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PubMed1986

AIDS risk reduction: a community health education intervention for minority high risk group members.

During the past year, members of the Detroit Health Department health education staff have developed an Acquired Immunodeficiency Syndrome (AIDS) community education intervention. The intervention was designed in response to the growing public health problem of AIDS and the need to provide the community with accurate information regarding the transmission and prevention of the disease. The gap in AIDS education and information was particularly evident in the black community. In attempting to develop a comprehensive health education program, the staff encountered a number of barriers. Traditional antagonisms between the high-risk groups, homosexual and bisexual males and intravenous drug abusers, and the health department hampered the ability of the intervention team to design a clinic centered program. Concurrently, lack of access to the high-risk population and reactionary public sentiment toward the disease posed serious problems for developing community support for the implementation of an effective community-based program. The intervention team also found that traditional methodologies of health education program planning were inadequate. The staff lacked sufficient data on the beliefs and attitudes of the high-risk populations necessary to design relevant risk reduction activities. Recognizing our limited awareness and accessibility to the high risk groups, a strategy was developed to encourage members of the high-risk population to assume a leadership role in the development and implementation of the community-based program. The success of the Community Health Awareness Group (C-HAG) is, in part, a result of the willingness of high risk individuals to assume some responsibility in educating themselves and others. It also speaks to the efficacy of collaborative relationships between health workers and target populations when designing public health interventions.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Improving asthma documentation in a paediatric emergency department.

OBJECTIVE: To improve documentation for children presenting to the Emergency Department (ED) of The Children's Hospital with acute asthma. METHODOLOGY: In phase I, the documentation process was analysed using a standard total quality management (TQM) approach to identify specific problems leading to poor documentation. Fifty-two medical records of children presenting over a 3 week period were reviewed for nursing and medical documentation. A set of minimum criteria, consistent with the Paediatric Asthma Management Plan, were established for documentation by both medical and nursing staff. Following dissemination and education, compliance with documentation was evaluated and compared to an asthma survey performed in the ED in 1991. In phase II, a specific proforma for medical assessment was developed and 80 medical records of children presenting over a 3 week period were reviewed. Fifty-two (65%) with completed proformas were evaluated. The outcome measure was the documentation rate for minimum criteria established by TQM process. RESULTS: In phase I, nursing compliance with documentation ranged from 46% for signs of respiratory distress to 83% for a past history of asthma and 100% for pulse rate. Doctors were similarly poor at documenting essential elements such as severity (31%), palpable pulsus paradoxus (29%), the child's usual doctor (46%) and follow-up arrangements (21-56%). In phase II, the documentation of the severity of acute asthma (42%) and of the child's usual doctor (42%) remained poor but there were statistically significant improvements in documentation of interval medications, palpable pulsus paradoxus, respiratory rate, pre-treatment oximetry, education, follow-up arrangements and communication letters. CONCLUSION: The process of TQM has proved valuable in improving some aspects of documentation of children presenting to ED with acute asthma. It remains to be shown whether improved documentation will result in improved outcome.

Asthma↗
PubMed1995

Improving breastfeeding support: a community health improvement project.

BACKGROUND: Because of the brevity of the postpartum hospital stay, mothers and their newborns are discharged home before breastfeeding is well established. In 1992, feedback from patients who had given birth at Fletcher Allen Health Care (Burlington, VT) suggested a need for more consistent, expert, and timely assistance with breastfeeding in the hospital and better continuity of care during the first few weeks at home. QUALITY IMPROVEMENT TEAM: In 1993 a team developed objectives, analyzed the problem and possible solutions, and made eight recommendations on how the hospital could do more to promote breastfeeding. Implementation by team members and hospital staff included policy development, staff education, acquisition of funding, a visiting professorship, development of a lactation consultant coordinator and team, and patient surveys to evaluate the program. A late 1994 survey of 63 postpartum patients on their day of discharge indicated a high level of satisfaction with breastfeeding support in the hospital. CURRENT STATUS: Activities are being undertaken for lactation consultation coverage, further policy development, implementation of nurse competency validation, improved patient and family education materials, and continued evaluation of the breastfeeding support program through patient surveys. CONCLUSION: In the face of barriers such as the project's large scope, a paucity of internal team members, and a large number and variety of recommendations, some of the recommendations and follow-up plans have yet to be implemented. Yet the project has yielded improvements in care and provides a model of how hospitals can expand their traditional boundaries of care and quality improvement into community health issues.

Breast Feeding↗
PubMed1997

Issues facing nurse teachers on the pre-registration diploma of higher education course (Project 2000): a case study approach.

This paper draws on the experience and expertise of nurse practitioners and teachers of nurses to report on significant issues facing the latter in their work. The findings form part of a larger study describing major changes in the role and work of nurse teachers resulting from Project 2000 initiatives. The rationale for adapting a case study approach is outlined. The results indicate that changes in the work of nurse teachers and diversity of activities expected has placed some major obstacles in their work. Nurse teachers were perhaps inadequately prepared for their new roles, given the haste required by the demonstration nursing schools in their curricular submission documents in order to compete for approved course recognition (Project 2000) and demonstration status. The study recommends extensive staff support, development and academic growth, and continuing commitment to steady progress and change.

Education, Nursing, Baccalaureate↗
PubMed2005

Methodologic and logistic issues in conducting longitudinal birth cohort studies: lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research.

