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PubMed2002

A new approach to assessing skill needs of senior managers.

Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. We propose using formal lists of technical, interpersonal, and strategic competencies and specific real events chosen by the respondent to identify and prioritize competencies. Results of a trial with 30 large health care system CEOs and 15 early careerists demonstrate that the method reveals useful depth and detail about managers' educational needs. The results suggest that current thinking about managerial education and learning patterns may be seriously inadequate in several respects. The continued improvement of U.S. health care is a pressing national concern. Quality of care is highly variable and substantially deficient in many institutions (Chassin and Galvin 1998; Committee on Quality of Health Care in America 2001). "Quality improvement should be the essential business strategy for healthcare in the 21st century (Kizer 2001)." Productivity improvements will be essential to balance cost pressures from an aging population and growing technology (Heffler, et al. 2002). Skillful management is necessary to improve quality and productivity. Teams of dozens of caregivers are often required to improve a patient's health. The organizations that provide care have grown larger in response to the greater cost, complexity of operation and finance, and evidence of the success of scale in other industries. While many small professional practices, hospitals, and nursing homes remain, consolidation has created a few dozen provider and intermediary organizations exceeding a billion dollars a year in expenditures. These large health care organizations are, or should be, modern corporate organizations at least as effective as their counterparts in manufacturing, retailing, or finance. To achieve that goal, they will require managers with comparable ability, motivation, and preparation. The National Summit on The Future Of Health Management and Policy Education emphasized the development of "evidence-based management education" by identifying, prioritizing, and measuring mastery of specific skills, knowledge, and abilities (Griffith 2001). Faculty of Association of University Programs in Health Administration (AUPHA) are working with practitioners to identify and prioritize specific learning competencies at the graduate degree level. Their effort focuses on skills teachable in the classroom, and it is expected to lead to measured performance of graduate school cohorts (Griffith 2001). The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. Although it deliberately draws competency elements from academic sources, it supplements the teachable skills approach with a questionnaire that asks practitioner respondents to identify the skills and knowledge necessary to manage a specific management event and to evaluate the performance of an anonymous colleague against these skills and knowledge.

Attitude of Health Personnel↗
PubMed1990

Worksite stress management interventions.

Despite the general agreement that stress plays a role in everyday life, there continues to be substantial controversy about how stress can be managed at the worksite. During the last decade, our knowledge of stress management interventions has increased substantially. Despite this improvement, deficiencies in the literature exist. In this article, we offer a framework that may be used for viewing organizational stress interventions, briefly review some of the stress management intervention literature in the context of this framework, and identify future needs that may be particularly appropriate for organizational psychologists to address.

Accidents, Occupational↗
PubMed1993

Process management: two control charts.

It is not at all surprising that many persons avoid involvement in statistical process control. The statistical procedures developed in industry to monitor production processes are somewhat different from those employed in biostatistics and social science applications. Many find it difficult to adjust to these procedures and to apply statistical process control techniques to situations in health care settings. Not everyone involved in a QI process, however, needs to become versed in statistical process control techniques. At the Indiana University Medical Center several persons from different hospital departments have volunteered to form a cadre of internal statistical process control consultants. The group has come to be known by some as the statistical process control "think tank." No doubt a small group of individuals who are interested in statistics, quality control, and computers can be found in most hospitals. While it is necessary that the large majority of managers and supervisors in any health care organization are knowledgeable about process management and control charts at the concept level of understanding, it takes a relatively few to understand and use such control charts. As internal consultants, these few persons can provide technical assistance when such aid is needed.

Computer Graphics↗
PubMed1989

Halo-body jacket immobilization in rheumatoid arthritis patients with cervical myelopathy.

The rehabilitation nurse may care for patients with arthritis in a variety of settings. When the patient has advanced RA, the problem of cervical myelopathy may require surgical intervention and use of the halo-body jacket immobilization orthosis. Expert pre- and postoperative management requires a knowledge of surgical nursing as well as rehabilitation nursing, in the traditional sense, to prevent complications and promote optimum recovery. When dealing with people who have lived with RA for many years, the rehabilitation nurse must continue to assess the patient's knowledge of the disease and use of self-management strategies and community resources.

