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PubMed2005

Assessment of nurses' work climate at Alexandria Main University Hospital.

Work climate is indicative of how well the organization is realizing its full potential. An accurate assessment of work climate can identify the unnecessary obstacles to nurses interfering with their best performance. The present study aims to assess nurses' work climate at Alexandria Main University Hospital. The study sample included all nurses (N=400) who were working in inpatient medical and surgical units at the Alexandria Main University Hospital who were available at the time of data collection. A structured questionnaire was developed to assess nurses' perceptions regarding the dimensions of work climate. Data was collected by individual interview using the structured questionnaire. Results indicated that the highest percentages of nurses in medical and surgical units perceived that their work climate is characterized by good way of performance management, feeling of responsibility, warmth and supportive relationships, quality of communication, morale, organizational clarity and feeling of identity and belongness to the hospital. Nurses perceived that they are lacking work climate conducive to conflict resolution, participation in decision making, opportunity for training and development, fair rewards and recognition, calculated risks, sufficient resources, effective leadership and teamwork. There were no significant difference between nurses perceptions in medical and surgical units regarding all dimensions of work climate. The highest percentage of nurses in all units were satisfied only with the feeling of responsibility, way of performance management, and quality of communication. Conflict and identity were perceived as the most important areas that need improvement in the hospital. Based on the results recommendations were given to enhance work climate through designing compensation and recognition systems, and negotiate their requirements and accomplishment based on established standards and outcomes measures. Also, encouragement of and planning for participative decision making, teamwork, in-service training program and open communication are recommended to be present in the work units.

Adult↗
PubMed2004

Establishing an endovascular carotid stent program.

FDA approval of carotid stent and distal protection devices has transformed carotid artery stenting (CAS) from an investigational procedure to a practical application. Recent approval by the Center for Medicare Services (CMS) has ensured that CAS will be a part of everyday practice throughout the country. To establish a competitive endovascular carotid stent program, one needs to develop an effective strategy. The key to success is substance and service. A high-quality clinical program with excellent communication between the patient and referring physician is essential. You must first get access to the patient by establishing a clinical practice. As a radiologist, you have the advantage of gaining access by identifying appropriate patients through noninvasive vascular labs, CTA, and MRA. An algorithm-driven evaluation and treatment protocol with good pre- and postoperative care, along with a quality assurance program, will ensure that your carotid stent program has substance and delivers optimal service. With good planning, you will have a firm clinical foundation for treatment of carotid artery stenosis in your community. Putting all of the ingredients together will ensure a successful carotid endovascular program.

Algorithms↗
PubMed1999

Effective prevention programs for tobacco use.

Several types of prevention programs have shown effects on delaying or reducing youth tobacco use for periods of 1-5 years or more. These are referred to as evidence-based programs. However, they are not widely used. At the same time, with few exceptions, adolescent tobacco use rates have been stable or have increased in the 1990s. The challenge for prevention is to identify critical components shared by effective prevention programs--that is, components most associated with effect, and then to evaluate factors that are most likely to promote adoption, implementation, and diffusion of effective programs across schools and communities in the United States. Effective tobacco prevention programs focus on counteracting social influences on tobacco use, include either direct training of youth in resistance and assertiveness skills or, for policy and community organization interventions, direct or indirect (through adults) training in community activism, and are mainly theory-based, with an emphasis on three levels of theory: (a) personal (attitudes, normative expectations, and beliefs); (b) social (social or group behavior); and/or (c) environmental (communications and diffusion). Program effects increase with the use of booster sessions, standardized implementor training and support, multiple program components, and multiple levels of theory. Overall, multi-component community programs that have a school program as a basis, with supportive parent, media, and community organization components, have shown the most sustained effects on tobacco use. Positive program adoption by the school or community, extent and quality of program implementation, and existence of credible networks of leaders to promote the program are critical for any effect. Research on predictors of adoption, implementation, and diffusion of evidence-based programs is scanty relative to outcome research. In addition, more research is needed on why multi-component programs appear to be most effective, whether effect is related to existing tobacco policies, whether prevention programs have differential effects on youth with different natural trajectories of tobacco use, and whether prevention programs can be used to recruit smokers into cessation programs.

