Experience and hopes for telehealth in Tokelau

The two key factors affecting healthcare in Tokelau are its small population and its great isolation. Both of these make telehealth a critical issue for the development of health services and it is hard to see how the services can develop to a modern standard without a larger component of telemedicine. The Tokelau islands consist of three roughly equal atolls usually served by 1-2 doctors who deal with all aspects of medical care. There is a small hospital on each atoll and each is staffed by a Nurse manager, two staff nurses and some nurse aides. There is a need for a communication facility for the nurse on the atoll(s) without a doctor to consult with a doctor about medical cases; doctors to consult each other; and for doctors to consult outside specialists about the management of cases. Distance education for health care staff is another perceived need. The current communications systems are still basic and although there is a PeaceSat terminal on each atoll it has largely failed to provide the above communication needs and most is still done by the costly telephone system. Recently ITC has been made a priority for the health department.     

护理不良事件管理实践

建立护理不良事件电子上报系统,明确事件定义、分类及分级标准,严格按要求进行事件上报、分析与审核,实施护士—护士长—护理部的扁平化管理及主动上报零惩罚策略,使护理人员主动上报护理不良事件,方便了管理者对不良事件的实时监控,有利于护理质量持续改进。     

Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.     

Training needs of staff in Romanian institutions for young children

Summary In order to make adequate provision for staffing and staff training in leagane (long-term residential care institutions for preschool age children in Romania) a postal survey was conducted in the autumn of 1991 to ascertain the demographic characteristics, job titles and educational attainment of directors and staff, staffing needs and the kinds of positions currently filled, the numbers of directors and staff exposed to continuing education programmes within the last 2 years, and the opinions of directors and staff regarding their most important continuing educational needs.
The bulk of the direct care workforce was less than 50 years old. Thirty-four per cent of the direct care staff had less than a high-school education. Sixty-seven per cent of the staff were health professionals or health care workers. There were few psychologists, physical therapists, teachers or social workers.
In the last 2 years, directors and other physicians had been mostly exposed to courses in the areas of psycho-social care/management and paediatric medical care. Nurses had attended professional development courses. Infirmiera (nursing assistants) had also attended professional development courses such as those offered by foreign non-governmental organizations on the care of institutionalized children. Educators (teaching assistants) had attended courses in child development and rehabilitation. Directors and staff expressed clear opinions regarding their needs and preferences for additional training     

A force field evaluation tool for telephone service in ambulatory health care

The tool presented here is useful in analyzing the constraints and capabilities of a health care telephone service. It also provides a systematic method for assessing systems problems. As part of our analysis, we recommended that the manager implement the following steps. First, the manager determines whether the driving force on the unit is continuity of care by an individual provider or consistency of response. This focus directly affects how the unit's telephone service can be best organized (i.e., decentralized or centralized) and clarifies the factors most needed for success. For example, to function effectively and efficiently, a centralized phone service needs strong provider-endorsed protocols. Second, the manager should carefully examine neutral constraint factors to determine methods to transform these constraints into capabilities, such as planning for extra staff or office hours (or both) during influenza season. Planning for extra hours or staff depends largely on whether budget and resource planning is done in advance and whether value is placed on customer access and satisfaction during peak demand periods. The manager must next determine whether the service delivery format (centralized or decentralized) is consistent with the force field analysis findings. If the findings are not consistent, can the analysis present a compelling argument for using the opposite approach? Finally, the manager must create a plan of action for minimizing the constraints revealed and maximizing existing capabilities to achieve the overall goal of excellent phone service. The process of analysis and creating a plan of action is an excellent opportunity to involve staff, providers, and administrators in efforts to achieve better health care telephone service for all customers.     

Hospital system works to ensure risk management, quality of care

A health care corporation that includes several hospitals and other related health services conducts a wide variety of institutional and corporate activities and programs of risk management and quality assurance. Some of these efforts include board review of medical staff organization and privileges, medical and nursing audits, patient care evaluation, a risk manager and steering committee, patient education, equipment maintenance, and safety programs.     

Achieving cardiovascular health through continuing interprofessional development

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.     

绵阳市社区护理人员培养需求分析及对策研究

目的 了解绵阳市社区护理人员岗位培训需求,为卫生主管部门制定人才继续培养计划提供参考.方法 采用整群便利抽样,对参与培训的绵阳市38家社区卫生服务中心的295名社区护理人员培养需求进行问卷调查.结果 90.8％护理人员希望通过网络快速获取培训知识,68.5％建议三级医院免费提供进修名额.结论 建立区域化社区卫生护理人才培养组织,需要护理学会及卫生行政部门重视,畅通培训渠道,提供对口帮扶,并建立多元化社区护理人才培训体系.     