Arthritis, Rheumatoid↗
PubMed1998

What parents think of fever.

OBJECTIVES: We aimed to assess knowledge, perception and management of fever by parents. METHODS: We conducted a questionnaire survey among 392 parents of children attending locally a paediatric clinic at The Royal Oldham Hospital. The main outcome measures were answers to questions covering a variety of aspects of the knowledge, perception and management of fever by parents. RESULTS: Almost half the parents used a liquid crystal forehead thermometer. Most could not use a glass thermometer. Thirty per cent did not know normal body temperature and would have treated children with a temperature below 38 degrees C. Sixty-four per cent treated fever with both paracetamol and tepid sponging. Most parents awakened children at night for antipyretics. Eighty-one per cent thought that untreated fever was most likely to cause fits or brain damage and 7% thought it could cause death. CONCLUSION: Parents perceive fever as being dangerous. They have a poor knowledge and measure it inaccurately. Needless consultations and hospital admissions could be avoided by a change in perception.

Adult↗
PubMed1995

Management of suspected neuroleptic malignant syndrome.

OBJECTIVE: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia. The objective of this paper is to provide data regarding early and suspected cases as well as offer guidelines for managing this condition. Knowledge of suspected cases will lead to early recognition and prompt management of this condition in the future. METHOD: To address the gap in knowledge, we present 2 case reports of patients with early NMS-like symptoms. The case reports are followed by a brief review of the literature on differential diagnoses, risk factors, early signs and treatment data. CONCLUSIONS: The most rational approach to treating NMS entails a hierarchy of interventions determined by the severity and progression of symptoms.

Adult↗
PubMed2006

[Management of the obstructive sleep apnoea syndrome: more knowledge required for an optimal choice of treatment modality].

In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to the obtrusive nature of this conservative treatment, especially in mild manifestations ofOSAS, the effectiveness of CPAP may be compromised due to poor therapeutic acceptance and adherence. Over the last decade, oral appliance therapy has emerged as an increasingly popular treatment alternative to CPAP. However, due to the methodological limitations of most trials studying this dental treatment modality, the precise indication for oral appliance therapy is still indistinct. In addition, based on the current level of evidence, most surgical interventions in OSAS should generally be reserved for patients with failing CPAP therapy. In order to determine whether the available treatment alternatives are competitive with CPAP, methodologically sound and preferably randomised studies are indicated.

Continuous Positive Airway Pressure↗
PubMed2000

A study of the knowledge that school rugby coaches have in the management and prevention of serious neck injury.

The following study is an analysis of the knowledge school rugby coaches responsible for Senior Cup Team in Leinster, have in the area of neck injury prevention and management. When serious neck injuries affect schoolboys it is particularly tragic and deserves special attention. The study targeted all the coaches of Senior Cup Teams in Leinster. Results showed that coaches lack vital knowledge in the area of neck injury prevention, recognition and management. Only 50% (n = 18) of coaches have a first aid qualification and only 47% (n = 17) carry first aid equipment to deal with neck injuries to matches. More than half of the schools in the study sample do not have neck collars available and a staggering 83% (n = 30) of schools do not have a stretcher available to SCT players. The study highlights the need to provide better first aid facilities in schools and demonstrates the need for further education of school rugby coaches.

Cervical Vertebrae↗
PubMed2004

Barriers to pain management by home care nurses.

This study examined home care nurses' perceived barriers to pain management. Major barriers included lack of knowledge, inadequate pain assessment, and difficulty managing opioid-related side effects. Home care nurses with more knowledge about pain management had significantly lower scores on the Barriers Questionnaire. The study documented the need for continued pain management education for home care nurses. Practice implications are provided.

Analgesics, Opioid↗
PubMed2006

Knowledge of Jordanian mothers with regards to emergency management of dental trauma.

