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PubMed2005

Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development.

AIMS: Description of nurse case management experiences across different settings and patient populations is needed to define critical elements of the intervention and to help develop a workforce capable of responding to the growing diabetic population. METHODS: In a clinic providing services to American Indian and Alaska Native people, a retrospective cohort design was used to assess outcomes of patients who did and did not receive case management services and to quantify the case load of a team of four nurse case managers. RESULTS: Patients with nurse case managers were more likely to have an eye examination [OR 2.9, 95% CI (2.1, 3.8)], diet and exercise instruction by a registered dietitian [OR 2.8, 95% CI (1.9, 4.1)], self monitor blood glucose [OR 2.1, 95% CI (1.5, 3.1)], dental examination [OR 1.7, 95% CI (1.3, 2.3)], foot examination [OR 1.6, 95% CI (1.2, 2.1)], and nephropathy screening [OR 1.6, 95% CI (1.2, 2.1)]. After adjustment for type of treatment, initial HbA(1c), and diet instruction by a registered dietitian, the change in HbA(1c) remained significantly greater among those patients with a case manager than in those without (-0.52 units with vs. -0.17 units without, P < 0.006). The case load used to achieve this outcome averaged one nurse case manager per 365 patients. CONCLUSIONS: In this setting, a case management team comprised of four nurses with varying degrees of clinical experience was effective in improving adherence with diabetes services and had a favourable effect on short-term glucose control trends.

Adult↗

PubMed2002

The health of the Australian workforce: 1998-2001.

OBJECTIVE: To describe the health of the Australian workforce in relation to occupational status. METHODS: Data on 9,167 workers, collected between 1998 and 2001, were obtained from the Campbell National Health Monitor, a cross-sectional national, health survey. Professional, white-collar and blue-collar workers were compared on five health outcomes: self-rated health, long-and short-term conditions, reduced activity days and work absences. RESULTS: One in 10 workers (M:11%; F:10%) rated their health as poor. Two-thirds (M: 60%; F: 64%) reported long-term conditions with four in five (M:77%; F: 83%) reporting short-term conditions. Smaller proportions took health-related actions, with 21% of men and 28% of women reducing their activity, and 17% of men and 20% of women taking time off work in a given month. Occupational inequalities in self-rated health were evident for both men and women, with professionals reporting the best health and blue-collar workers the worst (p < 0.001). Male, but not female, white- and blue-collar workers also had higher rates of short-term conditions (OR 1.25, 1.06-1.50 and 1.25, 1.07-1.46, respectively) and reduced activity days due to health (OR 1.43, 1.20-1.71 and 1.25, 1.07-1.47, respectively) compared with professionals. However, blue-collar workers reporting health problems were the least likely to take time off work (poor health: p = 0.043; short-term conditions: p = 0.001; long-term conditions: p = 0.003). CONCLUSIONS AND IMPLICATIONS: Blue-collar workers are the least healthy occupational grouping. They are also the most likely to present to work unwell. With employment conditions rapidly changing, better understanding of the impact of these changes on workers' health is vital.

Adolescent↗

PubMedDate not supplied

Use of public health nurse competencies to develop a childcare health consultant workforce.

UNLABELLED: The purpose of this article is to describe the efforts in the state of Georgia to train public health nurse-childcare health consultants (PHN-CCHCs) using the framework of the "Core competencies for public health practice." OBJECTIVES: The goal of the training was twofold: (1) to prepare a statewide cadre of PHNs as the primary workforce for Georgia's emerging childcare health consultation (CCHC) system and (2) to prepare their district nurse directors to lead and support CCHCs. DESIGN: Administrators attended a 2-day workshop followed by access to executive coaching for their management teams. PHNs participated in a three-phase training program, with phases 1 and 3 offered as 3-day workshops with field experiences, and phase 2 offered online and as a practicum. SAMPLE: Forty-four administrators and over 85 PHN-CCHCs completed the training. RESULTS: Graduates of the program reported satisfaction with training and reported the use of PHN core competencies in CCHC. Graduates also found enhanced skills in using core competencies to be applicable to a variety of population-based practices. Beyond CCHC being instituted in selected health districts, interest in CCHC has occurred statewide. CONCLUSIONS: The PHN-CCHC program enhanced the knowledge and use of core competencies and heightened interest in CCHC statewide.

