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This paper summarises issues pertaining to the environmental effects of clinical practice. Using examples of environmental awareness, the concept of environmental auditing is introduced by way of a pointer to actions to limit the environmental impact of dentistry. It is concluded that environmental management and auditing would be advantageous to dentistry.
Magnet hospitals must show evidence of professional practice models. A professional practice organizational environment is necessary, but not sufficient, to create professional practice models. The authors analyze the relationship between a professional practice environment and a professional practice and explore organizational commitments required to ensure professional practice at the unit level.
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The concept of telehealth has become a vital issue to healthcare providers in this day of instantaneous, varied, and technology-based communications. This article discusses the issues and implications of telehealth to nurses on Earth and in future space environments. Telehealth will be defined as currently implemented and the legal ramifications of practice across state lines, national borders, rural, and in remote and hazardous locations (space environments: orbital, Moon and Mars bases) will be delineated. The age of information is now here, and the age of communication is beginning. Telehealth is and will be an important means of providing communication links and healthcare to clients and providers alike. Healthcare professionals need to be aware of important concepts related to telehealth for their current and future practice.
Both the place of family practice in academic medicine and the intellectual underpinning of the specialty itself are thought by many to depend on the development of successful research programs in academic departments of family medicine. Yet many believe less research than desired is being done in such departments, even by faculty trained in research. To gain additional information on this important subject, a survey was conducted of the departmental research experiences of 42 graduates of the several Robert Wood Johnson Foundation Family Practice Academic Fellowship Programs who had had the opportunity for at least one year of faculty experience. The responses indicate that the majority of such graduates spend 20 percent or less of their time in research, that most perceive administrative duties as interfering with research, that a minority have budgeted research time, and few have departmental research funds. Despite these obstacles, those who do research publish with surprising frequency, about one paper per fellow per year. Several ways are presented to improve the research environment in departments of family practice and to lead to even more productive, secure research activities of these and other family practice faculty.
How patients experience out healthcare system is driven to a large extent by the excellence and consistency of standards in nursing practice. Best Practice Guidelines offer a bridge, that combined with organizational and professional commitment, can facilitate the goal of supporting knowledge workers.
BACKGROUND: This article examines the relationship at the community level between individual dietary practice and the grocery store environment. METHODS: Individual dietary practice was measured in 12 communities using a telephone survey to obtain self-reported diet. A protocol was developed to measure two aspects of the grocery store environment in these same 12 communities: the relative availability of healthful (low-fat and high-fiber) products, and the amount of health-education information provided. Comparisons were made between individual and store-level measures at two levels of geographic aggregation: community (typically a county) and zip code within community (n = 34). RESULTS: We found positive and statistically significant correlations at both the community and the zip code level between the availability of healthful products in stores and the reported healthfulness of individual diets. Positive correlations were also found between measures of the amount of health-education material provided by stores and the healthfulness of individual diets, but these correlations did not reach statistical significance. CONCLUSIONS: The results provide support for including measures of the grocery store environment as part of a community-level assessment of dietary behavior.
This article describes a national study designed to investigate the extent to which the outcome focus of worker intervention is to change either aspects of the client or aspects of the environment. This study also investigates whether the conceptual framework used in the research reflects the focus of social work practice regarding outcomes of intervention. The research instrument included four case vignettes with 60 possible outcome objectives from which to select. The instrument was sent to a nationwide random sample of 1,000 direct practice master's degree-level social workers from a variety of practice settings. The findings indicate that social workers' choice of personal and environmental outcomes can be quantified and categorized and that the framework is useful in understanding these phenomena.
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BACKGROUND: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. METHODS: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey. RESULTS: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2-88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58-100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%. CONCLUSIONS: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of "typical" bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.
Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.
Advanced practice neonatal nurses (APNNs) have participated as crucial care providers during the past two decades in supporting the development and implementation of safe, therapeutic interventions for critically ill infants in the neonatal intensive care unit (NICU). This role has been limited primarily to the NICU environment, however, and there has been minimal opportunity for APNNs to participate in caregiving that extends beyond this boundary. This boundary-based practice may no longer be practical as a result of significant changes in health care financing and health care reform. It is important for all neonatal health care providers to consider an expanded scope of practice for the APNN that extends beyond the NICU into the community and home and encompasses caregiving for the neonate and infant within the first year of life.
Chronic diseases of environmental origin are a significant and increasing public health problem among the children of New York State, yet few resources exist to address this growing burden. To assess New York State pediatricians self-perceived competency in dealing with common environmental exposures and diseases of environmental origin in children, we assessed their attitudes and beliefs about the role of the environment in children's health. A four-page survey was sent to 1,500 randomly selected members of the New York State American Academy of Pediatrics in February 2004. We obtained a 20.3% response rate after one follow-up mailing; respondents and nonrespondents did not differ in years of licensure or county of residence. Respondents agreed that the role of environment in children's health is significant (mean 4.44 +/- 0.72 on 1-5 Likert scale). They voiced high self-efficacy in dealing with lead exposure (mean 4.16-4.24 +/- 0.90-1.05), but their confidence in their skills for addressing pesticides, mercury and mold was much lower (means 2.51-3.21 +/- 0.90-1.23; p < 0.001). About 93.8% would send patients to a clinic "where pediatricians could refer patients for clinical evaluation and treatment of their environmental health concerns." These findings indicate that New York pediatricians agree that children are suffering preventable illnesses of environmental origin but feel ill-equipped to educate families about common exposures. Significant demand exists for specialized centers of excellence that can evaluate environmental health concerns, and for educational opportunities.
This retrospective chart review compared the intervention rates in 2,365 low-risk obstetric patients at three urban teaching hospitals, two of which were high-risk, perinatal referral centers. The third cared for mostly low-risk patients. The hypothesis was that rates of intervention in low-risk pregnancies would be higher in the high-risk care environment. Family physicians at the perinatal referral centers performed significantly more artificial rupture of membranes, epidural blocks, augmentations of labor, and episiotomies on their low-risk patients than did those at the low-risk hospital. This trend was also found for obstetricians but did not reach statistical significance. Thus, the conclusion was drawn that caring for low-risk patients in a high-risk care environment is associated with a higher intervention rate by family physicians. Factors that may contribute to this finding are discussed.
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