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As more hospitals implement bedside computer technology, staff development educators will be called on to develop complex training programs. This article describes a successful bedside computer training plan that includes use of a contract, pretraining activities, training methods, and training environment.
There is a growing concern over the quality of medical education for undergraduates in India. This paper is an attempt to define a need-based curriculum and outline the initiatives taken by the Medical Council of India (M.C.I.) in developing a need-based curriculum. The steps include: clear delineation of goals and objectives of education; adoption of innovative teaching and learning methodology, adjustments in the course structure, updating of course content, rationalizing assessment strategy, and emphasis on structured and skill oriented internship. For effective implementation of these measures, strategies such as establishment of Medical Education Unites (MEUs), visible funding of education, more recognition to teaching and impetus to staff development activities have been suggested.
Children and their caregivers are prime candidates for intervention to curb the rising incidence of skin cancer in the United States. Preschools provide a unique opportunity to influence the sun protection practices of parents and teachers on behalf of young children. Sun Protection is Fun!, a comprehensive skin cancer prevention program developed by The University of Texas M. D. Anderson Cancer Center in collaboration with The University of Texas-Houston Health Science Center School of Public Health, was introduced to preschools in the greater Houston area. The program's intervention methods are grounded in Social Cognitive Theory and emphasize symbolic modeling, vicarious learning, enactive mastery experiences, and persuasion. Program components include a curriculum and teacher's guide, videos, newsletters, handbooks, staff development, group meetings designed to encourage schoolwide changes to support the program, and sunscreen. The intervention map, including objectives for program development, implementation, and evaluation, is discussed.
Care-related work within continuing care settings is often perceived as being of low status and requiring little skill. In reality, however, creating a positive long-term care environment requires imagination and creativity. Education and training are a key element in any effort to improve the quality of care in nursing homes and similar settings, yet recent evidence suggests that opportunities for continuing education and training for staff in such environments are limited. This article considers the context of continuing education for nurses and care assistants employed in nursing homes, and uses a pilot evaluation of an educational package aimed at reducing the incidence of pressure sores as a case example to raise important issues. The difficulties in providing sufficient opportunities for education are highlighted and the need to embed any educational programme within a well-developed staff support structure is stressed.
This paper raises the question, "Is it the structure or the competency of the nursing staff that improves the quality of primary nursing over team nursing?" In the study an all-RN model of primary nursing was compared to a team nursing care system. The nursing competency scores of registered nurses on the two units were equalized through six months of continuing education and staff development programs, and the nursing competencies and the quality of patient care were measured by Slater and Qualpac scores, respectively. Although the primary nursing unit scored higher than the team unit on five out of six subscales, the scores were statistically significant (p = .06) only on one, the communications subscale. Results of this study were compared to Felton's study, which found primary nursing units had a more competent nursing staff and higher Qualpac scores. The comparison suggests that nursing competencies may be a stronger contributing factor to the quality of care than is the structure of primary nursing.
Center for State Sanitary Epidemiological Surveillance in the Samara region developed, tried, and introduced a system of administrative, legal, and economic decisions aimed at reduction of the effects of unfavorable environmental factors on population health. The main directions of the system is reorganization of the structure and administration of sociohygienic monitoring, norm-setting approach, organization of work in accordance with the state order, introduction of a system for evaluating the activities of the Center in cities and regions, optimization of staff, development and introduction of minimum social standards of activity, and realization of goal-oriented complex programs providing sanitary and epidemiological well-being.
OBJECTIVE: To determine the source of an international outbreak of shigellosis associated with consumption of food served by a Minnesota-based airline. DESIGN: Cohort studies of players and staff of a Minnesota-based professional football team and passengers on flights with a confirmed case of outbreak-associated Shigella sonnei infection. SETTING: Community- and industry-based studies conducted from October through November 1988. PARTICIPANTS: Sixty-five football team players and staff, and 725 airline passengers in the cohort studies. RESULTS: Twenty-one (32%) of 65 football players and staff developed shigellosis that was associated with consumption of cold sandwiches prepared at the airline flight kitchen (relative risk [RR], 17.1; 95% confidence interval [Cl], 2.4 to 120; P < .001). Confirmed or probable shigellosis was identified among 240 passengers on 219 flights to 24 states, the District of Columbia, and four countries between September 14 and October 13. An outbreak-associated strain of S sonnei was isolated from football players and staff, airline passengers, and flight attendants. Thirty (4.1%) of 725 passengers on 13 flights with confirmed cases had confirmed or probable shigellosis. Illness was associated with consumption of cold food items served on the flights and prepared by hand at the airline flight kitchen (RR, 5.7; 95% Cl, 1.4 to 23.5; P < .01). CONCLUSIONS: This international outbreak of shigellosis was identified only because of the occurrence of an index outbreak involving a professional football team. Prevention of Shigella transmission in mass catering establishments may require reduction of hand contact in the preparation of cold food items or elimination of these items from menus.
