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PubMed1996

Utilizing quality assurance as a tool for reducing the risk of nosocomial ventilator-associated pneumonia.

A multidisciplinary group was formed to develop strategies to reduce ventilator-associated lower respiratory tract infections (LRI) in an intensive care unit (ICU) of a 540-bed acute care teaching medical center. The group process was facilitated by the Infection Director and the quality management specialist. The group was made of medical, nursing, and respiratory therapy staff. Quality improvement techniques were used to define the process of care for ventilated patients in the ICU. "State of the art" care was defined after a literature review and brainstorming sessions. Current practice and new concepts were then forged into a realistic protocol for the ICU. The resulting protocol was introduced into the ICU in May 1992. The information was communicated to Respiratory Therapy and ICU staff in writing and at department meetings. After a 4-month introductory period and learning curve process, a decrease in the endemic rate of ventilator-associated LRI was reduced in the fourth quarter of 1992. The mean 1993 LRI rate was 21 LRI/1000 ventilator days versus 26 LRI/1000 ventilator days in 1992 before protocol implementation. This equates to 18 LRI prevented in 1993. This represents a savings of $126,000. There was a significant decrease in the process variation of the monthly mean LRI/1000 ventilator days in 1993 from 1992. To date, there continues to be improvement with a mean of 16 LRI/1000 ventilator days reported in 1994. The ICU staff developed a multidisciplinary process evaluation and monitored staff implementation of the protocol over time. The results of the evaluation were used as feedback to measure protocol implementation. This was found to improve compliance with the protocol. Both the process (care of ventilated patients) and the outcome (number of LRI) have been improved through use of continuous quality improvement concepts and transdisciplinary interventions.

Clinical Protocols↗

PubMed1984

Active hepatitis B vaccination of dialysis patients and medical staff.

One hundred six patients with terminal renal insufficiency and 29 medical personnel were given three doses of hepatitis B vaccine at an interval of 0, 1, and 6 months (Merck, Sharp and Dohme, West Point, Pennsylvania, part of a joint study no. 649). Chronic hemodialysis patients (N = 99) received 40 micrograms vaccine (V) i.m. Uremic patients, who were just about to start chronic dialysis treatment (N = 7), were given 40 micrograms V, and at the first vaccination 3 ml hyperimmune globulin (HBIG) in addition. The medical personnel was alternately vaccinated with 20 micrograms V (N = 8), 40 micrograms (N = 11), 40 micrograms V, and 3 ml HBIG at the first vaccination (N = 10). After 12 months, 50% of the male dialysis patients, 66% of the female dialysis patients, and 95% of the medical staff developed anti-HBs antibodies. The anti-HBs titer of the dialysis patients was ten times lower than in the medical staff. The simultaneous passive immunization did not lead to any impairment of the anti-HBs titer in the dialysis patients and staff. The type of renal disease, length of time on dialysis, hematocrit, and immunoglobulin concentration did not influence the rate of immunization. After 12 months, 43 patients without antibody response were vaccinated a fourth time. Sixteen of these patients then developed anti-HBs, improving the immunization rate from 56.5 to 71.7%. A fifth vaccination only led to seroconversion, when brief or borderline anti-HBs could already be demonstrated previously. In dialysis patients who fail to develop anti-HBs after three doses of vaccine, a fourth vaccination is recommended after 12 months.

Antibodies, Viral↗

PubMed1995

Discontent without focus? An analysis of nurse management and activity on a psychiatric in-patient facility using a 'soft systems' approach.

