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PubMed2006

Developing a partnership model for cancer screening with community-based organizations: the ACCESS breast cancer education and outreach project.

There is growing enthusiasm for community-academic partnerships to promote health in underserved communities. Drawing upon resources available at a comprehensive cancer center, we developed the ACCESS program to guide community based organizations through a flexible program planning process. Over a three-year period, ACCESS partnered with 67 agencies serving various medically underserved populations. Organizations included hospitals, parishes, senior centers, harm reduction programs, and recreational facilities. Program outcomes at the organizational level were quantified in terms of introduction of new cancer information, referral or screening programs, as well as organizational capacity building. ACCESS represents a viable model for promoting partnership to transfer behavioral health programs and adapt interventions for new audiences. Plans to further evaluate and enhance this model to promote cancer screening efforts are discussed. We argue that, ultimately, formation and development of community partnerships need to be understood as a fundamental area of practice that must be systematically integrated into the mission of major academic medical institutions in every area of public health.

Academic Medical Centers↗
PubMed2000

Intrapartum nursing care: a case study of supportive interventions and ethical conflicts.

BACKGROUND: Studies have shown that one-to-one labor support is associated with a reduced rate of operative births, and with long-term improvements of parenting and breastfeeding rates. Labor support by nurses may reduce the cesarean birth rate, but this has not been adequately studied. No one knows which labor support strategies nurses use, if they are effective, and how they work. METHODS: This pilot study used the qualitative techniques of observation and an audiotaped interview with an expert intrapartum nurse to describe labor support techniques and strategies to enhance labor progress and prevent cesarean births. RESULTS: The narrative revealed three major themes. The first theme, "the nurse's approaches to labor," included three subcategories: "following the mother's body," "hastening and controlling labor," and "labor support techniques." The second and third major themes, "ethical dilemmas: an unwilling partnership" and "nurse-physician conflict," were unanticipated. Labor support practices were limited by some physician practices. Inappropriate physician practice created ethical dilemmas for the nurse and impeded labor support interventions. CONCLUSIONS: Intrapartum nursing care reflected both a medical model of controlling and hastening birth, as well as a supportive, nurturing, and empowering model of practice that used independent clinical judgments and advocacy. Questionable medical care entangled the nurse in these practices and created moral dilemmas and nurse-physician conflicts. The nurse used various strategies to promote the wishes and welfare of the laboring mother.

Conflict, Psychological↗
PubMedDate not supplied

The Collaborative Evaluation Fellows Project. Background and overview of the model.

The Collaborative Evaluation Fellows Project (CEFP) of the American Cancer Society builds organizational capacity for evaluation by partnering with schools of public health to conduct local evaluation studies. This model was envisioned in response to the American Cancer Society's growing demand for program evaluation and the challenges of institutionalizing evaluation nationwide and at all levels of the organization. The CEFP also formalizes partnerships between the American Cancer Society and universities, and provides practical opportunities for public health graduate students and faculty. Working with an American Cancer Society evaluation facilitator and an advisory group, faculty and graduate students use a 15-step process to conduct evaluation studies at the local level. Students also can use these data for their master's these. The 15-step process is based on the utilization-focused evaluation approach and is designed to foster the use of evaluation findings by program stakeholders. The CEFP model has been implemented in American Cancer Society offices nationwide and has been replicated with another nonprofit health organization.

Cooperative Behavior↗
PubMed2003

An evaluation of personal medical services: the times they are a changin'.

The Personal Medical Services (PMS) pilot sites, launched in England in 1997 by the Secretary of State for the then Conservative government, introduced a local contract for primary care, aimed at promoting flexibility, innovation and policy participation. As part of the National Evaluation of PMS, this paper considers the professional and organisational relationships established between service providers working in those PMS sites which specifically set out to address inequalities in access to primary care for vulnerable populations. The introduction of PMS enabled a change of cultural values in primary care, particularly regarding GPs' relationships with nurses and practice staff. However, PMS has not necessarily led to equal partnerships within primary care teams. Rather,in the selected sites evaluated new interprofessional relationships emerged. There was evidence of intra and interprofessional partnerships being forged, providing the basis for further improved intersectoral collaboration. There was also evidence that the GP based medical model made way for a community oriented/public health model with emphasis on health maintenance for the vulnerable.

