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PubMed1995

The politics of nursing: a case study--clinical grading.

This paper is a study of the clinical grading policy for nurses in the United Kingdom and the extent to which the participating groups in the policy development process realized their objectives. The study is based on the literature available at the time of the research and the results of structured interviews with a range of individuals involved in the policy process. The results expose the cleavages between the different representative groups on the staff side. They also shed light on the differing power bases of the groups involved. In particular, they expose the weakness of nursing as a professional pressure group and the strength of the state and its agents in determining the outcomes of policy in the public arena. It is suggested that this weakness vis-à-vis the state is responsible for the failure of nurses to achieve a reward system which recognizes the value of clinical nursing expertise, and that the 'clinical grading' system, in practice, is having the opposite effect. The policy is explored from its origins, its acceptance on to the political agenda, its negotiation and agreement, its contentious implementation, the final outcomes, and its failure to establish a valid 'clinical' pay structure.

Clinical Competence↗
PubMed2000

The urban environment and health in a world of increasing globalization: issues for developing countries.

Urban living is the keystone of modern human ecology. Cities have multiplied and expanded rapidly worldwide over the past two centuries. Cities are sources of creativity and technology, and they are the engines for economic growth. However, they are also sources of poverty, inequality, and health hazards from the environment. Urban populations have long been incubators and gateways for infectious diseases. The early industrializing period of unplanned growth and laissez-faire economic activity in cities in industrialized countries has been superseded by the rise of collective management of the urban environment. This occurred in response to environmental blight, increasing literacy, the development of democratic government, and the collective accrual of wealth. In many low-income countries, this process is being slowed by the pressures and priorities of economic globalization. Beyond the traditional risks of diarrhoeal disease and respiratory infections in the urban poor and the adaptation of various vector-borne infections to urbanization, the urban environment poses various physicochemical hazards. These include exposure to lead, air pollution, traffic hazards, and the "urban heat island" amplification of heatwaves. As the number of urban consumers and their material expectations rise and as the use of fossil fuels increases, cities contribute to the large-scale pressures on the biosphere including climate change. We must develop policies that ameliorate the existing, and usually unequally distributed, urban environmental health hazards and larger-scale environmental problems.

Developing Countries↗
PubMed2001

Capacity for research in minority health: the need for infrastructure plus will.

Cardiovascular mortality has continued to decline, but racial disparities in cardiovascular diseases (CVD) continue to grow. To build the capacity to address these racial disparities, two things will be required. First, a research and policy infrastructure must be in place to provide guidance on what to do and how to do it. Second, the will to implement and activate this infrastructure must be present at the community and policy-making levels. The Jackson Heart Study is an example of a research infrastructure with the economic resources, scientific expertise, and technical manpower required to monitor, organize, assess, and follow a cohort of individuals over time to study the burden, natural history, predictive factors, and level of care for CVD in an African American community. The creation of will within the community for CVD research may require additional strategies than in the majority community, such as community organization and local policy development. These additional efforts at the community level should create a fertile environment to develop research and, ultimately, test strategies for reducing national disparities in cardiovascular health.

Black People↗
PubMedDate not supplied

Strengthening the public health system.

Although the American public health system has made major contributions to life expectancy for residents of this country over the past century, the system now faces more complex health problems that require comprehensive approaches and increased capacity, particularly in local and State public health agencies. To strengthen the public health system, concerted action is needed to meet these five critical needs: First, the knowledge base of public health workers needs to be supplemented through on-the-job training and continuing education programs. To this end, self-study courses will be expanded, and a network of regional training centers will be established throughout the country. Second, communities need dynamic leadership from public health officials and their agencies. To enhance leadership skills and expand the leadership role of public health agencies, focused personal leadership development activities, including a Public Health Leadership Institute, and national conferences will provide a vision of the future role of public health agencies. Third, local and State public health agencies need access to data on the current health status of the people in their communities and guidance from the nation's public health experts. To improve access to information resources, state-of-the-art technologies will be deployed to create integrated information and communication systems linking all components of the public health system. Fourth, local and State agencies need disease prevention and health promotion plans that target problems and develop strategies and the capacity to address them. To provide communities with structured approaches to this process, planning tools have been developed and distributed, and technical assistance will be provided to local and State health agencies to involve each community in planning,priority setting, and constituency building.Finally, public health agencies need adequate resources to fund prevention programs. To improve the use of existing Federal support and enhance the availability of new community resources, grant programs will be modified, and innovative approaches to local resource enhancement will be developed and shared.Activities in these five key areas are designed to improve the infrastructure of the public health system and its capacity to carry out effectively the core functions of public health assessment, policy development, and assurance of the availability of the benefits of public health. If the nation is to achieve the health objectives for the year 2000, the public health system-the individuals and institutions that, when working effectively together, promote and protect the health of the people-must be strengthened.

