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PubMed2006

Education needs for integrated care: a literature review.

AIM: This paper reports a systematic review to identify the education needs of the workforce within primary care to promote the effective delivery of integrated health and social care services. BACKGROUND: The need for different professionals to work more closely dominates global health policy. The drive to develop a workforce prepared for the future is crucial to the success of integrated services. However, some have argued that nurses are ill-equipped to meet the challenges of integrated service provision. The ability to work interprofessionally is an important skill which needs to be developed to support integrated working. METHODS: Structured searches were undertaken on organizational websites and the Caredata, CINAHL, Cochrane Library, MEDLINE, Sociofile databases between December 2002 and April 2004 to identify policy documents and primary research studies. The robustness of identified research studies were appraised using recognized appraisal tools. FINDINGS: Six themes were identified which indicate essential elements needed for integrated care. The need for effective communication between professional groups within teams and an emphasis on role awareness are central to the success of integrated services. In addition, education about the importance of partnership working and the need for professionals to develop skills in relation to practice development and leadership through professional and personal development is needed to support integrated working. CONCLUSION: Education which embeds essential attributes to integrated working is needed to advance nursing practice for interprofessional working. Further research exploring this and its impact on integrated provision is essential to ensure that evidence-based services are provided. The reinforcement of partnerships between higher education institutions and health and social care organizations should ensure that the workforce is educated to manage continuous change in service delivery. Innovative ways of teaching and learning which promote inter-professional working need to be explored.

Attitude of Health Personnel↗
PubMed2004

Researching patient-professional interactions.

This paper explores the nature and future of social research on patient-professional interactions. It first sketches the historical background to such research and notes that in the UK and US this was characterised by a focus on the doctor-patient relationship. This research embodied a sceptical view of the power of the medical profession in sustaining and promoting social inequalities, and a critique of 'medical dominance' over other health care professionals and patients. The paper then goes on to outline changes occurring in the nature of professional practice that suggest a fundamental shift in the social relations of health care and the role of medicine. These include a putative loss of public confidence in the medical profession and the authority of science, an increased role of the media in informing patients, and a change in the state's relationship with health care professionals. Finally, the paper outlines some items for a future research agenda, including the need to understand better patient preferences about changes in health care delivery, including a willingness to engage in 'partnership', and the possibilities and barriers to change in professional practice.

Health Services Research↗
PubMed1995

Interprofessional cooperation.

This paper presents various views on interprofessional cooperation and discusses the significant components and desired outcomes of such a relationship. Historically, the nurse-doctor relationship has been fraught with conflict; however, the challenge is to dismantle this imbalanced relationship and fashion new interdisciplinary collaboration. Collaborative practice is an ongoing, dynamic process, requiring time to develop. The creation of true partnership demands energy and commitment. Collaboration, a relationship of interdependence, is built on respect and understanding of the unique and complementary perspectives each profession makes to achieve desired outcomes. The health literature abounds with issues associated with interdisciplinary collaboration. Essential elements of collaboration, advantages and barriers to collaborative affiliation, impact of collaborative practice, and changes in practice patterns among professionals of various disciplines are some of the issues highlighted. Several universities and medical centres support faculty-practice joint appointment and believe this collaborative affiliation will bridge the accountability gap and will enhance the educational and organizational goals. The problem-based learning curriculum is permeating nursing schools. This educational strategy is valuable in that students learn team collaboration. Many studies believe that practice questions can be addressed better by merging the talents of clinicians and those in the academic setting. The authors point out that research-based knowledge is essential for clinicians to solve patient care problems. Favourable outcomes to collaborative practice outweigh the barriers. No doubt there is synergism when a new partnership is created which is the hallmark of a true interprofessional relationship. This affiliation must be nurtured and reinforced, for it holds great promise for enhancement of patient care and for providing job satisfaction in an increasingly complex and constraining world of health care.

Delivery of Health Care↗
PubMed2006

Knowledge translation versus knowledge integration: a "funder's" perspective.

