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Top management program: management development in New Zealand's health services.

This article describes New Zealand's program for developing managers in health services, called the National Management Development Program (NMDP), run by a newly established unit of the Department of Health. This is a set of programs for training various groups of individuals in health administration: those with no experience who wish to enter the field, those in a particular area of health, and those who are already managers in the health field. The Top Management Program, designed for professionals already heading health agencies, offers continuing education as a sustained approach to improving individual management ability.

Education, Continuing↗

Involvement of ethylene and 1-aminocyclopropane-1-carboxylate synthase gene in regulation of programmed cell death during rose (Rosa x hybrida) flower development.

Programmed cell death (PCD) is an integral part of plant development. Flower petal usually has the shortest lifetime among all plant organs. There must be a sensitive, tightly controlled PCD in the life cycle of the flower. To understand its mechanism, the ethylene production rate of petals and its correlation with degree of senescence, 1-aminocyclopropane-1-carboxylate (ACC) synthase gene expression, ACC synthase activity and ACC content were determined through the whole flower development period which was arbitrarily divided into five stages depending on appearance of the flower. The results showed that ethylene was not detectable at stages 1 and 2, appeared at stage 3 and increased at stage 5. Transcript of ACC synthase gene did not accumulate at stages 1 and 2, but did so at stages 3-5, and increased gradually at stage 5. ACC synthase activity and ACC content changed in similar way to ethylene production. Ethylene plays a critical role in initiation of rose flower senescence through regulating petal PCD.

Apoptosis↗

Designing a flexible user interface for both users and programmers.

The design of a user interface for computers is examined from both the end user's and the programmer's point of view. Different methods of menu selection and user feedback are discussed. A graphics interface using pull down menus and dialog boxes is ideal for simplifying user interaction and program organization. This style of interface also provides for a modular program development environment, reduced program development time, program portability, and reduced maintenance. Software tools for programming the user interface are explored and pseudo-code examples are given.

Feedback↗

Programmed cell death remodels lace plant leaf shape during development.

Programmed cell death (PCD) functions in the developmental remodeling of leaf shape in higher plants, a process analogous to digit formation in the vertebrate limb. In this study, we provide a cytological characterization of the time course of events as PCD remodels young expanding leaves of the lace plant. Tonoplast rupture is the first PCD event in this system, indicated by alterations in cytoplasmic streaming, loss of anthocyanin color, and ultrastructural appearance. Nuclei become terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling positive soon afterward but do not become morphologically altered until late stages of PCD. Genomic DNA is fragmented, but not into internucleosomal units. Other cytoplasmic changes, such as shrinkage and degradation of organelles, occur later. This form of PCD resembles tracheary element differentiation in cytological execution but requires unique developmental regulation so that discrete panels of tissue located equidistantly between veins undergo PCD while surrounding cells do not.

Anthocyanins↗

Genesis of a replantation program.

Development of a replantation program entails establishment of microsurgical skills in the laboratory, training in clinical microvascular technics, supervision, if possible, in the first microvascular free flaps, and close liaison with supporting personnel who transport patients, care for them acutely, and carry out their rehabilitation. Of twenty-six replantations or revascularizations (14 incomplete and 12 complete), twenty-three were successful. The three failures (1 complete and 2 incomplete procedures) were all digits, and each was part of a multiple digit injury.

Amputation, Traumatic↗

Using a program logic model that focuses on performance measurement to develop a program.

A program logic model is used to make a program ready for an evaluation. It diagrammatically shows the relationships between the objectives of the program, program activities, indicators, and resources. This article describes an expanded logic model that has a greater focus on measurement of program performance. The expanded logic model specifies both outcome and process indicators, whereas other logic models only show service delivery indicators. Also, this article describes how the expanded logic model was used to develop a bicycle safety program. A workgroup established program boundaries and reviewed documents early in the process of developing the logic model. The workgroup developed the logic model which was subsequently reviewed by other stakeholders. The workgroup continually assessed the plausibility of the logic model. Challenges and advantages in using the logic model are discussed.

Accidents, Traffic↗

Integrating quantitative and qualitative methods to assess the impact of child survival programs in developing countries: the case of a program evaluation in Ceara, Northeast Brazil.