“互联网＋”形势下延续护理开展形式与展望

随着“互联网＋”的不断深入发展,对医院越来越重要的延续护理,通过开展各种形式,如电话回访,科室网站开辟护理专栏,不定期地组织患者参加专病义诊联谊活动,以及建立基于网络平台的健康教育等,使更多患者受益,受众面越来越广,同时有助于满足其多样化、多层次的健康需求。     

高校医疗保健机构运行中面临的新问题

本文介绍了近年来高校医疗保健机构在功能定位、运行机制上面临的新问题,提出应根据国家对高校卫生工作要求和学校实际,树立科学、发展、客观的高校卫生工作定位观,重点做好预防保健和医疗工作,确保师生健康;协调处理好教育行政部门、卫生部门、属地化管理等各方面关系,切实解决高校医疗保健机构管理中的突出问题,以促进高校卫生工作的健康发展。     

高校医疗保健机构运行中面临的新问题

本文介绍了近年来高校医疗保健机构在功能定位、运行机制上面临的新问题，提出应根据国家对高校卫生工作要求和学校实际，树立科学、发展、客观的高校卫生工作定位观，重点做好预防保健和医疗工作，确保师生健康；协调处理好教育行政部门、卫生部门、属地化管理等各方面关系，切实解决高校医疗保健机构管理中的突出问题，以促进高校卫生工作的健康发展。     

The continuing care retirement community executive: a manager for all seasons

The continuing care retirement community industry is a growing source of residential and health care services for the elderly population. It is also a relatively new and expanding career path for both health care and hospitality managers. Using in-depth interviews with executives in a sample of 26 communities, this study provides one of the most complete portraits to date of the nature of managing these communities. The findings indicate that these organizations are complex and multifaceted, demanding versatile skills and abilities. Most critical are those skills that enable a manager to interact effectively with residents and staff to build and maintain a hospitable, accommodating community environment. As competition in the industry intensifies, community viability may become synonymous with customer satisfaction. Management training and development will need to be highly attentive to the distinctive features of these intriguing organizations.     

广东省中医医院管理人员继续教育需求的调查分析

目的了解广东省中医医院管理人员继续教育的需求,为医院制定切实可行的继续教育方案提供依据。方法采用问卷调查法,对广东省20余家中医医院的管理人员进行调查并作结果分析。结果 95.5%的管理人员对参加继续教育培训表示赞同,在对继续教育项目调查中,对管理基础知识和管理应用技能方面的需求最大;对培训方式则偏重于观摩进修、项目实训和课程教授、学位培养;授课老师则更倾向相关专业的专家或教授和具有管理经验的成功人士;在对继续教育项目激励约束机制这一项的调查中,35.4%的管理人员选择与岗位资格挂钩,24.1%的人偏向于与职称评聘挂钩。结论绝大部分管理人员对继续教育的态度是积极的,在设定继续教育方案时应充分考虑各类管理人员的不同需求,合理安排课程内容、培训方式和授课老师,制定好相关的激励约束机制,以提高继续教育的效果,共同提高广东省中医医院整体管理水平。     

Barriers to Providing Health Education During Primary Care Visits at Community Health Centers: Clinical Staff Insights

The rapid increase of diverse patients living in the US has created a different set of needs in healthcare, with the persistence of health disparities continuing to challenge the current system. Chronic disease management has been discussed as a way to improve health outcomes, with quality patient education being a key component. Using a community based participatory research framework, this study utilized a web-based survey and explored clinical staff perceptions of barriers to providing patient education during primary care visits. With a response rate of nearly 42 %, appointment time allotment seemed to be one of the most critical factors related to the delivery of health education and should be considered key. The importance of team-based care and staff training were also significant. Various suggestions were made in order to improve the delivery of quality patient education at community health centers located in underserved areas.     

Primary health care delivery and public health departments: a model and simulation

Describes development of a computer simulated design of primary care service delivery within a complex organization. Data for the model was obtained by interview, from financial records, patient charts, personnel files, and by questionnaire. The design regards primary health care need as a variable dependent on population characteristics and disease incidence rates, with delivery of care being determined by community needs. By extension of this line of thought, the most appropriate organizational design for the institution must necessarily be based on the specific environment in which it operates. The model and the simulation of primary health care activity in a health department supported the hypothesis that staff assignment is a function of community need for the service, and is also a function of the resources available. Changes in lag time for feedback regarding goal attainment did not produce any changes in performance, and political support was not found to be directly related to staffing of a particular program. An important conclusion to be drawn from this research is that resource administration and allocation requires skills in community diagnosis and internal management which health administrators would do well to include in their education.     

Management of pain in older people within the nursing home: a preliminary study

The provision of continuing care for older people has largely shifted from the hospital setting to the community, and nursing homes increasingly provide support for older people, many of whom exhibit multiple pathology and complex health and social care needs. However, the quality of pain management within this setting has been identified as an issue of concern. It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%. However, there exist a number of barriers to the identification and management of chronic pain among older people resident in nursing homes, including sensory impairments in older people themselves and educational deficits among professionals. Such barriers need to be overcome if pain management is to be improved. The present study involved administering a pre-piloted postal questionnaire to the managers of 121 nursing homes within a geographically defined area. Sixty-eight (56%) were completed and returned. The questionnaire broadly covered the following: prevalence of chronic pain and use of interventions; assessment and management strategies; education and training; and communication barriers. Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain (pain lasting longer than 3 months not caused by cancer) and 2% were reported as experiencing chronic malignant pain (pain lasting for more than 3 months caused by cancer). Paracetamol was identified as the most 'often' used analgesia for both pain modalities. Sixty-nine per cent of nursing homes did not have a written policy regarding pain management and 75% did not use a standardised pain assessment tool. Forty-four per cent of nursing homes provided education or training sessions for qualified staff and 34% provided this for care assistants. Forty per cent of qualified staff and 85% of care assistants had no specialist knowledge regarding the management of pain in older people. The present study confirms the need for the development of effective pain management strategies underpinned by appropriate training and education in order to meet the particular needs of older people.     

