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PubMed1984

The long-term effects of human sexuality training programs for public school teachers.

The current study evaluated long-term effects of a training model in human sexuality on public school teachers' knowledge and attitudes. The data indicated that, although significant changes were found from the pretest to posttest assessment of knowledge and attitudes on two standardized measures, attitudinal changes for teachers could not be maintained over time. In addition, knowledge decreased with most drastic changes occurring in the educator who, while trained, did not teach the material in a classroom setting. The results of this model staff development program suggest factors that may alter sex education training effects for professionals who work in public school settings.

Adult↗
PubMed2001

Successful implementation of community water fluoridation via the community diagnosis process.

OBJECTIVES: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. METHODS: Public health dental staff developed a survey instrument to collect community-specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities. RESULTS: Community-specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings to county health councils resulted in fluoridation being a high-priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents. CONCLUSIONS: The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community-specific assessments of children's oral health; (2) identification of communities with disparate oral health needs, problems, and resources; and (3) effective presentation of community-specific oral health survey data to community leaders, stakeholders, and decision makers.

Attitude to Health↗
PubMedDate not supplied

Transferring management technology: healthcare quality improvement education in central and eastern Europe.

The newly independent nations of the former Soviet Union continue to restructure and refine their political and economic environments. Competition for scarce of dwindling economic resources within these nations and between the nations of an expanding global community necessitates that they adopt more efficient and effective management methods to provide essential public services. As a result, organizational management concepts developed and used in the West (i.e., in the United States and the countries of the European Union) are eagerly sought for incorporation into new administrative systems. This is an opportune time for healthcare service management educators to develop and present total quality management (TQM) programs, stressing continuous quality improvement (CQI) methods specifically targeted and adapted to the organizational needs of these countries, as they restructure their societies from centrally planned to market-driven economies. In general, educators in healthcare service management, acting as information consultants, can play a pivotal role in guiding strategies for healthcare organizational change and in helping to stabilize transitional organizational processes, by providing guidelines that can improve utilization of healthcare resources and monitoring of healthcare service outcomes. Most of the observations and recommendations presented in this article are derived from the author's experiences in conducting healthcare management improvement projects in Bulgaria in 1993 and in Lithuania since 1991.

Commonwealth of Independent States↗
PubMedDate not supplied

Beth Lanham on Six Sigma in healthcare. Interview by Luc R. Pelletier.

Beth Lanham, BSN RN, is a Six Sigma Coordinator in the department of quality management, staff development and safety, at Froedtert Hospital in Milwaukee, WI. Ms. Lanham received her bachelor's degree from Otterbein College in Westerville, OH and has an extensive clinical and management background in critical care nursing. In April 2000, Ms. Lanham completed the Six Sigma Black Belt training program through the American Society for Quality. She is currently working as a Six Sigma Black Belt and is actively involved with numerous committees and projects aimed at reducing medical errors and enhancing patient safety. Ms. Lanham has presented Six Sigma initiatives at the International Quality Congress sponsored by the American Society for Quality, the University Healthcare Consortium National Conference, the International Quality and Productivity Center National Conference on Six Sigma for Healthcare Providers, and the American Hospital Association Patient Safety Leadership Fellowship Retreat. Six Sigma projects at Froedtert Hospital are aimed at reducing errors associated with patient controlled analgesia pumps, continuous intravenous infusions, narcotic sedation in postoperative patients, insulin therapy, and handling of laboratory specimens. Six Sigma has also been applied toward reducing falls on a rehabilitation unit.

Diffusion of Innovation↗
PubMed2006

Teaching and assessing medical ethics: where are we now?

OBJECTIVES: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning. DESIGN: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives. PARTICIPANTS: The lead for teaching and learning at each medical school was invited to complete a questionnaire. RESULTS: Completed responses were received from 22/28 schools (79%). Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development. CONCLUSIONS: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally.

Curriculum↗
PubMed1981

Shifting from external to internal provision of mental health services in a health maintenance organization.

A health maintenance organization whose mental health services had been supplied under contract by two successive external providers changed in 1978 to in-house provision of most services for both HMO and fee-for-service patients. The changeover necessitated a greatly enlarged staff, development of a treatment philosophy and utilization review procedures, and establishment of good cmmunications with external providers who supplied inpatient services. One objective of the change to in-house services was to further reduce hospital admissions and hospitalization costs; comparisons of admissions and costs over a five-year period before and after the change indicated substantial reductions in both areas.

Fees and Charges↗
PubMed1981

Continuity of mental health care to youth in the juvenile justice network.

