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At least 973 records · Page 54Linked to original sources
PubMed1999

Implementation of clinical guidelines for female urinary incontinence: a comparative analysis of organizational structures and service delivery.

The aim of the study was to explore and compare the development of continence services in two contrasting trusts. The first was a community trust which had initiated a top-down purchaser-led continence service. The second was a combined acute and community trust which had introduced a bottom-up, organic continence service based on staff development. The research used a qualitative, interpretative design. Evidence-based guidelines for female urinary incontinence (FUI) were analysed and key organizational features elicited. These were used to frame and analyse 20 semi-structured interviews with a range of community-based professionals who provided a service to women suffering from urinary incontinence. The interviews identified practitioner knowledge and awareness of the evidence pertaining to the management and treatment of FUI and also the features of the organizational structure of service provision in their locality which facilitated or constrained the implementation of evidence-based treatment in this area. The findings suggest that evidence-based guidelines were more closely adhered to in practice, in the trust using organic approaches to service development. Top-down, purchaser led approaches were more prescriptive and circumscribed the scope of professional practice. This adversely affected access to services for women suffering from urinary incontinence. Organic approaches to service development produce more flexible, responsive services. It is difficult, however, to integrate this approach with strategic planning as the flexibility required maybe incompatible with managerial responsibilities for defining roles and organizational functions.

Journal Article↗
PubMed2000

An Investigation of the Properties of Computer-Based Case Simulations.

Computer-based case simulations (CCS) require several development iterations, each involving a sizeable investment of time from physician volunteers and test development staff. Hence, a case that fails to demonstrate good measurement properties when administered to examinees at the pretest stage represents a costly loss. An earlier study investigated the relationship of case properties to case difficulty in part to obtain information that would permit (a) better instructions to case developers and (b) identification of problematic cases earlier in the developmental cycle. Some of the best predictors, however, were scoring points typically obtained at the pretest stage, making them inappropriate for meeting these two goals. The objective of this study was to determine if these scoring points could be predicted from cases properties that would be available early in case development. Case description variables and scoring points were available for 28 cases which were analyzed using regression procedures. Three models were identified that predicted the important scoring fairly well. These models differed primarily in the area of medicine: internal medicine, obstetrics/gynecology, or no medical area specified. The results were consistent with those found for predicting difficulty and appeared promising for better understanding of the nature of the simulations.

Journal Article↗
PubMedDate not supplied

Playing games with cardiopulmonary resuscitation.

The authors describe the process used to incorporate gaming into a level "A" cardiopulmonary resuscitation course. Needs assessment, planning, implementation, and evaluation phases are presented. Staff development instructors can use gaming, an interactive means of instruction, to teach a level "A" cardiopulmonary resuscitation (Heartsaver) course.

Cardiopulmonary Resuscitation↗
PubMed2005

Nurses' concerns about using information systems: analysis of comments on a computerized nursing care plan system in Taiwan.

AIMS AND OBJECTIVES: The purpose of this study was to pursue a deeper understanding of nurses' perceptions of a computerized nursing care plan as written in comments on a survey. BACKGROUND: Studies have examined nurses' perceptions of computer use, but comments written on surveys of computerized nursing care planning have never been reported and the pattern and meaning of such feedback have not been systematically analysed. DESIGN: Of 738 nurses in Taiwan who completed a two-part survey to evaluate a computerized nursing care plan, 202 responded on part II to an open-ended question about overall perceptions of a nursing information system. METHODS: A sample of 10 questionnaires with comments was subjected to qualitative content analysis. Key words and phrases were identified, then grouped into categories, which were used to code the remaining respondents' comments. Another 20 were used to pilot test these coding categories. The final coding categories were applied to all 202 questionnaires with comments for data analysis. RESULTS: Nurses were concerned about inconvenient access to computers; reduced work efficiency; inability to individualize patient care and nursing specialty deficiencies; poor content design, system function, and system integration; using the system as a policy requirement; and privacy and legal issues. CONCLUSIONS: Hardware availability, content design and user training/education programmes are critical issues that affect nurses' use of computers in their daily practice. RELEVANCE TO CLINICAL PRACTICE: These comments can be applied in strategic planning and staff development programmes to further use of information systems in patient care.

Adult↗
PubMedDate not supplied

Tissue viability: the facts and the law.

Accountability remains an integral part of nursing, irrespective of occupational status or setting. The leaflet reminds nurses involved in direct care, as well as those in advisory, educational or promotional roles, of the need to consider and fulfil professional obligations towards a vulnerable and expectant public. The need to select resources that will support, not replace, skilled nursing is crucial. As nurses expand their practice they may face greater risk of litigation, but the boundaries should be clarified through job descriptions, employer approved policy statements and UKCC standards. Being asked to account for actions or omissions of care may be perceived as daunting. However, complaints may help drive quality improvement as well as staff development. A sense of perspective is needed to prevent defensive practice, allowing the potential of autonomous and accountable professionals being realised in the delivery of tissue viability services.

