Integrated continence services and the female Bangladeshi population

Continence services should be developed to cater for the needs of the entire population, including those of ethnic minority groups. This study undertook focus groups and meetings with the local Bangladeshi community and with local GPs to assess the needs for continence care provision and to assess current understanding of the problem in this community. The aim was to identify appropriate models for provision of care. METHOD: Questionnaires were devised which related to access to services for bowel and bladder problems for women and GPs. Focus groups which people's views and suggestions on improving service accessibility were ascertained. RESULTS: A 50% return was achieved for the GP questionnaire. GPs did not routinely enquire about bladder and bowel function and did not feel that Bangladeshi women needed any different service to that in the white population. The majority of the women in the focus groups considered bladder weakness as a loss of self-control, and emphasized the major impact on everyday life. There was little awareness of available services. CONCLUSION: Despite the cultural differences this study found that women tended to accept their bladder problem; did not consider it important enough to discuss with their doctor (who may also not take the problem seriously) and considered bladder problems as a normal part of womanhood or ageing.     

A comparison of senior nurses and managers views on the development of mental health services in NHS trusts in London

Aims  To assess how lead nurses and senior managers of mental health services differed in their views concerning the drivers and barriers to service development in London.
Background  Since 1997, London managers in Mental Health have been surveyed to assess their views about the drivers and barriers to service development ( Peck et al . 1997 ). Under clinical governance, nurses are likely to have an enhanced decision‐making role. Therefore, in 1998, lead nurses were included in the study to identify differences in views.
Methods Lead nurses and senior managers of mental health services in Trusts in the London area were sent self‐administered questionnaire. Only if responses were obtained from the lead nurse and senior manager in the Trust were they included in the current analysis.
Findings  Few differences were identified in the ratings of drivers and barriers to service development. Reasons why lead nurses and senior managers felt drivers and barriers were important differed: senior mangers focused on organizational‐wide development, lead nurses focused staff expertise and clinical issues.
Conclusion Although areas of potential conflict are revealed, these areas may also be complimentary. Lead nurses highlight issues of concern for the optimum clinical functioning of the Trust, allowing management to incorporate these concerns into strategic planning.     

Roles, service knowledge and priorities in the provision of palliative care: a postal survey of London GPs

OBJECTIVES: To explore general practitioners' (GPs) current involvement in and attitudes towards the provision of palliative care in primary care. METHODS: Postal survey of 356 London-based GPs, assessing attitudes towards palliative care provision, district nursing and specialist palliative care services, and priorities for future service development. RESULTS: Currently, 65% of GPs were providing palliative care to patients on their list; 72% agreed or strongly agreed palliative care was a central part of their role; and 27% wanted to hand care over to specialists. Most GPs (66%) disagreed with the statement that 'palliative care is mainly district nursing (DN) work'. Many were unaware of out-of-hours DN and specialist palliative care services. Multi-variable analysis found four GP characteristics--larger practice size, more years experience as a GP, receipt of palliative care education, and current provision of palliative care--were associated with agreement that palliative care was central to a GP's role. CONCLUSION: A minority of NHS GPs in London would rather have no involvement in palliative care in primary care. Knowledge of current services for palliative care is generally poor among GPs. These findings highlight potential gaps in services, particularly in small practices. Specialists will need to consider these factors in working with GPs to develop primary palliative care and to enable greater access to specialist palliative care.     

Mental Health Nurse Incentive Program: Facilitating physical health care for people with mental illness?

People with serious mental illness have increased rates of physical ill‐health and reduced contact with primary care services. In Australia, the Mental Health Nurse Incentive Program (MHNIP) was developed to facilitate access to mental health services. However, as a primary care service, the contribution to physical health care is worthy of consideration. Thirty‐eight nurses who were part of the MHNIP participated in a national survey of nurses working in mental health about physical health care. The survey invited nurses to report their views on the physical health of consumers and the regularity of physical health care they provide. Physical health‐care provision in collaboration with general practitioners (GPs) and other health‐care professionals was reported as common. The findings suggest that the MHNIP provides integrated care, where nurses and GPs work in collaboration, allowing enough time to discuss physical health or share physical health activities. Consumers of this service appeared to have good access to physical and mental health services, and nurses had access to primary care professionals to discuss consumers’ physical health and develop their clinical skills in the physical domain. The MHNIP has an important role in addressing physical health concerns, in addition to the mental health issues of people accessing this service.     