In evaluating public health programs, the tradition has been to design quantitative approaches, relying on epidemiological and statistical techniques to determine if and to what extent a program has an effect on a predetermined targeted population. More recently, however, qualitative methods such as rapid ethnographic assessments and focus groups have been implemented more frequently. This article describes an outcome evaluation of a community health workers program that integrated quantitative and qualitative methods to assess the impact of child survival interventions in reducing infant mortality and inadequate weight gain in children among municipalities in the state of Ceara, Northeast Brazil. By using multiple methods that combine quantitative and qualitative components, researchers can broaden their understanding of complex public health issues and direct use of data for decision making.

Adult↗

Using focus groups to design a community health program: what roles should volunteers play?

This volunteer-based community health advisory program illustrated the benefits of using focus groups to monitor and guide program development. Three focus groups, conducted by program evaluators, obtained input regarding the role of community volunteers. Focus group findings confirmed some of the assumptions held by program developers but refuted others. For example, prospective community participants and program developers were found to view the role of "volunteer" in the neighborhood health advisory program differently. As a result, adjustments were made in recruitment strategies and other procedural aspects to accommodate the residents' perspectives and values. This experience illustrated how preliminary focus group research can enhance linkage between program developers and community members.

Attitude of Health Personnel↗

Developing effective physician leaders: changing cultures and transforming organizations.

In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.

Academic Medical Centers↗

Building bridges...and strengthening nursing.

In light of current nursing employment trends, nurses and employment specialists in one rural northern Iowa healthcare organization are collaborating to retain and recruit nurses. The purpose of this article is to describe how these individuals worked toward a comprehensive, cohesive approach to the development, implementation, and evaluation of learning opportunities that support these efforts. Staff development educators played key roles in developing program purposes, descriptions, curriculum, and outcome measures.

Humans↗

Smoking cessation programs for adolescents.

Many smoking cessation programs for adult smokers are described in the medical and nursing literature. Programs designed to prevent smoking among adolescents and children also are prevalent in the literature. Despite these prevention programs, many adolescents choose to start smoking. Once adolescents begin smoking, it is difficult to find ways to help them quit. Few programs exist that are targeted to help this population with smoking cessation. This article provides an in-depth review of 5 smoking cessation programs designed for adolescents. Each of the programs presents unique strategies for helping teenage smokers quit. Techniques used in these programs include peer leadership, nicotine patch therapy, peer support, computer instruction, and one-on-one counseling with a nurse practitioner. Each program was studied for efficacy with adolescents. Although none of the programs reviewed showed remarkable success, they serve as guides for future program development. Additional programs need to be developed and studied with larger, more diverse populations. Nurses must identify or develop smoking cessation programs that meet the needs of all types of adolescents and are effective in helping them to quit. Once designed, these smoking cessation programs should be made accessible to adolescents in a variety of settings.

Adolescent↗

Exploring the impact of the implementation of a nursing clinical development unit program: what outcomes are evident?

Nursing Clinical Development Units have become popular as a framework for the facilitation of the professional development of nursing and to contribute to improved outcomes for consumers of health care services. An exploratory evaluation of the Nursing Clinical Development Unit program implemented by the Centre for Psychiatric Nursing Research and Practice was undertaken using a qualitative approach. This paper focuses on the findings relating to outcomes. A number of positive outcomes were identified including: changes within nursing practices; the development of more positive attitudes by nurses, a greater focus on research utilization and evidence-based practice; and an increase in professional development activities, including conference presentations. Despite these positive findings, the need for more structured evaluation and an increased emphasis on dissemination of findings was identified.

Clinical Competence↗

Diversity among hospice volunteers: a challenge for the development of a responsive volunteer program.

Voluntary organizations such as hospices are increasingly being called upon to substitute for state health and social welfare delivery at a time when volunteer contributions are threatened because of organizational and demographic changes. These changes include: the adoption by the nonprofit sector of market strategies in response to health and social welfare reforms, increases in the size and complexity of hospices, increasing professionalization of staff, and the move of women away from voluntary work in the health and welfare services to paid employment. With these changes, hospices must be knowledgeable about their volunteer workforce and resourceful if they are to continue to attract and retain volunteers. A survey of volunteers conducted at the Mary Potter Hospice, Wellington, New Zealand, examined differences in volunteers' characteristics, motivations for joining hospice, and factors affecting work satisfaction according to age, gender, and the length of time volunteers had worked. Those findings of particular relevance to program development were: (1) the tendency for the recently recruited volunteers to be in paid employment; (2) the mixed motivations of the younger volunteers, reflecting both altruistic and personal gain needs; and (3) the rewards commonly identified by volunteers, such as feeling their work is of value, being accepted by hospice staff, and feeling like important team members. Practical outcomes of the study are described.