Studies in Jordan indicated that delay in seeking emergency management of dental trauma leads to unfavorable outcome of even mild forms of trauma. The purpose of this cross-sectional study was to assess, by means of a structured questionnaire, the level of general knowledge of mothers in Jordan with regards to the immediate emergency management of dental trauma, and its relation to socioeconomic variables. The questionnaire surveyed mothers' demographic data, basic knowledge of immediate management of tooth fracture, avulsion, and loss of consciousness. It also investigated the participants self assessed knowledge, attitude to public education, and knowledge of availability and priority of emergency services for trauma in Jordan. The sample consisted of 2215 mothers who attended mother and child care centers in the capital Amman, and in Irbid (the second largest city in Jordan) over a period of 3 months (July to September, 2003). Overall the participants' basic knowledge with regards to the emergency management of the trauma cases presented in the questionnaire was deficient regardless of age, level of education, socioeconomic class, or number of previous encounters with dental trauma. Generally, the attitude to public education on the topic was positive and chi-square test indicated that the level of education of mothers positively affected their knowledge of 'during working hour' emergency services and the importance of immediate management of dental trauma. Educational programs that can be added to the mother and child care advice protocols may help improve the knowledge and awareness of mothers and therefore improve the outcomes of dental trauma.

Adolescent↗
PubMed2001

Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management.

OBJECTIVES: This study was designed to examine the knowledge and attitudes of primary school teachers with regard to the emergency management of avulsed permanent incisors. DESIGN: Data were collected by self-administered questionnaire. SETTING: The study was conducted in primary schools lying within a 2-mile radius of the University Dental Hospital, Cardiff. Sample and methods. A total of 388 teachers in 31 participating schools were asked to complete a questionnaire, which was subsequently collected by two of the authors (CS and AT). RESULTS: Two hundred and seventy-four teachers returned completed questionnaires, a response rate of 70.6%. One hundred and eighty-one respondents (60.1%) had received no advice about the emergency management of dental avulsion. Of the 133 teachers (48.5%) who possessed a first aid certificate, 39 (29.3%) had been given relevant advice as part of this training. Less than one-third of respondents (85 (31%)) cited an optimum extra-oral time of 30 min or less, with only 43 (15.7%) considering that this should be 10 min or less. However, 125 (45.6%) knew milk to be the best transport medium. Two hundred and four teachers (74.5%) stated that they would not be prepared to replant an avulsed tooth themselves, 133 (80%) basing this decision on lack of expertise and training. Two hundred and sixty-two teachers (95.6%) expressed a desire for further information. CONCLUSIONS: The majority of respondents possessed, at best, rudimentary knowledge of the emergency management of dental avulsion. Teachers, and other individuals who supervise children in schools, should receive simple instruction in dental first aid.

Animals↗
PubMed2002

Monitoring the variability in drug-prescribing patterns: benchmarking and feedback in Belgium.

Health-care providers, insurance agencies, ministries, clinicians etc. are installing Information and Communication Technology to monitor patients, patient care and pharmaceutical drug-prescribing patterns. The ever-growing databases create opportunities for better knowledge about the health-care system and, eventually, more effective management. Yet, these databases run the risk of under-utilisation or simplistic interpretation through lack of appropriate knowledge methodology. On the one hand, managers and policy makers oversimplify the available information. Numerous individual patients and pharmaceutical drugs are classified into a small number of categories and measured using Great British pounds or Euros. Sums, averages and two-way tables cover up all the fine shades in patient problems and therapies that are recorded in great detail. On the other hand, investigations discover a wide diversity of patients and a great variability of care patterns among clinicians, hospitals and regions. When so-called unexplained regional, institutional and clinician differences are published, confusion and distrust arise. Examples exist in France, the USA, the UK and Belgium. This document investigates how to discover management knowledge with respect to drug prescribing patterns. The example presented covers the cases of the 18,000 Belgian home practitioners.

Belgium↗
PubMed1985

Mitral valve prolapse: physical assessment complications and management.

This article presents the fundamental knowledge nurse practitioners need when managing the care of a client with mitral valve prolapse (MVP). The assessment discussion includes information on where and how to perform cardiac auscultation, and it also includes a discussion of the particular mid-to-late systolic click with murmur that is typical of MVP. Client preparation for diagnostic tests (echocardiogram and ECG) is also presented. Potential complications of endocarditis, mitral regurgitation, ventricular dysrhythmia, chest pain, systemic emboli and sudden death are discussed. Particular emphasis is given to the nursing management and client teaching that are required for clients with MVP. Nursing management includes teaching the client 1) the need and schedule for chemoprophylaxis of endocarditis, 2) how to maintain left ventricular volume, 3) the possible relationship between chest pain and hypovolemia and 4) the advantages of regular exercise. Changes in the click-murmur that may occur with pregnancy and the impact of MVP on contraception and childbearing decisions are discussed. Specific nursing diagnoses that may arise with the client with MVP are listed. Outcome criteria that may be used for evaluation of nursing care are provided.