Adolescent↗
PubMed1999

Nurses' self-reflection via videotaping to improve communication skills in health counseling.

The purpose of this qualitative research was to describe nurses' opinions of their communication skills in health counseling situations and to analyze the levels of reflectivity in their evaluations according to Mezirow. Nineteen nurses participated in the research on a voluntary basis and evaluated their interaction with patients on video on two occasions half a year apart. Nurses gave verbal feedback in an interview immediately after videotaping, after which they read education materials, watched their counseling on video and wrote an evaluation of their communication skills. Transcribed audiotaped interviews and written evaluations were analyzed using content analysis. Nurses said that they were able to use familiar language, to listen and to encourage patients to express their feelings and ask questions. Nurses gave little feedback on nonverbal communication. They wanted to develop their listening skills and their ability to encourage patients to ask and express their feelings. They also wanted to improve their preparations for counseling sessions. On Mezirow's scale, nurses' evaluations weighted heavily towards the lower levels of reflectivity. Only one nurse's evaluations were on the sixth level and no evaluations were on the seventh level. The results indicated a need for training programs dealig with communication skills and self-reflection. Using the videotape and self-reflection were found to be good methods to enhance the quality of health counseling.

Adolescent↗
PubMed1988

Hand-held computer program for field-capture and analysis of herbage yield and composition data using a modified dry-weight-rank and yield estimate method.

A BASIC program is described which is used to collect, check and analyse rank estimates of plant yield in the field. The program operates in a portable, battery-powered Sharp PC1500A hand-held computer than can be used in a field environment. Data are collected using a modified dry-weight-rank method and comparative yield estimates. Much of the software is designed to trap incorrect data entry. Raw data or summary data may be printed, displayed, and stored on cassette tape or transferred to another computer through a communications interface. The program can be easily modified to run on other models of the Sharp PC series or other portable computers that use a similar BASIC interpreter.

Algorithms↗
PubMedDate not supplied

Clinical laboratory technician to clinical laboratory scientist articulation and distance learning.

Laboratory workers and educators alike are challenged to support access to education that is current and provides opportunities for career advancement in the work place. The clinical laboratory science (CLS) program at the Medical College of Georgia in Augusta developed a clinical laboratory technician (CLT) to CLS articulation option, expanded it through distance learning, and integrated computer based learning technology into the educational process over a four year period to address technician needs for access to education. Both positive and negative outcomes were realized through these efforts. Twenty-seven students entered the pilot articulation program, graduated, and took a CLS certification examination. Measured in terms of CLS certification, promotions, pay raises, and career advancement, the program described was a success. However, major problems were encountered related to the use of unfamiliar communication technology; administration of the program at distance sites; communication between educational institutions, students, and employers; and competition with CLT programs for internship sites. These problems must be addressed in future efforts to provide a successful distance learning program. Effective methods for meeting educational needs and career ladder expectations of CLTs and their employers are important to the overall quality and appeal of the profession. Educational technology that includes computer-aided instruction, multimedia, and telecommunications can provide powerful tools for education in general and CLT articulation in particular. Careful preparation and vigilant attention to reliable delivery methods as well as students' progress and outcomes is critical for an efficient, economically feasible, and educationally sound program.

Computer-Assisted Instruction↗
PubMedDate not supplied

The personal digital assistant, a new medical instrument for the exchange of clinical information at the point of care.

Personal digital assistants can provide a portable, integrated platform for point-of-care clinical reference, patient management and data communication. Clinical reference programs allow the user to access information from the Internet and guidelines. Patient management programs allow doctors to access and store clinical information. Wireless technologies have potential for rapid exchange of clinical laboratory results and efficient "electronic patient handovers". Thus, these devices provide the potential for true continuity of care across the healthcare system.

Communication↗
PubMedDate not supplied

[Cost-benefit analysis of the Program for Early Screening of Cervico-uterine Cancer].

