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PubMedDate not supplied

A model for answering the substance abuse educational needs of health professionals: the North Carolina Governor's Institute on Alcohol and Substance Abuse.

Physicians can play an increased role in recognizing, intervening, and moderating their patients' misuse of alcohol and other drugs. This article explores the need for educational changes to permit physicians to develop skills in prevention, screening, and office-based treatment. It includes a personal account by one of the authors of his experience in recognizing deficiencies in substance abuse education both in his own medical school training and in today's health science curricula in the United States. It reviews prior initiatives by NIAAA/NIDA to address curriculum needs and describes an innovative collaborative model in North Carolina called the Governor's Institute on Alcohol and Substance Abuse. The Institute was created in 1990 as a nonprofit corporation to promote education, research, and communication among health professionals. Some of the Institute's programs are described, including its curriculum integration project in the state's four medical schools. The article concludes that the time is right to introduce substance abuse concepts into basic and continuing education for all health professionals.

Curriculum↗
PubMed1978

Education as a force for change in mental health settings.

The authors focus on the educational process as a force for bringing about changes in the community or within an agency setting. Four change agent roles--specialist, problem solver, consciousness raiser, and advocate--are identified and described. Attention is then focused on criteria for choosing a change agent role. What kind of change is needed? What is the probability of success using a given role? What are the consequences of functioning in a given role? These are three questions an educational change agent should ask before choosing a role as specialist, problem solver, consciousness raiser or advocate.

Attitude↗
PubMedDate not supplied

[Education general surgery: viewpoint of the candidate surgeon].

An opinion poll about the surgical training performed among the Flemish surgeons in training showed us rather critical results. 54 of 62 assistants consider the technical training capable of improvement, 48 of 62 surgeons in training believe their is a lack of possibilities for a sound theoretical education. To improve the present day needs the following changes are suggested: the reduction of the number of training centers, the raise of the operative (and supervised) activities and more possibilities for a good theoretical education, changes more achievable in case of reduction of the overload with nonoperative tasks. The surgeons in training should have their say in the reorganisation of the training in surgery.

Adult↗
PubMedDate not supplied

Body weight measurement of patients receiving nutritional support.

A review of patient records over a 14-day period revealed that daily weights were recorded in only 65.5% of patients receiving parenteral nutrition and 53% of patients receiving enteral alimentation despite a hospital nursing practice requirement for daily weights during nutritional support. A semi-structured questionnaire was given to staff nurses to elicit their opinions regarding the importance of weight obtainment and to ascertain their reasons why patients are not weighted. Of 74 staff nurses who completed the survey, 68% considered weights "very important" but only 34% believed this attitude to be prevalent among their co-workers. The three reasons most often cited for failure to weigh patients were: (1) "patient too critically ill"; (2) "nurse felt other priorities of care existed; and, (3) "patient refuses." The two factors nurses most often felt should be changed to increase body weight measurement were "nurse staffing shortage" and "scales broken and/or unreliable." This study documents a need for both logistical changes (eg, equipment availability and reliability and timing of patient weights) and educational changes at both nursing staff and patient level to improve compliance with established requirements for daily weights during nutritional support.

Attitude of Health Personnel↗
PubMed1991

Specialty roles in community health nursing: a national survey of educational needs.

This study identified population groups, health conditions, and employment settings considered appropriate for graduate-level community health nursing (CHN) practice and employment, and described the relative importance of each of these areas as assessed by CHN leaders. According to 588 leaders in CHN service and education, (1) the population groups most in need of graduate-prepared CHNs are the elderly, persons of low socioeconomic status, the homeless, adolescents, and the unemployed; and (2) the health conditions most in need of CHN services are AIDS, pregnancy and prenatal problems, low birth weight and infant mortality, stress-related illness, and Alzheimer's and other chronic diseases of the elderly. Among the many employment settings rated as having a great need for CHNs are state and local health departments and home health agencies. The findings provide the direction and justification for developing specialty options within CHN that correspond to these identified and changing needs. This article provides suggestions and possible alternatives for initiating educational change to prepare graduate-level CHNs for these various specialties and for the settings in which the specialties will be applied.

Community Health Nursing↗
PubMed1987

Economics of essential drugs schemes: the perspectives of the developing countries.

Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.

Developing Countries↗
PubMed1989

[Does medical education change behavior, attitude and knowledge in relation to smoking? A survey of medical students in the 1st and next to last year of study].

Among the 831 students in the first and last-but-one year of medical studies, 21% were smokers, 4% occasional smokers, 63% non-smokers and 5% former smokers. There were no statistically significant difference in smoking habits between the first and fifth years of study. The different semesters did, however, reveal significant differences with respect to their evaluation of smoking as a health hazard, their knowledgability as to the causal effects of smoking in diverse diseases, the readiness of the doctors-to-be to counsel their patients to avoid smoking, self assessment of their knowledge about smoker counselling methods, their support for the ban on cigarette advertising, and further education in the field of smoker counselling. Significant difference were to be seen between smokers, former smokers and non-smokers with respect to their personal evaluation of their smoking habits over the next five years, the assessment of smoking as a hazard to health, and the subjective burdening of smoking, the question as to the example-setting and instructive role of the physician with respect to smoking, and the question of statutory measures affecting smoking.