Attitude of Health Personnel↗

PubMed1994

Social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample.

This study investigated the social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample. Based on the 'Theory of Planned Behaviour', but with additional variables of benefits, barriers and self-efficacy, it was found that both intended and actual activity could be predicted but only when strenuous activity was considered. In addition, the predictors were different for men and women. Specifically, the best predictors of intention to exercise were attitude, perceived control, benefits and self-efficacy for women, but only attitude for men. Predicting self-reported strenuous activity for women were intention and self-efficacy, and for men intention and attitude. Theoretical and practical implications for attitude research and exercise promotion are discussed.

Attitude to Health↗

PubMed1994

Doctors with problems in an NHS workforce.

OBJECTIVES: To describe the incidence, nature, and implications of serious disciplinary problems among the medical staff of a large NHS hospital workforce. DESIGN: Descriptive study with analysis of case records. SETTING: Northern Health Region, an administrative area within the NHS covering a population of three million. SUBJECTS: Forty nine hospital doctors: 46 consultants and three associate specialists. MAIN OUTCOME MEASURES: The nature of the problems encountered within the doctors' practice, and the types of action taken by the employing authority. RESULTS: Over a five year period concerns serious enough to warrant the consideration of disciplinary action were raised about 6% of all senior medical staff (49/850). Ninety six types of problem were encountered, and were categorised as poor attitude and disruptive or irresponsible behaviour (32), lack of commitment to duties (21), poor skills and inadequate knowledge (19), dishonesty (11), sexual matters (seven), disorganised practice and poor communication with colleagues (five), and other problems (one). Twenty five of the 49 doctors retired or left the employer's service, whereas 21 remained in employment after counselling or under supervision. CONCLUSIONS: Existing procedures for hospital doctors within the NHS are inadequate to deal with serious problems. Dealing with such problems requires experience, objectivity, and a willingness to tolerate unpleasantness and criticism. Because most consultants' contracts are now held by NHS trust hospitals, however, those who had developed skill over the years in handling these complex issues are now no longer involved.

Adult↗

PubMed2004

Occupational stress and incidence of sick leave in the Belgian workforce: the Belstress study.

CONTEXT: Sick leave is a major problem in public health. The Karasek demands/control/social support/strain (JDCS) model has been largely used to predict a wide range of health outcomes and to a lesser extent sickness absence. STUDY OBJECTIVE: The aim of the study was to test the predictive power of the JDCS model in relation with one year incidence of sick leave in a large cohort of workers. DESIGN AND SETTING: Cohort study conducted between 1994 and 1998 in 25 companies across Belgium. PARTICIPANTS: A total of 20 463 workers aged 35 to 59 years were followed up for sick leave during one year after the baseline survey. OUTCOMES: The outcomes were a high sick leave incidence, short spells (>/=7 days), long spells (>/=28 days), and repetitive spells of sickness absence (>/=3 spells/year). MAIN RESULTS: Independently from baseline confounding variables, a significant association between high strained jobs with low social support and repetitive spells of sickness absence was observed in both sexes with odds ratios of 1.32 (99% CI, 1.04 to 1.68) in men and 1.61 (99% CI, 1.13 to 2.33) in women. In men, high strained jobs with low social support was also significantly associated with high sick leave incidence, and short spells of sick leave with odds ratios of 1.38 (99% CI, 1.16 to 1.64) and 1.22 (99% CI, 1.05 to 1.44) respectively. CONCLUSIONS: Perceived high strain at work especially combined with low social support is predictive of sick leave in both sexes of a large cohort of the Belgian workforce.

Adult↗

PubMed2004

Evidence based practice in population health: a regional survey to inform workforce development and organisational change.