PURPOSE: School physical education (PE) is highly recommended as a means of promoting physical activity, and randomized studies of health-related PE interventions in middle schools have not been reported. We developed, implemented, and assessed an intervention to increase physical activity during middle-school PE classes. METHODS: Twenty-four middle schools (approximately 25,000 students, 45% nonwhite) in Southern California participated in a randomized trial. Schools were assigned to intervention (N = 12) or control (N = 12) conditions, and school was the unit of analysis. A major component of the intervention was a 2-yr PE program, which consisted of curricular materials, staff development, and on-site follow-up. Control schools continued usual programs. Student activity and lesson context were observed in 1849 PE lessons using a validated instrument during baseline and intervention years 1 and 2. RESULTS: The intervention significantly (P = 0.02) improved student moderate to vigorous physical activity (MVPA) in PE, by approximately 3 min per lesson. Effects were cumulative; by year 2 intervention schools increased MVPA by 18%. Effect sizes were greater for boys (d = 0.98; large) than girls (d = 0.68; medium). CONCLUSIONS: A standardized program increased MVPA in middle schools without requiring an increase in frequency or duration of PE lessons. Program components were well received by teachers and have the potential for generalization to other schools. Additional strategies may be needed for girls.
Standards and an assessment process were developed to evaluate the quality of traumatic brain injury services in New South Wales, Australia, by The Australian Council on Healthcare Standards. The set of standards developed addressed the provision of rehabilitation services, the management of human and physical resources, education, research and quality assurance. An educational peer review model was used to conduct on-site assessments of the 14 public sector Brain Injury Rehabilitation Program Services. Data collected on the level of compliance with the standards showed a high rate of conformity, particularly in the areas of patient management, the provision of outpatient and community services, and staff development. Feedback from the participating services indicated that the assessment process was regarded as a useful tool for identifying problems and improving services. The standards and assessment process were shown to be an effective tool for evaluating the quality of services provided, and repeat assessments will enable the ongoing development of services to be monitored.
The purpose of this project was to identify nurses' beliefs about medication incident reporting. A new medication incident form was developed and trialled in six clinical units. Forty-three nurses from these areas were recruited to participate in the project, with a 20-point self-reporting questionnaire and focus group discussions being used to collect the data. Theme analysis of the data was undertaken with the results of the project indicating nurses report medication incidents that are life threatening to patients, but do not want identifying information collected about themselves. This situation represents nurses' fear of reprimand from those in authority and may also indicate an unwillingness to accept responsibility for errors in which they may be merely the final player in a complex series of events. The results of the project also highlight problems associated with self-reported medication incident monitoring and challenge its effectiveness in gathering data required by managers and staff development educators.
Staff development educators struggle to prepare today's entry-level RN for effective decision making in a new healthcare climate that demands both skill and expertise with patients with high acuity levels. The clinical decision making simulator is an innovative approach to teaching and learning decision-making skills. The authors discuss the development and use of a computer simulation that provides repeated opportunities for clinical decision making for the newly licensed nurse without jeopardizing patient safety.
A multimethod needs assessment generated both qualitative and quantitative data about continuing professional education needs and interests of Pennsylvania clinical dietitians. The study also evaluated three different needs assessment procedures. First, data were obtained from 22 clinical dietitians invited to participate in focus group interviews. The dietitians suggested continuing education topics representing four aspects of practice: clinical, procedural, professional development, and management skills. With the data obtained, two needs assessment instruments subsequently were prepared and distributed at a statewide conference. Fourteen percent of 650 attending dietitians volunteered to participate in the needs assessment process. Forty-four completed a survey using an electronic preference recording device, and 50 completed printed questionnaires. Although not directly comparable, responses to both questionnaire formats generally confirmed suggestions obtained from focus groups. Topics such as computer applications, patient education, staff development, and time management led the wide variety of choices selected. Respondents favored live, affordable, conveniently located programs delivered effectively by experts using a participatory format. Of the three assessment procedures used, focus group interviews provided the most detailed information for planning continuing education. Surveys based on focus group results are useful for contributing quantitative data. We conclude that a comprehensive plan for dietitians' professional development through continuing professional education should include structured needs assessments. The assessments are necessary to determine the diverse and changing concerns, needs, and preferences of dietitians and the organizations employing them.
Is your staff well prepared for interviewing job applicants? The potential for legal action and the cost incurred when turnover is high area two reasons administrators should help staff develop effective interviewing skills. The author proposes using the structured interview, which is more valid and reliable than other interview methods. The guidelines for conducting effective interviews will be useful to beginning managers and can serve as a refresher for experienced administrators.
