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PubMed2001

Incorporating transcultural care education in allied health curricula.

A clinical skill recently identified as a necessary curricular component in allied health programs is transculturally competent care. It is imperative to teach allied health students transcultural care skills, first, because the population of the United States is becoming more ethnically, culturally, and racially diverse, and the allied health workforce must be prepared for this change. Second, Western medicine has historically reflected European values and traditions. Because other cultures view health and disease differently, health care workers must understand and be respectful of values and traditions that differ from their own. And finally, organizations that accredit health care facilities and academic programs, and licensing boards, are recognizing cultural competency as an important clinical skill for all health care workers. Based on existing literature on transcultural care education, which primarily comes from nursing, this article suggests a model for its incorporation in allied health curricula.

Allied Health Personnel↗

PubMed2002

Anticipating the profession's future.

This article considers the future of the physician assistant (PA) profession in light of trends in the US health care system. A bright job outlook is highlighted, and potential new professional roles are discussed. The author predicts opportunities for PAs in health care administration and entrepreneurship, syndromic surveillance and other public health efforts, and health workforce research, among other areas. PAs will be ideal proponents of new models of patients care, particularly with regard to helping health care consumers navigate the changes that will occur as a result of ongoing genetic discoveries. PAs' communication abilities, accessibility to patients, and socialization as team members make them well suited for these new roles.

Forecasting↗

PubMed2002

Comparison of psychiatrists and psychologists in clinical practice.

OBJECTIVE: The authors compared data from psychiatrists and psychologists in California to determine whether long-standing differences in clinical practice remain after the introduction of managed care and other changes in mental service delivery. METHODS: Responses from practicing clinicians in California who participated in the 1998 National Survey of Psychiatric Practice and the 2000 California Survey of Psychological Practice were compared on items related to patient caseload, practice profile, and insurance or reimbursement arrangements. RESULTS: Data from 97 psychiatrists and 395 psychologists were available for the study. Psychiatrists reported spending more hours on most aspects of practice and working more total hours per week than psychologists. The weekly caseloads reported by psychiatrists included a greater percentage of persons treated for psychotic conditions than did the caseloads of psychologists. Psychologists reported that their weekly caseloads included a greater percentage of persons treated for anxiety disorders, personality disorders, and other disorders. Psychiatrists reported receiving a greater average payment for services from public insurance, and psychologists reported treating a greater average percentage of patients who did not have insurance coverage. Significant differences in income sources and fee arrangements were observed, and the net reported income of psychiatrists was nearly 80 percent greater than that of psychologists. CONCLUSIONS: Long-standing differences in clinical practice patterns remain between psychiatrists and psychologists despite managed care staffing arrangements and treatment strategies that streamline the practices of both provider groups. The significant income and wage differences between psychiatrists and psychologists may be partly due to supply dynamics of the mental health workforce that adversely affect psychologists.

Female↗

PubMedDate not supplied

UNC certificate program in core public health concepts: lessons learned.

OBJECTIVES: Public health workers need to be trained in the core public health sciences. The University of North Carolina at Chapel Hill School of Public Health created a Certificate in Core Public Health Concepts to meet the training needs of public health workers, primarily those working in state or local public health agencies. METHODS: This article examines the demographic, educational, job classification, and workplace characteristics of certificate program applicants from the first 3 years of the program. In addition, this article assesses student performance and graduate satisfaction with the program. RESULTS: Among the 273 applications reviewed, the majority were from females. They worked in a variety of job classifications: 19% were public health agency workers, 64% were public health system workers, and 17% worked in other occupations. Nearly all students received High Pass or Pass grades on courses. Initial data on graduate satisfaction with the program are positive. CONCLUSIONS: Implications of the findings for training the public health workforce are discussed.

Certification↗

PubMed2001

HIV/AIDS preparedness in mental health care agencies with high and low substance use disorder caseloads.

PURPOSE: The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload. METHODS: The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs. RESULTS: Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found. IMPLICATIONS: Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.

Attitude of Health Personnel↗

PubMed2002

Student voices: perspectives on behavioral health education.