STUDY OBJECTIVE: To assess current capacity to implement evidence based practice (EBP) in population health. DESIGN: Postal survey of a regional population health workforce in Sydney, Australia. SETTING: Division of Population Health, South Western Sydney Area Health Service. PARTICIPANTS: 104 population health staff (response rate: 73%). MAIN RESULTS: In the sample of regional population health practitioners, views about the current promotion of EBP were positive. Non-medical respondents with less that Masters degree were more likely to report "high self assessed need" to increase their capacity in EBP (p = 0.022). Confidence in understanding of EBP terminology was not associated with seniority but with highest level of education reached (p<0.000) and having medical qualifications (p<0.000). Occupational category was not associated with respondents' self assessed "need for evidence", "need for EBP skills" or "need to increase their capacity in EBP" in their current position. The proportion of participants "strongly" supporting implementation of a colorectal cancer screening programme whose benefit was expressed as relative risk reduction was greater than that so supporting a programme whose benefit was expressed as number needed to screen (p = 0.008). Most respondents referred to their immediate managers when seeking support for EBP. CONCLUSIONS: The findings provide a quantitative baseline for capacity building through workplace programmes. Managerial commitment has been increased and performance development is now underway.

Adult↗

PubMed1987

Application of weight-height relations for assessing adiposity in a United Kingdom offshore workforce.

Weight (W), height (H), and skinfold thicknesses at biceps, triceps, subscapular, and suprailiac sites were measured in a United Kingdom offshore workforce. Weight and height were used to calculate W/H relations. The percentage body fat was estimated from skinfold thicknesses and the correlations of adiposity with the various W/H relations were evaluated. The significant increase in percentage body fat (%BF) with increasing age resulted in the development of age group specific regression equations relating %BF to the indices of W/H1.5 and W/H2 (body mass index or Quetelet index). Little difference regarding the qualities of these two indices were detected in terms of poor correlation with height and strong correlation with weight. Thus either may be used with similar levels of confidence. Comparison with other studies, however, would be more easily accomplished if W/H2 were used. In the absence of skinfold thickness measurements the W/H2 could readily be implemented during a routine medical and applied for the estimation of %BF in the offshore population provided that the appropriate regression equation were used and that the limitations of the technique are recognised. Percentage values for W, H, W/H relations, and %BF by age group are provided for comparison with other population studies.

Adult↗

PubMed2000

Cross sectional study of a workforce exposed to hand-arm vibration: with objective tests and the Stockholm workshop scales.

OBJECTIVES: Medical surveillance of workforces exposed to vibration has been recommended with the Stockholm workshop scales. The aims of this study were (a) to evaluate how the results of the objective tests individually and jointly associated with the final Stockholm workshop staging, (b) how this staging related to the history of exposure to vibration, and (c) how different trades were affected by the hazards from vibrating tools. METHODS: All workers exposed to vibration in a heavy engineering company were examined with a questionnaire and a battery of tests. An assessment of staging by the Stockholm workshop scales was made. Estimates of the daily exposure and lifetime dosage of vibration of the various trades were reached. RESULTS: The average years of tool use was 23.3 years (range 3-47 years) and the mean lifetime exposure was 11,022 (range 1012-46,125) hours. The individual neurological tests were all strongly associated with the Stockholm neurological staging but the cold provocation test was not associated with the Stockholm vascular staging. Neurological staging was significantly associated with age, years of tool use, and total hours of exposure to vibration, but not with trade or smoking. Vascular staging was significantly associated with age, years of tool use, total hours of exposure to vibration, and trade, but not with smoking. The mean neurological latent period was 19.7 (range 2-40) years and for the vascular component 19.1 (range 2-40) years. These means varied significantly by trade. The overall prevalence of neurological findings of 62% was greater than the overall prevalence of vascular findings, which was 33%. CONCLUSIONS: (1) The neurological objective tests were found to be of use in neurological staging. The cold provocation test was not associated with the vascular staging and therefore was of little value. (2) Years of tool use was the exposure variable most significantly associated with evidence of damage to neurological component while years of tool use and trade were the variables most associated with vascular damage. (3) The prevalence of neurological symptoms (62%) was greater than the prevalence of vascular symptoms (33%). (4) Dressers and welders have shorter latent periods than platers and fitters.