The experiences of teenagers and young adults with cancer--results of 2004 conference survey.

In 2004, 350 teenagers and young adults (TYAs) attended the third Find Your Sense of Tumour Conference for cancer patients. This provided a unique opportunity to survey a large group of patients regarding their cancer experience. Analysis of the results showed that delegates had both positive and negative experiences of the cancer journey and had clear views regarding service provision. The survey showed that the majority of TYAs with or who have had cancer would like to be treated on a specialist unit. There are currently 7 Teenage and Young Adult Units developed by Teenage Cancer Trust within the UK; however, a large number of patients do not have access to these specialist services. Despite the increased attention to TYA health needs there are still a number of issues relating to cancer services that need addressing as a matter of urgency in order to ensure that future patients receive a timely diagnosis, together with appropriate care that meets the specific needs of this unique client group.     

General practitioners' views of community mental health services: A survey in one London borough

Community mental health teams are increasingly focusing their activities on people with severe mental illnesses. At the same time, the overall extent of mental health need in primary care ensures general practitioners (GPs) remain key professionals in the co-ordination and provision of mental health services to a wide range of patients. This study sought to establish the views of GPs working in one London borough on community mental health services, and to establish what they believed were appropriate services for community mental health professionals to provide. A postal questionnaire sent to all 104 GPs working in the borough produced a 48% response rate. GPs believed community mental health teams were useful, and effective in dealing with patients presenting with a variety of mental health problems. Many believed that enhanced primary health care teams, adequately resourced and staffed with attached mental health professionals, could provide a wide range of mental health interventions. Dissatisfaction appeared to be related to the evolving focus of community mental health teams. Many GPs believed that they had lost a valuable service for people with less severe mental health needs.     

Effects of practice setting on GPs’ provision of care

Objective

To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications.

Design

A cross-sectional, retrospective study.

Setting

Province of Quebec.

Participants

All GPs in Quebec in 2002 who had been practising for at least 2 years.

Main outcome measures

Practice setting variables were based on physician income in the different settings. Service provision was assessed using indicators related to continuity, comprehensiveness, accessibility, and productivity of services provided by the GPs. A multiple correspondence analysis with ascending hierarchical classification was conducted to construct the taxonomy of GPs based on their practice settings.

Results

Our study produced 7 practice setting models. Two were essentially single-practice models. The 5 others combined several settings. Service provision varied from one model to another. Continuity was greater in the private practice model, in which older GPs were predominant, while accessibility was greater in multi-institutional practice models, in which younger GPs were more active.

Conclusion

To ensure balance between continuity, accessibility, and comprehensiveness in primary care services provided by GPs, it is important to consider the service provision associated with different practice models.     

Can services marketing concepts be applied to health care?

Aim: To generate thought and discussion regarding the application of key features of generic services which may influence management and marketing decisions in health care. Background: Health care, as many other services provides benefits to the consumer, the quality of which is largely dependent on the interpersonal element of the service delivery. Services now dominate the UK economy, and consumer participation in service delivery is as important in health care as in services in the private sector.
Background: Health care, as many other services provides benefits to the consumer, the quality of which is largely dependent on the interpersonal element of the service delivery. Services now dominate the UK economy, and consumer participation in service delivery is as important in health care as in services in the private sector.
Origins of information : There is now an established body of research on the nature of services and the particular management and marketing challenges posed by service provision. The application of general management concepts and tools to the public services is an area of current debate.
Key issues: The paper firstly discusses key features of services and their application to health care contexts. Secondly, a discussion of strategic classifications of services seeks to identify common themes which exist across the diverse service sector.
Conclusions: Nursing and midwifery managers have much to gain from understanding the use of services management frameworks, and have scope for much creativity in adapting generic frameworks for their own areas of practice.     