Adult↗
PubMedDate not supplied

The PRO-SELF(c): Pain Control Program--an effective approach for cancer pain management.

PURPOSE/OBJECTIVES: To describe the PRO-SELF(c): Pain Control Program, an educational approach that provides patients and family caregivers with the knowledge, skills, and nursing support needed to improve pain relief. DATA SOURCES: Published research studies, articles, and conference abstracts. DATA SYNTHESIS: Patients with cancer and family caregivers lack knowledge about pain management and side effects. Engaging in self-care behaviors improves patients' health outcomes. CONCLUSIONS: The PRO-SELF: Pain Control Program is an effective approach that can be used to help patients with cancer and their family caregivers obtain the knowledge and skills that are needed to manage pain. Three key strategies for delivering the PRO-SELF program are (a) provision of information using academic detailing, (b) skill building with ongoing nurse coaching, and (c) interactive nursing support. IMPLICATIONS FOR NURSING: Adequate pain relief is vital to decreasing cancer morbidity and improving patients' quality of life. The PRO-SELF: Pain Control Program should be implemented in all settings where cancer care takes place.

Aged↗
PubMed2003

The effect of medication management training on community mental health nurse's clinical skills.

Background. There is evidence that compliance therapy improves treatment adherence and clinical outcomes in patients with schizophrenia. Community Mental Health Nurses (CMHNs) are ideally placed to deliver compliance therapy but require training to develop the necessary clinical skills.Aim. To explore whether a brief medication management training package is effective in developing the compliance therapy skills of CMHNs.Method. The study had a within subjects repeated measures design. A representative sample of 52 CMHNs entered the study. They performed a role-play task pre- and post-training that was videotaped and blind rated by an independent rater using the Cognitive Therapy Scale (CTS). Knowledge was assessed pre- and post-training using a knowledge about medication management questionnaire. Trainees also completed a satisfaction with training questionnaire at the end of the course.Results. Following training there was a statistically significant improvement in mean scores on the primary measure of skills, the CTS (mean pre-training CTS-total score 13.88, mean post-training CTS-total score 31.12; p<0.01). There was also a significant categorical improvement in the number of trainees who demonstrated satisfactory skills. Knowledge about medication management was significantly improved and trainees reported that training was acceptable and relevant to their clinical practice.Conclusions. In this uncontrolled study training improved the medication management skills of CMHNs.

Clinical Competence↗
PubMed2005

Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal.

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Attitude of Health Personnel↗
PubMed2007

A national assessment of knowledge, attitudes, and confidence of prehospital providers in the assessment and management of child maltreatment.

OBJECTIVE: The goal was to assess the knowledge and confidence in recognition, management, documentation, and reporting of child maltreatment among a representative sample of emergency medical services personnel in the United States. METHODS: A questionnaire was developed and pilot-tested, with the input of experts in emergency medical services and child maltreatment, to assess knowledge, attitudes, confidence, and training needs regarding assessment and treatment of child maltreatment. The questionnaire was distributed nationally to a random sample of prehospital providers by using a previously validated sampling plan. RESULTS: Of 2863 surveys sent to prehospital providers, 1237 (43%) were returned. Most prehospital providers reported receiving < or = 1 hour of continuing medical education regarding child maltreatment. Most (78%) asked for additional educational opportunities, with only 3% stating that they required no additional training. Participants lacked knowledge regarding the developmental abilities of children, management of families in which child maltreatment is suspected, key elements of the history that should be noted, and the degree of suspicion necessary for reporting. CONCLUSIONS: Prehospital providers expressed confidence in their abilities to recognize and to manage cases of child abuse and neglect; however, significant deficiencies were reported in several critical knowledge areas, including identification of child maltreatment, interviewing techniques, and appropriate documentation.

Attitude of Health Personnel↗