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PubMed1995

Development of a comprehensive clinical pharmacy workload documentation system.

The purpose of this project was to develop a workload documentation system which captures the clinical activities of the pharmacist, as well as the pharmacist's impact on the patient's drug therapy outcomes and costs. The documentation system consists of three sections: clinical activities, clinical effectiveness indicators, and cost-effectiveness indicators. In addition to those established by the National Hospital Productivity Improvement Program-Pharmacy Workload Measurement System, other indicators are incorporated to more accurately reflect the pharmacists' daily clinical activities. Clinical effectiveness indicators of patient outcomes include the number and type of drug-related problems identified and resolved and the number of therapeutic interventions made and accepted. Cost-effectiveness is measured by pharmacists' interventions on 14 focused areas of drug therapy. Compliance with daily documentation is facilitated by use of pocket-sized cards for data collection and retrieval. This documentation system has been implemented since December 1990. Quarterly reports submitted to the Director identify changes and trends in workload. Information is used for staff justification, impact assessment of clinical service provided, identification of needs for staff development and planning future clinical directions. In order to enhance the efficiency of documentation and data analysis, future plans include computerization and evaluation of the frequency of data collection.

Clinical Pharmacy Information Systems↗
PubMed1997

The nurse as coach in care of the dying.

Nurses' inability to articulate many aspects of their work leads to its invisibility, a problem compounded in home-based palliative care where the nurse's work is rarely seen by others. A staff development exercise was undertaken which aimed to assist specialist palliative care nurses to articulate their relationships with patients to members of the inter-disciplinary team. The process was specifically aimed at understanding patients' and families' refusals to receive psycho-social care from other team members. It explores, through four narrative vignettes, the tension between nursing and non-nursing roles when patients refuse non-nurse care. At the centre of this tension are the issues inherent in nursing roles which frequently sit at the boundaries of other health practitioners.

Adult↗
PubMed2001

[Evaluation of the public health service law of the Saxony-Anhalt region--community affairs, transfer of power and loss of control].

AIM: In the state of Saxony-Anhalt, a new Public Health Service law came into force in 1998. Our study investigated whether this new legislation has led to an extension of duties performed by regional health departments and to a subsequent increase in expenditure. METHODS: Guided interviews at all administrative levels of the public health system were conducted. The catalogue of duties was systematized and a questionnaire was developed and distributed to all regional health departments (response rate: 17 out of 24). Data concerning revenues and expenditures of the regional health departments were analysed on the basis of the administrative districts' budget data. RESULTS: Regional health departments stated that there had been practically no change in their activities over the last few years. When questioned about the coverage of 58 specific duties, a considerable disparity was evident between departments. A core group of "classical" duties comprising environmental health and hygiene, child health protection, individual health appraisal, and public health supervision are carried out on an established basis. Some duties were handled by external institutions, others, mostly community health duties, were not performed on an extensive scale. When asked about the desired model for their health department, most departments preferred the model of being an executor of sovereign duties, however a corporate model was deemed to be almost as acceptable. The following fields will gain increasing significance in the future: environmental medicine, health reporting, preventive medicine, co-ordination of regional health care, and health promotion. Since 1995, staff has been reduced in all regional health departments (-10.4%; 1999: 2.92 employees per 10,000 inhabitants). In 1999, expenditures amounted to an average of 24.64 German Marks per capita (range 14.20-44.58 DM). The number of inhabitants and the revenue of the regional districts were determinants of their health budgets. CONCLUSION: Our results showed that no uncompensated additional expenditure by regional authorities resulted from this law. So far, most districts have not perceived regional health as a community affair offering possible competitive advantages. The federal state lost considerable influence at the regional level. Recommended are regional health priorities, conjoint staff development, and state guidance by a head agency providing leadership and support, while leaving responsibility with the districts.

Budgets↗
PubMedDate not supplied

Inservice education: calculating the cost.

Cost effectiveness is the mandate in healthcare today. Nursing staff development especially has needed to rethink its methodologies because of the significant cost of programs. The Department of Nursing Education and Resources of Miami Valley Hospital in Dayton, Ohio adopted an "All-Day" concept in an effort to achieve maximum efficiency from its resources for inservice education. To comprehensively and accurately determine how efficient the all-day method was in terms of cost in comparison with the previous "unit-based" process, a detailed cost analysis was undertaken. Each method was studied for 1 year, and the comparison revealed the all-day method was more viable from a cost perspective, as well as more beneficial from the participants' perspective.

Cost-Benefit Analysis↗
PubMedDate not supplied

Role perception of the staff nurse in the intensive care unit.