The Annapolis Conference on Behavioral Health Workforce Education and Training was convened in September 2001 to address the relevance and quality of efforts to educate those who provide mental health and addiction services. It was essential that students, as the consumers of educational programs, be represented in the dialogue. Four students and one recent graduate joined a diverse group in Annapolis, which included professionals, administrators, educators, consumers of behavioral health services, and family members. The students who attended were drawn from the professions of psychiatry, psychology, social work, and nursing. In a series of personal narratives, these individuals present their views on the conference, on education and training, and on the behavioral health field in general.

Behavioral Sciences↗

PubMed2005

Hurdles to health: immigrant and refugee health care in Australia.

Refugees and asylum seekers face a number of barriers to accessing health care and improved health status. These include language difficulties, financial need and unemployment, cultural differences, legal barriers and a health workforce with generally low awareness of issues specific to refugees. Importantly, current Australian government migration and settlement policy also impacts on access to health and health status. An adequate understanding of these 'hurdles to health' is a prerequisite for health providers and health service managers if they are to tailor health care and services appropriately. We include tables of available resources and entitlements to health care according to visa category to assist providers and managers.

Australia↗

PubMedDate not supplied

The nurse practitioner role in Fiji: results of an impact study.

The Nurse Practitioner role, a relatively new role in Fiji, was introduced by the Ministry of Health in order to increase local access to adequate health care for people living in remote areas. Both developed and developing countries have introduced Nurse Practitioner or similar roles in order to provide a cost effective and sustainable health workforce. This paper provides the results of a qualitative, descriptive study undertaken to explore the introduction of this role and its impact on health service delivery in Fiji. It involved semi structured and focus group interviews with nurse practitioners, key stake holders and community members. The findings demonstrate the positive impact of the role and its benefits to people living in the remote areas of Fiji. It also outlines the satisfaction of villagers with Nurse Practitioners and the extensive scope of practice undertaken by these practitioners. Issues related to the introduction of the role are also discussed. Finally, recommendations for future research and practice are offered.

Attitude of Health Personnel↗

PubMed2006

The slow death of psychiatric nursing: what next?

Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.

Attitude to Health↗

PubMed2002

Substance abuse integration in nursing education: an innovative collaborative model.

This paper reports the outcomes of a 3-year faculty development project, the Nursing School Education Collaborative (NSEC), implemented in four baccalaureate schools of nursing. The focus of the NSEC was to strengthen educational programs through faculty development and curriculum integration in the area of substance abuse and addictions education. A comprehensive needs assessment process is outlined, and faculty development and curriculum integration activities are detailed. Faculty development has resulted in significant improvements in each school's substance abuse curriculum. Outcomes at each participating school have included continuing education activities, acquisition of additional teaching resources, the development of an integration model, and increased curriculum and clinical contact hours. With the increasing recognition of substance abuse as a number one public health problem and nursing as a major health workforce, this project serves as a model for replication.

Adult↗

PubMed2026

Direct and spillover hospitalisation patterns during climate hazards across regions of different health-system resilience levels in China: a nationwide retrospective analysis.