An examination of senior nursing roles: challenges for the NHS

Wellhouse NHS Trust moved its inpatient services to the new Barnet General Hospital in 1997 and merged with Chase Farm Hospital NHS Trust in 1999. To assist with the trust's management of resulting changes in care provision, a short project was conducted to examine the nursing services provided by ward managers (20) and senior nurses (27), that is nurses who undertake specialist/ advanced nursing practice. The project also aimed to present the views of the stakeholders (66) with regard to nursing in the trust and nurse-led services. The project involved two stages of data collection--focus groups and postal questionnaires. The project provided a great deal of information about the nursing service within the trust: a profile of the senior nurses, roles and responsibilities, skills and competencies, training and development, and support needs for their roles. The findings considered a number of issues: (i) employment--diversity of grading for posts; (ii) work roles--conflicts in role composition; (iii) stakeholders--perspectives of stakeholders on nursing. It is anticipated that the findings are not unique to the one trust and that they will contribute to the development of new clinical career pathways for senior nurses within the trust.     

Sustaining complementary therapy provision in primary care: lessons from existing services

OBJECTIVE: To examine factors which sustain complementary therapy services in primary care in order to inform policy making in a context of rapid change. DESIGN: In-depth qualitative case studies, including semi-structured interviews with key informants. SETTING: 10 existing schemes of complementary therapy provision in primary care across England. RESULTS: GPs and complementary practitioners reported wide-ranging benefits from complementary therapy provision in primary care. However, they felt that their ability to sustain complementary therapy provision was mediated by a) funding, b) the need for research, and c) appropriate service delivery mechanisms. a) Many schemes were the result of and sustained by personal vision. As such they had negotiated a variety of funding sources over a considerable period, against a background perception that continued funding was uncertain. b) Most informants believed that more research was needed to provide a solid evidence base for service continuation and development, in particular clinical and cost-effectiveness work. c) The manner of service delivery, notably whether a service was located within a general practice or in a referral centre, was seen as having implications for the integration of practitioners and for patient access to services. CONCLUSIONS: Current complementary therapy provision in primary care has developed on an 'ad hoc' basis. In particular, the existence of GP fundholding in the 1990s, in which primary care physicians were able to purchase health services on a practice basis, facilitated the development of services in this way. Within the current Primary Care Group context, where purchasing decisions are made collectively by a group of general practices within a region, consideration needs to be given to both the continuity of schemes already in existence and to whether a more standardized approach to service development will be required to facilitate sustainable provision.     

GP views of nurse-led telephone referral for paediatric assessment

Following the introduction of a new nurse-led telephone referral service to a dedicated paediatric emergency assessment unit (PEAU), a study was conducted to determine the views of general practitioners (GPs) who use the service. The PEAU operates between 10 am and 10 pm on weekdays and between 10 am and 6 pm at weekends. The unit has four beds and treatment and stabilization areas, plus associated services in a dedicated area of a regional child health unit. The design utilized a faxed questionnaire over a 1-month period to all consenting GPs using the PEAU with a postal questionnaire follow-up. Non-parametric Likert scores and qualitative data were used to determine levels of satisfaction with the service and the subsequent management of the referred children. Sixty-nine GPs referred 80 children to the PEAU via the service over a period of 1 month. All consented to participate and were sent a faxed questionnaire, which generated 39 (57%) responses. A follow-up questionnaire sent to the 39 respondents achieved a return of 25 (64%) responses. Thirty-four GPs agreed that referral via the dedicated nurse service was easier than the previous senior house officer referral system. Of the 25 GP respondents to the follow-up postal survey, the majority (17) agreed that the follow-up morning after discharge telephone call to parents by the PEAU nurses was helpful. Four GPs indicated that the 24-hour open access system, offered by the nursing staff, in which a parent may attend PEAU with a discharged child causing concern without a previous appointment, does not always work. This study has shown that a nurse-led telephone referral system to a PEAU for GPs and the subsequent management of the children has been favourably received.     