A group of 201 ICU staff nurses were questioned regarding those activities they perceived as (1) most important, (2) most time-consuming, and (3) most professional. This information was collected to provide a data base for defining the role of the ICU staff nurse and evaluating the implications for nursing administration and staff development. The results indicated that the nurses are doing what they perceive to be important, but not what they perceive to be professional. There were differences in ranking relationships when the basic educational preparation of the nurse was considered as a variable. The results indicate that role perception was more a function of job requirements than a function of educational background. Comparing functional groupings of activities, the nurses ranked direct patient care activities high in time consumption and for importance when compared to nondirect patient care activities, but neither was ranked high for professionalism. This implies a disparity between perception of importance vs. professionalism.

Adult↗
PubMed1991

ALERT-India 1981-89: nine years' experience of leprosy control in the slums of Bombay.

Bombay has a population of about 8 million people, one-half of whom live in slums. In 1981, ALERT-India started its first leprosy control project in N, S and T Wards of Greater Bombay Municipal Corporation covering an area of 122 sq km in the north-eastern suburbs of Vidhyavihar, Ghatkopar, Vikhroli, Kanjurmarg, Bhandup and Mulund, with a total population of 1,100,000 according to the 1981 census. In the 9 years of operation, over 12,000 patients have been registered and treated and of these 7425 have been released from treatment, having satisfactorily completed courses of chemotherapy. However, over 1000 cases are still identified every year by house-to-house or school surveys, or by self-reporting, including a considerable percentage in children. The origin, development, staff structure, operational procedure, administration and recording system of ALERT-India are described in detail, with emphasis on what has been accomplished with purely outpatient facilities, using paramedical workers, all of whom have received inservice training from Government recognized training centres for their specific tasks. The account includes a brief description of an expansion of the organization's work into townships in New Bombay, where preliminary surveys in 1988 confirmed the presence of leprosy cases and the need for treatment facilities. The discussion addresses: 1, the better use of the large volume of statistical information which has been collected by ALERT-India during the past 9 years, with emphasis on its value in assessing the impact on the control programme and modifying future policy; 2, the need to radically examine the present policy of survey, versus an 'education campaign approach' with regard to increasing early case-detection and self-reporting; 3, the establishment of a central coordinating body for leprosy control in Bombay to exchange information, coordinate efforts and formulate a future plan of action, the latter in association with the National Leprosy Eradication Programme; and 4, the development of a health education resource centre in association with the Bombay Municipal Corporation.

Health Services↗
PubMed1998

Tutor intervention profile: reliability and validity.

An instrument has been developed to provide tutors with feedback about their performance in problem-based tutorial groups. This questionnaire consists of 33 statements reflecting the behaviour of the tutor in the tutorial group when students analyse the case and generate learning issues and the behaviour of the tutor when students report back to the tutorial group about their self-study. The statements are grouped on theoretical dimensions found in the literature about co-operative learning and problem-based learning. This study focuses on the validity and the reliability of this instrument. Confirmatory factor analysis showed that a four-factor model showed a weak fit, whereas each separate factor fitted the data reasonably well. The four factors are: (1) elaboration; (2) directing the learning process; (3) integration of knowledge and (4) stimulating interaction and individual accountability. These factors were strongly correlated with the overall judgement of the tutor at the end of the unit, so the concurrent validity of this instrument was high. Generalizability studies indicated that the rating scales provide reliable information with a sample size of student responses falling within the range of real tutorial group sizes. The results of this study show that the instrument for providing tutors with feedback is valid and reliable. This questionnaire can be used in staff development activities and also provides needs assessment for faculty development.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Physical restraint management of hospitalized adults and follow-up study.

During the winter of 1998 the management of 118 (N = 118) physically restrained adult patients in a 238-bed urban acute care hospital were assessed by 26 registered nurse (RN) data collectors. In the spring of 1999, following a comprehensive hospital-wide staff development program and revised physical restraint protocol, 10 RN data collectors conducted a follow-up study of 53 (N = 53) restrained adults in the same institution. In both studies, data regarding restraints management were gathered using a Restraint Management Improvement Indicator. Following a program of restraint management education, substantial improvements were found for virtually all of the physical restraint indices studied. The findings suggest that future educational efforts should be undertaken to further improve the documentation in hospital medical records regarding medical orders and ongoing observation, assessment, and interventions for physically restrained patients. Future research should further document and study interventions to reduce or eliminate the use of physical restraints.

Adult↗
PubMedDate not supplied

Nursing diagnosis anyone? Do staff nurses use nursing diagnosis effectively?

