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PubMed1994

Geriatric psychiatry consultation in the community.

While increasing emphasis is being placed on geriatric psychiatry consultation and outreach services, there is considerable variation in terms of the composition and direction of these programs. Programs vary in terms of their objectives, location, target population, use of health professions and other resources and their method of consultation. The purposes of this paper are to review the characteristics of existing programs, to review the needs of the targets of consultation and to consider theoretical and methodological approaches which have been found to be useful in mental health/psychiatric consultation, in continuing medical education, and in program evaluation. On the basis of this review, future directions for effective approaches to consultative outreach in geriatric psychiatry will then be proposed.

Aged↗
PubMed2000

Quantifying the process and outcomes of person-centered planning.

Although person-centered planning is a popular approach in the field of developmental disabilities, there has been little systematic assessment of its process and outcomes. To measure person-centered planning, we developed three instruments designed to assess its various aspects. We then constructed variables comprising both a Process and an Outcome Index using a combined rational-empirical method. Test-retest reliability and measures of internal consistency appeared adequate. Variable correlations and factor analysis were generally consistent with our conceptualization and resulting item and variable classifications. Practical implications for intervention integrity, program evaluation, and organizational performance are discussed.

Adult↗
PubMedDate not supplied

A model to restructure nursing education. Vision on 22nd street.

Since 1993, the Cleveland State University Department of Nursing and the Visiting Nurse Association of Cleveland have been involved in an innovative partnership known as Vision on 22nd Street. This partnership has produced a model to restructure the nursing curriculum and the practice setting in such a way that a seamless process, fully integrated within university and agency operations, prepares undergraduate nursing students for community-based practice. The groundwork supporting the model, the development of the curriculum, the preparation of participants, and the implementation of the model for program evaluation are the subject of this article.

Clinical Competence↗
PubMed1999

Evaluation of early childhood programs.

Unlike kindergartens for 5-year-old children, which are taken for granted, preschool programs for 3- and 4-year-old children are accepted tentatively in the United States, making them ideal candidates for evaluative research. Evaluative research compares the performance of program participants either with ideal performance, the performance of other children in general, or the performance of children who did not attend early childhood programs. Evaluative research assesses and compares child and family outcomes, after equalizing child and family background characteristics by design or statistical analysis and taking program characteristics into account. Evaluative research is either ideal-program research, typical program research, or specific-program evaluation. Ideal-program research has provided evidence of the value of ideal preschool programs. Typical-program research, however, has shown how far from ideal actual programs are, and thus sets the context for specific-program evaluations. Done well, such evaluations can improve school, Head Start, and child care early childhood programs by focusing the attention of teachers, parents, and other stakeholders on program processes and children's development.

Child Day Care Centers↗
PubMed1998

Mental health consultant to law enforcement: Secret Service development of a Mental Health Liaison Program.

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants--psychologists and psychiatrists--with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions.

Case Management↗
PubMedDate not supplied

Doula birth support for incarcerated pregnant women.

The objective of this study was to provide trained labor support (doulas) to pregnant women in jail. A multiagency intervention project provided doula birth services to pregnant women in urban jails. Program evaluation included interviews with women and written satisfaction surveys of providers and correctional officers. A convenience sample of 18 incarcerated women received doula services. A doula visited each woman in jail antepartum to review expectations for labor and birth; during hospitalization, the doula provided continuous support throughout labor and birth. Doulas visited women postpartum to review birth events. Surveys administered to providers and officers demonstrated high satisfaction with the program. Qualitative interviews with 14 women indicated unanimous support for the services and documented women's major concerns. Findings support offering doula services to all pregnant women in custody and expanding doula services to include early and comprehensive intervention coordinated by nurses.

Female↗
PubMed1993

Evaluation of the noncognitive professional traits of medical students.

BACKGROUND: Professional attributes such as honesty, integrity, and reliability are critical to success in medical school and postgraduate practice, yet such noncognitive attributes have traditionally been poorly evaluated. METHOD: A program of evaluating students' noncognitive professional attributes at the University of New Mexico School of Medicine was reviewed over a four-year period, from 1987-88 through 1990-91, involving the approximately 525 students enrolled at the school at that time. The evaluation program enabled faculty and staff to quantify their impressions of problem students in a uniform manner, by using an evaluation form that listed and described seven basic professional traits. RESULTS: Over the study years the program identified ten students with difficulties in the basic science and clinical years regarding their character and professionalism. For these ten students, interventions ranged from nothing being done, in one case, to such significant remediations as recommendations of extensive counseling and a leave of absence. One student was dismissed, on the basis of poor academic performance, and the other nine have graduated. In some cases, students noticeably improved their professional behaviors, but whether their behaviors changed as a result of the interventions can't be determined. CONCLUSION: By identifying and tracking students with difficulties, the program offers the opportunity for intervention and, ideally, remediation. This program can complement systems that evaluate academic performance. Such a program can help an institution assure not only the cognitive competence of its graduates, but the competence of their professional behaviors as well.

Character↗
PubMedDate not supplied

Surgical careers and preparedness of graduating residents--an outcomes-based study.