Bereaved carers' views of a hospice at home service

INTRODUCTION: In recent years, there has been an increase in specialist palliative care services in the home. Despite this, there have been relatively few published evaluations of such care. METHODS: This is a qualitative study which used semistructured interviews to explore bereaved carers' views and experiences of a hospice at home (HAH) service in the East Midlands, UK. Eleven interviews were conducted and analysis followed the framework approach. RESULTS: Carers' views were divided into four themes: caring for someone at home; formal care provided by HAH; access to out-of-hours care; and provision of specialist equipment. CONCLUSIONS: Bereaved carers generally gave very positive accounts on care delivered by the HAH service. Shortcomings identified were the provision of out-of-hours care and the untimely supply and removal of specialist equipment. It is suggested that bereaved carers provide useful insights for qualitative evaluations of end-of-life services delivered in the home.     

A comparison of community pharmacy methadone services between Dublin and Glasgow: (1) Extent of service provision in 1997/1998 and views of pharmacists on existing provision and future service developments

Objectives: To determine the extent of pharmacists' participation in methadone services, type of services provided, views on current service provision and suggestions for future service developments.

Methods and setting: An anonymous postal questionnaire was distributed to all community pharmacies in the greater Dublin area (n=291) and in Glasgow (n=200), excluding 12 pharmacies in each city that had participated in the pilot study.

Key findings: The response rates were 50% (146/291) and 56% (112/200) for Dublin and Glasgow respectively. Participation in methadone services was considerably higher in Glasgow (80%, 90/112, of respondents) than in Dublin (38%, 55/146) and the number of patients per pharmacy was higher. A majority of pharmacists participating in methadone services (76% in Dublin, 92% in Glasgow) felt they had a professional responsibility to provide such services. In both cities the most common grounds for lack of service provision were business reasons, including risk to staff or property and theft. Current non‐participants identified increased demand for the service and improved security measures as two factors that may encourage their participation in the future.

Conclusion: Pharmacists in Dublin and Glasgow differed significantly in the extent and types of services provided. This may be because a structured scheme was in place in Glasgow but not in Dublin at the time of the study. Despite these differences in service provision, views were very similar in both cities.     

Do women want women health workers? Women's views of the primary health care service

This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined The findings presented m this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women However, for other health needs factors such as the personal approach of the provider become paramount Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs     

UK accident and emergency departments and emergency contraception: what do they think and do?

OBJECTIVES: A postal questionnaire survey was conducted to assess what staff in UK accident and emergency (A&E) departments thought of providing an emergency contraception service, the degree of enthusiasm in and level of provision of the service, and staff attitudes to the introduction or continuation of provision of the service. METHODS: A questionnaire was sent to all 560 departments providing A&E services in the UK. RESULTS: Of the 560 units sent questionnaires, 355 (63.4%) replied. Half the units were located in small county towns, and a quarter in large towns. Requests for emergency contraception were received by 96% of responding units, but only 57% provided treatment. Requests for emergency contraception in 84 of these units ranged between one and 50 per month. The A&E senior house officer (SHO) and the gynaecology SHO and registrar prescribed most of the pills. Nurses were more involved in nurse led or general practitioner (GP) led units. Initial treatment only was given by 77% of providing units while the remainder also discussed subsequent contraception. Follow up was arranged with GPs by 92 units, and with family planning clinics by 66 units. Information packs were available in only 37 providing units. A total of 155 of providing units felt it was worthwhile and 56% of respondents thought emergency contraception should be provided by A&E departments. However, 91 units could identify one or more groups within the hospital who were antagonistic to provision by A&E departments, of which non-A&E medical staff formed the largest group. Over the counter availability of emergency contraception was not supported by 62% of respondents. CONCLUSION: The results show that while the female population appears to see a need for emergency contraception services to be provided in A&E departments, there is some reluctance by UK A&E departments to provide the service. Given the current interest in approaches to reducing unplanned pregnancies, especially in teenagers, provision of emergency contraception by A&E departments requires a pragmatic approach to ensure their cooperation in providing the service when alternative sources of provision are not available.     

