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Benchmarking medical absence: measuring the impact of occupational health nursing.

Occupational health nurses are in a unique position to influence medical absence costs through their focus on health promotion and restoration. Corporate management looks to occupational health nurses to maximize employee productivity and reduce costs through lowered disability claims, fewer on-the-job injuries, and improved absentee rates. Benchmarking provides the occupational health nurse with the diagnostic tools to measure and manage productivity, demonstrate results, and justify the resources needed to accomplish desired outcomes. Benchmarking assists the occupational health nurse in all standards of practice outlined by the AAOHN: Assessment, diagnosis, outcome identification, planning, implementation, evaluation, resource management, professional development, collaboration, research, and ethics.

Benchmarking↗

Professional development through preceptorship.

Preceptor programs provide new staff with planned, individualized orientation while easing the transition into a new work environment. In this article, the evolution and evaluation of preceptorships at a large academic medical center are described. The development of a conceptual framework and the orientation process model provided a means to organize the various components of orientation and to design individualized developmental plans for new employees. Based on data collected from preceptors, unit staff members, and new nurses, the impact of preceptor programs on staff satisfaction and the professional development of nurses is examined.

Education, Nursing, Continuing↗

The professional renewal program: aiding nurses in career change.

A professional renewal program gives nurses the opportunity to reflect on their current work situation and imagine the opportunities for change and growth in the nursing profession. Nurses return to work refreshed and re-energized, directly affecting their working environment. This article gives specific strategies for developing a professional renewal program.

Career Mobility↗

Recommendations for establishing a drug and toxicology information center in a developing country.

The purpose of this work was to formulate guidelines to help health professionals in establishing or strengthening the capabilities of drug and toxicology information centers and related facilities in developing countries. These guidelines are based on the experience of an established drug and toxicology information service in Zimbabwe which has been operating for more than ten years and on information obtained from other centers in developed countries. The guidelines provide advice rather than a unique model and should therefore be adapted rather than adopted. We conclude that national drug policies should include provision for establishing drug information centers. The World Health Organization and similar organizations should assist in establishing these centers. We believe that a drug and toxicology information center is more beneficial to the community when it is part of the teaching curriculum and continuing education for health professionals. Therefore, the center should be located in a medical teaching institution.

Developing Countries↗

Development of a clinical physical therapy research program.

Clinical physical therapy research is important for the continued growth of the physical therapy profession. Such research results in improved patient care and heightens the professional standing of the physical therapy field. One of the major barriers to clinical physical therapy research is unfamiliarity with the research process by practicing physical therapists. The purpose of this article is to present a model for developing a clinical physical therapy research program that may assist novice investigators interested in initiating clinical physical therapy research at their facility.

Models, Theoretical↗

[Infection control systems in the United States: its history and problems].

The purpose of this study is to review recent literature regarding the role of the infection control nurse in the United States. Recent relevant literature, published between 1982 and 1995, was selected by using a computerized literature search, cumulative index to nursing and allied health literature (CINAHL). Four major points in the development of infection control practitioners (ICPs) were identified from the literature review: (1) Since the late 1960s the number of ICPs had increased continuously, through the Center for Disease control training programs, and through training programs developed by members of the Association for Professionals in Infection Control and Epidemiology (APIC) at the national, regional and local chapter levels. (2) The ICPs became certified upon receiving satisfactory results on the infection of 2 years of work in the field of infection control, and then are authorized to use the title "CIC". The certification was valid for five years and is renewed after the ICP passed a re-examination. (3) Six duties of the ICP were identified: management, prevention, surveillance, identification, education, and research. (4) The cost of health care was constantly restructuring the health care delivery system in the United States. The ICPs also were influenced by these changes. New challenges facing ICPs today were, a) the integration of resources to be shared by infection control and quality assurance, b) the change of role from specialist to generalist, c) the expansion of their roles in the area of epidemiology.

Certification↗

A qualitative study of GPs' views of treating obesity.

BACKGROUND: Due to the increased prevalence of obesity GPs now have a key role in managing obese patients. AIM: To explore GPs' views about treating patients with obesity. SETTING: An inner London primary care trust. DESIGN OF STUDY: A qualitative study using semi-structured interviews. METHOD: Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis. RESULTS: GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight. CONCLUSION: GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.

Adult↗

Dutch obstetric care: home or hospital, midwife or gynaecologist?