Computer Communication Networks↗
PubMed1998

Early intervention and early experience.

For 4 decades, vigorous efforts have been based on the premise that early intervention for children of poverty and, more recently, for children with developmental disabilities can yield significant improvements in cognitive, academic, and social outcomes. The history of these efforts is briefly summarized and a conceptual framework presented to understand the design, research, and policy relevance of these early interventions. This framework, biosocial developmental contextualism, derives from social ecology, developmental systems theory, developmental epidemiology, and developmental neurobiology. This integrative perspective predicts that fragmented, weak efforts in early intervention are not likely to succeed, whereas intensive, high-quality, ecologically pervasive interventions can and do. Relevant evidence is summarized in 6 principles about efficacy of early intervention. The public policy challenge in early intervention is to contain costs by more precisely targeting early interventions to those who most need and benefit from these interventions. The empirical evidence on biobehavioral effects of early experience and early intervention has direct relevance to federal and state policy development and resource allocation.

Child Development↗
PubMed2000

BIOMED-MEROPE project: service provision for adults with intellectual disability: a European comparison.

The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self-advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers.

Adult↗
PubMed2005

kNOw workplace violence: developing programs for managing the risk of aggression in the health care setting.

Strategies to prevent and manage violence and aggression in the health care setting have become a primary health and safety issue. A series of vignettes are provided to highlight key elements in developing a program for preventing behavioural violence and aggression in a tertiary hospital. Key components of the program include staff education and training, risk assessment and management practices, the use of patient contracts and policy development. The program aims to integrate and balance occupational health and safety obligations to staff with the duty of care owed to patients.

Adult↗
PubMed2002

Development of U.S.-Russian medical support procedures for long-duration spaceflight: the NASA-Mir experience.

As the Russian Space Agency and the U.S. National Aeronautics and Space Administration began in the mid-1990s to plan a preliminary cooperative flight program in anticipation of the International Space Station, programmatic and philosophical differences became apparent in the technical and medical approaches of the two agencies. This paper briefly describes some of these differences and the process by which the two sides resolved differences in their approaches to the medical selection and certification of NASA-Mir crewmembers. These negotiations formed the basis for developing policies on other aspects of the medical support function for international missions, including crew training, preflight and postflight data collection, and rehabilitation protocols. The experience gained through this cooperative effort has been invaluable for developing medical care capabilities for the International Space Station.

Certification↗
PubMed2006

Medical informatics in population health: building Wisconsin's strategic framework for health information technology.

Medicine is increasingly practiced through the application of information sciences. Medical informatics deals with optimal information use within bioinformatics, imaging, clinical, and population health domains. Population health informatics plays an important role in that it critically informs practice in each of the other domains. Proper functioning of health care systems requires an advanced health information network that supports clinical care, personal health management, population health, and research. But this infrastructure does not yet exist in the United States. A number of federal initiatives are underway to address this problem, including the development of a framework for a national health information network and funding for implementation. This network will be facilitated by federal leadership, but public and private partnerships, and state, regional, and local implementation and policy development will play a critical role. In this article, we describe several Wisconsin initiatives that are keys to developing a strategic framework and building the state's electronic health information infrastructure.

Biomedical Technology↗
PubMed2000

Future directions for gerontology: a nursing perspective.

This paper discusses the contribution nursing has made to the development of person-centred services, and the influence of gerontology upon such developments. It examines traditional attitudes to medicine and nursing, when curing was all-important and caring treated as secondary and the shift away from this attitude to a more holistic approach to nursing, where the dignity of the patient is an important issue. It argues that good practice utilizes different sources of knowledge, including intuitive knowledge, and discusses the integrated programme of policy, development, research and education activities that the Royal College of Nursing is developing. The options currently available to anyone wishing to study gerontology are discussed, and the pros and cons of the current emphasis on broad-based clinical and educational experience prior to specialization analysed. The key aim of the RCN is to develop the specialism of gerontological nursing and the quality of care experienced by older people. With this end in view, this paper describes the education programme being developed by the RCN, leading to the award of Gerontological Nurse Specialist--a person able to demonstrate knowledge of rehabilitation, clinical assessment, health care assessment and a holistic knowledge of the ageing process.

Aged↗
PubMed1993

Pharmaceuticals and public policy: learning from the New Zealand experience.

