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PubMed2005

Targeting sexually transmitted infections.

Nurses and other healthcare professionals working in the field of sexual health face significant challenges. The way that resources, which are allocated on the basis of the Choosing Health consultation, are used will have an impact on service modernisation and new opportunities for service delivery. But targets and the desire among PCTs to meet their LDPs must not compromise clinical quality, and robust mechanisms for clinical governance must be set in place. These should include: The education and training of all healthcare professionals, The development of effective pathways for referral to specialist GUM providers, Arrangements for ongoing supervision and support of clinical work undertaken in non GUM settings. For many patients, access to services and plurality of supply are of paramount importance. New technology is making different patterns of service delivery possible, as is better use and development of staff, particularly nurses. Nurses however must decide upon and, if necessary, develop nationally recognised specialist education in STIs that supports the development of skills and expertise from novice to expert. Whether this education should, and could, be delivered uni- or multiprofessionally is a matter for ongoing debate. What must be clarified however are the levels of competence achieved and their parity across professional groups. Ultimately, whether government targets are achievable remains to be seen. What is important is the fact that, by setting targets, the government has finally recognised STIs and GUM as health priorities.

Adolescent↗
PubMed1990

Self-scheduling: a unique staffing approach for a regional poison information center.

For optimal effectiveness, a regional poison information center (RPIC) must be operational 24 h daily, every day of the year. While the formula to calculate the number of full-time equivalents (FTE'S) needed to staff a shift at an RPIC is well known, the best method for successful estimation rotation of an RPIC's professional staff to attain adequate 24-h coverage remains a conundrum. For a 12-mo period, full and part-time Poison Information Specialists at an RPIC self-scheduled all of their work time. Each Specialist rotated 2 shifts (days/nights) or chose a steady off-shift (evenings or nights). On a rotation basis, a Poison Information Specialist schedule coordinator was assigned to "balance" each 4-week period of self-scheduled time. This eliminated inadequate staffing on any given shift. Self-scheduling of work time has impacted positively on staff morale, since it commits the ownership of scheduling to those directly affected by the outcome. Costly illness time has decreased by 23 d/y and administrative staff are able to expand the 10 h, once spent in developing weekly staff schedules, in other areas of productivity.

Humans↗
PubMedDate not supplied

A creative safety program.

Mandatory safety programs can be creative and fun using the instructional game approach. Games can be completed on the patient care unit when a free moment is available. Once the instructional games are developed, they can be used throughout the year to help the staff review safety policies, procedures, and standards.

Accident Prevention↗
PubMed1998

Remote area health service delivery in central Australia: primary health care and participatory management.

This paper provides a description of initiatives and changes made in remote primary healthcare service delivery in Central Australia. These changes included the introduction of an orientation and Aboriginal cultural awareness program, revising the recruitment process to include communities in staff selection, developing policies and protocols to support practice, and increasing support for remote area staff through managers being out and about in remote areas. The change from centralised management to an increasingly decentralised participatory management model, and involving local communities and local staff in decision making, was initiated early in the change process and continues to be of prime importance. After 5 years of intensive effort, it is clear that despite these initiatives sustainable change has been elusive and some problems remain. Further change and development is necessary. A number of new initiatives are described, including a Menzies School of Health Research project that examines structural issues, which will provide direction for the future by providing better support for remote area staff and facilitating greater community participation.

Community Participation↗
PubMed1999

'It's not the same as him being at home': creating caring partnerships following nursing home placement.

Admission to a nursing home is a major life event for both older people and family carers. Despite a policy of community care in both the UK and the US, entry to nursing homes will be an increasingly common event. Family carers are often the key decision makers but little is known about their experience of placement, especially adjustment after the event. Antagonistic relationships can often develop between staff and relatives, as the former seek to take over care and the latter to develop new roles. There is a need to create a partnership between staff and family so that the care of the older person is improved and the carers' need to remain involved is acknowledged.

Aged↗
PubMed2000

Change counselling in diabetes: the development of a training programme for the diabetes team.

Skills in counselling for behaviour change may help staff working in diabetes care to facilitate self management in people with diabetes. A feasibility study was conducted to define the essential competencies (attitudes, knowledge and skills), training methods, and assess whether this approach was practicable in a diabetes resource centre. Semi structured interviews with staff were routinely conducted throughout the duration of the study. The findings suggest that the stages of change model, motivational interviewing and behavioural techniques are relevant to work in this area. Acquiring the competencies was harder to achieve than anticipated, though most were evident after one years training. The most valued training methods were individual supervision and video examples. However, the competencies were difficult to apply in the clinical setting given time constraints, the strength of existing staff routines and the patients' readiness to change. The lessons learned and suggestions for future work are presented.