Humans↗
PubMedDate not supplied

Development and implementation of a skin care program.

The incidence of nosocomial pressure ulcers for the identified high-risk patient care areas totaled 21% of the 152 patients in the first skin audit. The incidence of nosocomial pressure ulcers for the second audit of 156 patients was 12%. The second skin audit was accomplished six months after the implementation of a skin care program that included assessment forms, general and unit based education of nursing staff, development and implementation of Standards of Care for Skin Care, and provision of skin care products on the nursing unit. The population characteristics of the total sample indicated a fairly even male-to-female ratio and the average age was 60 to 69 years for both audit populations. The mode for the first audit was age 70 to 79 and for the second was 60 to 69. Most of the sample experienced neurological and musculoskeletal problems that adversely affected the patients mobility. One-fourth of the first sample and 1/2 of the second audit sample were bedridden. One-fifth of both samples experienced incontinence and almost 1/3 of both samples used incontinence devices (Foleys and collectors).

Academic Medical Centers↗
PubMedDate not supplied

Writing for publication.

Clinically based nurses have many relevant and informative experiences to share. It is often difficult, however, to find effective ways to support staff in writing about these ideas. To achieve this support, a "Writing for Publication Seminar Series" is more effective than 1-day workshops. More staff development departments are being challenged to demonstrate positive outcomes. A Writing for Publication Seminar Series is an approach that works.

Curriculum↗
PubMedDate not supplied

Effectiveness of medication calculation enhancement methods with nurses.

Medication calculation errors occur in all settings and can cause serious disruption in treatment protocols. This experimental study used a pretest-posttest, control group design. Sixty-seven RNs from three healthcare agencies completed all phases of the study. All nurses completed a 20-item medication calculation test, used both as the pretest and the posttest, and completed a short questionnaire that contained demographic and attitudinal items. After taking the pretest, nurses were assigned randomly to one of three experimental groups or a control group. Intervention times for the experimental groups totaled 3 hours, followed by a posttest 4 to 5 months after the pretest. Scores on the pretest ranged from 25% to 100% (mean = 75.5%, standard deviation = 15.13) and from 30% to 100% on the posttest (mean = 80%, standard deviation = 14.72). Scores improved for all groups except the self-study workbook group. No significant difference was found between the experimental groups or the control group for posttest medication calculation test scores. The classroom intervention was most costly, and the workbook intervention was least costly. The nurses identified the workbook intervention as the most satisfying method and computer-assisted instruction (CAI) as least satisfying. A strong positive correlation existed between the nurses' self-assessment of comfort and skill levels with medication calculation test scores. Questions necessitating multiple calculations and those necessitating a conversion not provided were the most difficult to answer correctly. Staff development educators need to address their role in improving the effectiveness of medication calculation.

Clinical Competence↗
PubMed1994

The evolution of undergraduate medical informatics programmes.

This article summarizes developments in the teaching of medical informatics to undergraduate health care professionals. Whilst clinical schools are adopting quite different approaches to informatics education and training, there seem to be a number of common factors shaping educational policies and the resultant programmes. Different professional schools face similar problems in relation to resources and staff development. At the same time, examination of different syllabuses suggests the existence of divergent models as to what medical informatics should encompass, as well as different views as to what elements of the domain should be included in preliminary or undergraduate courses. The relevance of these trends to health libraries is briefly considered.

Attitude to Computers↗
PubMedDate not supplied

Learning difficulties: staff support needs in residential services.

The past 20 years have witnessed a movement away from hospital-based care and accommodation for people with learning difficulties towards dispersed housing in the community. This affects not only the users of such services but also the staff employed to work with them. Because of this, it is important to closely monitor whether the need for staff support and staff development is being met appropriately. This article discusses the results of a survey carried out by Mansfield and Ashfield Community Mental Handicap Team to evaluate such service provision by interviewing the managers of residential services. It was found that the areas of largest perceived shortfall between need and provision were meetings between staff from different residential units and training in the skills of counselling, keyworking and liaising with the relatives of service users. The implications of the survey for service planning and future research are discussed.

Adult↗
PubMedDate not supplied

Professional nursing roles. The reintegration of patient teaching.

This article stresses the critical nature of the education function of the nurse and suggests strategies for reintegrating teaching as a professional role. It is important that administrators value teaching and that staff development departments assist nurses in refining teaching skills.

Humans↗
PubMedDate not supplied

Use of learning contracts in a RN-to-BSN leadership course.

Educating RN-to-BSN students can be challenging and rewarding. The diversity of these students can make designing courses quite difficult. In addition, the RN with experience in nursing practice may resent being put in the traditional role of student. Nominal group process and use of learning contracts in a leadership course in one RN completion program are described as two means of meeting the unique learning preferences of working, adult learners. Houle (1984) identified the learning contract as one means of assisting the adult learner seeking continuing professional education. Accordingly, examples of use of these two strategies in continuing nursing education and staff development are described.

Attitude of Health Personnel↗
PubMed1989

Easing transitions in care delivery with a core training group.