Pharmaceuticals provide a useful analytical prism through which to view a wider range of policy issues in the health arena. The fundamental characteristics of pharmaceuticals are shared by many other health care items and raise important policy questions in five key institutional areas: the market, science, the State, the professions, and the public. In one way or another the key policy issues raised in each one of these areas concern fundamental questions of restraint and regulation: the ability of the market to exert the normal disciplines of price competition on pharmaceuticals; the extent to which the claims of intellectual property conflict with the norms of scientific advance; the reconciliation of the different functions of the State, particularly in the management of risk; the efficacy of traditional mechanisms of self-regulation and peer review in the health professions; and the implications of pharmaceuticals for broader questions of social control. These issues are illustrated from the recent experience of a country, New Zealand, that has undergone major deregulation and restructuring of State activities. Conclusions are drawn for policy development in the pharmaceuticals area.

Drug Approval↗
PubMed1998

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies.

It is now well established that children's exposure to environmental tobacco smoke (ETS) results in substantial public health and economic impacts. Children are more likely than adults to suffer health effects from ETS exposure, and the home is the most important site of such exposure. Although the responsibility and authority of the community and health professionals to protect children from harm are entrenched in North American society, social, economic, legal, and political factors contribute to a lower level of support for ETS control measures in homes compared with workplaces and public places. It is now clear that ETS control in home environments must be a priority on the public health agenda. Programme and policy options and strategies for ETS control in home environments are outlined. We conclude that the current research base is inadequate to fully support programme and policy development in this area and priorities for research are identified.

Adult↗
PubMed1996

Media advocacy: a strategy for advancing policy and promoting health.

The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.

Adolescent↗
PubMed2001

Comments on the process and product of the health impacts assessment component of the national assessment of the potential consequences of climate variability and change for the United States.

In 1990 Congress formed the U.S. Global Change Research Program and required it to conduct a periodic national assessment of the potential impacts of climate variability and change on all regions and select economic/resource sectors of the United States. Between 1998 and 2000, a team of experts collaborated on a health impacts assessment that formed the basis for the first National Assessment's analysis of the potential impacts of climate on human health. The health impacts assessment was integrated across a number of health disciplines and involved a search for and qualitative expert judgment review of data on the potential links between climate events and population health. Accomplishments included identification of vulnerable populations, adaptation strategies, research needs, and data gaps. Experts, stakeholders, and the public were involved. The assessment is reported in five articles in this issue; a summary was published in the April 2000 issue of Environmental Health Perspectives. The assessment report will enhance understanding of ways human health might be affected by various climate-associated stresses and of the need for further empirical and predictive research. Improved understanding and communication of the significance and inevitability of uncertainties in such an assessment are critical to further research and policy development.

Animals↗
PubMed2004

Transdisciplinary collaboration as a basis for enhancing the science and prevention of Substance use and "Abuse".

Transdisciplinary scientific collaborations (TDSCs) have the potential to strengthen substance use and misuse research and prevention. Despite its growing prominence as a mode for scientific research, research on TDSC remains in a nascent form and its value to the field of substance use and misuse merits further exploration. The overarching purpose of this article is to examine the potential contributions of transdisciplinary science to research and prevention using conceptualizations, methods, and evidence from a case study of two university-based research centers. The article provides (a) a discussion of the societal context and historical developments that have prompted increasing interest in TDSC; (b) a definition and conceptualization of TDSC; (c) a methodological approach for studying TDSC; (d) initial findings from the case study that reflect instances of transdisciplinary intellectual integration and it examines implications of these methods and findings for future research and policy development relevant to substance use and misuse.

Biomedical Research↗
PubMed2001

Community interdisciplinary education to promote partnerships in family violence prevention.

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month post-evaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.

Cooperative Behavior↗
PubMed2002

Children exposed to domestic violence: psychological considerations for health care practitioners.

This article reviews the psychological impact of exposure to domestic violence on child development. The purpose is to give insight to the following questions: How does the experience of family violence affect a child's perception of the world and relationships with others? What type of coping style might this same child be likely to develop? What factors help protect a child who has been exposed to violence in the home? In addition, the article discusses assessment considerations for health care practitioners and recommends areas for future research and public policy development.

Adaptation, Psychological↗
PubMedDate not supplied

Leadership and empowerment: the value of the National Student Nurses Association for beginning students.

Leadership development has long been emphasized in nursing curricula, but how can it be effectively taught and learned? The authors discuss how beginning student experiences with the National Student Nurses Association (NSNA) promotes colleagueship, research utilization, policy development, political activity, and advocacy. Student reflections on their experience illuminate how they were empowered to effect change and understand their social responsibility.

Education, Nursing↗