The use of nursing diagnosis by staff nurses in a 225-bed metropolitan hospital was examined. The sample consisted of 82 newly hired nurses who had participated in a mandated staff development program on nursing process theory and use of nursing diagnosis, with an emphasis on transfer of knowledge to practice. The data collected included demographic information, attitudes concerning nursing diagnosis, pretest and posttest scores, and percent completed on the audits of chart documentation. A cross-tabulation by clinical arena was performed on the forms used to document utilization of nursing diagnosis. Analysis of the data indicated that a greater proportion of the charts for the nurses in the maternal/child clinical arena evidenced use of nursing diagnosis as a component of practice. The nurses in the critical care arena scored slightly lower. The nurses in the medical/surgical arena had the lowest compliance of both completion and utilization of nursing diagnosis. This study demonstrated that nurses can be taught to use nursing diagnosis in the clinical setting.

Adult↗
PubMed2006

Work-related empowerment of the multidisciplinary team at the Rheumatism Foundation Hospital.

Carried out as part of a staff development project, this study describes the experiences of work-related empowerment within a multidisciplinary team at the Rheumatism Foundation Hospital in Finland. The data were collected using a structured questionnaire consisting of background variables and questions concerning verbal, behavioural and outcome empowerment. The questionnaire was sent to all members of the multidisciplinary team at the Rheumatism Foundation Hospital, with the exception of physicians, departmental secretaries and administrative personnel. The response rate was 58%. The data were examined using statistical methods. The multidisciplinary team felt quite strong verbal and behavioural empowerment, but was less confident in terms of outcome empowerment. Several factors were found to be associated with the different fields of empowerment. In conclusion, the multidisciplinary team felt quite strong work-related empowerment.

Adult↗
PubMed2004

Using a Nursing Minimum Data Set with older patients with dementia in an acute care setting.

BACKGROUND: Many older people with dementia are admitted to acute care settings suffering from comorbidities. These and their treatments can lead to confusion in these patients, adding to their existing cognitive deficits, and this may not be recognized by care staff. The care of such patients is complex and requires multidisciplinary team input. The purposes of the Nursing Minimum Data Set are to describe the nursing care of patients in a variety of settings and to establish comparability of nursing data across clinical populations, settings and time. AIMS: This paper reports a study to describe the characteristics of hospitalized older patients with dementia and nursing diagnoses and nursing interventions for these patients, and to identify trends in the nursing care provided over a 3-year period using a Nursing Minimum Data Set from a community hospital in the United States of America. METHODS: Secondary data analysis was conducted in 2000 on a large clinical discharge data set containing Nursing Minimum Data Set elements. The sample included 597 elders with dementia among a total of 7772 older patients who were discharged between 1996 and 1998. RESULTS: The most common comorbidity was hypertension (n = 123, 21%), followed by cardiac dysrhythmias (n = 80, 13%). The most frequent nursing diagnoses were altered health maintenance (n = 419, 84%), knowledge deficit (n = 357, 71%), potential for injury (n = 242, 48%), potential for infection (n = 230, 46%), pain (n = 184, 37%), impaired physical mobility (n = 169, 34%), and altered thought process (n = 144, 29%). The most frequent interventions were discharge planning (n = 340, 68%), surveillance safety (n = 195, 39%), fall prevention (n = 175, 35%), teaching: disease process (n = 166, 33%), learning facilitation (n = 148, 30%), and infection protection (n = 147, 29%). CONCLUSIONS: The results provide a description of nursing diagnoses and interventions for elders with dementia in an acute care setting using the Nursing Minimum Data Set framework. They identify the need to develop staff education programmes for individualized care of older patients with dementia. In addition, they support the need for continued work on linkage of the nursing care elements of the Nursing Minimum Data Set, including nursing diagnoses, nursing interventions, and nursing-sensitive outcomes.

Aged↗
PubMed2006

Organizational change in management of hepatitis C: evaluation of a CME program.

INTRODUCTION: Effective treatment regimens exist for the hepatitis C virus (HCV); however, clinicians are often resistant to evaluation or treatment of patients with alcohol or substance abuse problems. We describe a continuing medical education (CME) program for clinicians in a nationwide health care system, with emphasis on current treatment practices, multispecialty collaboration, and organizational change. METHODS: Quantitative measures were used to assess changes in knowledge and treatment confidence, and site-specific organizational changes were qualitatively evaluated. The CME program included a preassessment of current HCV knowledge and care; a 2-day preceptorship; and follow-up with coaching calls at 1, 3, and 6 months. Program attendees included 54 medical and mental health providers from 28 Veterans Affairs Medical Centers. RESULTS: Knowledge following the CME program increased significantly. In 93% of the sites, there were organizational changes such as HCV support group-initiated group education, in-service training, improvement in patient notification or scheduling processes, hiring of new clinical staff, development of a business plans, and discussions about changes with administration. Of all sites, 15 (54%) changed existing antiviral treatment protocols, 18 (64%) established collaborative relationships, and almost half (13/28) established regular use of depression and alcohol use screening tools. Major barriers to change included lack of administrative support or resources (or both) and difficulty collaborating with mental health colleagues. DISCUSSION: This multifaceted CME program with follow-up coaching calls significantly increased individual knowledge and confidence scores and resulted in improved clinic processes and structures. Organizational change was facilitated by the development of an action plan. The major change agent was a nurse; the primary deterrent was an administrator.