Caring pathways of terminal cancer patients: a retrospective survey

Caring pathways of terminal cancer patients: a retrospective survey. Introduction. The caring patways of terminal cancer patients of the Vallagarina district, dead in 2008, cared at home and/or by district services in the last 90 days of life of cancer patients, were retrospectively described. Aim. To describe the last 90 days of life of all patients dead for cancer. Methods. Data were collected from different sources: hospital discharge forms, local health unit informative systems, data bank of the palliative care service (PC), charts of PC and home care services and through interviews to caregivers, for patients cared by General practitioners (GPs). Results. Four caring pathways were identified: patients mainly cared by GPs, in nursing homes, in long term care or by the PC service. The rate of hospital admissions varies widely: 25% of potential days of care for GPs patients; 1.3% for PCs patients; same for length of hospital stay: mean duration 18.7 days for GPs and 5.6 days for PC patients. Only rarely the GPs activate other forms of care such as care by multidisciplinary teams (10.8% patients) or visits at home by GPs (12.7% patients). Caregivers would like more information on the clinical situation of the patient and on the different caring services, to be involved in the decision making process. Conclusions. Patients cared by GPs and PC Service experience different caring pathways. Lack of information to caregivers may profoundly impact the type of care received.     

Perceptions of Public Health Nursing Practice by Municipal Health Officials in Norway

ABSTRACT Objectives: The objective of this study was to describe and analyze municipal decision-maker's views on public health nursing and to reflect upon and discuss the relevance of those views to the future of public health nursing in Norway.
Design: This explorative qualitative study using face-to-face interviews is part of a larger project, comprising 5 studies, that explores perceptions of public health nursing.
Sample: A purposeful sample of 11 municipal decision-makers was selected for interview during 2006–2007 to reflect variation in community size and perspective.
Results: Thematic content analysis of the transcribed interviews revealed 4 content categories: contribution, collaboration, challenges , and visibility . The decision-makers expressed satisfaction with the public health nursing services, showed concern about lack of visibility and clear boundaries, and some expressed irritation over lacking collaboration. The interviewees elaborated on their past experiences as the public health nurses coworkers, leaders, collaborators, and service users.
Conclusions: The respondents recognized public health nursing's contribution to public health but they lack sufficient knowledge of its content and tend to take services at local health clinics for granted. Dialogue between nurses and decision-makers is necessary in order to ensure updated evaluation and continued development of public health nursing services.     

Primary health care provision for adults with a learning disability

BACKGROUND: During the last decade, primary care has been designated as the main provider of health care to people with learning disabilities. Practice nurses based in primary care teams are increasingly the first points of contact with health services. They make an important contribution to promoting good health, with health screening and illness prevention work being a significant part of their role. However, little is known about their views or involvement regarding the provision of primary care for people with learning disabilities. There is therefore a need to explore the nursing perspective, from within primary care, on the current provision of care for people with a learning disability. RESEARCH AIM: To inform the learning disability service of the role of primary care in current service provision for people with learning disabilities. RESEARCH METHOD: A survey of all practice nurses currently employed by Grampian Health Board in Aberdeen was conducted in June 2001. An initial pilot study was conducted in primary care and learning disability services. Data collection took place during June and July 2001. All practice nurses working in the geographical region of Grampian were invited to participate. RESULTS: Communication barriers exist, preventing access to health screening and treatment for some people with learning disabilities. Independent living skills, for example dietary management and budgeting, require additional community support. These conditions pose complex problems for practice nurses and other members of the primary care team. CONCLUSION: This study indicates a need for closer support and partnership with the learning disability service. The factors necessary for providing health care to people with learning disabilities extend beyond the domain of primary care teams. The findings of this survey have important implications for education and support to enable carers and professionals to provide a high standard of care.