Psychiatric nursing in the United Kingdom is undergoing major change as a consequence of the policy of community care. Whilst much has been written about the role of the community psychiatric nurse (CPN), less has been said about the preparedness of nurses in in-patient facilities to adapt to the changes. Checkland's (1981) 'soft systems' methodology was used to analyse the situational environment on an acute admission unit. It was found that an increased sense of accountability, combined with the demands of the Mental Health Act 1983, led the ward manager to develop a system, particularly in relation to discharge planning, in which his role was central. This left the ward staff feeling unrecognized and insufficiently experienced in a vital aspect of patient care. Lack of support from the college of nursing and inadequate staff development programmes were also found to have played a part in the situation. The use of reflection in action is recommended as a way of initiating changes in structure, processes and attitudes. Wider inferences are drawn concerning the competence of registered mental nurses (RMNs) practising in in-patient facilities, and the role of the colleges of nursing in operating effectively in the new care and market paradigms.

Communication↗

PubMed1991

Immunisation of staff of a regional blood transfusion centre with a recombinant hepatitis B vaccine.

Medical, nursing, laboratory and other staff of the Mersey Regional Blood Transfusion Centre at risk of acquiring hepatitis B were vaccinated against the virus with a recombinant vaccine. Altogether, 86% staff developed greater than 10 mIU/ml antibody to hepatitis B virus surface antigen after immunisation but the proportion was lower in older staff. After a further injection of vaccine was given to poor and non-responders the overall proportion responding rose to 93%. The difference in response between the sexes was significant. Women had a higher rate of response and, among those persons responding, women developed a higher concentration of antibody.

Adult↗

PubMed2002

A postal survey to identify and describe nurse led clinics in genitourinary medicine services across England.

BACKGROUND: Nurses in genitourinary medicine (GUM) services are progressively extending their roles to conduct "comprehensive care" nurse led clinics. In such roles the nurse coordinates the first line, comprehensive care of patients presenting with sexual health conditions and issues. OBJECTIVES: To identify and describe comprehensive care nurse led clinics in GUM services across England. METHODS: A postal questionnaire consisting of 17 closed response questions was sent to 209 GUM services across England. A second questionnaire was sent to non-responders to increase the response rate. Data were single entered and analysed using SPSS. RESULTS: Of the 190 GUM clinic respondents (91% response rate), 44 (23%) reported providing some form of comprehensive care nurse led clinic, 90% of which were initiated since 1995. Key results show staff development featured as the main reason for initiating such services and there was general consistency in the aspects of care undertaken by these nurses. There was evidence of guideline development specific to nurse led care and some patient group direction use for supplying medication. The level of support from medical staff while nurse led clinics were being conducted varied between services. Few services have conducted any audit or research to monitor/evaluate nurse led care. There was little consistency in the clinical experience and educational prerequisites to undertake comprehensive care nurse led clinics. Continuing professional development opportunities also varied between services. CONCLUSIONS: The steady growth of comprehensive care nurse led clinics indicates that the skills of GUM nurses are being recognised. Nurses working in advanced practice roles now require courses and study days reflecting these changes in practice. Locally agreed practice guidelines can define nursing practice boundaries and ensure accountability, as will the development of patient group directions to supply medication. Monitoring and evaluation of nurse led clinics also require attention.

Ambulatory Care Facilities↗

PubMedDate not supplied

Simulations: their selection and use in developing nursing competencies.

Efficient and effective use of simulations for teaching or review requires that they be matched carefully to a target nursing competency. Guidelines are provided to assist nursing staff development educators in selecting and using simulations for psychomotor assessment and interpersonal skills as well as problem solving.

Computer Simulation↗

PubMed2005

Identification, assessment and intervention--Implications of an audit on dyslexia policy and practice in Scotland.