PURPOSE: Outcome-based measures have recently become the focus of residency program evaluations. The ultimate outcome of a surgical training program is the successful development of surgical careers by its graduates. METHODS: We developed a survey that was sent to all residents completing our surgical residency from 1989 to 1999 in order to evaluate practice location, type of practice, practice mixture, additional training obtained after residency, Board certification, and membership in the American College (ACS) or other professional societies. Graduates were asked to report their impression of their residency education program's ability to prepare them for surgical practice as well as to give an overall opinion of their training using a scale of 10 (high) to 1 (low). Solicitations were also made for means to improve the training program. RESULTS: Of 32 graduates sent surveys, 30 responded (94%). A total of 29 of 30 responding graduates (97%) are active in surgery. A total of 26 of 30 graduates are in private or government practice, 3 of 30 are full-time academic, and 1 of 30 is completing fellowship training. A total of 13 of 30 (43%) immediately entered practice, whereas 17 of 30 (57%) received additional fellowship training. Board certification has been achieved by 24 graduates. A total of 17 of 30 (59%) are members of the ACS, and 24 of 30 (83%) are members of at least 1 regional or specialty society. The average score for practice preparedness was 8.35. Overall score for the residency program was 8.7. Specific graduate comments demonstrated a perceived need for additional vascular and oncology operative experience that led to changes in our program. These results demonstrate an overall high satisfaction with our training program by graduates over the past 10 years as well as high success rate as evidenced by successful surgical practices by 97% of our graduates. CONCLUSIONS: We believe this type of outcome information provides valuable feedback to programs with regard to planning and development based on the types of careers graduates choose as well as specific changes in curriculum based on perceived deficiencies.

Journal Article↗
PubMed1995

Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities.

Using the focus group methodology, data were gathered from the initial experiences of Missouri's four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.

Community-Institutional Relations↗
PubMedDate not supplied

Reporting medication errors through computerized medication administration.

The incidence of medication errors has risen dramatically during the last decade to an alarming number. Nurses report only 5% of significant errors, those considered life threatening. Little research has been done related to medication errors at the administration stage or reporting methods. The purpose of this study was to compare medication error rate per 1,000 doses administered before and after the implementation of a bar code medication administration system. The study was conducted on two medical-surgical units at a midwest government hospital 12 months both before and after the implementation of the Bar Code Medication Administration system. The medication error rate per 1,000 doses administered by a nurse after implementation of the Bar Code Medication Administration system showed an 18% increase. The results probably do not indicate an increase in medication errors but rather an increase in the number of medication errors reported. This research highlights problems with programs evaluating medication errors and new technology implementation. Evaluators must have accurate baseline data before implementation. Past research has shown that the medication error rate has been underreported. In contrast to a staff reporting system, the computerization of medication administration improves the reporting system by reporting all errors. Once a more accurate error rate is known, new technology can be created, evaluated, and refined to reduce medication errors.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

Gerontology coursework in undergraduate nursing programs in the United States: a regional study.

Because of the changing demographics, it is increasingly necessary for nurses to acquire competence in gerontology. In this article, the authors present the findings of a study investigating the extent to which undergraduate nursing programs in the United States include gerontology. Fifty-six undergraduate nursing programs in the United States were examined. In this study, course content and program curricula were examined to assess the extent to which programs include gerontological content, either integrated into other courses, or as required, stand-alone courses. The sample was randomly chosen from the Northeast, South, West and Midwest regions. All programs were accredited. More than 85% of programs evaluated did not require coursework in gerontology. The authors suggest that nurses are not being educated adequately to care for older adults.

Aged↗
PubMed2000

Evaluating aboriginal empowerment programs: the case of Family WellBeing.

OBJECTIVE: To evaluate the effectiveness of a Family WellBeing empowerment course. METHOD: A range of methods were used, including: theory-driven analysis of literature and project documentation; participant observation; and analysis of course participants' personal narratives against set empowerment criteria. RESULTS: Participation in the Family WellBeing course resulted in high levels of personal empowerment. The course enhanced participants' sense of self-worth, resilience, ability to reflect on root causes of problems and problem-solving ability, as well as belief in the mutability of the social environment. They were able to bring about modest, but significant, improvements in their general sense of wellbeing and those of the people around them in ways that were previously impossible. There was no evidence of organisational and community empowerment, such as stronger social networks and systems-level changes. DISCUSSION: The effectiveness of the Family WellBeing course shows the importance of resourcing Aboriginal people to develop their own programs that address trauma and other issues resulting from settler colonisation. CONCLUSIONS: The study highlights three lessons for the use of empowerment interventions to improve health conditions, particularly among socially disadvantaged groups: 1) A need to adopt an ecological approach that simultaneously addresses empowerment at multiple settings or levels. 2) A need to ensure that such programs reach a critical mass of the target group. 3) Policy-makers and practitioners need to take a longer-term approach to empowerment interventions, including properly resourced longitudinal studies to document and enhance the evidence base for such interventions.

Family Health↗
PubMed1998

Rationalizing decision-making through computer technology: a critical appraisal.