Each year, billions of US tax dollars are spent on basic discovery, intervention development, and efficacy research, while hundreds of billions of US tax dollars are also spent on health service delivery programs. However, little is spent on or known about how best to ensure that the lessons learned from science inform and improve the quality of health services and the availability of evidence-based approaches. To close this discovery-delivery gap, researchers and their funding agencies not only must recognize the gap between basic discovery and intervention development, addressed in part through translational research investments, but they must also work together with practitioners and their funding agencies to recognize the growing gap between innovative interventions developed through research and what is actually delivered to reduce the burden of chronic disease within the United States. From a funding-agency perspective, the complexity of the challenges of translating lessons learned from science to public health, primary care, or disease specialty service settings requires a multifaceted partnership approach to accelerate the translation of research into practice. This essay reviews the background and challenges of closing the development-to-delivery gap and some exemplar strategies that have been used by funding agencies to address these challenges to date.

Education, Continuing↗
PubMed2003

The role of a mental health consumer in the education of postgraduate psychiatric nursing students: the students' evaluation.

Recent Australian Government policy reflects the integral nature of active consumer participation to the planning and delivery of mental health services. The effectiveness of consumer participation in improving mental health services has received some attention in the literature. Commonwealth Government funding enabled the development of a partnership between the Centre for Psychiatric Nursing Research and Practice and the Melbourne Consumer Consultants' Group. The successful application enabled the employment of a mental health consumer as an academic staff member of the Centre for Psychiatric Nursing Research and Practice. One important aspect of this role involved the mental health consumer teaching a consumer perspective to postgraduate psychiatric nursing students. The primary aim was to increase the students' awareness of and sensitivity to greater consumer participation within the mental health arena. This paper presents the results of an evaluation of the consumer academic role in teaching within the Postgraduate Diploma in Advanced Clinical Nursing (Psychiatric Nursing). An evaluation form was distributed to students (n = 21) on completion of the semester. The findings suggest the experience was considered beneficial to students and was impacting significantly on their current practice. This project supports the value of consumer participation in the education of mental health professionals.

Adult↗
PubMed2000

Mental health services in faith communities: the role of clergy in black churches.

A small but growing literature recognizes the varied roles that clergy play in identifying and addressing mental health needs in their congregations. Although the role of the clergy in mental health services delivery has not been studied extensively, a few investigations have attempted a systematic examination of this area. This article examines the research, highlighting available information with regard to the process by which mental health needs are identified and addressed by faith communities. Areas and issues where additional information is needed also are discussed. Other topics addressed include client characteristics and factors associated with the use of ministers for personal problems, the role of ministers in mental health services delivery, factors related to the development of church-based programs and service delivery systems, and models that link churches and formal services agencies. A concluding section describes barriers to and constraints against effective partnerships between churches, formal services agencies, and the broader practice of social work.

Black or African American↗
PubMedDate not supplied

MAPP in the classroom: oxymoron or opportunity?

As Mobilizing for Action through Planning and Partnerships (MAPP) becomes increasingly important for community public health practice, it is critical to examine what learning MAPP entails as well as its barriers and benefits. Competency-based education and training interventions that prepare public health workers to effectively contribute to the implementation of MAPP in their communities face significant obstacles. Current public health education and training programs are poorly positioned to enhance MAPP-related competencies among significant numbers of public health students and workers. Establishing the community as the classroom for learning MAPP and forging links with professional education and lifelong professional development strategies are necessary for MAPP to be successful in promoting healthy communities.

Community Health Planning↗
PubMed1995

Building community capacity for health promotion: a challenge for public health nurses.

The centennial celebration of public health nursing is a strong reminder of the tradition and practice of public health nursing's commitment to communities. Partnerships with communities give public health nurses fiduciary responsibility to be actively involved in public health reform to advance health promotion and health protection. Public health nurses must rise to the challenge to build community capacity through facilitating community participation, enhancing community health services, and coordinating public policy to achieve core public health responsibilities of assessment, policy, and assurance. This paper explicates strategies for building community capacity for health promotion.

Community Health Services↗
PubMedDate not supplied

Infrastructure for reaching disadvantaged consumers: telecommunications in rural and remote nursing in Australia.

