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PubMed2002

Evaluation of health-care worker vaccination in a tertiary Australian hospital.

BACKGROUND: Maintaining a complete vaccination status for health-care workers (HCWs) is important to minimize morbidity among staff and patients. Despite recommendations from public-health authorities to support this process, not all hospitals have adequate policy and practice in place. AIMS: To independently assess the implementation and impact of a new policy aimed at improving HCW vaccination coverage in a tertiary Victorian hospital. METHODS: Two cross-sectional surveys were conducted by telephone in July and October 2000 for a random sample of HCWs, before and after the introduction of the policy. These surveys examined knowledge, attitudes and practices surrounding vaccination and self-reported vaccination status. Policy implementation was assessed by ascertaining completion of compulsory vaccination status forms and attendance at suggested appointments to review vaccination status. RESULTS: Only 19% of 269 HCWs reported a complete vaccination status at baseline. Most (76%) had not heard of or seen vaccination guidelines and 39% kept written vaccination records. This was despite a belief in the importance of vaccination (94%) and a willingness to update if necessary (96%). At follow up there was no improvement in any outcome. Only 11/26 (42%) newly employed HCWs surveyed received and returned compulsory vaccination status forms. Of the few HCWs who attended recommended vaccination appointments, all received vaccinations. CONCLUSIONS: HCW vaccination coverage and knowledge of vaccination requirements were poor. Although attending a physician to discuss vaccination status did result in vaccination, few HCWs made such an appointment. While policy development is an important first step towards improving vaccination coverage, effective implementation requires ongoing evaluation, adequate resources and HCW education.

Adult↗
PubMed2002

Evaluation of distance learning delivery of health information management and health informatics programmes: a UK perspective.

The aim of the article is to review evaluations of distance learning programmes in health information management, in order to identify the critical success factors for such programmes and discuss future directions. The emphasis is on the UK experience, based partly on reflections on the experience of one programme at University of Wales Aberystwyth (now over 10 years old), and partly on a policy review conducted for the NHS Information Authority and the NHS Information Policy Unit. The methods are, as far as possible, those of a systematic review of existing research, with, additionally, an overview of relevant policy developments for lifelong learning. The topics covered include the aims, objectives and educational philosophies of the programmes. The evidence, combined with the UWA experience, indicates the importance of face-to-face interaction, to complement distance or virtual learning. A student-centred approach to curriculum design and delivery is essential.

Competency-Based Education↗
PubMed1999

Surveillance of suicidal behavior in Kitsap County, Washington: a retrospective study.

Suicide is a major source of preventable morbidity and mortality in Kitsap County, Washington State. This article describes a study of suicidal behavior to identify risk groups in order to design intervention strategies. A retrospective study was conducted by reviewing the charts of individuals exhibiting suicidal behavior who had presented to the county's only civilian hospital emergency department over a 7 month period. Frequencies were calculated to identify at-risk populations and determine risk factors. One hundred forty-five charts were reviewed. Subjects were mostly female (69%), and ages ranged from 10 to 80 years with 73% between 15 and 44 years. Two-thirds of the subjects were not working. More than half had previously exhibited suicidal behavior and more than 75% had previous mental health encounter(s). Most admissions (67.6%) occurred between 4:00 p.m. and 4:00 a.m. The core public health functions of assessment, policy development, and assurance provided the framework for this community to explore the finding that suicide was a major source of preventable morbidity and mortality. Community-based intervention strategies have been developed in an effort to reach the Healthy People 2000 objective of reducing suicide deaths to no more than 10.5 per 100,000 residents.

Adolescent↗
PubMed2001

Practice guideline for evaluation of fever and infection in long-term care facilities.