Competency-Based Education↗
PubMed2003

Microsystems in health care: Part 9. Developing small clinical units to attain peak performance.

BACKGROUND: This last Microsystems in Health Care series article focuses on what it takes, in the short term and long term, for clinical microsystems--the small, functional, front-line units that provide the most health care to the most people--to attain peak performance. CASE STUDY: A case study featuring the intensive care nursery at Dartmouth-Hitchcock Medical Center illustrates the 10-year evolution of a clinical microsystem. Related evolutionary principles begin with the intention to excel, involve all the players, use measurement and feedback, and create a learning system. DISCUSSION: A microsystem's typical developmental journey toward excellence entails five stages of growth--awareness as an interdependent group with the capacity to make changes, connecting routine daily work to the high purpose of benefiting patients, responding successfully to strategic challenges, measuring the microsystem's performance as a system, and juggling improvements while taking care of patients. A MODEL CURRICULUM: Health system leaders can sponsor an action-learning program to catalyze development of clinical microsystems. A "green-belt curriculum" can help clinical staff members acquire the fundamental knowledge and skills that they will need to master if they are to increase their capacity to attain higher levels of performance; uses action-learning theory and sound education principles to provide the opportunity to learn, test, and gain some degree of mastery; and involves people in the challenging real work of improving.

Benchmarking↗
PubMed1980

Use of an information retrieval service in an obstetrics/gynecology residency program.

The need for a more effective and timely method of keeping a department's faculty and house staff knowledgeable of current developments and research is recognized. A program utilizing the clinical librarian as a member of the patient care team has been developed by the staff of the Department of Obstetrics and Gynecology and the Medical Library Department, UCLA Medical Center. The objectives, methodology, and costs of the program are described. At the completion of one year evaluation of the program indicates successful achievement of the objectives. Utilization of library literature search services by the Department of Obstetrics and Gynecology increased 12 percent after the program initiation.

California↗
PubMed1998

Strategies for improving teaching practices: a comprehensive approach to faculty development.

Medical school faculty members are being asked to assume new academic duties for which they have received no formal training. These include time-efficient ambulatory care teaching, case-based tutorials, and new computer-based instructional programs. In order to succeed at these new teaching tasks, faculty development is essential. It is a tool for improving the educational vitality of academic institutions through attention to the competencies needed by individual teachers, and to the institutional policies required to promote academic excellence. Over the past three decades, strategies to improve teaching have been influenced by the prevailing theories of learning and research on instruction, which are described. Research on these strategies suggests that workshops and students' ratings of instruction, coupled with consultation and intensive fellowships, are effective strategies for changing teachers' actions. A comprehensive faculty development program should be built upon (1) professional development (new faculty members should be oriented to the university and to their various faculty roles); (2) instructional development (all faculty members should have access to teaching-improvement workshops, peer coaching, mentoring, and/or consultations); (3) leadership development (academic programs depend upon effective leaders and well-designed curricula; these leaders should develop the skills of scholarship to effectively evaluate and advance medical education); (4) organizational development (empowering faculty members to excel in their roles as educators requires organizational policies and procedures that encourage and reward teaching and continual learning). Comprehensive faculty development, which is more important today than ever before, empowers faculty members to excel as educators and to create vibrant academic communities that value teaching and learning.

Ambulatory Care↗
PubMed2001

Lessons learned from a distance-based consulting program to assist faculty development projects.

Changes in faculty roles and demographics necessitate a re-examination of the types of professional development opportunities offered in academic institutions. A distance-based consulting program was designed to assist faculty development projects as they progress through all stages of faculty development: needs assessment, project design, implementation, and, in particular, program evaluation and dissemination of results (i.e., presentations and published articles). The progress of 17 faculty development projects in primary care educational sites that received assistance in the United States and Canada was tracked over two years. Three factors were identified as having the most impact on the success of faculty development projects: (1) funds committed to and designated for faculty development; (2) funded, protected time for at least one person to implement the faculty development initiative; and (3) an environment capable of supporting faculty development initiatives (e.g., no major budget shortfall, few faculty transitions, a strong mission, no threat of mergers). Only a few of the participating sites reached the stage of evaluating and publishing articles about the outcomes of their projects within the designated 15-month time frame, with many sites reporting environmental impediments to project success. The authors describe the institutional characteristics that facilitated project success, assess the usefulness of distance-based consulting efforts, and offer recommendations for future distance-based consulting programs. They conclude by noting that the personal touch (i.e., one-on-one contact with consultants) is what is most appreciated, and that excellent one-on-one, in-person assistance may be inherently more effective than even the best-run distance-based consulting.