A sizable number of youth at risk for psychiatric disabilities enter the juvenile justice system each year without sufficient screening mechanisms or treatment systems. In 1977 the children and youth division of a mental health center began a program of evaluation, treatment, and consultation for juveniles in the subsystem of probation, secure and nonsecure detention centers, urban group homes, and other postadjudication residential facilities. One of the major benefits--a central and coordinated response to youth identified as having significant emotional problems--stems from the opportunities opened up through the continuing care offered to this population. The agencies involved have been more accepting of the patient-centered method of service involvement than of program or staff development consultation.

Adolescent↗
PubMed1994

Guidelines for handling domestic violence cases in community mental health centers. Kentucky Department for Mental Health and Mental Retardation Services.

Community mental health centers are becoming increasingly involved in the delivery of services to victims and perpetrators of domestic violence. To help centers plan a domestic violence program and address the risk of liability in treating clients who may be dangerous, the authors suggest principles to guide clinical decisions, standards for service delivery, and standards for staff development. Domestic violence is clearly defined as criminal behavior. In treatment, cessation of violence takes priority over family reunification and resolution of issues between victim and perpetrator. Decisions about accepting a perpetrator in treatment should be made by the treatment provider, even if treatment is mandated by the court. Suggestions for reducing the burden of domestic violence cases on individual clinicians include using treatment teams, establishing guidelines for maximum caseloads, and encouraging mixed caseloads. CMHCs have an important role in a comprehensive approach to domestic violence that includes a wide array of services and careful coordination among agencies that provide them.

Adult↗
PubMedDate not supplied

Renovating and refurbishing the field experience structures for novice teachers.

Teacher education at both the preservice and the inservice level has been criticized for not adequately preparing teachers for the demands and challenges in the classrooms of today, or for the future. This article describes a federally funded project awarded through the Office of Special Education Programs. The intended outcome was to improve the knowledge and application of professional skills and competencies for both preservice teachers (student teachers) and inservice teachers (supervising master teachers) through continuous, focused staff development, reflection, discussion, and coaching. The project focused attention on three related issues: (a) the role and training of the supervising and/or master teacher, (b) better partnerships between teacher preparation programs and the public schools, and (c) the effects of school structure on teachers' continued professional growth. This article describes the program planning, goals, activities, components, and impact of this personnel preparation project.

Cooperative Behavior↗
PubMed2006

An exploration of nursing home organizational processes.

The purpose of this study is to explore the relationship between nursing home staffs' perceptions of organizational processes (communication, teamwork, and leadership) with characteristics (turnover, tenure, and educational preparation) of the nursing home administrator (NHA) and director of nursing (DON). NHAs and DONs rate communication, teamwork, and leadership significantly higher than direct care staff do (registered nurses, licensed practical nurses, certified nurse aides [CNAs]). CNAs have the lowest ratings of communication and teamwork. Turnover of the NHA and DON is significantly and negatively associated with communication and teamwork. Two thirds of DONs surveyed hold less than a baccalaureate degree; this does not influence staffs' ratings of communication, teamwork, and leadership. Findings from this study highlight the need to explore differences in perceptions between administrative and direct care staff and how these may or may not influence staff development and quality improvement activities in nursing homes.

Administrative Personnel↗
PubMed1993

Application of the FOCUS-PDCA model to home care equipment management.

Issuing durable medical equipment to patients for use at home is a costly and complex process. Selection, delivery, setup, and maintenance of home care equipment and the education of patients in its use are currently included in Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) accreditation surveys for those health care organizations that issue equipment. In this Department of Veterans Affairs teaching hospital, the process was complicated by eligibility regulations and frequently rotating housestaff. We organized a team who studied the process and identified opportunities for improvement in three areas: the selection of equipment items ordered, management of equipment-related data, and standardization of equipment delivery contracts. We produced a reference manual for staff, developed a simple database, and incorporated JCAHO home care equipment management standards into equipment delivery vendor contracts. The results of the team's efforts were an increase in efficiency, a decrease in discharge delays, and improved continuity of care. We chose to use the FOCUS-PDCA model to illustrate our approach to improving these processes.

Durable Medical Equipment↗
PubMed1997

Clinical reasoning strategies used during care planning.

This descriptive study provides insight into home health nurses' thinking processes as they planned care for chronically ill clients. The author interviewed five experienced home health nurses to elicit think-aloud data about 10 different chronically ill clients, obtaining 20 interviews. The researcher used verbal protocol analysis, a content analysis interpretive strategy, to unravel the concepts and label the cognitive processes used in the thinking task of planning nursing care. The following cognitive strategies were discovered: hypothesizing, cue logic, framing, reflexive comparison, prototype case reasoning, and testing. Findings support the importance of content, clinical context, and experience whenever reasoning to plan care. Findings did not support problem-solving models of thinking such as the nursing process. The findings for this study are applicable to staff development and education programs. Theoretical models of clinical reasoning need to be further developed and tested.

Clinical Competence↗
PubMed2003

Maintenance of effects of the CATCH physical education program: results from the CATCH-ON study.