The elderly population (i.e., persons aged > or = 65 years) in the United States is rapidly expanding and will nearly double in number over the next 30 years. It is estimated that >40% of persons aged > or = 65 years will require care in a long-term care facility (LTCF), such as a skilled nursing facility (SNF), at some point during their lifetime. For the most part, residents of LTCFs are very old and have age-related immunologic changes, chronic cognitive and/or physical impairments, and diseases that alter host resistance; therefore, they are highly susceptible to infections and their complications. The diagnosis of infections in residents of LTCFs is often difficult because LTCFs differ from acute-care facilities in their goals of care, staffing ratios, types of primary care providers, availability of laboratory tests, and criteria for infections. Consequently, guidelines and standards of practice used for diagnosis of infections in patients in acute-care facilities may not be applicable nor appropriate for residents in LTCFs. Moreover, the clinical manifestations of diseases and infections are often subtle, atypical, or nonexistent in the very old. Fever may be low or absent in LTCF residents with infection. The initial evaluation of an LTCF resident suspected of an infection may not be done by a physician. Although nurses commonly perform initial assessments for infection in residents of LTCFs, further studies are needed to determine the appropriateness and validity of this practice. Provided there are no directives (advance or current by resident or caregiver) limiting diagnostic or therapeutic interventions, all residents of LTCFs with suspected symptomatic infection should have appropriate diagnostic laboratory studies done promptly, and the findings should be discussed with the primary care clinician (see Recommendations). The most common infections among LTCF residents are urinary tract infections, respiratory infections, skin or soft tissue infections, and gastroenteritis. Decisions concerning possible transfer of an LTCF resident to an acute-care facility are best expressed through an advance directive or, when not available, through transfer policies developed by the LTCF. In general, LTCF residents have been transferred to an acute-care facility when any of the following conditions exist: (1) the resident is clinically unstable and the resident or family goals indicate aggressive interventions should be initiated, (2) critical diagnostic tests are not available in the LTCF, (3) necessary therapy or the mode of administration of therapy (frequency or monitoring) are beyond the capacity of the LTCF, (4) comfort measures cannot be assured in the LTCF, and (5) specific infection-control measures are not available in the LTCF.

Aged↗
PubMed2004

Delineating disability, labour force participation and employment restrictions among persons with psychosis.

OBJECTIVE: To delineate at a population level: activity restrictions, labour market participation, educational attainment, employment restrictions and employment characteristics of persons with psychosis compared with healthy non-disabled persons. METHOD: Confidentialized data files were provided by the Australian Bureau of Statistics. The data were collected in a national survey titled "Survey of Disability, Ageing and Carers, Australia 1998". Multi-stage sampling strategies obtained a probability sample of 42 664 individuals. Trained interviewers using ICD-10 computer-assisted interviews identified household residents with psychosis. RESULTS: Among householders with psychosis aged 15-64 years, 75.2% were non-participants in the labour market, 21.1% were employed and 3.7% were looking for work. Completing school years 10 and 11, and vocational training, appeared to offer an employment advantage. CONCLUSION: Persons with psychotic disorders have low rates of labour force participation and may benefit from greater participation in educational and vocational services. Implications for policy development are discussed.

Adolescent↗
PubMed2002

Measuring unmet needs and services among persons with traumatic brain injury.

OBJECTIVES: (1) To develop a comprehensive list of needs and services appropriate for persons with traumatic brain injury (TBI); (2) to determine whether these needs and services formed unidimensional hierarchies from least common to most common; (3) to describe the relationship between unmet needs and services received; and (4) to estimate the extent to which a variety of demographic, injury, and service characteristics predict unmet needs. DESIGN: Statewide mailed survey. SETTING: Illinois communities. PARTICIPANTS: A total of 895 persons who had had a TBI recruited from Brain Injury Association members and rehabilitation service recipients. The median time post-TBI was 7 years; the median age was 37 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A 27-item instrument assessing service needs and utilization of services, and equal-interval measures of needs and services derived with Rasch analysis. RESULTS: The most prevalent unmet needs were improving memory or problem-solving skills (51.9%), increasing income (50.5%), and improving job skills (46.3%). The instrument defined unidimensional and reliable constructs of needs and services. Persons with greater unmet needs tended to receive fewer services; to report lower life satisfaction and worse medical health and psychologic well-being since injury; to be younger, single, black, dependent in 1 or more daily activities; and to have more recent injuries. CONCLUSIONS: The results show the common pattern of unmet needs and services and emphasize the importance of comprehensive, statewide assessment of services and needs in developing policies.

Adult↗
PubMed2002

Quality of life measurement in rehabilitation medicine: building an agenda for the future.

In November 2001, a conference convened to discuss the state of the science of measuring of quality of life (QOL) in rehabilitation medicine. The meeting brought together leading researchers in areas of behavioral health and physical medicine and rehabilitation to address the fragmentation that exists across specialty areas and disciplines. The goal was to bridge terminology, techniques, and advances across the fields of behavioral and rehabilitation medicine. The 5 topic areas included: (1) general versus targeted measurement, (2) QOL in policy development, (3) measuring QOL from the patient's perspective, (4) cultural aspects of QOL measurement, and (5) the future of QOL research. This introduction synthesizes the information presented at the conference and provides context to the articles contained in this 2-part supplement.

Cultural Characteristics↗
PubMed2002

Education for community mental health nurses: a summary of the key debates.

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. 'Specialist practitioner' courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide 'psycho-social interventions' have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.

Community Health Nursing↗
PubMed2000

Beyond multidisciplinary care: a new conceptual model for spina bifida services.