Clinical Competence↗
PubMedDate not supplied

Revitalizing a documentation system.

The nursing department of a 154-bed acute rehabilitation facility, cognizant of the changing trends in health care and responding to feedback from staff, developed and implemented a comprehensive documentation system. The previous system had been fragmented, inconsistent, and inefficient. The development of the new system focused on the complex needs of the rehabilitation client and the equally complex standards required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and insurance carriers. The final product, which was based on the nursing process and functional health patterns, encompassed the following areas from admission to discharge: providing feedback on clients' functional abilities and progress toward goals, satisfying requirements of the 1990 JCAHO standards, and, finally, using a flow sheet that saves nursing time and increases objectivity. This article describes the system from conceptualization to successful implementation.

Humans↗
PubMed1994

Vocational integration services in community mental health: professionals' perceptions of training needs.

Vocational integration in mental health is part of a national initiative to make quality, community-based work a possibility for persons with psychiatric disabilities. While effective delivery of these services requires trained staff, preparing professionals to provide relevant vocationally oriented services is complex and challenging. This study examines perceived priority training needs in vocational integration services from the perspectives of professionals in mental health, rehabilitation, and education organizations in Mississippi. Findings suggest that vocational integration activities are perceived differently across organizations and across occupational specialties. Implications for staff development in community support and psychosocial rehabilitation programs are discussed.

Community Mental Health Services↗
PubMed1995

American College of Physicians (ACP) medical informatics and telemedicine.

The American College of Physicians (ACP) is the largest speciality society in the United States with over 83,000 Internal Medicine physician members. ACP seeks to be the foremost comprehensive education and information resource for all internists in support of its mission "to enhance the quality and effectiveness of health care." Medical Informatics and telemedicine is an integral part of the American College of Physicians' strategy to achieve its goals. ACP Medical Informatics Subcommittee and staff develop ACP policies and programs to improve clinical care and medical education through the use of Information Systems and new technologies for managing and integrating medical information and knowledge. This paper describes present and planned ACP informatics and telemedicine programs and projects focussing particularly on strategies to meet physicians' information needs incident to their patient care activities.

Forecasting↗
PubMed2006

Physicians' perceptions of clinical teaching: a qualitative analysis in the context of change.

BACKGROUND: Change is ubiquitous. Current trends in both educational and clinical settings bring new challenges to clinicians and have the potential to threaten the quality of clinical teaching. OBJECTIVE: To investigate hospital specialists' perceptions of clinical teaching in the context of change. DESIGN: Qualitative study using in-depth semi-structured interviews. SETTING: Three hospital trusts in the United Kingdom associated with a new medical school. PARTICIPANTS: A purposive sample of 15 clinicians from each of the three participating hospitals was approached. A total of 13 participated in the in-depth interviews: three from hospital A, six from hospital B and four from hospital C. RESULTS: The two main themes of 'Characteristics of Good and Bad Teachers' and 'Clinical Teaching Approaches' emerged. These were underpinned by a number of sub-themes; including some seen by participants as potential barriers to teaching and learning, for example, organisational and personal issues. CONCLUSIONS: Potential barriers to teaching and learning, including why good clinical teachers may at times seen to be intimidating or to cause humiliation and problems of engaging with new educational practices, can be understood within the context of change resistance. Knowing more about how clinical teachers think about their task as educators is essential and this should underpin staff development and training programmes.

Education, Medical, Graduate↗
PubMedDate not supplied

Munchausen by proxy syndrome: the triad of abuse, self-abuse, and deception.

The Munchausen By Proxy Syndrome (MbPS) is a complicated phenomenon whereby a peculiar threefold relationship between perpetrator, victim, and medical staff develops. This triad is based on abuse of the child, deception of the doctor, and, in many cases, self-abuse or passivity of the victim towards the perpetrator's deeds. We have analyzed the interrelationship between the perpetrator, the victim, and the medical authority, in light of the mother's pathology.

Child↗