This article reports on research commissioned by the Scottish Executive Education Department (SEED). It aimed to establish the range and extent of policy and provision in the area of specific learning difficulties (SpLD) and dyslexia throughout Scotland. The research was conducted between January and June 2004 by a team from the University of Edinburgh. The information was gathered from a questionnaire sent to all education authorities (100% response rate was achieved). Additional information was also obtained from supplementary interviews and additional materials provided by education authorities. The results indicated that nine education authorities in Scotland (out of 32) have explicit policies on dyslexia and eight authorities have policies on SpLD. It was noted however that most authorities catered for dyslexia and SpLD within a more generic policy framework covering aspects of Special Educational Needs or within documentation on 'effective learning'. In relation to identification thirty-six specific tests, or procedures, were mentioned. Classroom observation, as a procedure was rated high by most authorities. Eleven authorities operated a formal staged process combining identification and intervention. Generally, authorities supported a broader understanding of the role of identification and assessment and the use of standardized tests was only part of a wider assessment process. It was however noted that good practice in identification and intervention was not necessarily dependent on the existence of a dedicated policy on SpLD/dyslexia. Over fifty different intervention strategies/programmes were noted in the responses. Twenty-four authorities indicated that they had developed examples of good practice. The results have implications for teachers and parents as well as those involved in staff development. Pointers are provided for effective practice and the results reflect some of the issues on the current debate on dyslexia particularly relating to early identification.

Aptitude Tests↗

PubMed2000

'We, not them and us?' Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes.

'We, not them and us?' Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes This study describes relatives' and staffs' experiences of each other in their relationships and interactions in connection with the care of old people with dementia living in nursing homes. The aim was to identify obstacles and promoters concerning these interactions. A qualitative method was used. Data were collected from 27 hours of observations of group discussions about relatives' and staffs' communication, interactions and experiences. Three different groups, with eight participants, relatives, staff and a group leader in each, met six times during a period of 3 months. Findings indicate that the experiences that relatives and staff have of each other are related to issues about influence, participation, trust and measures to avoid conflicts. These conclusions build on concrete descriptions about care, activities, competence, communication and visits given by research participants. Experiences of situations were sometimes contradictory between relatives and staff. This implies that the potential for cooperation between relatives and staff in care of the elderly is not fully utilized. Suggestions for enhancing the relationships between relatives and staff are: pre-planned informal, individual conversations between relatives and staff; development of ways to give regular two-way feedback about matters concerning the resident and the relationship between staff and relatives; giving staff credit for measures taken to facilitate relatives' involvement in the nursing home care; measures to improve documentation about families' involvement; and working together with minor practical tasks.

Adult↗

PubMedDate not supplied

[Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

Anesthesiology↗

PubMedDate not supplied

Helping staff help students.

Nurses in a variety of health care settings work with nursing students. Staff development educators can help the nurses create a successful student affiliation while protecting the agency and patients. By teaching staff what to ask and what to tell, educators help students learn without compromising care. Positive student experiences also may help recruit new graduates to the agency. Teaching the staff to share information will help staff help students.

Humans↗

PubMedDate not supplied

Stages in the development of a needs assessment questionnaire.

This article describes the stages in the development of a questionnaire for use in a large-scale needs assessment study as the basis for a staff development program. While a considerable literature exists on questionnaire design in general, we emphasize the need for a conceptual framework behind the questionnaire, proceeding from analysis of the objectives of the needs assessment and guiding both the construction of variables and the reduction and analysis of the questionnaire's data.

Data Interpretation, Statistical↗

PubMed1983

Staff training through collaboration: the training resources center.

As fiscal resources for mental health programs dwindle, it is becoming increasingly important to preserve non-direct-service priorities such as staff development. The West Virginia Training Resources Center, a collaborative program operated by the West Virginia Department of Health and the West Virginia University department of behavioral medicine and psychiatry, addresses problems of staff training in the state mental health service system. The authors discuss the development of the center and its functions as provider of training programs, sponsor of statewide training conferences, and clearinghouse of information and expertise. They also discuss problems stemming from the increased need for continuing education for paraprofessionals, the use of outside consultants, and the relationship between academia and the health service sector.

Community Mental Health Centers↗

PubMedDate not supplied

An interview with Ellen Canepa Brzytwa and Scott Sutorius. Interview by Connie R Curran.