Both consumers and health service providers need access to up-to-date information, including patient and practice guidelines, that allows them to make decisions in partnership about individual and public health in line with the primary health care model of health service delivery. Only then is it possible for patient preferences to be considered while the health of the general population is improved. The Commonwealth Government of Australia has allocated $250 million over five years, starting July 1, 1997, to support activities and projects designed to meet a range of telecommunication needs in regional, rural, and remote Australia. This paper defines rural and remote communities, then reviews rural and remote health services, information, and telecommunication technology infrastructures and their use in Australia to establish the current state of access to information tools by rural and remote communities and rural health workers in Australia today. It is argued that a suitable telecommunication infrastructure is needed to reach disadvantaged persons in extremely remote areas and that intersectoral support is essential to build this infrastructure. In addition, education will make its utilization possible.

Australia↗
PubMed2002

Making the most of collaboration: exploring the relationship between partnership synergy and partnership functioning.

Considering the challenges inherent to collaboration and the time it takes to achieve measurable outcomes, partnerships need a way to determine, at an early stage, whether they are making the most of collaboration. The authors have developed a new measure, partnership synergy, which assesses the degree to which a partnership's collaborative process successfully combines its participants' perspectives, knowledge, and skills. This article reports the results of a national study designed to examine the relationship between partnership synergy and six dimensions of partnership functioning: leadership, administration and management, partnership efficiency, nonfinancial resources, partner involvement challenges, and community-related challenges. Data were collected from 815 informants in 63 partnerships. Results of regression analysis conducted with partnership-level data indicated that partnership synergy was most closely related to leadership effectiveness and partnership efficiency. Implications of these findings for research and practice are discussed.

Community Health Planning↗
PubMedDate not supplied

The Integrated Care in Shropshire project: lessons from experience.

Support for the idea of teamwork as an abstract ideal is not matched by practice. The Integrated Care in Shropshire project formed a partnership between Shropshire Social Services Department, Shropshire District Health Authority and Shropshire Family Health Services Authority together with the Helen Hamlyn Foundation. The first strand of the project was the development of procedures for assessment; it had a relatively clear goal and a firm deadline. The second strand was the development of better-integrated primary health care teams, but insufficient time and resources limited what could be achieved. Collaboration between the agencies has been extended for a further period and local units will be invited to put forward their own schemes. The ICIS project illustrates the need for 'pilot projects' to be conceived and managed by their sponsor agencies as sites for organisational learning if they are to be effective.

Aged↗
PubMed1999

[Care of hospitalized children: reflexions about the participation of parents].

The care of a child admitted in the hospital is going through meaningful changes and, in a more actual approach, the main strategy seems to stimulate parents or relatives to stay with their children in the hospital. The purpose of this study is to analyse parents' participation in the process of staying in the hospital with their children. We have chosen the qualitative method and used as a theoretic--methodological reference the Model of Technological Work Organization. Based on the process of work, we have pointed out that bringing mothers to the ward is not so simple as it interferes in the reorganization of the work at the theoretical and practical levels. Concepts such as co-operation and partnership are built, however, sharing knowledge, power and room is not a simple action. It implies in changes of values and postures by parents and professionals.

Child↗
PubMed1995

Women's perceptions and experience of menopause: a focus group study.

Focus groups were used to investigate women's perception and experience of menopause, hormone replacement therapy, osteoporosis and doctor-patient relationships. Forty women aged between 45 and 55 years participated in seven focus groups. Most women thought that these topics were not widely or freely discussed in the community. Nevertheless they were able to share their experiences on this occasion. Lack of reliable, accessible and current information on menopause and related topics was identified as a problem. This was compounded by the contradictory nature of the information which was available. Hysterectomy and osteoporosis were identified as specific areas in which information was inadequate and not readily accessible. Solutions suggested by the women included distributing information pamphlets with contact numbers for further information to non-health-related settings such as hairdressing salons. The need to foster open discussion between women and their doctors was highlighted, with contributions required from both parties to develop a more equal partnership. A review of doctors' and women's surveillance practices with regard to hormone replacement therapy may also be warranted. We found focus groups a useful method for accessing women's experiences and perceptions. There was particular benefit in researchers being involved as moderators and scribes, and in an early post-focus group meeting to amplify and clarify records of the discussions. Small group size and an emphasis on confidentiality were, we believe, helpful strategies in encouraging discussion of intimate topics.