Adult↗

PubMed2005

The geriatric psychiatry workforce in 2002: analysis from the 2002 National Survey of Psychiatric Practice.

OBJECTIVE: Using the 2002 National Survey of Psychiatric Practice (NSPP), authors update demographic and professional work activities of a nationally representative sample of the psychiatric workforce who treat geriatric patients. METHODS: The sampling frame for the 2002 NSPP used the American Medical Association's Masterfile of Physicians. Professional, demographic, and patient data are compared between general and self-reported geriatric psychiatrists. Authors also present detailed analyses comparing high geriatric providers (HGPs; geriatric caseloads >20%), and board-certified geriatric psychiatrists (BCGPs). RESULTS: The proportion of HGPs in the 2002 NSPP was 26.0% of all respondents and was 28.1% among American Psychiatric Association (APA)-member respondents. Among the APA-member psychiatrists, this reflected a 55% increase from the 1996 NSPP. Of HGPs, 31.0% were certified in geriatric psychiatry. As compared with general psychiatrists, proportionally fewer men and American medical-school graduates were self-reported geriatric psychiatrists. Geriatric psychiatrists saw nearly three times as many geriatric patients and five times as many dementia patients as did their generalist counterparts. Mood-disorder patients were the largest treatment group, however. Investigators observed no significant differences in professional and practice characteristics between HGPs and BCGPs. CONCLUSIONS: About 1 in 4 psychiatrists in the 2002 survey are HGPs. Geriatric psychiatrists treat proportionally more geriatric patients than do generalists, but they do not have exclusively geriatric practices. The similarities between HGPs and BCGPs raise issues about the incentives for geriatric psychiatry certification, but not the need to train subspecialists to serve as faculty and community resources.

Adolescent↗

PubMed2005

Development and implementation of a public health workforce training needs assessment survey in North Carolina.

Assessing the training needs of local public health workers is an important step toward providing appropriate training programs in emergency preparedness and core public health competencies. The North Carolina Public Health Workforce Training Needs Assessment survey was implemented through the collaboration of several organizations, including the North Carolina Center for Public Health Preparedness at the North Carolina Institute for Public Health, the outreach and service unit of the University of North Carolina School of Public Health, the Office of Public Health Preparedness and Response in the North Carolina Division of Public Health Epidemiology Section, and local health departments across the state.

Data Collection↗

PubMed1995

Heart and arterial disease risk factor levels in the Scottish workforce: cross-sectional study of risk factor levels. The SHARP Committee. Scottish Heart and Arterial Disease Risk Prevention.

Between 1991-93 a specially trained team of nurses screened 19,435 subjects from various workforces in different regions of Scotland to identify cardiovascular disease risk factor levels in the Scottish working population. The regions visited provided a wide geographical spread. Name, age, occupation, social class, personal and family history of cardiovascular disease were recorded along with consumption of tobacco, alcohol and salt. Height and weight were measured and Body Mass Index (BMI) calculated; systolic (SBP) and diastolic (DBP) blood pressure, blood glucose and blood cholesterol were also measured. The proportion of social class I-IV in men studied was 49, 22, 22, and 7% respectively and in women 28, 29, 39 and 5%. Fifty two per cent of men and 61% of women had never smoked and 24% of men and 17% of women had previously stopped smoking. Twenty one per cent of both sexes were still smoking. Eighteen per cent of men drank more than 21 units of alcohol per week and 3.4% of women drank more than 14 units per week. Mean values of SBP and DBP increased with age and the percentage with hypertension (> or = 148/90 mm Hg) in men and women was 5% and 24% respectively. Mean BMI was slightly higher in men than women (25.3 & 24.5 respectively) and there was a significant (p < 0.01) rise in BMI with age in both sexes. Forty six per cent of men and 32% of women were classified as overweight (BMI > 25) while 9% of men and 9% of women were classified as obese (BMI > 30).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

Heart and arterial disease risk factors measured in an office workforce: changes from 1993 to 1996. The Scottish Heart and Arterial Risk Prevention Group (SHARP).

