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PubMed2002

Career paths beyond nursing and the contribution of nursing experience and skills in attaining these positions.

This paper reports on an exploratory study undertaken in New South Wales, Australia which sought to identify the positions nurses go on to when they leave nursing and the skills and experience they gained from nursing which they believe enabled them to obtain employment outside the profession. In addition, the reasons why they left nursing were also ascertained. A network sampling technique was used to recruit 17 participants. A tape-recorded semi-structured interview of approximately 1h was conducted with each participant. Interviews were conducted until no new information emerged (14) and the remaining three interviews were used for validation. While many participants were employed in health-related fields, others were in diverse areas such as business, landscape coordination and market research, to name a few. All participants reported positively on the range of skills they had acquired as a nurse. Reasons provided for leaving the nursing workforce included reaching a ceiling in nursing or wishing to develop themselves in another direction. Respondents had also undertaken a wide range of additional qualifications.

Career Mobility↗
PubMed1998

Risk in cleaning: chemical and physical exposure.

Cleaning is a large enterprise involving a large fraction of the workforce worldwide. A broad spectrum of cleaning agents has been developed to facilitate dust and dirt removal, for disinfection and surface maintenance. The cleaning agents are used in large quantities throughout the world. Although a complex pattern of exposure to cleaning agents and resulting health problems, such as allergies and asthma, are reported among cleaners, only a few surveys of this type of product have been performed. This paper gives a broad introduction to cleaning agents and the impact of cleaning on cleaners, occupants of indoor environments, and the quality of cleaning. Cleaning agents are usually grouped into different product categories according to their technical functions and the purpose of their use (e.g. disinfectants and surface care products). The paper also indicates the adverse health and comfort effects associated with the use of these agents in connection with the cleaning process. The paper identifies disinfectants as the most hazardous group of cleaning agents. Cleaning agents contain evaporative and non-evaporative substances. The major toxicologically significant constituents of the former are volatile organic compounds (VOCs), defined as substances with boiling points in the range of 0 degree C to about 400 degrees C. Although laboratory emission testing has shown many VOCs with quite different time-concentration profiles, few field studies have been carried out measuring the exposure of cleaners. However, both field studies and emission testing indicate that the use of cleaning agents results in a temporal increase in the overall VOC level. This increase may occur during the cleaning process and thus it can enhance the probability of increased short-term exposure of the cleaners. However, the increased levels can also be present after the cleaning and result in an overall increased VOC level that can possibly affect the indoor air quality (IAQ) perceived by occupants. The variety and duration of the emissions depend inter alia on the use of fragrances and high boiling VOCs. Some building materials appear to increase their VOC emission through wet cleaning and thus may affect the IAQ. Particles and dirt contain a great variety of both volatile and non-volatile substances, including allergens. While the volatile fraction can consist of more than 200 different VOCs including formaldehyde, the non-volatile fraction can contain considerable amounts (> 0.5%) of fatty acid salts and tensides (e.g. linear alkyl benzene sulphonates). The level of these substances can be high immediately after the cleaning process, but few studies have been conducted concerning this problem. The substances partly originate from the use of cleaning agents. Both types are suspected to be airway irritants. Cleaning activities generate dust, mostly by resuspension, but other occupant activities may also resuspend dust over longer periods of time. Personal sampling of VOCs and airborne dust gives higher results than stationary sampling. International bodies have proposed air sampling strategies. A variety of field sampling techniques for VOC and surface particle sampling is listed.

Air Pollution, Indoor↗
PubMed2003

The educational needs of non-specialist breast care nurses.

AIMS: To provide an indicative occupational profile and identify the educational needs of non-specialist nurses working with breast cancer patients. DESIGN: A postal questionnaire survey, using a modified, but psychometrically validated, training needs analysis instrument. SETTING: The acute and community sectors of three large trusts. PARTICIPANTS: 119 general nurses working with breast cancer patients. FINDINGS: Significant educational needs were identified for all 30 items of the questionnaire, thereby indicating that participants had both general and cancer-specific training needs. However, 13 of the 14 cancer-related items were among the top 19 training needs, suggesting that these should be a priority focus for targeted educational programmes. No differences were found between acute and community nurses, although D grade (newly qualified) nurses had significantly greater educational needs than E grade nurses (with around 2 years' experience post-qualifying). The indicative occupational profile suggested that the most important tasks were perceived to be communication/team-work, self-management, awareness of special psycho-social problems, knowledge of specific clinical issues, and management of the care package; the least relevant tasks were seen to be specific health promotion activities, supervision, using technical equipment and research/audit. CONCLUSION: This sample of general nurses working with breast cancer patients reported both general and specific educational needs. The information yielded by the current survey could be used to inform continuing educational development for this group, and in this way, could inform the content and mode of delivery of its provision. Continuing professional development (CPD) courses which are based on empirical studies of workforce educational needs could rationalise resources and ultimately enhance patient care. The indicative occupational profile could be used as a competency indicator and might also inform CPD provision.

