Developing successful preceptor programs.
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This study shows a program about nonverbal communication and is the continuation of a study of the failures in the perception of nonverbal communication in nurses who assist patients in nursing consultation. This study is one of the first to discuss the theme and describes the theoretical frameworks that legitimate its existence: LUFT & INGHAM (1961); BIRDWHISTELL (1970); HALL (1986); STEINBERG (1988); SILVA (1989) and GAGNE (1980).
PURPOSE/OBJECTIVES: To review published research on barriers to cancer treatment to provide a foundation for subsequent research and program and policy development directed at diminishing these barriers. DATA SOURCES: Relevant literature from medical and behavioral science data bases published between 1964 and 1994. Researchers reviewed 752 abstracts; they identified 160 articles that related directly to research on barriers to cancer treatment. Of these 160 articles, researchers chose 61 for a subsequent review using criteria to evaluate the strength of the study design and sampling procedures. DATA SYNTHESIS: The major barriers consistently documented to influence whether or not patients with cancer sought or continued treatment included communication problems between patients and providers, lack of information on side effects, cost of treatment, difficulties in obtaining and maintaining insurance coverage, and absence of social support networks. Access barriers generally were greater for older women, members of minority groups, and patients of lower socioeconomic status. The vast majority of the studies were conceptual or descriptive in nature and were based on nonprobability clinic-based samples. CONCLUSIONS: The limitations of existing research point to the need for studies on barriers to cancer treatment based on analytic population-based study designs that examine the relative importance of factors derived from multivariate explanatory models. This information may be used to develop programs and policies to ameliorate treatment barriers for patients with cancer. IMPLICATIONS FOR NURSING PRACTICE: The research priorities set forth by the Oncology Nursing Society also indicate a need for this type of research because quality of life, cost containment, and outcomes assessment all are directly or indirectly affected by the timely diagnosis of cancer. Treatment barriers have the potential to significantly affect an individual's ability to seek care and ultimately to increase the cost of care associated with adverse outcomes that may result from delays in seeking treatment.
With clear and accurate peritoneal dialysis departmental policies, procedures, and patient care standards, the creation of an orientation module with objective and measurable patient care and staff performance outcomes is easily produced. This article describes revision of policies, procedures, and patient care standards, and an approach for building linkages with the employee orientation program. No formal classroom time is required, and the level of orientee experience is accommodated. All peritoneal dialysis staff members are capable of equal preceptor participation.
BACKGROUND: Although several studies have outlined the need for and benefits of diversity in academia, the number of underrepresented minority (URM) faculty in academic health centers remains low, and minority faculty are primarily concentrated at the rank of assistant professor. In order to increase the diversity of the faculty of the University of California, San Diego (UCSD) School of Medicine, the UCSD National Center for Leadership in Academic Medicine, in collaboration with the UCSD Hispanic Center of Excellence, implemented a junior faculty development program designed in part to overcome the differential disadvantage of minority faculty and to increase the academic success rate of all faculty. METHODS: Junior faculty received counseling in career and research objectives; assistance with academic file preparation, introduction to the institutional culture; workshops on pedagogy and grant writing; and instrumental, proactive mentoring by senior faculty. RESULTS: After implementation of the program, the retention rate of URM junior faculty in the school of medicine increased from 58% to 80% and retention in academic medicine increased from 75% to 90%. CONCLUSION: A junior faculty development program that integrates professional skill development and focused academic career advising with instrumental mentoring is associated with an increase in the retention of URM faculty in a school of medicine.
Problems affecting the quality of medical education and health services in Latin America include variable standards of medical education, geographic maldistribution of physicians, a shortage of nurses and allied health workers, overtraining of physicians in high technology, government control of health and education systems, and economic problems. The Panamerican Federation of Associations of Medical Schools (PAFAMS) was founded for the purpose of addressing such problems in Latin American medical education. PAFAMS has promoted the exchange of ideas and experience among its member associations and schools by establishing a data base of information on medical education and developing mechanisms to disseminate such information. Other PAFAMS initiatives include a program to integrate professional health education and health care services within individual communities, and the linkage of medical education programs with health care institutions as a means of improving the quality of health care. A crucial next step in Latin America is the development of a leadership program to identify and nurture leaders in individual countries who will be instrumental in developing community-based health services by means of medical education oriented to such purpose. Thus, the key issue is to develop healthcare-oriented medical education.