Attitude to Health↗
PubMed2006

Policy change and policy dilemmas: interpreting the community services White Paper in England.

CONTEXT: In 2006 the Labour Government in England published its long awaited White Paper on 'community services', following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger focus on preventive care. Several mechanisms are to be put in place to ensure this shift takes place, most notably practice-based commissioning, payments-by-results and enhanced partnership working. PURPOSE: This article outlines the intended changes and assesses the extent to which they add up to a coherent strategy. CONCLUSION: It is argued that although there is widespread support for the overall vision, the strategy contains some difficult policy tensions that are common to other welfare systems. These will have to be addressed if the vision is to be a reality.

Journal Article↗
PubMed1992

Purchase considerations for a radiology information system.

Since choosing a radiology information system can be a trying endeavor, this "nuts and bolts" article offers some practical advice. The authors first emphasize that a strong partnership between the institution and vendor must exist for successful implementation to happen. Ms. Rowe and Ms. Parrish then proceed to outline the commitment, tasks and training necessary to ensure that your organization undertakes this project with favorable results!

Computer User Training↗
PubMed1996

Remaking health care in America.

Academic medical centers, vulnerable populations, rural health. Each represents the fragmentation of the current health care delivery system. Not surprisingly, the challenge of achieving cost-effective integrated delivery raises complex issues for each. These issues are explored in Remaking Health Care in America, based on research by Stephen Shortell, Ph.D., and his colleagues at Northwestern University, in partnership with KPMG's National Health Care & Life Sciences practice and 11 integrated health care systems. Hospitals & Health Networks presents an exclusive preview of the book.

Academic Medical Centers↗
PubMedDate not supplied

Health professionals' perspectives in exercise referral: implications for the referral process.

The number of exercise referral schemes expanded rapidly across the UK during the 1990s. Health professionals are thought to be one of the most credible sources of health advice for patients and, hence, are thought to have a pivotal role to play in exercise referral schemes. The aim of the study was to investigate the exercise referral process from the health professional's perspective, specifically examining perceived barriers to referral, priority given to an exercise referral scheme in day-to-day consultations, perceived importance of their role in the process and referring practices. Quantitative and qualitative research methods were utilized with 49% (n = 71) of general practitioners and practice nurses (collectively referred to as health professionals throughout), in a large North West borough (population size approximately 287,000) responding to a postal survey and 11 health professionals (general practitioners n = 9 and practice nurses n = 2) volunteering to take part in a semi-structured interview. Barriers to the referral of patients included lack of time, lack of feedback regarding the patients referred, medico-legal responsibility, a feeling that patients may not take exercise advice given and the belief that physical activity promotion is not a priority during routine consultations. Health professionals refer individuals to an exercise referral scheme on an unsystematic basis and express mixed opinions regarding their perceived role in patient physical activity behaviour change. This study calls for closer partnership working, involving training for promoting physical activity in general practice. Also, greater feedback with regard to patient benefits is needed, in order to overcome some of the practical and perceived barriers for health professionals when referring patients to an exercise referral scheme.

Attitude of Health Personnel↗
PubMed2000

Improving clinical practice guidelines for the 21st century. Attitudinal barriers and not technology are the main challenges.

Through the use of three scenarios, this paper presents the challenges for clinical practice guidelines in the 21st century. Such challenges relate to technological developments to improve the efficiency and pace of the development process, to ensure that clinical practice guidelines are kept up to date, and to facilitate implementation of guidelines in the clinical setting. To improve and ensure the validity of the content of clinical practice guidelines, we need to address the important problem of publication bias, for which researchers, granting agencies, industry, and journal editors share responsibility. This means insisting on registration of trials at their inception, and incentives backed up by rules for funding and peer review publication that would promote behaviors to avoid publication bias. The more difficult challenges for clinical practice guidelines relate to what are referred to as attitudinal factors. To achieve optimal efficiencies in development and maintenance of clinical practice guidelines, we need to promote cooperation among various information resource providers internationally and to stress partnership over leadership. Finally, there need to be reconciliation of the different stakeholder perspectives of the value and purpose of clinical practice guidelines so that they are used appropriately as aids to decision making and are not abused as tools for controlling clinical practice.

Decision Support Systems, Clinical↗