A collaborative approach was used by the nursing staff of a state psychiatric hospital to make a transition from traditional nursing services to a self-care model on one ward. The core training group, including representatives from all levels of nursing staff, developed and evaluated a personal hygiene protocol for 30 patients with chronic mental illness. Underwood's adaptation of Orem's self-care model of nursing was modified to provide the framework for this protocol. Evaluation of the project demonstrated both improved personal hygiene for the patients and greater job satisfaction for the nursing staff. The collaborative core training group approach was effective in facilitating the transition to the self-care nursing model.

Hospital Bed Capacity, 300 to 499↗
PubMed1987

The implementation of nursing diagnoses. The Iowa Veterans Home experience.

This article has reviewed the process of implementing nursing diagnoses in one long-term care agency. Nursing diagnoses improved nursing process skills, made problem identification more accurate, and aided the identification of nursing interventions and desired outcomes. Nursing diagnoses have become the organizing framework for quality assurance, staff development, specialization and consultation, and computer applications. The presence of a professional model of nursing practice facilitated the use of nursing diagnoses. Prior to implementing nursing diagnoses, IVH nurses had defined the scope of nursing practice and formed a committee structure for decision-making by all RNs. The structure included mechanisms for collective and individual accountability. All nurses participated in the decision to use nursing diagnoses in their practice. Each nurse had the opportunity to influence the process of change. The process of implementing nursing diagnoses at IVH continues. Nurses recognize the need to establish the validity of each diagnostic statement. Skill with the diagnostic process is expected to improve. Nurses also recognize the need to test interventions for specific diagnoses. The standard nomenclature will continue to be used for the improvement of nursing practice and for nursing department programming. The use of nursing diagnoses is the basis of the continued development of a professional model of nursing practice.

Adult↗
PubMedDate not supplied

Critical care nursing orientation: a comparison of teaching methods.

In summary we have shown in this small group of 32 nurses that the PIM approach is as effective a method for critical care orientation as traditional classroom teaching. The savings in instructors' and orientees' time via PIMs result in dollar savings; but more importantly, the PIM was found by our orientees to be more satisfying. PIMs encouraged flexibility and individualized attention, and by self-pacing allowed several nurses to begin practice in the critical care setting earlier than usual. In light of the high cost of orientation, one finding that warrants further exploration is the orientee's uncertainty of remaining in critical care nursing. It is possible that as the orientee becomes socialized into the critical care setting, her values, attitudes, and commitment to remain may change over time. Future follow-up will help us to examine changing attitudes as these nurses become acclimated to the critical care setting. Head nurses and staff development instructors play a major role in preventing frustration and turnover and in creating a positive climate for growth.

Costs and Cost Analysis↗
PubMedDate not supplied

A patient-centered approach to nurse orientation.

An orientation pathway was developed using a patient-centered approach. The pathway provides a guide or "road map" for the preceptor and new nurse to care for high-volume patient populations in medical and surgical units. Benefits include application of the nursing process, promotion of critical thinking skills, reduction of reality shock, and improvement in job satisfaction and retention. This article describes the rationale behind the approach and its application to nurse orientation. Steps in the process are described. Staff development educators can use the steps to develop orientation pathways for other practice settings.

Critical Pathways↗
PubMed1990

Waterborne Campylobacter jejuni epidemic in a Finnish hospital for rheumatic diseases.

A waterborne Campylobacter jejuni outbreak in the Rheumatism Foundation Hospital in Heinola, Finland, in November-December 1986 is described. 32 patients and 62 members of the staff developed gastrointestinal symptoms. C. jejuni heat-stable serotype 45 was isolated from the faeces of 32 enteritis patients and from none of the controls. No other enteropathogens were found. Positive serological responses to C. jejuni acid extract antigen were detected by enzyme immunoassay in 34% of the symptomatic hospital patients, in 40% of the symptomatic staff members, and in 10% of the controls. The clinical course of the illness was mostly mild and self-limited. No striking progress in the arthritis symptoms of the patients was found after the outbreak. The hospital has its own water supply. C. jejuni of the same serotype as the epidemic strain was isolated from the water of the pipeline system. After a careful examination some aged components of the waterworks were found to be responsible for leaks that resulted in the contamination of the water.

Adult↗
PubMed1996

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents.

Given the serious consequences of HIV infection, other STDs, and pregnancy among teens, professionals must develop and evaluate new approaches to reduce risks associated with adolescent sexual behavior. The Safer Choices intervention is a comprehensive, theoretically based program designed to reduce risk behaviors and increase protective behaviors to prevent HIV, other STDs, and pregnancy among high school adolescents. The program includes five components: a School Health Promotion Council involving administrators, school staff, students, parents, and community members; curriculum and staff development activities; school environment activities designed and implemented by a team of peer educators; parent education activities; and school-community linkage activities. The School Health Promotion Council is responsible for planning and overseeing program implementation. This article describes the theoretical framework, process for intervention development, and key intervention strategies used in Safer Choices.

Adolescent↗