This paper describes the importance of epidemiologic surveillance as a systematic, ongoing and population-based system for early warning and program development in the 21st century. Such a system routinely collects data on three classes of indicators (health outcomes, risk factors and intervention strategies) to set up both an early warning system (to identify associations and make predictions on health outcomes) and a program development system (to assess the need for intervention strategies, to plan and implement such strategies and to assess their effectiveness). A comprehensive surveillance system must be systematic (evidence-based selection of indicators, not hypothesis-driven), ongoing (continuous data collection, including repeated surveys) and population-based (whole population, or representative samples of the population). Such a system need not be developed from scratch, but can be based on linkage of existing databases and collection of additional information for identified data gaps. The initial steps for selecting indicators and creating a prototype framework for a comprehensive surveillance system are proposed to stimulate further discussion. It is suggested that surveillance systems should be more widely used in public health.
OBJECTIVE: To ensure safe care of mothers and babies after birth, irrespective of length of hospital stay, and to ensure effective links between hospital and community postnatal services. METHODS: Program aimed toward consumers and professionals working with them in Ottawa-Carleton (750,000 persons.) All pregnant women in the community included. Program developed by professionals, institutions and community agencies. Information on current practices elsewhere and early discharge literature studied. New provincial survey on practice changes performed in Ontario. Emergency room utilization data analyzed. Discharge and post-discharge criteria, and a common prenatal education curriculum, developed. RESULTS: Multidisciplinary, multi-sectoral committees, institutions and agencies have developed programs for appropriate discharge practice and improved postnatal follow-up. Professionals have supported flexible discharge guidelines. CONCLUSIONS: Provided discharge criteria and follow-up are available, flexible discharge timing and safety appear compatible. The Ottawa-Carleton process to develop criteria and programs has allowed a collaborative, consensus-based approach to 'early' newborn discharge.
The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.
The development of a cardiac research program in the current health care setting can bring many challenges. The myriad of changing regulations involving research with vulnerable populations combined with the need to protect patient confidentiality is an issue that must be addressed in the initial stages of development. Also, the lack of an experienced workforce can often make the search for research staffing difficult at best. In 2001, Children's Healthcare of Atlanta initiated a cardiac research program. Over the last year, many obstacles have been overcome, and this experience has led to the appreciation of the challenges ahead.
A U.S. medical educator noted that the needs of developing countries are not necessarily addressed by traditional methods of medical education in the United States, involving high-technology education, technology transfer, development of academic personnel, and the like. In many developing nations, where there may be a surplus of doctors and many unemployed doctors, there is also a vast population of underserved people. Many of the physicians may have been trained inappropriately, or they were not comfortable in certain environments. In order to have an impact on the vast population, that kind of anachronism must be addressed. He inquired whether there is a role for the United States in addressing the health of communities rather than the sickness of individuals. It was observed that the health needs of developing countries are often thought to relate to the issues of hygiene, sanitation, and prevention and that these needs are homogeneous. The needs for interventional technology and preventive primary care should be differentiated, and the requirements at both levels of assistance should be heeded, be it at a primary and preventive level or at the level of specialist-oriented technological intervention. There was discussion about the dichotomy that exists between schools of public health in the United States and the medical schools with which they are associated. They were referred to as "two separate cultures." Thus, some suggested that U.S. physicians involved in curative medicine need to be exposed to community-based medicine in other countries, and many questioned whether other countries should seek to model their systems after those in the United States.(ABSTRACT TRUNCATED AT 250 WORDS)
Within the sample of 1783 children from the prospective study "Schwangerschaftsverlauf und Kindesentwicklung" (Course of pregnancy and development of children) followed-up until the age of 6 years the mothers of 182 suffered from late gestosis (10.2%). The values of the systolic blood pressure and of the protein concentration in the urine of the mothers measured at their last examination before onset of labour were crucial for the diagnosis of gestosis. According to this definition 95 mothers with systolic pressure greater than or equal to 150 mm Hg were classified as hypertensive (group of the hypertension children) and 87 mothers with both systolic pressure greater than or equal to 150 mm Hg and proteinuria greater than 1 g/l as being preeclamptic (group of the preeclamptic children). The control groups contained the same number of children (matched pairs). There were no significant differences in the findings between the different groups. Apparently, the prognosis of the child's development is favourable provided that the gestosis does not last long and does not lead to placental insufficiency.