As human services become more complex and multifaceted, sound decision-making guiding the service delivery process becomes critical. Administrators and others view computer technology as a means to rationalize the decision-making process at all levels of organizational life. The Management Information System (MIS) and program evaluations are viewed as technologies particularly useful for enhancing the decision-making process through computer technology. The strengths and limitations of computer technology are discussed. Strategies for using computer technology responsibly are offered.

Data Collection↗
PubMedDate not supplied

Early detection is the key to successful treatment.

In the United States today, healthcare reform is prompting an increase in education, community awareness, and early detection, as well as a decrease in healthcare costs and days missed at work due to illness. A program like the HVE Program accomplishes all of these things. People are starting to take a more active role in their healthcare. The advantages and benefits of preventive and alternative medicine are now recognized as a way to lower the cost of healthcare and as a way to minimize the loss of human life via early detection and treatment of disease. Continuous improvement, support from hospital administration, dedication of staff members, and community participation have enabled the Heart and Vascular Evaluation Program to evolve into the valuable service it is today--and the kind of service that will lead us into the future of healthcare.

Aged↗
PubMed2002

How we implemented a service-learning elective.

This paper describes the process used to introduce a service-learning course into the medical curriculum at the University of Kentucky College of Medicine. The rationale for taking the initiative to begin such a project is outlined and curriculum planning considerations are reviewed, including how to identify project team members, choose community agency partners, develop the instructional plan, and define roles and responsibilities of the participants. The importance of understanding the philosophy of service learning and taking time for reflection are underscored. Also discussed are program evaluation issues and strategies are suggested for evaluating service learning, obtaining information relevant to the continuation of the project, and disseminating information about the service learning outcomes.

Community-Institutional Relations↗
PubMed2004

Effective collaboration enhances rural preceptorship training.

Preceptorship is a valuable strategy largely underestimated in its ability to influence nursing students' attitudes and beliefs about mental health nursing. As a model, it has the potential to influence nursing practice, enhance clinical learning, promote recruitment and retention, and generate a more collaborative approach for nursing student supervision. The relationship is usually for a fixed and limited timeframe where the preceptor inspires and supports the growth and development of the student nurse, and encourages role socialization into the profession (Morton-Cooper & Palmer 2000). The challenge for mental health services is to achieve success in the provision of effective preceptorship, ensure positive and rewarding clinical experiences for nursing students, and improve recruitment and retention rates for the service. These aims are substantially more difficult to achieve in the absence of quality education, training and support for preceptors. This paper describes the use of preceptorship training to address recruitment issues in a rural service, particularly the need for effective preceptorship at undergraduate level, which has been shown to have an impact on the willingness of new nursing graduates to enter the mental health nursing field. The design and delivery of the training programme is outlined, including details of the program evaluation and its subsequent impact on psychiatric nurses' approach to and practice of preceptorship. Finally, the broader issue of the value of training nurses in larger groups, enlisting a critical mass of preceptors within an individual mental health service, is discussed.

Community Mental Health Services↗
PubMed2006

Relationships between self-assessment skills, test performance, and demographic variables in psychiatry residents.

Some researchers have seen the capacity for self-assessment in trainees as a special skill, and some reports have concluded that this skill is positively and crucially correlated with academic competence. Thus, it is believed that those trainees who are most deficient in knowledge are least likely to be aware of their limitations. Other researchers have emphasized the impact of statistical regression and other technical considerations in the studies, which have led to these conclusions. Our study used a relative-ranking design to measure the accuracy of self-assessments of both strengths and weaknesses in psychiatry residents. We analyzed the relationships between indices of self-assessment accuracy and other resident characteristics, particularly current academic strength as measured by a standard test of psychiatric knowledge. A total of 56 residents in two general psychiatry programs evaluated their performance on the Psychiatry Resident in Training Examination by estimating the rank order of their scores in the 11 psychiatry subject areas. For each resident, actual examination results were then used to generate measures of the accuracy of the identification of strengths and weaknesses. Residents' identifications of their strengths and weaknesses were significantly more accurate than chance levels. Strengths and weaknesses were identified with roughly equal proficiency, and accuracy in these assessments was not correlated to any of the following variables: academic competence as measured by examination raw scores, postgraduate year, gender, international vs. American medical education, program membership, or age. Our results do not support the hypothesis that trainees who show the least academic mastery also make the most inaccurate self-assessments. In addition, we found no resident characteristics that accounted for variation in self-assessment accuracy.

Age Factors↗
PubMed1992

The role of the generalist in health administration education programs.

Health administration education programs frequently have at least one faculty member who is a nondisciplinary specialist in health services rather than a member of a mainline discipline such as economics, psychology, or sociology. Such personnel perform valuable functions in research areas requiring multidisciplinary teams and extensive knowledge about health services delivery. Policy analysis, planning, organizational analysis, and program evaluation are examples of research areas where the generalist can be of value. Generalists may have more knowledge of health services than other faculty and thus can insure that research findings are realistic. Second, the generalists' broad orientation is conducive to interdisciplinary research. Third, they often are well suited to lead research teams. And finally, generalists are often better equipped to explain how research findings are useful in the practice of health administration, thus increasing the relevance of health administration programs.

Faculty↗