Medical care for people who are born with spina bifida (myelodysplasia) is complex and challenging, but the goal of such care is to optimize health and function for people with this condition. Despite years of expert agreement that multidisciplinary care is the medical standard for individuals with spina bifida, this model does not seem to go far enough towards accomplishing the goal of improved function as well as health for all people with spina bifida. Advances in the medical and surgical management of people with spina bifida and society's increased desire to include those with disabilities in family and community life has heightened our expectations for functional/participatory improvement for people with this condition. Some large spina bifida programs have added a separate rehabilitation component to the comprehensive package of services offered to people with spina bifida. The problem with adding further services to the traditional multidisciplinary spina bifida program is the increased complexity and potential for fragmentation that it presents, particularly for the patient and family. We performed a MEDLINE literature search to find information on integrating these services. Although several articles address the importance of either the multidisciplinary spina bifida clinic or a rehabilitation approach, there is little information about integration of medical and rehabilitation services. We propose a new model for spina bifida services throughout the lifespan that integrates the medical and functional/rehabilitative perspectives. Our model for conceptualizing spina bifida services builds on the WHO framework for coding disability (ICIDH-2). This framework includes not only health and functional perspectives, but a participation dimension as well. Furthermore, our new model emphasizes the importance of anticipatory guidance and transitional planning as an integrating dimension applicable across the lifespan. The model is based on three main conceptual dimensions--comprehensiveness, coordination and longitudinality. We are using the model to create standards of care, integrate services and improve their efficiency, and to develop policies regarding spina bifida services. Through this effort we hope to provide better medical and rehabilitation services to those with spina bifida and meet the complex challenge the condition presents throughout the lifespan.

Comprehensive Health Care↗
PubMed2002

Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

Adolescent↗
PubMed2005

Sink or swim--ageing in Australia.

As the number of people under the age of 65 declines, the number over 65 will double in the next half century, Australia. By 2031, it is estimated those over 65 will account for more than a quarter of the Australian population. The fastest rate of growth will be in the over-85-years category, projected to double over the next 20 years and to triple over 50 years to include 2.3 million people. Health care providers cannot afford to wait for the inevitable crises this vast demographic shift will provoke. To meet these future demands, educational and health care institutes should consider establishing interdisciplinary think-tanks for multidisciplinary research, policy development and innovations in aged care and health service delivery.

Aged↗
PubMed2005

Nursing in Australian general practice: directions and perspectives.

Primary health care services, such as general practices, are the first point of contact for many Australian health care consumers. Until recently, the role of nursing in Australian primary care was poorly defined and described in the literature. Changes in policy and funding have given rise to an expansion of the nursing role in primary care. This paper provides a review of the literature and seeks to identify the barriers and facilitators to implementation of the practice nurse role in Australia and identifies strategic directions for future research and policy development.

Australia↗
PubMed2005

Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali.

BACKGROUND: In Mali, an estimated 73% of pregnant women are anaemic largely due to iron deficiency. National policy recommends women to take iron and folic acid supplements daily from first prenatal contact until 3 months postpartum. However, many pregnant women in Mali could benefit from multiple micronutrient supplements. OBJECTIVE: To assess pregnant women's acceptability of and adherence to a daily multiple micronutrient supplementation scheme compared with the current daily iron and folic acid supplementation scheme. DESIGN: Seventy pregnant women were allocated to either the daily multiple micronutrient or daily iron and folic acid supplementation scheme. Women started receiving supplements at the end of the first trimester of pregnancy until delivery and throughout the first 3 months postpartum. RESULTS: No significant differences were observed between comparison groups with respect to women's perceptions about supplement size, colour, taste or flavour. Adherence to the multiple micronutrient supplementation scheme was better (257.5+/-20.9 tablets; average adherence 95.4%) than that to the iron and folic acid supplementation scheme (238.5+/-32.7 tablets; average adherence 92.2%; P=0.008) although both were very good, as were women's perceptions about the benefits of micronutrient supplements to their health and that of their newborns. CONCLUSION: Malian women adhere to prenatal/postpartum micronutrient supplementation - no matter what supplement is chosen - when access to supplements is guaranteed and when they are provided with minimum, consistent and easily understandable information and counselling, indicating that these are key elements to ensure effective programmes. These findings, together with those of the global research agenda on the efficacy of multiple micronutrient supplements for pregnant women, will inform policy development in Mali for the effective control of iron deficiency and iron-deficiency anaemia in pregnant women.

Adolescent↗
PubMed1996

Availability and use of advance directives.