Nurse educators, searching for the best use of technology to facilitate the development and administration of tests, are confronted with a wide variety of computerized test development programs from which to choose. This article provides a comparative review of seven commercially available computerized test development programs: A+ Test Manager and Test Taker, AUTOGENT, CATSoftware System, LXR*TEST, MicroCAT, Question Designer for Windows, and Test Construction Set. Criteria for evaluating these programs including ease of use, psychometric properties, security, and system requirements are discussed. Issues associated with the implementation of computerized test development and computerized test administration are considered. It is imperative that nurse educators understand their goals for computerized test development and administration in the context of their own setting before purchasing a program.
Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different "community" scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of "target" beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.
OBJECTIVE: To explore the impact of young maternal age, coresidency with infant's grandmother, and other familial and environmental factors on development of low-birth-weight (LBW) infants. DESIGN: Prospective cohort analyses. SETTING: Eight medical institutions in different geographical locations participating in the Infant Health and Development Program. PARTICIPANTS: Control population of 272 LBW, preterm infants enrolled in the Infant Health and Development Program born to mothers aged 15 to 24 years. MAIN OUTCOME MEASURE: Child cognitive, behavioral, and health outcomes at 36 months' gestation-corrected age. RESULTS: Maternal age was not significantly related to child development. Coresidence with infant's grandmother was associated with improved cognitive and health outcomes. Maternal ethnicity, maternal verbal ability, and other environmental factors were also associated with child outcomes. CONCLUSIONS: Findings of this study support the need for programs that include the extended family of at-risk infants, providing education and literacy skills to the mothers and encouraging participation of all care givers of the child.
In 1982, the Veterans Administration established Health Services Research field programs in each of the six VA regions. Herein, we describe the historical origins, organization, responsibilities, activities, and early accomplishments of one of these programs--the Northwest Regional HSR&D field program. Special reference is made to this program's commitment to health services research relevant to geriatrics and gerontology, including the development of a system-wide agenda for research, information syntheses in geriatrics-relevant health services research topics, and the conduct of funded projects pertinent to care of the elderly. The importance of a medical center location for the field programs is discussed, and early indications of institutional impact are described.
Sixty percent of the U.S. population drinks alcohol. Although numerous investigators have shown that low-volume alcohol intake has positive influences on cardiovascular health, bone density, and cognition, there is a fine line between positive, neutral, and negative ramifications of alcohol consumption on health. Alcohol accounts for 7% of the global burden of disease and injury from all causes and for 10% to 11% of all illnesses and death each year worldwide. So alcohol use is a two-edged sword. Psychiatric nurses have a long history of involvement with alcoholic patients, and alcohol users, misusers, and abusers comprise a significant percentage of the patient load in every specialty and subspecialty of nursing. Yet nursing education has neglected this important area of content in general nursing curricula, staff development has not trained mainstream nurses to routinely assess for alcohol problems among hospital patients, and primary care providers have failed to do case finding. During the past 25 years, the federal government has funded curricular and faculty development programs to bring alcohol information into the core of health provider training. The process has been halting and minimally successful at best. One ramification of the inattention to alcohol-related education is the dearth of nurse-scientists engaged in programs of research in the field of alcohol abuse. A federally funded faculty development program in the 1990s focused attention on this issue, and a small cadre of nurses were trained to do related research. Several of the authors in this volume are members of that group. A brief overview of the focus of each of the remaining chapters in this volume is presented. A rationale is provided for the importance of this area of research for nursing knowledge and quality patient care in essentially all areas of nursing practice. Finally, several burning research questions are posed that would most appropriately be answered through nursing research.