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PubMedDate not supplied

Organizational infrastructure to support development of newly graduated nurses.

This is the second article in a series exploring the transition of newly graduated nurses to competent clinicians. The first article [Schoessler, M., & Waldo, M. (2006). The first 18 months in practice: A developmental transition model for the newly graduated nurse. Journal for Nurses in Staff Development, 22:47-52] described the developmental transition model derived from focused research activities and interaction with new graduates. This article presents the corresponding organization infrastructure designed to support development. The use of the term "infrastructure" denotes that this program extends beyond classroom and clinical experience to planned changes in the culture and practice of nursing staff and management team. Program success is measured in stakeholder satisfaction and decreased turnover of new graduates.

Attitude of Health Personnel↗

PubMed1998

Team approaches to treating children with disabilities: a comparison.

OBJECTIVE: To investigate differences in team functioning between the multidisciplinary and transdisciplinary models when treating children with disabilities. DESIGN: A crossover trial. SETTING: An outpatient educational and rehabilitation program in a rehabilitation institute based at a university medical center. PARTICIPANTS: A population-based sample of 19 rehabilitation specialists and educators. INTERVENTION: Participants attended four team meetings using the multidisciplinary approach and then attended four team meetings using the transdisciplinary approach. OUTCOME MEASURES: Behavioral ratings of team participation (Transdisciplinary Team Rating Scale) and self-report instruments of team development (Team Assessment Questionnaire) and treatment planning and goal development (Staff Perception Questionnaire). RESULTS: Results of t tests confirmed the hypothesis that there was more team member participation during transdisciplinary meetings than during multidisciplinary meetings (p=.027). There were no differences in levels of team development (p=.329); however, staff members favored the transdisciplinary model for treatment planning and goal development (p < .001). CONCLUSION: This study provides evidence of the effectiveness of the transdisciplinary model. Further research is now needed to investigate outcome variables such as rate of success in attaining treatment goals when using this model.

Child, Preschool↗

PubMed1984

Cost and performance of malaria surveillance in Thailand.

Some results are presented from a study to determine the costs and performance of the antiparasite elements of the malaria disease control programme in Thailand. Issues examined in the paper are the concept of cost-effectiveness and its relevance in evaluating health care processes, procedures for measuring the performance of malaria surveillance and monitoring processes and procedures for measuring costs. Some data on the costs and the performance of operational services and control activities in two malaria zones are presented and the paper closes by considering how health economics research can be stimulated and supported in developing countries. It is argued that the cost-effectiveness of malaria surveillance and monitoring processes (and probably many other health care processes) can not be measured retrospectively. In the case of malaria control the effectiveness of each operational services can not be compared because services provided are interactive and complementary rather than alternatives. In addition the targets set and levels of effectiveness achieved may not be the same for these complementary processes. Procedures developed for measuring the performance and costs of malaria operational services and activities are described. Five types of measurement are used to evaluate the performance of the operational services and activities; effectiveness (%); time (days); performance (%); and efficiency (cost/unit). Actual expenditure on malaria operational services and activities is not known since all expenditure of government departments in Thailand is recorded under nine budget headings. Budget expenditure at division, region and zone levels must therefore be apportioned to assess the costs of operational services and activities. Since a variety of criteria may legitimately be used to apportion costs at each level, a network technique was developed which allows examination of the effect of all possible combinations of criteria. By this means the maximum, minimum and most appropriate costs are determined. Examples of the costs and performance of surveillance operational services and activities in two zones are presented. Data illustrates the outcomes from the procedures developed and indicates how malaria disease control managers might interpret and use the information obtained. The paper closes with some observations on how health economics research in developing countries could be better stimulated and supported through staff development programmes and through supervised 'on the job' training.

Communicable Disease Control↗

PubMed2001

The delay in transfer between the emergency department and the critical care unit for patients with an acute cardiac event--in hospital factors.

The Lyell McEwin Health Service (LMHS) is a major public hospital located in the northern suburbs of Adelaide, a region where the death rate from ischaemic heart disease (IHD) is higher than the expected death rate in the population. A retrospective case note study conducted at this hospital investigated the duration that patients with unstable angina pectoris (UA) or acute myocardial infarction (AMI) spent in the emergency department (ED) before admission to the critical care unit (CCU) and the factors that contributed to delays of greater than 70 minutes. All patients admitted to the LMHS over an 18 month period with a discharge diagnosis related group (DRG) for AMI and UA were included in the study. A total of 667 case notes were examined; 403 of these cases met the inclusion criteria for the study. The mean duration between arrival in the ED and subsequent admission to the CCU was found to be 161 minutes. DRG was a major factor in the length of time spent in the ED. The mean duration for patients with AMI was 124 minutes, whilst for UA the duration was 190 minutes (difference = 66 minutes, p<0.001). Other factors that were significant were gender (females = mean duration 29 minutes > males, p=0.015), and mode of transport to the ED (arrival by ambulance mean duration 30 minutes < private transport, Recommendations arising from this study included that a system be established to enable the rapid assessment of all patients suspected of suffering AMI and UA, inclusive of their expeditious transfer to the CCU. In addition, a staff development programme was proposed to ensure medical and nursing staff became aware of a bias in this hospital toward transferring male patients in a shorter timeframe than females with the same DRG.