Screening for cardiovascular risk factor prevalence was arranged in an office workforce in Scotland with two screenings taking place three years apart, in order to measure and attempt to modify individual risk factor profiles, and in order to explore the nature and extent of any changes. There were some increases over time for both sexes, with increased tobacco usage for men, significant increases in diastolic blood pressure for both sexes and a significant increase in mean cholesterol levels for women. A separate analysis was restricted to those individuals screened on both occasions and sought to explore the effect of personal counselling and advice: in fact there were significant increases in tobacco usage for women, with more starting smoking than stopping, and for both sexes there were significant rises in cholesterol levels and increases in body mass index for many individuals. There was significantly increased use of wine and spirits by both sexes.

Adult↗

PubMed2005

The corporate university: a model for sustaining an expert workforce in the human services.

The human service industry has become a complex industry in which agencies must respond to the demands of the marketplace. To respond to these demands, agencies must develop and maintain their knowledge capital by offering an extensive array of learning opportunities related to their business goals. The corporate university, a contemporary educational model designed to maintain an expert workforce, allows agencies to meet this need effectively.

Employment↗

PubMed2006

Evaluating the effectiveness of the Massachusetts workforce development system using no-shows as a nonexperimental comparison group.

This article examines the effect of the Massachusetts workforce development system on the earnings of disadvantaged adults using nonexperimental data from the late 1990s. The authors construct a comparison sample for program participants using individuals who apply for and are offered services yet do not participate in a training program. They present a series of difference-in-difference estimates that make several alternative efforts to correct for selectivity bias, including econometric models that regression adjust for observable characteristics and fixed-effect models that adjust for time-invariant person effects. They also employ probabilistic matching techniques to more finely align the treatment and comparison samples. On average, program participants experienced 20% increases in annual earnings 1 year postintervention and 25% increases after 2 years. The authors uncover considerable heterogeneity in these effects, suggesting that the most difficult to serve and the most job ready benefit the least.

Education↗

PubMed1998

Further flexing? Issues of employment contract flexibility in the UK nursing workforce.

This paper, based on research commissioned by the Royal College of Nursing (Buchan, 1995), reports on the changing working patterns and flexibility in the employment of nursing staff in the National Health Service (NHS) in the UK. It reviews relevant literature, examines official data and draws information from 12 case study NHS trusts. Flexibility is invariably portrayed as a good thing, and as a means to a positive end, yet is rarely defined in detail, if at all. The aim of this paper is to consider flexibility not as a slogan or panacea, but in terms of the rationales for, and likely effects of, changing patterns of nursing work. It examines the reasons why NHS employers have been attempting to increase the flexibility of their nursing workforce.

Contract Services↗

PubMed2006

Atmosphere, tolerance, and cultural competence in a baccalaureate nursing program: outcomes of a nursing workforce diversity grant.

The purpose of this article is to report the results of a comparison between the educational climate of a baccalaureate nursing program and that of a Nursing Workforce Diversity Grant. Fifteen Hispanic/Latino and American Indian upper-division baccalaureate nursing students completed 37 questionnaires. A 76-item questionnaire was designed to measure the effectiveness of grant services. There was a difference (t [34] = 3.174, p = .003) in satisfaction across the two climates on "caring and respect" and "atmosphere" (t [33] = 3.267, p = .003), with the grant climate rated higher. Although there was overall satisfaction with both the nursing program and grant services, students requested improvements in atmosphere, tolerance, and cultural competency. There is a need to create an atmosphere of trust, caring, and cultural congruity to recruit and to retain diverse students.

Adult↗

PubMed1993

HIMAA workforce survey 1991/1992.

In 1991, and again in 1992, the Health Information Management Association of Australia (HIMAA), formerly Medical Record Association of Australia (MRAA), distributed a Workforce Survey to all members to collect information about the demographic, professional and employment characteristics of HIMAA members. There was a response rate 66.8% in 1991 and 40% in 1992, which rise to 80.9% in 1991 and 51.7% in 1992 for responses from full members. The collection will continue on an annual basis, providing a cumulative database and the opportunity for trend analysis.

Age Distribution↗