Adult↗

Developing a child safety seat program.

The Car Seat Committee at our facility was formed in April 2000 to implement the American Academy of Pediatrics policy statement and recommendations for "Safe Transport of Newborns at Hospital Discharge." This study details the program developed at our facility to implement the American Academy of Pediatrics recommendations. In addition to the development of policies, the goals of the committee included: patient and staff education, marketing car seat information, community outreach, and research/reporting. The many initiatives and innovations of the committee enabled the hospital to create a solid foundation of child passenger safety. As a result of the actions of our committee, the Safety Restraint Coalition of the State of Washington designated the committee as a Child Passenger Safety Team, which is believed to be the first military team in the nation.

Community-Institutional Relations↗

The Claxton Elementary School Health Program: merging perceptions and behaviors to identify problems.

The Claxton Elementary School Health Program was developed to improve the health of a school community in a western North Carolina city of 60,000. Using the principles of Community-Oriented Primary Care (COPC) in fall 1991, a health advisory board composed of interested parents, teachers, and physicians was organized. A comprehensive needs assessment was implemented, including focus groups with teachers and parents, a self-administered health behavior survey for children in grades three-five, and a self-administered survey of parents' health problems. Teachers, children, and parents agreed on perceived problems requiring attention. The Board then prioritized health problems, selecting nutrition and self-concept as the most critical areas in which to develop programs. Using target population members to identify needs can be a valuable approach to the development of community-based programs for improving children's health behaviors.

Attitude to Health↗

California's Professional Mentoring Program: how to develop a statewide mentoring program.

Trends in downsizing, restructuring, increased diversity, and individual responsibility for career development have sparked a renewed interest in mentoring. Technology is changing the way professionals practice, including dieticians. This is reflected in the strategic goals for the American Dietetic Association (ADA). In 1999, with the aid of an ADA Affiliate/Dietetic Practice Group (DPG) Collaborative Strategic Initiatives Grant, a Mid-Career Mentoring Program (MCMP) was developed in California. This program provided an opportunity for dietitians with advanced skills (mentors) to be matched with those desiring to develop new skills (mentees). A six-step process was used to develop the program. The six steps include: appoint a coordinator; identify prospective mentors; locate resources; define tasks and establish procedures; identify mentees; and begin the program. A final product of the grant was the development of the handbook The Helping Hand. This handbook can be used by other affiliates or practice groups that may wish to develop a mentoring program. Mentoring programs can assist registered dietitians and DTRs (dietetic technicians, registered) in developing their educational plans for the new Professional Development 2001 certification process.

California↗

Genetic programming of development: a model.

Genetic programming of the developmental processes in multicellular organisms is proposed to be so intricate and vitally important that a large set of genes is dedicated solely to this end. It is further proposed that this set can be compartmentalized into subsets on the basis of the changes in gene activities that occur during ontogenesis, and that the genes in each subset transiently control the epigenetic activities of a small group of cells. Automatic subset activation is achieved by the product of a gene in each subset that transfers activity specifically to the subset next in the developmental sequence. This device can generate a unidirectional series of activations that cascade hierarchically through development like toppling dominoes. The model provides a basis for developmental phenomena, such as pattern formation, morphogenesis, and regeneration, and it makes testable predictions at the molecular level.

Animals↗

A conceptual framework for a clinical nurse leader program.

Developing a map to guide the design of a novel educational program for nursing students can assist educators in piecing together identified conceptual variables in a logical and reasonable manner. We developed a conceptual model for a clinical nurse leader (CNL) program to present to a school of nursing faculty and a state board of nursing for approval and adoption. The concept map was created following a literature review and analysis of the American Association of Colleges of Nursing description of the CNL. Following the identification of certain variables, such as theories underpinning nursing practice, clinical processes, and education, each team member researched identified variables of the conceptual diagram, wrote a thoughtful explanation of the components, and frequently met with the others to discuss each element of the model and the relationships among the variables. Over time, an emerging model developed and was adopted by the school of nursing and approved by the state board of nursing. An explanation of the components of the conceptual framework and their relationship to the CNL role may assist educators in developing and implementing other emerging CNL programs.

Clinical Competence↗