OBJECTIVE: Previous researches pointed out the critical changes needed to increase the efficiency of the National Screening Programme of Cervical Cancer in Mexico. These changes were assessed through a cost-benefit analysis. This paper presents the results of that appraisal. Figures are presented as US Dollars of 1996 valued as 7.5 pesos for each dollar. RESULTS: The operational unitary cost of the integral process of the cytology-the obtention of the Pap smear, its transportation to the interpretation centre, its analysis, and the notification of results to users-was estimated in US$ 11.6. If the proposed changes are operated, the cost of each citology would increase by 32.7%. The benefit/cost ratio would be 2 and the net benefit of 88 millions of US dollars for the next five years. CONCLUSIONS: The operation of the proposed changes is socially desirable, but should be supported the training activities of the personnel, the increase of the coverage of women at risk, the quality control activities, the monitoring of the program and the communication with women detected as positive cases.

Carcinoma in Situ↗
PubMed2001

Return-to-work: The importance of human interactions and organizational structures.

The purpose of this study was to gain insight into stakeholder perspectives on barriers and facilitators for return-to-work (RTW). Qualitative methodology with purposive sampling was employed. A total of 55 participants, representing a wide spectrum of stakeholders and industry, were interviewed in individual or group format. Interview transcripts were coded, categorized according to themes, and placed within a framework which reflected the dynamic interaction of individuals and the structural systems or context of those individuals. Findings indicated that perceived barriers to RTW included delays of all types in processing or delivery of information or treatment, and ineffective communication among stakeholders. Facilitators to RTW included establishment of RTW programs in the workplace, effective communication and teamwork, as well as trust and credibility among stakeholders. The interdependence of organizational structures and human interactions was evident in successful RTW programs which emphasized teamwork, early intervention, and communication. Differing stakeholder perspectives, however, especially on issues such as worker attitudes and participation, must be acknowledged and addressed if more injured workers are to be successful in returning to full employment.

Journal Article↗
PubMed1997

The treatment of type II diabetes in Texas. Current issues for managed care and employers.

In 1995, a forum was held in Dallas, Texas, to discuss the current state of treatment for type II diabetes and the issues facing managed care organizations (MCOs) and employers. Attendees included representatives from the American Diabetes Association (ADA), diabetologists, medical directors from leading MCOs in the area, benefits managers and employee representatives from large corporations in the region, diabetes educators, and a range of health care personnel directly involved in the care and treatment of patients with type II diabetes. The objectives of the forum were to discuss the state of diabetes treatment from the perspectives of MCOs and employers, to create a better understanding of the issues in treating diabetic patients, and to reach a consensus on the standards of care and the treatment guidelines for managed care patients with diabetes. Several needs were agreed on and identified by the attendees, including the need to develop minimum standards of care for the management of diabetes care, to improve patient and physician education programs and the communication between MCOs and employers, to acquire more sophisticated outcomes data, to pursue aggressive treatment of hyperglycemia, to increase emphasis on managing care to achieve long-term cost savings, and to stress greater patient responsibility for their own care.

Algorithms↗
PubMed1979

A model for communication skills development for family practice residents.

The purpose of this paper is twofold: (1) to demonstrate the need for including interpersonal communication skills training in family practice residency programs, and (2) to present a communication model that can be used for such training. Interpersonal communication skills are important in almost all areas of contact with patients: history taking, physical examination, prescription writing and patient education, counseling, and psychotherapy. Presentation of the communication model includes definition of the interpersonal communication skills that would be stressed in family practice residency programs. These skills include empathy, respect, warmth, concreteness, genuineness, self-disclosure, confrontation, immediacy, and behavior modification. Examples of how a family physician may communicate each of these skills are also included. The implementation of the communication model in a department of family practice for training residents and faculty in the use of these communication skills is also described.

Communication↗
PubMed2001

Web servlet-assisted, dial-in flow cytometry data analysis.

BACKGROUND: The obvious benefits of centralized data storage notwithstanding, the size of modern flow cytometry data files discourages their transmission over commonly used telephone modem connections. The proposed solution is to install at the central location a web servlet that can extract compact data arrays, of a form dependent on the requested display type, from the stored files and transmit them to a remote client computer program for display. METHODS: A client program and a web servlet, both written in the Java programming language, were designed to communicate over standard network connections. The client program creates familiar numerical and graphical display types and allows the creation of gates from combinations of user-defined regions. Data compression techniques further reduce transmission times for data arrays that are already much smaller than the data file itself. RESULTS: For typical data files, network transmission times were reduced more than 700-fold for extraction of one-dimensional (1-D) histograms, between 18 and 120-fold for 2-D histograms, and 6-fold for color-coded dot plots. Numerous display formats are possible without further access to the data file. CONCLUSIONS: This scheme enables telephone modem access to centrally stored data without restricting flexibility of display format or preventing comparisons with locally stored files.