BACKGROUND: Health-system resilience serves as a key contributor in mitigating adverse health impacts during climate hazards. However, quantitative insights into resilience-associated health-care utilisation patterns and targeted adaptation policies remain scarce. We aimed to capture the spatiotemporal health impacts in disaster-exposed counties and their neighbouring counties in China during storms, floods, tropical cyclones, and blizzards or winter storms; understand the association between health-system resilience metrics and hazard-attributable hospitalisations; and develop evidence-based adaptation policies towards climate extremes. METHODS: In this retrospective, observational analysis of county-level aggregated hospitalisation data, we used a propensity score matching-difference-in-differences framework to assess the spatiotemporal changes of nine types of disease-specific hospitalisations in both disaster-exposed and neighbouring regions during storms, floods, tropical cyclones, and blizzards in China. We quantified the relative importance and health gains of health-system metrics during such hazards through random forest approach with interpretable partial dependence plots to derive evidence-based adaptation recommendations. FINDINGS: We included hospitalisation data from Jan 1, 2016 to Dec 31, 2023. In this period, 3241 county-hazard event combinations and 41 747 482 hospitalisations were recorded across 955 Chinese counties. The disaster-exposed regions experienced an initial decline in hospitalisation rates, followed by admission surges after disasters. For example, infectious disease admissions decreased by 11·92% (95% CI -10·53 to -13·31) during the flood-active period but increased by 7·68% (6·46-8·91) after 1-2 weeks of floods. Neighbouring zones were also affected through spillover effects, with infectious disease admissions increasing by 3·18% (1·76-4·61) after 1-2 weeks of the floods. Cardiovascular disease, injuries, infectious, respiratory, and mental disorders were more sensitive across all regions. Particularly for disaster-exposed counties, cardiovascular hospitalisations increased by 14·31% (7·34-21·29) during the tropical cyclone-active period. Notably, compared with low-resilience counties, high-resilience counties were associated with 19·48-30·03% smaller hazard-related relative changes in hospitalisation rates during the hazard-active period and 27·07-31·08% smaller hazard-related relative changes in hospitalisation rates in post-hazard periods. For instance, during the storm-active period, the increase in respiratory hospitalisations was 7·21% (0·67-13·75) in high-resilience counties versus 12·13% (5·20-19·05) in low-resilience counties. Health workforce (relative importance 14·58% during the hazard-active period and 13·80% during the post-hazard period) and service delivery (14·10% during the hazard-active period and 14·17% during the post-hazard period) were identified as key contributors of health-system resilience. Empirical synergistic effects were observed when combining interventions during the post-hazard period, with the combined effect of service delivery (individual contribution 8%) and workforce (individual contribution 4%) exceeding the sum of their individual contributions (16% reduction in cumulative excess admissions) by 33%. INTERPRETATION: Climate hazards are associated with substantial changes in hospitalisation rates in both disaster-exposed and neighbouring regions. Health-system resilience is essential in addressing disaster-health challenges. Targeted adaptation interventions should be context-appropriate and threshold-aware, thereby maximising the public health benefits relative to resilience-oriented investments in health systems. FUNDING: Gates Foundation and the National Natural Science Foundation of China.

Journal Article↗

PubMedDate not supplied

Local partnerships for community assessment and planning.

PURPOSE: Community assessment is a core function of public health. National and state policies encourage local health departments (LHDs) to engage local partners in conducting community assessments. This study examined the prevalence, characteristics, and effectiveness of community assessment partnerships between LHDs and other organizations. METHODS: LHDs in Wisconsin completed a 2-stage, cross-sectional survey. A subset analysis of community assessment partnerships was conducted using descriptive, bivariate, and multivariate statistical methods. RESULTS: Ninety percent of LHDs reported a partnership focused on community assessment (n = 69). Sixty-six percent of community assessment partnerships had existed for three or more years, and all of these had implemented plans (n = 43). Community assessment partnerships were more likely than partnerships focused on other issues to have formed because of a mandate, to include many partners, and to receive some forms of financial support from the LHD. Partnerships focused on community assessment were no more likely to be effective than other types of partnerships. CONCLUSIONS: LHDs and community partners realize mutual benefits from collaborating on community assessment. Successful community assessment partnerships can be supported by building competencies in the public health workforce and sustaining partnerships for substantial periods of time.

Community Health Planning↗

PubMed2004

Healthcare reforms: implications for the education and training of acute and critical care nurses.

This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of existing professionals to function effectively in the future will require education, training, and human resource investment supportive of the changes. It suggests a clear definition of competence and a national standard to practice is essential for nurses working in acute and acute critical settings. There should therefore be a correlation between levels of practice, levels of education, and remuneration. Furthermore, education programmes for senior nurses should sit coherently alongside the education programmes required by Modernising Medical Careers. Finally, the realisation of the government's service and modernisation agenda will require a culture change within higher education institutions, postgraduate deaneries, professional organisations, workforce development confederations, and NHS trusts.