Cooperative Behavior↗
PubMed2003

A comparative study of Chinese, American and Japanese nurses' perceptions of ethical role responsibilities.

This article reports a survey of nurses in different cultural settings to reveal their perceptions of ethical role responsibilities relevant to nursing practice. Drawing on the Confucian theory of ethics, the first section attempts to understand nursing ethics in the context of multiple role relationships. The second section reports the administration of the Role Responsibilities Questionnaire (RRQ) to a sample of nurses in China (n = 413), the USA (n = 163), and Japan (n = 667). Multidimensional preference analysis revealed the patterns of rankings given by the nurses to the statements they considered as important ethical responsibilities. The Chinese nurses were more virtue based in their perception of ethical responsibilities, the American nurses were more principle based, and the Japanese nurses were more care based. The findings indicate that the RRQ is a sensitive instrument for outlining the embedded sociocultural factors that influence nurses' perceptions of ethical responsibilities in the realities of nursing practice. This study could be important in the fostering of partnerships in international nursing ethics.

Adult↗
PubMedDate not supplied

Development, implementation, and evaluation of a geriatric nurse education program.

Substantial gaps exist between the number of older adults requiring competent geriatric care and the number of nurses able to provide it. The purpose of this study was to develop, implement, and evaluate a geriatric nurse education program to ensure nurses meet the needs of the increasing elderly population. Establishing partnerships between individuals in academia and those in a clinical practice was imperative in the development of the program. Content for the program was created with the assistance of a geriatric nursing consultant and approved by the State Nurses Association. The program was piloted with 18 participating nurses. Using paired ttests, pretests and posttests revealed significant improvements in the level of knowledge and attitudes toward older adults. As a result of the program, participants showed improved attitudes toward and increased knowledge of older adults' needs, and further program development and dissemination are planned nationally and abroad.

Aged↗
PubMed2002

Development of guidelines for non-indigenous people undertaking research among the indigenous population of north-east Victoria.

The Department of Rural Health, University of Melbourne, has developed a framework for conducting research in partnership with Indigenous communities. The framework addresses past inappropriate research practices, incorporates cultural understandings, and outlines culturally appropriate protocols. The four parts of the framework are a committee to initiate, direct and oversee all research projects; a Koorie Team to guide research; a set of research guidelines; and a policy for the department. The framework has been used to develop strong relations with Koorie communities and conduct various health projects.

Ethics, Clinical↗
PubMed2001

Using a transcultural, patient based approach to improve patient outcome in a pediatric ESRD patient.

In this case, the medical team learned about the Hmong cultural beliefs and collaborated with the family to design a plan of care that included their nonwestern medical practices. Improved health care for the child resulted from a partnership between the Hmong community, extended family members, cross-cultural nursing staff, and the nephrology team. This experience amended existing protocols for managing diverse populations and because of its success, the pediatric nephrology team was awarded the UCSD Healthcare Diversity Award in 1998.

Adaptation, Psychological↗
PubMed2002

Kids in cars: closing gaps in child occupant restraint laws.

This article provides background on the latest research and findings related to child occupant restraint laws; highlights recent and proposed legislation mandating child occupant restraints, along with strategies and partnerships leading to the adoption of the legislation; and identifies practical steps that elected officials and public health practitioners can take to adapt and replicate those strategies and policies in their states and communities.

Accidents, Traffic↗
PubMedDate not supplied

Return on investment in pay for performance: a diabetes case study.

With purchasers' increasing frustration with healthcare costs, more innovative approaches to performance-based reimbursement are in demand. Establishing pay-for-performance programs has become a popular strategy for reorienting payments from rewarding volume to rewarding adherence to performance measures. However, while performance on quality measures has improved, no reports exist about the return on investment (ROI) of pay-for-performance programs. This article compares the overall costs of implementing and maintaining a pay-for-performance program with the resulting cost trend savings for diabetes care for a health maintenance organization's (HMO's) population. The program was a five-year partnership (2000-2004) between a health plan and an independent practice association (IPA) for the HMO product. It reported performance scores on quality, patient satisfaction, and practitioner efficiency at the individual physician level. Physician performance reporting began in 1999, and payment for that performance began in 2002. The cost of the program was 1,150,000 dollars yearly. Savings for diabetes alone in 2003, the first post-intervention year, were 1,894,471dollars. Second-year (2004) savings against the two-year rolling trend were 2,923,761 dollars. For 2003, the resulting ROI was 1.6:1, and for 2004, it was 2.5:1. To our knowledge, this article is the first report of a positive ROI for an HMO-based pay-for-performance program, and it begins to answer the question of whether the investment in such programs is worth the effort.