Computer Communication Networks↗
PubMed2004

Evaluation of an assertiveness training program on nursing and medical students' assertiveness, self-esteem, and interpersonal communication satisfaction.

This study's objective was to evaluate the effect of an assertiveness training program on nursing and medical students' assertiveness, self-esteem, and interpersonal communication satisfaction. Using a longitudinal research design, 69 participants whose scores on the Assertive Scale were < or = 50% (i.e., low assertiveness) and who were willing to participate were included and assigned to an experimental group (33 subjects) or comparison group (36 participants; participants were matched with the experimental group by grade and sex). Participants in the experimental group received eight 2-h sessions of assertiveness training once a week. Data were collected before and after training and again one month after the end of the training using the Rotter's Internal versus External Control of Reinforcement Scale, Sex Role Inventory, Assertive Scale, Esteem Scale, and Interpersonal Communication Satisfaction Inventory. The generalized estimated equation (GEE) method was used for statistical analysis. The assertiveness and self-esteem of the experimental group were significantly improved in nursing and medical students after assertiveness training, although interpersonal communication satisfaction of the experimental group was not significantly improved after the training program.

Assertiveness↗
PubMed1984

Matrix organization increases physician, management cooperation.

Because of the development of multihospital systems and the establishment of diagnosis related groups, hospitals increasingly will establish matrix organizations for their corporate structures. St. Luke's Hospital adopted the matrix concept in the mid-1970s, utilizing program administrators for each specialty service or "clinical center of excellence." Such centers have been developed in digestive diseases, cardiovascular and pulmonary medicine, orthopedics and rheumatology, ophthalmology, and behavioral health. The program administrator's functions are diverse: To serve as primary liaison between physicians and the hospital; To project levels of program utilization and patient and physician satisfaction, to identify areas requiring administrative and marketing emphasis, and to develop the program's marketing plan; To develop, implement, and evaluate the program's strategic, operational, and financial plans; To recruit physicians to practice at St. Luke's and to cultivate referrals from outside physicians; To participate in selecting members of all board and medical staff committees relating to the particular specialty area; and To determine the need for new programs within the specialty area and to develop services. As indicated by a medical staff survey, most physicians at St. Luke's believe that the program administrator system has improved communication with the hospital administration, that the program administrator is able to respond effectively to physician requests and problems, and that the quality of patient care has been enhanced. A great majority said they would recommend the system to other hospitals.

Arizona↗
PubMedDate not supplied

[Reviewing structures and reorganizing our communication].

The development of training programs on system enterprise can be carried out individually or in group taking into consideration the importance of the balance between cost and benefits. Presently, people are exposed to different sorts of communication that convey multiple personal, interpersonal and group situations. For health professionals, communication is fundamental since they are constantly facing crisis situations. The article reports on the implementation of a sensitization program carried out with a group of nurses from a problematic unit, aiming at restoring their sense of self-worth in order to prepare them for team work. The program relies on two basic premises: changes are part of life and the importance of being aware of people's development. Communication is what makes possible the awareness of these changes. Such training is a continuous process and represents a challenge for health managers in search of better quality of health care.

Communication↗
PubMed1997

Estimates of reports of notifiable diseases by general practitioners in regional Western Australia.

We surveyed the attitudes of general practitioners to the notification of gazetted diseases in the south-west of Western Australia. Notification rates were calculated from the number of notifications recorded by the Southern Public Health Unit or the Communicable Disease Control Program of the State Health Department, and the estimated population of the region, the metropolitan area and the State. Of the 80% of general practitioners responding to the survey, 96% advised they intended to notify all gazetted diseases they diagnosed. Notification rates in the south-west of Western Australia ranged from 380 to 900 per 100,000 population, compared with approximately 450 per 100,000 population in the metropolitan area.

Attitude of Health Personnel↗