Adult↗

PubMed2000

High-dose chemotherapy with autologous stem cell rescue in the outpatient setting.

Intensive outpatient care is rapidly becoming the primary mode of care for selected patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation. Although the traditional inpatient model of care may still be necessary for high-risk patients, published data suggest that outpatient care is safe and feasible during or after administration of high-dose chemotherapy and autologous PBSC transplant. Blood and marrow transplant (BMT) centers have developed programs to provide more outpatient care under three basic models: an early discharge model, a delayed admission model, and a comprehensive, or total, outpatient model. This review will describe these models of care and address the elements necessary for the development of an outpatient BMT program, including patient selection, staff development, and patient and caregiver education. Available supportive care strategies to facilitate outpatient care will also be highlighted. Clinical outcome data and pharmacoeconomic analyses evaluating various outpatient BMT programs, as well as limited quality-of-life evaluations, will be reviewed.

Ambulatory Care↗

PubMedDate not supplied

Enhancing verbal communication skills and promoting effective socialization of newly hired Spanish-speaking registered nurses.

Eight Spanish-speaking registered nurses from Puerto Rico were hired at the Veterans Affairs Medical Center, Washington, DC. Verbal communication with patients and staff was difficult for these highly skilled, competent nurses. This article describes a program to improve English language skills provided for the orientees. Such a program can assist staff development educators to attract well-qualified, professionally satisfied staff nurses during acute shortages in hospital settings.

Communication Barriers↗

PubMedDate not supplied

Electronic fetal monitoring. Education and quality assurance.

Although electronic fetal monitoring (EFM) has been widely used in clinical practice for more than two decades, educational standards and competency validation for EFM use in hospitals have been developed only recently. This article highlights a community hospital's program for EFM. Basic education, staff development, and quality assurance activities involving staff nurses and managers are discussed.

Documentation↗

PubMedDate not supplied

The nursing role in ICU outreach: an international exploratory study.

It is widely acknowledged that many critically ill patients are managed outside of designated critical care units. One strategy adopted in Australia and England to assess and manage risk in these patients is the intensive care unit (ICU) outreach or liaison nurse service. This article examines how ICU outreach/liaison roles in Australia and England operate in the context of Manley's theoretical framework for advanced nursing practice. Descriptive case study design using semi-structured interviews and job descriptions as sources of evidence. Findings of interviews with six Australian ICU Liaison nurses are already published; this study replicated the Australian study with four ICU Consultant Nurses in England and mapped interview and job description data from both countries onto Manley's conceptual framework for advanced practice/consultant nurse. Four themes emerged from the English data: patient interventions, support for ward staff, liaison between ward and ICU staff and hospital-wide impact. The first three of these comprised the core service common to the roles in both countries. Manley's four subroles (expert practitioner, consultant, educator and researcher) were present across both countries. However, the interview and job description data demonstrated that there were lower expectations in Australia that the roles would lead to staff development and build capacity across the hospital system. Similarly, formal education for ward staff such as ALERT and CRiSP courses were more developed in UK. Our data demonstrate that the role undertaken in England and Australia is sufficiently comparable to use as a research intervention in international studies across the two countries. However, the macro service level differs. Job descriptions across both countries emphasized the need to influence hospital policy; however, the ICU consultant nurses in England might be considered better placed to achieve this through role title and access to the hospital executive. In both countries, the roles would benefit from systematic evaluation of the impact on outcomes. This is particularly important for longer-term integration of the role in the health services in both countries.

Aftercare↗

PubMedDate not supplied

CAM therapies and nursing competency.

Americans are embracing complementary and alternative medical (CAM) therapies in ever-increasing numbers, with more than $30 billion spent on CAM each year. This consumer-driven trend challenges staff development leaders to learn more about CAM and the implications for staff competency. This article reviews CAM integration from the Federal to state level, and describes guidelines to facilitate development of policies related to CAM, nursing competency, and promotion of patient advocacy in use of CAM therapies.

Clinical Competence↗

PubMedDate not supplied

Experiencing nursing governance: developing a post merger nursing committee structure.

In a mid-sized city in south-central Ontario, two hospitals with four physical sites underwent a merger to form one large corporation; this merger was in response to the recommendations of a provincial restructuring commission. Health care delivery within the large corporation was reorganized using a program management structure. An outcome of program management within this corporation was the dissolution of the traditional nursing departments. In recognition of the need for a professional voice, the corporation created a new governance structure, which included the Professional Advisory Committee. Twenty-five disciplines are represented within this committee; each of these disciplines created its own professional committee. Nursing, then, was responsible for developing the Nursing Practice Committee (NPC). The following article describes the process by which front line nursing staff developed the NPC. A nursing structure task force was struck to accomplish this purpose; the task force is described, including membership, mandate, activities, principles and goals. The environmental assessment that was conducted by the task force is described, along with the process by which the NPC structure was designed and implemented. Challenges and successes experienced are presented. Rosabeth Kanter's framework for staff empowerment is used to understand how nursing governance was transformed in the development of the NPC.