Improving School Nursing Practice in South Carolina Through Continuing Education

ABSTRACT: School nurses often provide direct health care to school-age children, and thus need a range of knowledge and skills to meet the needs of less healthy children, as well as healthy children. To meet this challenge in South Carolina, a statewide continuing education program with didactic and school-based clinical instruction was implemented to enhance the scope of school nurse practice. The physical, psychosocial, and environmental health dimensions of the school nurse's role improved significantly when the program ended at nine months and were maintained at 18 months follow-up. However, program management skills did not improve. Practice guidelines indicate continuing education can improve practice in areas under direct control of the school nurse. Focus on development of program management skills is called for in continuing education. Redefinition of this aspect is crucial to full development of the school nurse role and improved health for school-age children.     

Needs assessment for health care management education in Russia

INTRODUCTION: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist with health care management in Russia, we analyzed health care providers' educational needs, as they perceive them. METHODS: A total of 4, 367 questionnaires were sent to practicing physicians and physician-executives in 3 regions of the Russian Federation. The questionnaires included 14 items designed to determine respondents' current levels of satisfaction and preferences for health care management education in Russia. RESULTS: There were 847 questionnaires returned, for a total response rate of 19.4%. Physicians were dissatisfied with the current status of health care management education, but they were interested in learning the skills of health care management. The health care legal system and computer systems and data analysis were the most popular courses requested; health care management and marketing were the least popular. Learning interests of executives differed from those of practicing physicians, and regions differed in their combined interests for courses. Medical school and continuing education departments were seen as the best choices for delivering health care management education. DISCUSSION: As health care policy shifts in new directions, physicians in leadership positions expect Russian medical schools and continuing education departments to provide courses that enable improvements in health care.     

The effects of appreciative inquiry interviews on staff in the U.K. National Health Service

PURPOSE: To obtain preliminary data on the short- and medium-term effects and personal acceptability of appreciative inquiry (AI) in staff development in health care. DESIGN/METHODOLOGY/APPROACH: AI is a non-problem-solving management approach focusing on developing current successes into the future through reflection at individual and group level. Individual one-hour interviews were undertaken with nursing staff on a national paediatric liver in-patient ward. They were asked to recount stories based on their experiences of successful delivery of health care, with active listening, followed by reflection on the process. A total of 32 staff members took part with only two refusals. Data were written and analysed by an open coding method. Follow up was obtained two years later using a written, open question method. FINDINGS: The process was emotional-but well received. Staff described quality in interpersonal interactions, preventing errors and engaging their personal values in their work. No improvement in recruitment or retention was shown but a high level of sickness absence fell significantly during the period of the project. Two years later, significant positive effects were recalled and attributed to the interviews by many respondents. AI appears a cost-effective way of connecting professionals' motivation toward quality in their work with strategic intentions. RESEARCH LIMITATIONS/IMPLICATIONS: The interviewer was a medical consultant and ward manager, implying either that the interviews could have worked as a form of managerial supervision or improvements could be a Hawthorne effect. Other unknown influences were likely to be occurring on the ward during the study period. PRACTICAL IMPLICATIONS: Short AI interventions on an individual basis can change sickness absence, at least while the interventions are continuing. It is an important tool for staff motivation with the potential for connecting strategic with micro-operational levels. AI is an approach to NHS management with wide application including appraisal, personal development and mentoring. It can be a positive introduction to reflective practice. ORIGINALITY/VALUE: AI is gaining recognition for its value in staff and service development in health care. The paper shows service and personal effects, cost-effectiveness and illustrates how to use AI for these purposes.     

Participant evaluation and cost of a community-based health promotion program for elders.

There is little information on how best to provide health promotion and disease prevention services to elderly persons. This paper reports participants' perceptions of the effectiveness of a health promotion program consisting of health education classes and case management services. A single-group, posttest only design was used for the county-wide program, which operated independent of participants' primary care physicians. Each person received a thorough screening evaluation, was invited to health education classes, and was assigned a case manager for a 2-year health promotion period. Community residents 64-71 years of age were recruited; 475 entered the study, and 378 (79.6 percent) completed the followup evaluation interview. Only one-third of the participants attended at least one class, but a majority of those attending each class rated it very or extremely effective in increasing knowledge. To determine the effectiveness of the case managers, each participant identified the three health problems that were of greatest concern to him or her and indicated which of these priority problems were discussed with the case manager. Discussion with the case manager was significantly associated with continuing to see a personal physician for the problem, following the physician's recommendations, the problem's being under control, and the problem's improving over the 2-year followup. The classes and case management services benefited the participants who used them. How to best deliver these services to the target group needs further study.