Cost-Benefit Analysis↗
PubMed1984

Vice-president of medicine/vice-president of nursing. Collaboration or conflict?

In the current environment of Diagnosis Related Groups and competition for the health care market share, there is a significant increase of vice-president of medical affairs or medical director positions on the hospital management team. This partnership is seen as vital for the survival of private practice physicians and hospitals. What does the addition of this role mean to the nursing administrator? What is the likelihood of a confusion of responsibilities between the vice-president of nursing and the vice-president of medical affairs or medical director? What involvement should the vice-president of nursing have in the vice-president of medical affairs or medical director's job description? These are some of the questions discussed in this article.

Administrative Personnel↗
PubMed1995

Pioneers of professional practice: an interview with a CRNA. Interview by Sister Sarah Bertler.

Developing professional interdependence is imperative to ensuring clinical outcomes for patients as well as outcomes within the structure of the integrated health care models where advanced practice nurses (APNs) will provide care. Defining roles and building partnerships that are based on trust and result in synergy provide both challenges and opportunities critical to the future success of care providers in integrated health care models.

Humans↗
PubMedDate not supplied

Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice.

:Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.

Clinical Competence↗
PubMed2005

Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine.

BACKGROUND: Evidence-based behavioral medicine (EBBM) aims to improve the process through which best scientific research evidence can be obtained and translated into best clinical decisions regarding behavioral treatments to improve health. PURPOSE: The objective was to examine some legitimate concerns raised by both clinicians and researchers about the evidence-based movement. METHODS: This article begins with a discussion of clinicians' fears that EBBM devalues clinical judgment and the therapist-patient relationship, will be used to restrict practice, is unnecessary, and is based on research that is irrelevant to clinical decision making. Next we consider researchers' worries that EBBM neglects evidence not based on randomized controlled trials and ignores causal mechanisms. RESULTS: We find that these fears, although understandable, largely reflect misinterpretations of the evidence-based movement. Further, it is suggested that behavioral medicine is in a unique position to enhance the evidence-based movement by encouraging increased attention to treatment mechanisms and to knowledge translation. CONCLUSIONS: Clinicians, researchers, and, importantly, the public will benefit from the evidence-based movement by having a health care system that is built on solid grounds of evidence in determining which treatments should constitute the standard of care. A full partnership between clinicians and researchers is called for to generate the practical, rigorous evidence base needed to take behavioral health treatments to the next level of scientific support and implementation.

Attitude of Health Personnel↗
PubMed2002

GP recruitment and retention: a qualitative analysis of doctors' comments about training for and working in general practice.