Hospitals need to assure themselves that advance directives are available to caregivers, especially physicians, and that the patient's wishes expressed in them are being followed. This can be done only with data collection and analysis and improvement of the processes that support availability and use of advance directives. On a broader, societal perspective, it has been suggested that wide-spread use of advance directives such as natural death act declarations might encourage systematic rationing of healthcare to the elderly. If a right to die becomes a duty to die, the living will and its progeny, the natural death act declaration, will have become a Frankenstein monster. Indeed, in the mid-1980s the suggestion by then-governor Richard Lamm of Colorado, as well as officials at Health and Human Services that the elderly should be required to have living wills raised a storm of protest. Regardless of true motives, such suggestions are often seen as motivated by economics. The hospital must be alert to the ethical issues of advance directives, which are present regardless of a natural death act statute or a living will. Hospitals and their managers must consider these issues prospectively and develop policies that enable them to respect and meet patients' wishes, consistent with the organizational philosophy.

Advance Directives↗
PubMedDate not supplied

Injection drug users in the Midwest: an epidemiologic comparison of drug use patterns in four Ohio cities.

Variations in the drug use patterns of injection drug users (IDUs) can have important implications for public health efforts aimed at reducing drug abuse and the transmission of the human immunodeficiency virus. This article describes and compares the characteristics of IDUs living in four Ohio cities and compares African-American and White IDUs at a statewide level. Data from 2,001 IDUs who were recruited for the National AIDS Demonstration Research project between 1989 and 1991 in Columbus, Cleveland, Cincinnati, and Dayton were compared on a number of variables by city and by ethnicity using descriptive statistics and ANCOVA analysis. Significant differences among IDUs in the four cities exist for the use of alcohol, marijuana, cocaine, crack, heroin, speedball, other opioids, shooting gallery use, "safer" needle practices, treatment history, and self-help participation. Differences by ethnicity emerged on all variables except marijuana use, overall injection frequency, and incarceration experience. The results suggest that dramatic differences exist between African-American and White IDUs, and among IDUs in cities relatively close together, regardless of ethnicity. These findings should be considered when developing policy and programs for prevention and treatment activities targeting IDUs.

Adult↗
PubMed1991

Hospice and the do-not-resuscitate order.

Recent passage of the Patient Self-Determination Act will require health care providers to develop policies concerning patients' wishes for life prolonging therapy. Since American hospice programs have generally had do-not-resuscitate (DNR) policies since their inception we thought it timely to review the experience of hospice programs with the DNR order. Many programs assume that a signed DNR order is a prerequisite to being accepted as a hospice patient. Other programs are more flexible. This lack of uniformity exposes the unresolved issue within the hospice community as to what is considered appropriate hospice or palliative care. Problems with paramedics responding to 911 calls and not respecting DNR orders or living wills are also discussed.

Advance Directives↗
PubMed2003

Challenges to HIV service provision: the commonalities for nurses and social workers.

Interdisciplinary collaboration can be enhanced through an understanding of the challenges and needs associated with service provision. This study explores the experiences of 192 service providers, with additional comparisons of nurses and social workers. Service providers reported fear of contracting HIV, feeling helpless, problems getting up-to-date information, grief and inadequate referral resources. Except for many more nurses expressing worry about contracting HIV, nurses and social workers shared many of the same problems. In addition, both groups were concerned with the comprehensive health needs of people living with HIV/AIDS. Moreover, they demonstrated shared professional values such as the importance of self-awareness and professional knowledge, positive and non-judgemental attitudes, and non-discriminatory treatment of client groups. This commonality makes nurses and social workers natural allies in responding to the many challenges associated with HIV service provision. Study findings support collaboration in the areas of service delivery, policy development, advocacy and professional development.

Adolescent↗
PubMed1994

'We just want to be a normal family...'. Paediatric HIV/AIDS services at an inner-London teaching hospital.

The nature of the HIV epidemic in the UK is changing with the increasing number of infected women and children. This recent onset means that there are few data about the specific problems of HIV in families. This study examines current issues in service provision to HIV infected children and their families at an inner-London teaching hospital. A sample of ten families were interviewed, from a caseload of approximately 100 HIV-positive children. Of the ten children, seven were under the age of 5 years. All the children were vertical transmissions and six of the mothers were from Sub-Saharan Africa. Only three of the ten children were identified antenatally. In terms of service provision, families were very satisfied with the care provided by the study hospital's paediatric HIV team but felt that the hospital's paediatric and adult HIV services were poorly co-ordinated and impractically located over different sites. Families did not have confidence in GP and community services, preferring to use hospital services which they felt to have more expertise in paediatric HIV. Future policy developments will have to confront the hospital-centred nature of paediatric HIV services and develop primary and community care services.

Acquired Immunodeficiency Syndrome↗