Attitude of Health Personnel↗

PubMedDate not supplied

Mandatory education via the computer: cost-effective, convenient, and creative.

With reduced budgets, few resources, minimal time allotted for education, and a long list of topics to cover, staff development and inservice educators often find it difficult to implement cost-effective, comprehensive mandatory education programs. Upper Valley Medical Center's annual mandatory education program via the computer was created to address these issues and resulted in substantial cost-savings as well as increased employee satisfaction.

Attitude of Health Personnel↗

PubMed1989

Guidelines (1988) for training in clinical laboratory management. International Federation of Clinical Chemistry (IFCC) Education Division and International Union of Pure and Applied Chemistry (IUPAC) Clinical Chemistry Division Commission on Teaching of Clinical Chemistry.

Trainees in laboratory medicine must develop skills in laboratory management. Guidelines are detailed for laboratory staff in training, directors responsible for staff development and professional bodies wishing to generate material appropriate to their needs. The syllabus delineates the knowledge base required and includes laboratory planning and organisation, control of operations, methodology and instrumentation, data management and statistics, financial management, clinical use of tests, communication, personnel management and training, and research and development. Methods for achievement of the skills required are suggested. A bibliography of IFCC publications and other material is provided to assist in training in laboratory management.

Administrative Personnel↗

PubMedDate not supplied

Organizational renewal in the healthcare ministry.

The Irish Province of the Hospitaller Order of St. John of God, which sponsors healthcare services for the mentally ill, the mentally handicapped, and the elderly, initiated a renewal process in 1984 to reevaluate its mission. The process, which was launched with a three-day conference, was divided into four parts: reflection on the order's values, reflection on the brothers' mission work, reflection on the work of the local centers, and reflection on the organization's services in relation to the healthcare environment. Data gathered during the organization's reflection included: Perceptions that the order needed to clarify its goals; Suggestions that the brothers adopt a simpler life-style; Concerns about communication and staff development in the local centers; Recommendations that the organization become more innovative and that it collaborate more frequently with other organizations. An important feature of the ongoing renewal is its focus on the present, involving those who make up the organization in a continuing reeducation process that prepared them to make informed decisions in the future. The process not only has contributed to an increased awareness of the order's roots, its values, and the client as a person, but also has developed a sense of partnership between the brothers and lay staff and brought new energy, hope, and confidence to the organization.

Aged↗

PubMedDate not supplied

Assisting nursing staff to learn and conduct research. An interinstitutional approach.

This article describes a resource sharing and collaborative interinstitutional project designed to assist the nursing staff of three hospitals to gain expertise in research and to promote collaborative research endeavors. Information is provided that will help staff development educators complete a similar project with a group of staff nurses.

Diffusion of Innovation↗

PubMed1989

International Federation of Clinical Chemistry Education Division and International Union of Pure and Applied Chemistry Clinical Chemistry Division Commission on Teaching of Clinical Chemistry. Guidelines (1988) for training in clinical laboratory management.

Chemistry, Clinical↗

PubMed1989

International Federation of Clinical Chemistry (IFCC), Education Division. Guidelines (1988) for training in clinical laboratory management.

Chemistry, Clinical↗

PubMed1984

Managing training programs for pharmacy employees.

Principles for managing training programs for supportive personnel and new pharmacist employees in hospital pharmacy departments are discussed, and ongoing staff development activities are described. General management objectives of training programs are outlined. Training programs for supportive personnel should include general theory, such as basic pharmacology and metric conversions, and practice in the specific skills required for the job. The practical component of the training program should be based on a job analysis, and behavioral objectives of the training program should be developed. Various approaches for structuring and monitoring training programs for supportive personnel are described. Besides mastering specific practice skills, new pharmacist employees must become thoroughly familiar with the pharmacy department's policy and procedure manual. Hospital pharmacy managers should implement ongoing activities for developing the decision-making, interpersonal, and practice skills of staff pharmacists. Well-organized training programs can effectively raise the performance standards of pharmacy departments and decrease the time spent in monitoring, evaluating, and correcting performance deficiencies of the staff.

Feedback↗

PubMed1996

Process for preventing or identifying and resolving problems in drug therapy.

A consistent process for preventing or identifying and resolving problems related to drug therapy is described. The process was originally developed to help pharmacy students focus on drug therapy issues during their clinical clerkship rotations. The first version of this approach to quality improvement consisted of lists of questions designed to prompt the student to prevent or identify and correct drug therapy problems. Because the learning style of some students is more visual, the questions were incorporated into flow charts. Students at a community hospital used the flow charts during their rotations through the critical care, medical-surgical, and psychiatric units, and the process appeared to result in improvements in the quality of care and in savings in the cost of care. As a result, a staff development and training project was begun to determine if staff pharmacists who use this process to evaluate drug therapy will begin to provide pharmaceutical care. This sort of transitional model of pharmaceutical care may expedite global implementation of the new practice philosophy. Flow charts encouraging a uniform approach to the prevention or identification and correction of drug therapy problems were developed for use by pharmacy students and generalist pharmacists.

Clinical Clerkship↗