Adult↗
PubMed1982

Low back pain in forty to forty-seven year old men. II. Socio-economic factors and previous sickness absence.

The relationship of low back pain (LBP) to various socio-economic factors and previous sickness absence was studied in a random sample of 940, 40-47 year old, men. Since most of the data were available from official registers a comparison between participants and non-participants was possible. The participation rate was 76%, and the life-time incidence of LBP was 61%. No differences were found between men with and men without LBP with respect to education, changes in income, and family conditions. Among the men with LBP there was a tendency to a higher proportion of foreign citizens. The LBP men had an increased previous sickness absence and on average a lower sickness benefit. A higher proportion of the LBP men were blue collar workers. When the influence of other variables was assessed by an analysis of co-variance, two of the variables maintained a direct association with LBP, viz. foreign citizenship and an increased number of sickness absence days. A lower average sickness benefit, an increased previous sickness absence, and a larger proportion of unmarried and divorced men were found among the non-participants who were also more frequently foreign citizens and blue collar workers.

Absenteeism↗
PubMed1977

Primary care residency training: the first five years.

The training of physicians for the delivery of primary care is becoming a national priority. The period of residency training is viewed by many as the focal point for educational change to meet this demand. The Residency Program in Social Medicine at Montefiore Hospital and Medical Center was begun in 1970 and offers primary care residency training toward board eligibility in internal medicine, pediatrics, or family practice. The pairing concept of scheduling guarantees the resident a continuity of care experience for his own panel of patients at the ambulatory site. The hospital and the ambulatory site share the cost of residents' salaries. Primary care curriculum for clinical and clinical-support areas, delivery-site design, and faculty-utilization models must all be uniquely suited to the training of the future primary care practitioner. Resident recruitment and selection and the involvement of residents in the management of the residency program are crucial features of program success and training for future practice.

Administrative Personnel↗
PubMed1989

Implementing change in nursing education.

Nursing education faces a period of change within the next decade. Blueprints for educational change have been developed in the United Kingdom, Australia and Canada. Change in education needs to be planned rather than a reaction to internal or external pressures. Blueprints for education should extend beyond the entry to practice level and include specialisation, baccalaureate and graduate education. A plan for practice for the future should encompass both hospital and community based health care. Nursing practitioners as well as nurse educators need to be involved in educational planning. In light of the changing student body and societal needs, consideration must be given to the development of a variety of models for nursing education. Prior to instituting wholesale change, pilot projects need to be developed and tested. Plans for preparing adult educators competent in the use of modern technology, are a necessary adjunct to new programme development. Education also needs to be available to the practising nurse to enable professional growth. Professional associations must play a role in educating nurses, other professionals and consumers of nursing care on the changing roles and functions of the nurse, as movement is made toward the goal of 'Health For All By The Year 2000'.

Education, Nursing↗
PubMedDate not supplied

Curriculum innovation and the management of change.

Change in Nurse Education is occurring at such a rate that interest in the management of change is increasing. This article constructs an anatomy of an innovation and considers elements which helped and hindered the change process. The innovation was the development of a new RMN curriculum which was a cooperative venture between three health districts. Continuous assessment, student centered learning and a humanistic approach were all embodied in the innovation. By interviewing the Change agents the innovations are considered in a way which highlights internal and external resistances to change. The use of planning, personal effort and a collegial approach are noted as assisting factors when used within a humanistic framework and a normative re-educative change strategy. Ownership of the innovations is seen as a measure of the strategies success.

Communication↗
PubMed1991

Emergency medicine's role in the education of medical students: directions for change.

Emergency medicine, as a young field emphasizing basic clinical skills, should be in the forefront of the changes in undergraduate medical education. Change needs to occur in our own courses and in our role in the general education of medical students. By graduation, students completing our courses should be able to provide immediate aid, create a problem list, discuss a differential diagnosis for key problems, present a treatment plan for key diagnoses, understand issues pertaining to societal interface with emergency care, and perform essential monitor skills. The general goals of medical education that pertain to strengths of emergency physicians are the ability to use the essential tools of clinical medicine, use data base resources, select the appropriate specialties for consultation, work as a member of a health care team, and use time- and cost-efficient diagnostic adjuncts. Methods for achieving these goals are suggested.

Clinical Competence↗
PubMed1994

The measurement of nurse performance and its differentiation by course of preparation.

This paper addresses the concept of nurse performance, its measurement and its differentiation by programme of preparation. It is evident from the research conducted to date that a variety of methodologies have been used to explore and compare nurse performance. The process of direct observation, however, has been selected to a lesser degree, and it is argued that its potential has yet to be realized. Further, in recognition of the methodological challenges inherent within research of this nature it is suggested that nurse performance should be explored from a variety of perspectives, using a multi-method research design. Significantly, educational preparation as a potential discriminator of performance has been explored only to a limited extent and studies carried out in the United States predominate. In view of recent nurse education changes in the United Kingdom and the introduction of Project 2000, empirical work comparing outcomes of the different courses of pre-registration preparation is urgently required. The authors are currently engaged in a comparative study of outcomes of pre-registration nurse education programmes funded by the English National Board for Nursing, Midwifery and Health Visiting. This paper draws upon the literature reviewed to date.

Clinical Competence↗
PubMed1995

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS: Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS: The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS: The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.

Adolescent↗