open, closed, forced choice, rating, or ranking); orientation (the person who is being inquired about: self or other), and subject (the content of the question: behavior, feelings, beliefs, meaning, or relationship). The model is presented in the context of our post-Milan version of couple and family therapy training. The model is useful in that it allows students gradually to increase their repertoire of questions in a way that offers step-wise learning and integrates with their existing skills.
BACKGROUND: Motivational researchers have suggested that the environment plays a key role in students' goal formation. However, some recent work (Seifert, 1996) suggests that students' emotions may play a role in goal formation. AIM: This study examined the relationship between environment, emotions, and goals. Do emotions and perceptions of teachers both contribute to goal orientation, or do emotions mediate the influence of perceptions of teachers on goal orientation? SAMPLE: 559 Grade 10 students in Newfoundland and Labrador. METHOD: Two structural equations were postulated: one in which students' affect mediated the influence of perceptions of teachers on goal orientation and one in which students' affect contributed to goal formation in addition to perceptions of teachers. A cluster analysis of affect scores was performed followed by between-group and within-group contrasts of goal orientation scores. RESULTS: The structural equation model in which emotions mediate the influence of perceptions of teachers on goal orientation fit the data better than the model in which perceptions of teachers directly predicted goal orientation. The cluster analysis showed that groups with different profiles of affect pursued different goals. CONCLUSIONS: Emotions seem to be directly linked to goal orientation. Teachers who are perceived as nurturing will foster feelings of self-assuredness and control in students which will lead to a learning orientation.
OBJECTIVES: To assess the knowledge of unintentional injury epidemiology, the attitudes towards, and current practices in injury prevention among practice nurses. SETTING: Practice nurses employed by general practitioners in Nottinghamshire, United Kingdom. METHOD: A postal questionnaire was sent to all practice nurses on the Family Health Services Authority list (n = 322) with questions covering sociodemographic details, occupational details, unintentional injury epidemiology, attitudes towards the injury prevention activities suggested by a government report as part of the role of the primary health care team, and current practices in injury prevention. RESULTS: A response rate of 71.1% was achieved. More than 50% knew that unintentional injuries were the most common cause of death in childhood. A similar per cent knew the site of most fatal injuries in the under 1 and 5-16 year age groups. More than two thirds correctly identified a range of risk factors for unintentional injury. However, only two fifths of nurses believed they could be effective in preventing injuries. There were considerable gaps between attitudes and practice for most activities. The activities most commonly undertaken include displaying posters and leaflets (69.4%), giving advice on prevention (51.1%), and advice on first aid (45.0%) during injury consultations. CONCLUSIONS: Most practice nurses hold positive attitudes towards injury prevention activities, but fewer undertake these activities regularly. The activities most commonly undertaken employ an educational model. Further research is needed on the barriers to practice nurses undertaking more injury prevention work, the effectiveness of systems to overcome such barriers, and the effectiveness of these injury prevention activities.