The Greater Cleveland Hospital Association Center for Health Careers Development analyzes health care manpower issues and implements action plans to assist its members with image, retention, recruitment, and other staff development initiatives. In this interview, Ellen Canepa Brzytwa and Scott Sutorius discuss their work with the Center for Health Careers Development, the nurse's presence at the decision table, and nursing leadership development.

Career Mobility↗

PubMedDate not supplied

A cost-effective competency program for a rehabilitation unit.

As competency evaluations become the standard for assessing proficient nursing practice, the need for validated, cost-effective, and efficient programs will increase. This article describes a competency assessment program that was implemented for a hospital-based, 15-bed acute rehabilitation unit in Chehalis, WA. The program, initiated and executed by the hospital's staff development department, was efficient in terms of financial costs to the unit and the time required for implementation for all participating staff. Appropriately selected psychomotor and cognitive skills were verified through return demonstration and written examination. The 14 members of the licensed staff successfully completed all aspects of the program.

Clinical Competence↗

PubMedDate not supplied

Integrating centralized and decentralized organization structures: an education and development model.

Organization change efforts have led to critically examining the structure of education and development departments within hospitals. This qualitative study evaluated an education and development model in an academic health sciences center. The model combines centralization and decentralization. The study results can be used by staff development educators and administrators when organization structure is questioned. This particular model maximizes the benefits and minimizes the limitations of centralized and decentralized structures.

Academic Medical Centers↗

PubMed1982

Hepatitis B surveillance: 4-year survey of staff in a National Blood Transfusion Service.

The prevalence of HBsAg and anti-HBs in personnel of the Canadian Red Cross Blood Transfusion Service (BTS) during 1979 was not found to be significantly different from that of staff first employed in 1978-1979 or from that found among voluntary blood donors. Between 1976 and 1979, 2525 individuals were tested, of whom 13 seroconverted to HBsAg-positive; 54% of these cases appeared to be accident-related. During the same period 29 staff developed anti-HBs; of these 21% were apparently accident-related. Actual rates of seroconversion were not calculated because of staff turnover. The data suggest that BTS employees do not constitute a 'high-risk' group.

Blood Banks↗

PubMed2001

Performance-related pay in health care.

OBJECTIVE: Performance-related pay (PRP) has been widely extended within the British public sector in the last 15-20 years, mostly because of pressure from central government. Its penetration in the National Health Service (NHS) has not so far been very deep but it has been sufficient to permit preliminary judgements on its likely impact. METHODS: Review of published accounts of the extent of use of PRP in the NHS and its impact, plus two case studies. RESULTS: There have been few rigorous studies reported. PRP has been introduced for a variety of reasons: an incentive to motivate staff; to enhance staff recruitment and retention; to signal a change in organizational culture; to control staff costs; to reduce the power of trades unions; to reinforce staff development policies. Very few NHS provider organizations have implemented PRP. Despite this, senior managers see real merit in it in improving staff performance and delivering a clear message about the importance of organizational performance. Employees are much more skeptical, seeing PRP as having no effect or being detrimental. CONCLUSIONS: PRP has had, at most, only a very modest beneficial impact in the British NHS. In the absence of better evidence, it would be sensible for government to continue to encourage local initiatives rather than propose a mandatory national scheme. It would also be prudent to subject local schemes to rigorous evaluation.

Employee Incentive Plans↗

PubMed1998

Use of project ontologies and terminology servers to support software engineering.

Complex medical software imposes new requirements on the methods and tools used for maintenance. Appropriate maintenance tools can increase software reliability and quality by providing means to trace dependencies among software artifacts for reducing unexpected impacts in software caused by software changes. We have used the GRAIL concept-representation language for medical terminologies to build a project ontology that models relationships among software artifacts. Our approach involves modeling of the terminology used in software projects, which enables us to describe, classify and relate individual software artifacts. A networked repository accessible to the entire software development staff stores the conceptual model, source code and associated documents. We present an architecture for a maintenance tool, and show how developers can use GRAIL to build a project ontology.

Databases as Topic↗