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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↗
PubMed1997

Lothian surgical audit: a 15-year experience of improvement in surgical practice through regional computerised audit.

For the past 15 years, general surgeons in Lothian, UK, have done a computerised audit. Lothian Surgical Audit (LSA) has two components: the first is educational, in the form of a weekly meeting and an annual report; the second is the accurate recording of surgical activity by use of a simple three-digit code. The main message from LSA is that changes in surgical practice typically occur over 3 to 4 years, and require repeated education. Changes attributable to LSA include the establishment of specialist units, improved results after large-bowel surgery, and the demise of outmoded techniques. Audits should have a clear educational commitment, and be carried out long enough to allow for reauditing. The LSA software has been developed at minimal cost and is networked throughout Lothian hospitals. LSA provides clear evidence that regional audit can significantly influence and improve surgical practice. Its success has resulted from its surgeon-driven development, its flexible use in everyday practice, and the confidence it inspires in local surgeons.

Female↗
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↗
PubMed1996

The changes in the role of the nurse teacher following the formation of links with higher education.

A national study was conducted in England over a three-year period (1991-1994) to explore the changing role of the nurse teacher. The study used multiple methods of data collection, including a modified Delphi survey and a series of telephone interviews. A wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers) were included in the sample. This paper presents findings relating to the changes in the role of the nurse teacher following the formation of links with higher education. Some of the issues discussed include the difficulties related to academic status and the relationships between nurse teachers and other lecturers in higher education, changes in teaching styles and the place of student nurses within higher education. The implications for nurse teachers which stem from a closer association with higher education are explored.

Burnout, Professional↗
PubMed1997

Managing change in nurse education: the introduction of Project 2000 in the community.

The United Kingdom Central Council's proposals for nurse education (Project 2000: A New Preparation for Practice) were implemented in 13 demonstration districts in England in 1989. In 1991, as part of an English National Board-funded research study, the author conducted 15 interviews with first line managers from three of these demonstration districts. The data were reinterpreted in 1995; the experience of implementing educational change in the community setting was discovered to be a complex and difficult process for the managers involved. They found themselves confronted with sometimes conflicting responsibilities; their perception of their role encompassed the meeting of a range of needs, which are presented in this paper within three categories. Firstly, the managers felt they had an obligation to meet the needs of students and of education in general in order both to provide an adequate experience for each individual student and to safeguard standards in community nursing in the long-term. Secondly, they were confronted with the need to mitigate the pressures of Project 2000 placed on 'their' staff. The new educational programme meant that community nurses spent much more time with students than formerly, and the difficulties they encountered were exacerbated by uncertainty about their role with these elements. Finally, and most importantly, managers were responsible for ensuring that clients' needs were met. In particular, they saw it as their role to ensure that the presence of large numbers of students in the community for long periods of time did not compromise standards in the delivery of community nursing services.

Attitude of Health Personnel↗
PubMed1997

How peer education changed peer sexuality educators' self-esteem, personal development, and sexual behavior.

Despite peer education's having become an extremely common strategy on many college campuses, very few outcome evaluations of these programs, particularly evaluations that focus on the peers themselves, have been performed. In this article, we report on a study that measured changes in self-esteem, personal development, and sexual behavior over 1 academic year in 65 sexuality peer educators from 10 universities in the United States. Objective measures of those traits demonstrated a shift in a positive direction; after analysis, however, the changes were not statistically significant. Qualitative data described increased levels of self-esteem, confidence, and safer sexual behavior as a major outcomes of the program, reinforcing the notion of the positive effects of peer education. Implications for program enhancement and considerations of the importance of evaluation are discussed, and recommendations for future research are offered.

Adolescent↗
PubMed1998

Instructional intranets in graduate medical education.

Changes in medicine, medical education, and technology have influenced graduate medical education (GME) and have altered many traditional concepts of resident training. Three issues in particular have led to changes. The first is the shortage of time that academic and community physicians have to devote to medical teaching because of the demands to bring in revenue through clinical practice. The second is the limited exposure that residents have to various medical conditions due to a shift in training venues from hospitals to ambulatory care settings. Last is residents' lack of training in using information technologies. The resultant deficits the exist in GME make it more difficult for residents to practice medicine in the most efficient manner. Hence, there is a need for health care professionals' education to address the coming demands of the 21st century. Instructional computer technology can be useful in bridging this gap. Intranets, internal organizational networks, are private versions of the World Wide Web that are often available only to members of a particular organization. This paper reviews changes in medicine and medical education, describes how instructional intranets can be incorporated into GME, and discusses the impact intranet and Internet technologies can have on GME.