In anticipation of the National Children's Study, lessons can be learned from the smaller birth cohort studies conducted by five Centers for Children's Environmental Health and Disease Prevention Research funded by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency. The populations studied are diverse in ethnicity and social class and reside in urban and rural environments. Although almost all of the centers chose to enroll participants through medical care facilities, they had to develop independent staffs and structures because of the overburdened medical care system. Some of the lessons learned by the centers include the importance of continuous funding, building community partnerships to conduct culturally appropriate research, hiring bilingual and bicultural staff from the community, prioritizing research goals, developing biorepositories to ensure future utility of samples, instituting quality control procedures for all aspects of specimen and data collection, maintaining frequent contact with study participants, ensuring ethical conduct of the research in a changing medical-legal climate, and communicating results in a timely and appropriate manner to participants and the wider community. All centers underestimated the necessary start-up time, staff, and costs in conducting these birth cohort studies. Despite the logistical complexity and added expenses, all centers emphasize the importance of studying the impact of environmental exposures on those children most at risk, those living in minority and low-income communities. These centers present barriers encountered, solutions found, and considerations for future research, with the hope that the lessons learned can help inform the planning and conduct of the National Children's Study.

Adolescent↗
PubMed2000

Evergreen staff: building a tree of knowledge for continuous learning.

Healthcare institutions breathed a collective sigh of relief on January 1, when efforts made for remediation, testing, and contingency planning for the year 2000 finally paid off. Now that the technology has been improved to ensure compatibility, it is important to keep the momentum going to improve efficiency and increase productivity and patient satisfaction levels. One way to incorporate organizational priorities, goals, and strategy at the departmental level is to develop an education plan that stresses mastering fundamental skills. This article explores the components and role of an education plan and identifies the types of efforts that result in the greatest return. It concludes with a case study.

Computer User Training↗
PubMed1994

Lessons from America? US magnet hospitals and their implications for UK nursing.

This paper examines possible implications of the US 'magnet hospital' concept for the UK nursing labour market. Magnet hospitals have been researched in the US and have been demonstrated to exhibit lower nurse turnover and higher levels of reported job satisfaction than other hospitals. Key characteristics include a decentralized organizational structure, a commitment to flexible working hours, an emphasis on professional autonomy and development, and systematic communication between management and staff. The paper examines the labour market characteristics of UK nurses and US nurses and finds many similarities. Detailed case studies of employment practice in 10 US hospitals and 10 Scottish hospitals are reported, with specific attention to remuneration practice, methods of organizing nursing care, establishment-setting and flexible hours. The paper concludes that there are features of the magnet hospital concept which are of relevance and applicable to the UK nursing labour market, but that piecemeal importation of ideas is unlikely to be beneficial.

Adult↗
PubMed2006

Prisons and health reforms in England and Wales.

Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty's Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.

Adolescent↗
PubMed2006

Learning providers. University challenge.

The former NHSU core learning unit has been charged with developing and managing learning programmes for NHS staff. Each SHA is represented on a steering committee that discusses current priorities and future direction. The unit is fighting to fill the financial gap left by NHSU, while Unison has requested the government guarantees future funding for certain training programmes.

Hospital Administrators↗
PubMed2002

Primary care trusts. Heavenly body.

A primary care trust has found that managers value the provision of locum cover for staff to attend multidisciplinary workshops. Evaluation shows that GPs and other staff appreciate protected learning time. If funding can be secured, the workshops will be supplemented with protected learning time in practices.

Education, Medical, Continuing↗
PubMedDate not supplied

A G.R.E.A.T. (guest relations emphasis all the time) idea. Guest relations program emphasizes a patient-based mission.

Healthcare, in spite of its tremendous clinical, technological, and financial pressures, is patient based. Guest relations programs seek to remind clinicians, technicians, and financial officers of that fact. St. Joseph Medical Center, Fort Wayne, IN, is striving to combine its mission-driven philosophy of healthcare with responsible competitive strategies, and guest relations is a natural and integral part of the plan. St. Joseph appointed 10 persons to a task force to develop its guest relations project. The task force assigned teams of two members each to concentrate on specific objectives: implementation, policy development, medical staff involvement, existing areas that overlapped with the new guest relations efforts, and evaluation. The task force chose 10 persons outside the education department to train 1,400 associates in 65 sessions over three shifts in three months. An outside consultant trained the trainers on the same day she addressed the management team on the importance of their ownership and involvement in the program. While the task force worked on operational details, the advisory group on policy development began laying the groundwork for what may be the most valuable part of any guest relations program: administration-approved policy and procedures, which address communication, standards of excellence, human relations skills, and positive personal attitudes.

Hospital Bed Capacity, 300 to 499↗
PubMed2000

Frustrated by the nursing shortage? Try these tactics instead of bonuses.

There is a nationwide shortage of ED nurses due to an aging work force, fewer students enrolling in nursing schools, and demoralized nurses leaving the profession. Effective strategies for retaining staff include developing career ladders, starting a nurse leadership program, and sending nurses to conferences. When hiring nurses, address how well they fit into your ED's culture. Morale-boosting programs help nurses feel valued.

Career Mobility↗
PubMed2003

Teaching primary care trusts. In a class of their own.

The first three teaching primary care trusts, which came into operation in April 2001, have increased recruitment of GPs and practice staff. Sunderland PCT has reduced practice list sizes as a result of the initiative. Salford teaching PCT has tripled the number of training practices. Eighteen GPs have been recruited in Bradford.

Education, Medical, Continuing↗