Analysis of Variance↗
PubMed2001

A lead cancer nurse role at Birmingham Children's Hospital National Health Service Trust.

This paper reports on an innovative scheme and course developed as part of a Lead Cancer Nurse role based at the Birmingham Children's Hospital NHS Trust, UK. In doing so issues are raised which may be helpful to others should they consider adopting a similar scheme and the possibilities of the scope of the role are highlighted.

Education, Nursing, Continuing↗
PubMed1999

Community participation in the recruitment and retention of rural doctors: methodological and logistical considerations.

Two Queensland rural communities with histories of poor general practitioner (GP) recruitment and retention participated in a process aimed at developing broadly based community action plans to recruit and retain GPs. Despite their very different physical and social characteristics, the two communities developed many similar objectives and strategies, which had the possibility of being implemented more widely. The community participation process can be both time- and cost-effective if consideration is given to a variety of methodological and logistical issues. The process is a means by which communities, Divisions of General Practice, government, academic institutions and others can work together to recruit and retain medical practitioners.

Community Participation↗
PubMed2005

Weight management in primary care: how can it be made more effective?

Obesity is often difficult to tackle in primary care. Pressure of time in the consultation, a lack of appropriately-trained primary care staff, a shortage of community dietitians or nutritionists, the potentially enormous caseload, language or cultural barriers and the sheer intractability of patients' eating habits, exercise behaviour and their clinical condition, all conspire to make general practitioners, other team members and often the patients themselves lose heart and stop even trying. However, there are ways of overcoming these difficulties. Examples of changes that evidence suggests are able to support and enhance basic one-to-one interventions in general practice include: improved clinical guidelines; better training of primary care staff; at-risk patient registers; smarter database search tools; new quality incentives; closer working with dietitians, counsellors and pharmacists; more hospital outreach clinics; designated general practitioner specialists and practice clustering; expanded exercise referral schemes and links with leisure providers; subsidised referral to commercial slimming groups; better use of patient groups and voluntary and community workers. The present paper describes a proposed 'triple-tier' pathway for weight management incorporating most of the elements mentioned earlier. With a more joined-up and creative approach to the development and organisation of primary care, more comprehensive training and workforce planning, and better integration with social care, voluntary groups and the commercial sector, weight management in general practice has the potential to be much more effective.

Combined Modality Therapy↗
PubMed1984

The effect of unemployment duration on national suicide rates: a time series analysis, 1948-1982.

The relationship between unemployment and suicide in the United States is examined. Data for the period 1948 to 1978, primarily from the U.S. Public Health Service, are used to examine the effect of the duration of unemployment on suicide. "The results of a Cochrane-Orcutt iterative regression analysis indicate that the greater the duration of unemployment the greater the suicide rate. Using ex post forecasting techniques it is estimated that increases in unemployment during the Reagan administration have been associated with at least 929 additional deaths from suicide."

Americas↗
PubMed1989

Life-cycle labor-force participation of married women: historical evidence and implications.

"The seven-fold increase, since 1920, in the labor force participation rate of married women [in the United States] was not accompanied by a substantial increase in average work experience among employed married women. Two data sets giving life-cycle labor-force histories for cohorts of women born from the 1880s to 1910s indicate considerable (unconditional) heterogeneity in labor-force participation. Employed married women had substantial attachment to their jobs; increased participation brought in women with little prior work experience. Average work experience among cross sections of employed married women increased from 9.1 to 10.5 years over the 1930-50 period. Implications for 'wage discrimination' are discussed."

Americas↗
PubMed2000

Integration of student-health physicians into U.S. medical schools and their affiliated teaching hospitals.