BACKGROUND AND AIMS: General practice in the UK is experiencing difficulty with medical staff recruitment and retention, with reduced numbers choosing careers in general practice or entering principalships, and increases in less-than-full-time working, career breaks, early retirement and locum employment. Information is scarce about the reasons for these changes and factors that could increase recruitment and retention. The UK Medical Careers Research Group (UKMCRG) regularly surveys cohorts of UK medical graduates to determine their career choices and progression. We also invite written comments from respondents about their careers and the factors that influence them. Most respondents report high levels of job satisfaction. A noteworthy minority, however, make critical comments about general practice. Although their views may not represent those of all general practitioners (GPs), they nonetheless indicate a range of concerns that deserve to be understood. This paper reports on respondents' comments about general practice. ANALYSIS OF DOCTORS' COMMENTS: Training Greater exposure to general practice at undergraduate level could help to promote general practice careers and better inform career decisions. Postgraduate general practice training in hospital-based posts was seen as poor quality, irrelevant and run as if it were of secondary importance to service commitments. In contrast, general practice-based postgraduate training was widely praised for good formal teaching that met educational needs. The quality of vocational training was dependent upon the skills and enthusiasm of individual trainers. Recruitment problems Perceived deterrents to choosing general practice were its portrayal, by some hospital-based teachers, as a second class career compared to hospital medicine, and a perception of low morale amongst current GPs. The choice of a career in general practice was commonly made for lifestyle reasons rather than professional aspirations. Some GPs had encountered difficulties in obtaining posts in general practice suited to their needs, while others perceived discrimination. Newly qualified GPs often sought work as non-principals because they felt too inexperienced for partnership or because their domestic situation prevented them from settling in a particular area. Changes to general practice The 1990 National Health Service (NHS) reforms were largely viewed unfavourably, partly because they had led to a substantial increase in GPs' workloads that was compounded by growing public expectations, and partly because the two-tier system of fund-holding was considered unfair. Fund-holding and, more recently, GP commissioning threatened the GP's role as patient advocate by shifting the responsibility for rationing of health care from government to GPs. Some concerns were also expressed about the introduction of primary care groups (PCGs) and trusts (PCTs). Together, increased workload and the continual process of change had, for some, resulted in work-related stress, low morale, reduced job satisfaction and quality of life. These problems had been partially alleviated by the formation of GP co-operatives. Retention difficulties Loss of GPs' time from the NHS workforce occurs in four ways: reduced working hours, temporary career breaks, leaving the NHS to work elsewhere and early retirement. Child rearing and a desire to pursue interests outside medicine were cited as reasons for seeking shorter working hours or career breaks. A desire to reduce pressure of work was a common reason for seeking shorter working hours, taking career breaks, early retirement or leaving NHS general practice. Other reasons for leaving NHS general practice, temporarily or permanently, were difficulty in finding a GP post suited to individual needs and a desire to work abroad. CONCLUSIONS: A cultural change amongst medical educationalists is needed to promote general practice as a career choice that is equally attractive as hospital practice. The introduction of Pre-Registration House Officer (PRHO) placements in general practice and improved flexibility of GP vocational training schemes, together with plans to improve the quality of Senior House Officer (SHO) training in the future, are welcome developments and should address some of the concerns about poor quality GP training raised by our respondents. The reluctance of newly qualified GPs to enter principalships, and the increasing demand from experienced GPs for less-than-full-time work, indicates a need for a greater variety of contractual arrangements to reflect doctors' desires for more flexible patterns of working in general practice.

Attitude of Health Personnel↗
PubMed2002

[General practitioners' practices and attitudes in regard to suicidal behavior].

As demonstrated at the recent Consensus Conference on the "suicidal crisis" held by the French Psychiatry Union and the National Agency for the Accreditation and the Evaluation of Care, suicide is recognised as a current public health problem. The general practitioner's role is situated on two levels: in a preliminary stage, the early identification of risk, and in a secondary stage, the provision of care at the time of a suicide attempt and then the provision of on-going follow-up care in partnership with other special services. The study aimed at evaluating general practitioners' practices when encountered with suicidal patients and assessing their management of suicidal behaviour, as well as difficulties met and their expectations. Responses to a questionnaire were received from 290 general practitioners in one regional department in France. The results revealed that two-thirds of the respondents considered the identification of suicidal tendencies as being difficult, in particular with regard to the detection of young people at risk. General hospitals are the most common structures where patients are referred to in the event of a suicide attempt, as a facility that is permanently open and capable of delivering ambulatory care. A majority of the general practitioners expressed the need for training which was focused on methods for the early identification of risk as well as the development of listening skills.

Aftercare↗
PubMedDate not supplied

Community health nursing education: where we are going and how to get there.

This article discusses practical aspects of providing community health nursing (CHN) education in community-based care in partnership with a community. Changing from traditional CHN clinicals to more current models involves a shift in values and implementation of principles leading to the change. These values are: refocusing the purpose of CHN education; broad (generalist) scope of practice; problem-solving as a means of discovery; collaboration with peers, faculty, community, and service providers; and working to empower individuals, families, and the community, as well as the students themselves. Principles for developing community-based educational programs in partnership with a community are: examining and incorporating critical concepts; identifying community needs and basing activities on these needs; providing services as a means of studying the community and its problems/needs; expanding and refining services based on problems/needs and assets of the community; and maintaining services based on problems/needs and assets of the community. Each principle is discussed in a process and application format.

Community Health Nursing↗