Acute Disease↗

PubMedDate not supplied

An estimate of the need for environmental health academicians in the workforce.

In July 1987, a workshop was held to evaluate the environmental health workforce. The workshop was sponsored by the Bureau of Health Professions. Health Resources and Services Administration of the Public Health Service. Participants were drawn from State and local agencies, Federal agencies, industry, and academia. Estimates of workforce needs were based on background information and informed consensus judgments of workshop participants. The final report of the workshop was published in January 1988. The authors synthesize some of the consensus judgements and review data from a position paper developed for the workshop. The supply, demand, and projected need for new academicians in environmental health on both graduate and undergraduate levels through 1992 are estimated. These estimates are based on the need for persons trained in the various environmental health subspecialties identified during the workshop. Outlined are the number and educational backgrounds of new faculty required. The types of new training programs that are required to meet the needs for environmental health specialists through 1992 are discussed.

Environmental Health↗

PubMedDate not supplied

Examining the impact of a distance education MPH program: a one-year follow-up survey of graduates.

This article addresses the critical issue of measuring impact of a distance education Master of Public Health degree program on public health practitioners. It is based on an online survey of the 49 graduates of the Public Health Leadership Program at the School of Public Health of the University of North Carolina at Chapel Hill. The survey was carried out 1-year postgraduation and had a 73% response rate. Results indicated that graduates continued to have a high level of satisfaction with the program; 97% of respondents indicated they would recommend the program to others, and 75% said that their overall opinion about the program had increased since graduation. On a scale of 1 to 10, 79% of respondents rated the program with a score of 8 or higher in terms of the impact of the program on their ability to do their current job. Regarding new opportunities, 75% of respondents reported that they had new professional affiliations or service commitments, and 31% had job promotions since graduating. The methodology and results reported here may be a model for assessing the impact of a distance learning degree program for mid-career professionals. These results support the viability of a distance-education format for providing necessary training at the master's level for the public health workforce.

Career Mobility↗

PubMed2005

Public health nurses for Virginia's future: a collaborative project to increase the number of nursing students choosing a career in public health nursing.

A shift in the role of public health practice in the United States to population-focused care, together with demographic shifts increasing the diversity and age of the population, has created a need for a public health workforce more highly skilled in community and population-based practices. Despite this need, few changes have been made in the pattern of field placements for nursing students, in part because many public health nurses in population-focused roles are unfamiliar with models of successful student fieldwork in their areas. We describe the Public Health Nurses for Virginia's Future project, a successful project undertaken by nurse educators and public health leaders to increase the number of highly qualified graduates working in state and local health departments.

Career Choice↗

PubMed2006

The health migration crisis: the role of four Organisation for Economic Cooperation and Development countries.

The crisis of human resources for health that is affecting low-income countries and especially sub-Saharan Africa has been attributed, at least in part, to increasing rates of migration of qualified health staff to high-income countries. We describe the conditions in four Organisation for Economic Cooperation and Development (OECD) health labour markets that have led to increasing rates of immigration. Popular explanations of these trends include ageing populations, growing incomes, and feminisation of the health workforce. Although these explanations form part of the larger picture, analysis of the forces operating in the four countries suggests that specific policy measures largely unrelated to these factors have driven growing demand for health staff. On this basis we argue that specific policy measures are equally capable of reversing these trends and avoiding the exploitation of low-income countries' scarce resources. These policies should seek to ensure local stability in health labour markets so that shortages of staff are not solved via the international brain drain.

Developed Countries↗

PubMed2005

An innovation in partnership among first responders and public health: bridging the gap.

To properly prepare for and respond to bioterrorism and other urgent public health threats and emergencies, response disciplines must work together in well coordinated efforts to address the preparedness needs of their communities and the nation. Traditional public health workforce and first responder roles have been challenged and new partnerships have emerged, increasing the need for innovative education and training. This article provides a review of an approach the Heartland Center for Public Health Preparedness took to foster these partnerships and increase the provision of competency-based, integrated responder education and training in the St. Louis, MO, metropolitan area.

Bioterrorism↗