PURPOSE: To determine whether physicians in the student health services (SHSs) at U.S. medical schools and their affiliated teaching hospitals, referred to here as academic medical centers (AMCs), have unique opportunities for integration into AMCs that do not exist for physician-faculty at SHSs on purely academic campuses. METHOD: A survey of SHS offices at the 124 U.S. medical schools was conducted in the spring of 1999. The questionnaire asked about the reporting relationships of the SHS within the AMC, whether the student-health physicians had academic appointments within the AMC, and whether these physicians participated in the AMC's clinical services, administration, research, or teaching activities. RESULTS: There were 116 (94%) responses (not all responses were complete and eight were excluded because their campuses offered no formal SHS). Approximately half of the SHSs (52/107, 49%) reported to their AMCs. Student-health physicians with career-track appointments were more likely to be found at SHSs reporting to AMCs (35/58, 60%) than at SHSs reporting solely to a division of student affairs (20/58, 34%). Having a career-track appointment increased the likelihood of the student-health physicians' attending on the wards (34/59, 58%), seeing private patients in an AMC's faculty practice (40/59, 68%), participating in administrative activities for an AMC (50/56, 89%), and participating in research activities (36/57, 63%). CONCLUSIONS: Student health services that reported to their AMCs were more likely to have faculty with career-track appointments, and these appointments were more likely to result in the integration of student-health physicians into their AMC's clinical services, administration, and research activities. Career-track appointments, however, had no influence on whether teaching activities occurred within the SHS. Fully integrating student-health physicians into the AMC's activities enhances outcomes for both the SHS and its AMC.

Academic Medical Centers↗
PubMed2004

Facilitating faculty success: outcomes and cost benefit of the UCSD National Center of Leadership in Academic Medicine.

PROBLEM AND BACKGROUND: In 1998, the University of California San Diego (UCSD) was selected as one of four National Centers of Leadership in Academic Medicine (NCLAM) to develop a structured mentoring program for junior faculty. METHOD: Participants were surveyed at the beginning and end of the seven-month program, and one-four years after. The institution provided financial information. Four primary outcomes associated with participation in NCLAM were assessed: whether participants stayed at UCSD, whether they stayed in academic medicine, improved confidence in skills, and cost-effectiveness. RESULTS: Among 67 participants, 85% remained at UCSD and 93% in academic medicine. Their confidence in skills needed for academic success improved: 53% personal leadership, 19% research, 33% teaching, and 76% administration. Given improved retention rates, savings in recruitment was greater than cost of the program. CONCLUSIONS: Structured mentoring can be a cost-effective way to improve skills needed for academic success and retention in academic medicine.

Academic Medical Centers↗
PubMed2004

Educating the next generation of pediatricians in urban health care: the Anne E. Dyson Community Pediatrics Training Initiative.

To improve the health of children who are exposed to urban health risks, there has been a national recognition of the need for better models of training pediatricians. In 2000, in response to this need, the Dyson Foundation launched a new residents-training model that focuses on community health and advocacy, The Anne E. Dyson Community Pediatrics Training Initiative (the Initiative). The Initiative is made up of 12 programs at ten sites, which are working in their communities to improve the health of the children. At its core are five objectives: to equip residents with tools and knowledge to provide community-based health care, to make use of community resources so that residents learn to practice as medical home providers, to engage residents in the communities in which they work, to develop meaningful partnerships between departments of pediatrics and their communities, and to enhance pediatrics training through interdisciplinary collaborations among schools and departments. Curricular approaches at the participating sites differ slightly, but all have explicitly incorporated teaching community pediatrics into their standard rotations and continuity clinics. The authors showcase the programs of the Initiative and explore how the programs have sought buy-in from their parent institutions, faculty, residents, and communities.

Academic Medical Centers↗
PubMed1996

Information and surveillance systems and community health: building the public health information infrastructure.

The scope and purpose of public health injury and disease surveillance systems will expand in response to the increasing information needs of communities and health organizations. Public health leaders must focus on the entire information infrastructure. Surveillance and information systems need to evolve to include targeting and evaluating community-wide prevention programs. Standards governing exchange as well as data content will become central to these new systems and the emerging health information infrastructure. Future surveillance systems will face challenges in forming partnerships with managed care organizations, in developing new information tools, and in training the public health workforce.

Humans↗