Canada↗
PubMed2004

End-of-life education using the dramatic arts: the Wit educational initiative.

Caring for dying persons requires skill in interpersonal aspects of care, which may be difficult to teach using conventional educational methods. The Pulitzer Prize-winning play Wit relates the personal story of a patient dying from metastatic ovarian cancer and describes the protagonist's experience with medical care from diagnosis to death. Members of the Department of Medicine at the VA Greater Los Angeles Health care System and the David Geffen School of Medicine, UCLA developed a program that utilized Wit to educate medical students, residents, and staff providers in the humanistic elements of end-of-life care. Between February 2000 and January 2002 the Wit Educational Initiative organized on-site readings of Wit by local professional theatre companies at medical centers throughout the United States and Canada, inviting medical students, housestaff, and other providers to attend the play followed by structured discussions of the play's themes. The Initiative provided extensive support for potential program sites including publicity, providing a handbook with a step-by-step guide to organizing local programs, and feedback of postperformance survey results. The Initiative was successful in organizing performances at 32 out of 54 (59%) medical centers where a local production of Wit was identified. Survey respondents confirmed the appeal, emotional impact, and perceived relevance of drama in end-of-life education. An educational program using theatre to educate trainees in the humanistic aspects of end-of-life care was enthusiastically received by medical schools and rated highly by attendees.

Attitude of Health Personnel↗
PubMed2001

Assessing the professional development needs of public health professionals.

This article describes the major activities associated with designing and implementing a comprehensive, professional development needs assessment of public health professionals in four states of the South Central region of the United States. The instrumentation, research design, and summary results of the needs assessment described in this article may facilitate similar efforts by interested researchers and program developers to assess the public health professional workforce training needs. Results of needs assessments can be useful in designing and evaluating professional development curricula and activities to strengthen public health services in the United States.

Adult↗
PubMed1992

Consequences of the division of nursing labour for elderly patients in a continuing care setting.

Detailed analysis of nursing activity has suggested that unqualified nursing auxiliaries provide most of the direct patient care and one-to-one contact for elderly patients requiring continuing care. In order to investigate the effects of this division of labour on the quality of care received, a comparison of the content of nurses' verbal interaction with patients was made between qualified and unqualified staff. Content analysis of tape-recorded nurse-patient interaction revealed recurring types of nurse verbal behaviour and a framework for examining similarities/differences between qualified and unqualified staff was developed. Frequency counts for individual verbal behaviour types suggest some differences between staff grades, particularly in relation to verbal behaviours which attempt to increase the patients' control over their activities and environment. The difficulty of assessing the implications of the differential use of particular verbal strategies is discussed in relation to the absence of evidence to confirm patient outcomes in relation to different verbal techniques. Further research in this area is required.

Choice Behavior↗
PubMed2005

Web-based learning in professional development: experiences of Finnish nurse managers.

AIM: The aim of this article is to describe the nurse managers' expectations, attitudes and experiences on web-based learning before and after participation in a web-based course. BACKGROUND: Information technology has rapidly become more common in health care settings. However, little is known about nurse managers' experiences on web-based learning, although they have a crucial role in promoting the professional development of their staff. METHODS: Diagnostic assignments (n = 18) written before and interviews (n = 8) taken after the web-based education. The data were analysed by inductive content analysis. RESULTS: Nurse managers found web-based education to be a suitable and modern method of learning. On the basis of their experience they found multiple ways to utilize web-based learning environments in health care. Information technology skills, equipment, support and time were considered essential in web-based learning. Additionally, they found that their own experience might lead to more widespread implementation of web-based learning in health care settings. CONCLUSIONS: Information technology skills of nurse managers and staff need to be developed in order to use information technology effectively. In order to learn in a web-based environment, everyone needs the opportunity and access to required resources. Additionally, nurse managers' own experiences are important to promote wider utilization of web-based learning.

Education, Nursing, Continuing↗