The Dutch obstetric system is traditionally characterized by extensive primary health services, supported by more specialized care. Midwives and GPs are responsible for normal deliveries, obstetricians for the deliveries considered high risk. Home deliveries are fairly common. Over the last decade this relatively positive approach to reproduction has threatened to give place to methods that seem to oppose the goals of health promotion. The percentage of home deliveries has declined from 57% in 1970 to 35% in 1985. The distinction between normal and pathological pregnancies and deliveries has become more blurred. A growing number of women with a normal pregnancy are giving birth in hospital. In sparsely populated regions, primary health care is inadequate, but this explains only part of this development. As far as parents-to-be have a choice, little is known about their considerations and about the role of different professional groups in how they choose. Between the various medical professions, competition arises about the division of tasks and about the hierarchical relation to one another. The role of obstetricians has become more important, GPs are losing ground, while midwives retain their share in practising obstetric care. Rivalry between different professional groups has been stimulated by the decline in the birth rate and the increase in the number of professionals. The increased number of pregnant women whose pregnancy and delivery is defined as 'pathological' reflects the continuing process of medicalization. Different developments may explain this process: the increase in hospital births, progress in medical science, the older age of women having their first baby.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

Exploring educational needs of multiple sclerosis care providers: Results of a care-provider survey.

Our objective was to survey experienced multiple sclerosis (MS) care providers, determine their ongoing professional educational needs, and develop future education programs. We asked providers across a variety of disciplines to identify the areas in which clinical consultation and continuing medical education (CME) would most improve their ability to provide care to individuals with MS; their preferred education modalities; and their confidence in providing care related to disease-modifying agents (DMAs), fatigue, depression, spasticity, and bladder management. At a national meeting of MS professionals, 152 MS care providers completed a self-report survey that was designed for this cross-sectional cohort study. Areas of greatest interest for clinical consultation and CME were identical and included cognition, fatigue, DMA use, spasticity, pain, sex, diagnosis of MS, and depression. Participants expressed a preference for live and interactive CME modalities. Confidence in providing specific disease-related care sometimes differed between Veterans Health Administration (VHA) and non-VHA providers. The results indicate that clinical consultations and CME should be targeted to the topics of greatest interest identified by providers and delivered in a live or interactive modality whenever possible.

Clinical Competence↗

2.3 Towards global convergence of education, training, quality, outcome and assessment.

The purpose of this section's report is to propose strategies which will help those committed to promoting and implementing higher standards in dental education. There is a wide variety of systems throughout the world. These systems are developed, governed, operated and applied differently. Their standards, whether they are controlled by governments (federal and/or state), councils, universities or professional organizations are frequently determined cooperatively with dental educators, so that there is often some agreement among interested constituencies as to the content and application of the standards. These standards, whether they be called 'accreditation standards"requirements' or 'guidelines' (formal or informal), or written as laws or statutes reflect a region's history, traditions, culture and socio-economic realities. The emphasis in this report will be on the development of an organic or growing electronic database containing worldwide information relating to standards in dental education. This database might contain or be linked with similar sources detailing, inter alia, best practices, innovations and core values as they relate to the convergence of standards in education, professional training, continuous quality analysis, assessment and outcome. The linking of such a database to others containing electronic curricular modules, clinical management and practice information needs to be further developed.

Accreditation↗

Supporting emergency medicine research: developing the infrastructure.

The long-term goals of developing research within the specialty of emergency medicine (EM) include the following: 1) to continue to improve the quality and quantity of EM research in order to ultimately improve emergency patient care; 2) to maximize the research potential of emergency health care professionals in order to develop new emergency research talent and enthusiasm; and 3) to establish the academic research credentials of the specialty of EM in order to become competitive for federal research funding, and further improve emergency patient care. This article addresses the process by which the infrastructure for EM research can be developed at academic medical centers and provides recommendations. The roles of the academic chair, research director, senior researcher, and departmental faculty are discussed.

Academic Medical Centers↗

Critical care nurses: professional development in the private sector.

The purpose of this study was to gain a greater understanding of the experiences and perceptions of private hospital critical care nurses regarding critical care education delivery. It addressed the question of whether rural private hospital critical care nurses have different experiences and perceptions of critical care education delivery than metropolitan private hospital critical care nurses, and the implication these differences may have for the providers of continuing professional education for critical care nurses. The study used a phenomenographic approach to identify participants' common sense conceptions of their experiences and perceptions of critical care education delivery. A focus group session was held at a rural private hospital and a metropolitan private hospital, where interviewees were encouraged to reflect on previously unthematised aspects of the phenomenon in question. In addition, questionnaires were distributed to critical care staff in each unit and interviews were held with key stakeholders. Nineteen nurses participated in the study, providing a cross section of the experiences and qualifications present within these units. A number of issues were identified from the data, namely the need for clinical educators within critical care units to support students undertaking critical care courses and the desire for a move back to hospital based courses supported by the tertiary system. Education providers need to look closely at the issues of access, cost and organisation of courses to make them more appealing and relevant for both rural and metropolitan critical care nurses.

Adult↗

Learning needs assessment as a vehicle for integrating staff development into a professional practice model.

Restructured nursing roles resulting from innovative professional practice models and participative governance systems create a demand for new and expanded competencies. The impact for nursing staff development is the concurrent requirement to develop programs that match the skill/competency requirements of nurses in emerging practice models. This article recounts how one nursing department implemented a learning needs assessment (LNA) process as a means of integrating staff development into professional nursing practice.

Clinical Competence↗