Computer Communication Networks↗
PubMedDate not supplied

Quality assurance not equal to quality improvement.

The intent is not to be critical and the misconceptions are easy to understand. The verbiage related to QI and QA sound alike. Quality improvement is not an easy undertaking for any industry. Some industries have tried QI and failed, while others have tried with admirable successes (e.g., Ford, Florida Power and Light, Motorola). The undertaking of the successful programs has not been easy or painless. QI requires extensive education, change of management philosophy and re-evaluation of our organizational structure. For QA professionals this transition will not be easy or painless . We must first accept that the terminology sounds similar but that the definitions are different. We must accept that our prior processes are far from perfect and can improve. As QA professionals, we must accept that the time is here to learn and to improve. We must begin by improving those processes which we own. This effort must coincide with identification of our customers and implementing systematic mechanisms for identifying their needs and expectations. Through energy expenditure and analysis of data over time, we can improve our processes and ultimately improve the output of our efforts. Only after we have learned QI processes, practiced them through daily application, and improved them can we begin to think about applications of QI to clinical process. After we expend the energy to learn about QI and apply it daily, we will be among the informed. QA professionals must prepare for and learn to value this change. Quality improvement and its technology represents a concept which may truly improve America's healthcare.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administration↗
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↗
PubMed1979

Managing the change process.

Change is a normal and expected phenomenon in the 20th century, but how well are health professions educators prepared to deal with necessary educational change? This article presents a conceptual model for the change process, which provides a framework for adopting an innovation. Although a systems model is used, the human factors associated with change are emphasized. The model provides a basis for action, but the limitations of a static, inflexible viewpoint are discussed. The manager of the change process must be sensitive and responsive to human factors. To be successful, the manager must capitalize on his/her intuitive and creative capabilities. The phenomenon of change may be disruptive to an educational organization. The manager of change may not be in a comfortable position, but the manager who perseveres will see innovations adopted, experience personal growth and contribute to the professional development of others.

Faculty↗
PubMed1995

Physicians for the 21st century: implications for medical practice, undergraduate preparation, and medical education.

Changes in medical education and the practice of medicine have resulted from the push for both education and health care reforms. Undergraduates planning application to medical school should broaden their preparation to include communications, computers, economics, and multicultural educational experiences. To prepare graduates for medical practice in the new millennium, the University of Kentucky College of Medicine has implemented a new curriculum focusing on integration of basic and clinical sciences, primary care in ambulatory sites, health promotion and disease prevention, and attention to the ethical, social, psychologic, and financial impact of disease upon the patient, family, and society.

Curriculum↗
PubMed1998

Changes in gestational trophoblastic tumors over four decades. A Korean experience.

OBJECTIVE: To review changes that occurred in gestational trophoblastic tumor (GTT) patients treated over four decades and to identify factors leading to the changes. STUDY DESIGN: A retrospective study of 287 cases treated during 1961-1967, 1975-1979, 1980-1986 and 1990-1994. The method of diagnosis, incidence and outcome in each decade and factors that may have had an influence, on incidence, outcome or both, were reviewed. RESULTS: Diagnosis shifted from pathologic (1960s) to clinical (1990s). The incidence per 1,000 births decreased from 4.4 (1960s) to 1.6 (1990s). The incidence showed a 26-fold increase in women aged 40 and over and 13.4-fold increase in women para 3 and over. The obstetric population showed a decrease in the high-risk group of greater age and higher parity. Assessment by the 1983 World Health Organization prognostic score showed an increase in low-risk and decrease in high-risk disease. Prognostic score changes are related to a decrease in GTT in older women, increase in GTT with a short interval and increase in nonmetastatic disease. Overall mortality decreased from 32.6% to 2.6%. CONCLUSION: The decreased incidence and improved outcome of GTT in Korea are related to improved medical care and to social, economic and educational changes.

Adult↗