Long-term maintenance effects of physical education (PE) curriculum and staff development programs have not been studied. The authors assessed the sustainability of the Child and Adolescent Trial for Cardiovascular Health (CATCH) PE intervention using direct observations of 1,904 PE lessons in former intervention and control schools in four U.S. states 5-years postintervention. Student physical activity levels, lesson contexts, and level of CATCH PE training of teachers were analyzed. Student energy expenditure levels and proportion of PE time in moderate-to-vigorous physical activity in intervention schools were maintained 5 years later, but vigorous activity declined sharply. Meanwhile, postintervention gains in former control schools, influenced by delayed program implementation and secular trends, resulted in a convergence of activity levels in intervention and control schools. Use of CATCH PE curricula was associated with increased levels of teacher training and school support for PE in both former intervention and control schools.

Child↗
PubMed1988

Exemplary school health education: a new charge from HOT districts.

School health education is generally regarded as instructional programs for students. Such programs have limited impact, especially when the social environment is inconsistent with instructional messages. A study of Oregon school districts reveals that some school personnel have gone beyond curricula in their school education programs. Exemplary districts addressed noninstructional issues, most notably staff development programs and food service offerings. In doing so, they have changed not only the social context of the schools, but their ability to directly influence a greater number of Health Objectives for the Nation.

Attitude to Health↗
PubMed1999

Hospital transformation and organisational learning.

Kwong Wah Hospital was founded by the charity organisation Tung Wah Group of Hospitals some 88 years ago, with management transfer to the Hong Kong Hospital Authority in 1991. Capitalizing both from the traditional caring culture of its founder, as well as opportunities in the new management environment, the hospital has scored remarkable successes in service quality, community partnership, organisational effectiveness, and staff development. Underpinning these transformations were Structure, Process, People, and Culture strategies. The learning imperative is heavily mandated or the success of each of these strands of development. Indeed, the embodiment of a learning organisation culture provides the impetus in sustaining the change momentum, towards achieving the Vision of becoming a 'Most Preferred Hospital' in Hong Kong.

Hong Kong↗
PubMedDate not supplied

Memories in the making: outcome-based evaluation of an art program for individuals with dementing illnesses.

The author presents the results of a pilot project, an outcomes-based evaluation of Memories in the Making: An art program for individuals with dementing illnesses. Sponsored by the Greater Cincinnati Chapter of the Alzheimer's Association and implemented at adult day and nursing home sites, participants in the weekly art program use paints to express themselves by creating colorful visual images on paper or fabric. The individuals experienced pleasurable, sustained activity while engaged in making art. Utilizing M.P. Lawton's conceptualization of psychological well-being as a framework, chapter staff developed an observational instrument, which measured objective and subjective indicators of the affect state and self-esteem of 41 participants in the art program. Overall, preliminary data suggests that participation in the weekly sessions contributed to the individuals' sense of well-being. However, more rigorous study is warranted using comparison groups to determine if indeed an enhanced sense of well-being can be attributed with certainty to the intervention of the Memories in the Making art program.

Adaptation, Psychological↗
PubMed2006

Adoption and sustainability of decision support for patients facing health decisions: an implementation case study in nursing.

BACKGROUND: Effective interventions prepare patients for making values-sensitive health decisions by helping them become informed and clarifying their values for each of the options. However, patient decision support interventions have not been widely implemented and little is known about effective models for delivering them to patients. The purpose of this study was to describe call centre nurses' adoption of a decision support protocol into practice following exposure to an implementation intervention and to identify factors influencing sustainable nursing practice changes. METHODS: Exploratory case study at a Canadian province-wide call centre guided by the Ottawa Model of Research Use. Data sources included a survey of nurses who participated in an implementation intervention (n = 31), 2 focus groups with nurses, interviews with 4 administrators, and a document review. RESULTS: Twenty-five of 31 nurses responded to the survey measuring adoption of decision support in practice. Of the 25 nurses, 11 had used the decision support protocol in their practice within one month of the intervention. Twenty-two of the 25 intended to use it within the next three months. Although some nurses found it challenging to begin using the protocol, most nurses reported that it: a) helped them recognize callers needing decision support; b) changed their approach to handling these calls; and c) was a positive enhancement to their practice. Strategies identified to promote sustainability of practice changes included integration of the decision support protocol in the call centre database, streamlining the patient decision aids for easier use via telephone, clarifying the administrative direction for the call centre's program, creating a call length guideline specific for these calls, incorporating decision support training in the staff development plan, and informing the public of this enhanced service. CONCLUSION: Although most nurses adopted the decision support protocol for coaching callers facing values-sensitive decisions, to sustain practice changes, interventions are required to manage barriers in the practice environment and integrate decision support into the organization's policies, resources, and routine activities.

Journal Article↗
PubMed2006

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

BACKGROUND AND OBJECTIVES: Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS: The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS: This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION: Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

Journal Article↗