BACKGROUND: On March 11, 2003, a World Health Organization (WHO) physician was admitted to Bamrasnaradura Institute, after alerting the world to the dangers of severe acute respiratory syndrome (SARS) in Vietnam and developing a fever himself. Specimens from the first day of his admission were among the first to demonstrate the novel coronavirus, by culture, reverse transcription-polymerase chain reaction (RT-PCR), and rising of specific antibody, but proper protective measures remained unknown. The authors instituted airborne, droplet and contact precautions from the time of admission, and reviewed the efficacy of these measures. MATERIAL AND METHOD: A specific unit was set up to care for the physician, beginning by roping off an isolated room and using a window fan to create negative pressure, and later by constructing a glass-walled antechamber, designated changing and decontamination areas, and adding high-efficiency particulate air (HEPA) filters. The use of personal protective equipment (PPE) was consistently enforced by nurse managers for all the staff and visitors, including a minimum of N95 respirators, goggles or face shields, double gowns, double gloves, full head and shoe covering, and full Powered Air Purifying Respirator (PAPR) for intubation. To assess the adherence to PPE and the possibility of transmission to exposed staff a structured questionnaire was administered and serum samples tested for SARS coronavirus by enzyme-linked immunosorbent assay (ELISA). Exposure was defined as presence on the SARS ward or contact with laboratory specimens, and close contact was presence in the patient's room. RESULTS: The WHO physician died from respiratory failure on day 19. 112 of 129 exposed staff completed questionnaires, and the 70 who entered the patient's room reported a mean of 42 minutes of exposure (range 6 minutes-23.5 hours). 100% reported consistent handwashing after exposure, 95% consistently used a fit-tested N95 or greater respirator, and 80% were fully compliant with strict institutional PPE protocol. No staff developed an illness consistent with SARS. Serum samples from 35 close contacts obtained after day 28 had a negative result for SARS coronavirus antibody. CONCLUSIONS: Hospitalization of one of the earliest SARS patients with documented coronavirus shedding provided multiple opportunities for spread to the hospital staff, but strict enforcement of conservative infection control recommendations throughout the hospitalization was associated with no transmission.
Diabetes knowledge among hospital nurses is suboptimal. Studies that measured basic diabetes knowledge among nurses in a variety of clinical settings have consistently reported poor understanding of hemoglobin A1C, medication usage and side effects, and self-care diabetes management. Although diabetes is a common diagnosis among hospitalized patients, many nurses report they have never attended an update on diabetes management. To promote advances in glycemic control within the hospital setting, the nursing staff must be better educated in the theoretical framework and clinical practice guidelines for diabetes management. The methods used to promote continuing education in diabetes among staff nurses need to be cost-effective as well as flexible to accommodate work shifts and learning needs. Because many hospitals are facing staff shortages and increased patient acuity, staff development needs may not be a high priority. To be successful, updating diabetes knowledge must be a collaborative effort involving clinical care, research, and education. Mentoring and peer support also are useful methods for improving glycemia in the hospital setting.
The authors' purpose in this study was to (1) compare the effects of three teaching methods on registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies, and (2) to compare registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies using a pretest/posttest design. Registered nurses (n = 129) and licensed practical nurses (n = 21) employed by two hospitals constituted the study sample. Subjects were assigned alternately to three intervention groups: videotape (n = 50); instructional booklet (n = 50); and lecture (n = 50). A 38-item test, including true-false, multiple choice, matching items and dosage calculation problems, was administered to subjects in each group before and after the teaching intervention. On the basis of the results, there was no statistically significant difference in total knowledge scores for the three intervention groups (F = 2.07, P = 0.130). Staff development instructors should consider the advantages of a videotape and instructional booklet over the time-intensive lecture strategy.
This article describes the process of reorganizing an existing Nursing Policy and Procedure Manual. The process of restructuring the Nursing Policy and Procedure Committee and clarifying its priorities is also described. This discussion has significance for staff development educators because this type of project is often entrusted to them and few detailed guidelines exist for completing this task.
The present study illustrates the efforts by a community mental health service to restructure the Mental Health Rehabilitation Program to meet more adequately the needs of the Arabic-speaking population. It was discovered that the principles of mental health rehabilitation theory are inherently Anglo-Australian and not suitable for the Arabic-speaking population. Action research methodology was used as a tool to drive the changes necessary to implement effective mental health rehabilitation across cultures. Two new culturally relevant programs were developed, staff attitudes to rehabilitation were changed and assertive strategies were introduced to alter clients' attitudes and perceptions about mental health rehabilitation.