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Developing a national patient safety education framework for Australia.

BACKGROUND: In 2004, The Australian Council for Safety and Quality in Health Care recognised that the lack of a comprehensive framework describing competencies for patient safety was a barrier to achieving a competent and safe health workforce. This article describes the building of a national patient safety education framework that describes the competencies for healthcare workers. AIM: Develop an educational framework that was patient centred and identified the knowledge, skills and behaviours required by healthcare workers irrespective of their profession, position or location. METHODS: The content of the framework was developed using a four-staged approach: literature review, development of learning areas and topics, classification into learning domains and, lastly, converting into a performance-sbased format. An extensive consultation and validation process was also undertaken. RESULTS: A national patient safety education framework was endorsed by The Australian Council for Safety and Quality in Health Care in 2005. The framework is already being used to develop curricula and train the trainer programmes in patient safety. CONCLUSIONS: The framework, which draws its educational approach from adult learning principles, was extensively researched and built on the experience of healthcare workers. The next challenge is to test different strategies for implementing the framework.

Adult↗

Cigarette smoking and health. American Thoracic Society.

Cigarette smoking remains the primary cause of preventable death and morbidity in the United States. Smoking causes lung cancer, COPD, and CHD and contributes significantly to mortality from other conditions such as stroke. Maternal smoking during pregnancy causes low birthweight and perinatal mortality, and it may have lasting impact on the child's physical and cognitive growth. Passive exposure to ETS causes lung cancer and poses particular danger to the respiratory health of young children. Smoking cessation strategies are important, but the should be supplemented by community and policy-level interventions. Workplace or community smoking bans, statewide taxes on tobacco, and antismoking media campaigns may be effective adjuncts to individual cessation strategies. These strategies may be an even more important disincentive to smoking initiation. The expanding horizon of health consequences of smoking and its costs to American society should again challenge public health agencies to develop and implement effective strategies to prevent smoking acquisition by young people. These health effects should also motivate health professionals in other countries where smoking prevalence is increasing, rather than decreasing, to initiate more effective efforts to reverse this trend and minimize the excess morbidity and death that accompany this dangerous habit.

Cocarcinogenesis↗

Maintaining integrity through clinical supervision.

This article suggests that there is a relationship between successfully maintaining integrity in nursing and the practical provision of opportunities for shared reflection offered by good clinical supervision. In order to establish this case, I will first give some definitions and then proceed to consider how these ideas relate conceptually. The article makes no attempt to offer empirical research as confirmation, but provides a conceptual and moral argument making use of anecdotes for purposes of clarification and illumination. It is the author's belief that, if it is understood and implemented properly, clinical supervision offers a radical challenge to nursing's existing culture. If nurses are interested in the survival of the profession, it is perhaps a challenge that has to be addressed.

Anecdotes as Topic↗

Collaborative initiatives: where the rubber meets the road in community partnerships.

Amajor challenge facing a community partnership is the implementation of its collaborative initiatives. This article examines the progress Community Care Networks (CCNs) made in implementing their initiatives and factors that helped or hindered their progress. Study findings suggest that partnership progress is affected by external market and regulatory factors beyond the control of the partnership, the availability of local community resources to support efforts, the scope and intensity of tasks associated with an initiative, expansion of the partnership to include new members, and the balance of work between partners and paid partnership staff. Implications of study findings for community partnerships include (1) recognizing and anticipating dependency on others, (2) acknowledging that the tasks that lie ahead will be more complicated than imagined, (3) maintaining focus on priorities, and (4) learning to be adaptive and creative, given a constantly changing environment.

Community Health Services↗

Marketing social marketing: getting inside those "big dogs' heads" and other challenges.

Social marketing provides a powerful process for planning and implementing public health programs. Although often applied to the promotion of healthier lifestyles, social marketing can also be used to promote utilization of direct services or policy changes. Despite growing popularity among public health professionals, resistance by senior management, community advocates, policy makers, and others can create barriers to the use of the social marketing model. This article draws on the authors' observations, practice experiences, extensive training interactions, and qualitative studies with public health practitioners across the nation. It examines some of the key reasons that public health practitioners encounter resistance to using social marketing and discusses how a logic model can be used to market social marketing in organizations and communities.

Administrative Personnel↗

Occupational health challenges and success in developing countries: a South African perspective.

Implementation of occupational health and safety practices in South Africa is impeded not only by lack of funds, expertise, and technologic sophistication but also by worker apathy and employer ignorance, such that there is no pressure on government even to enforce existing regulations. The author explores the reasons for the problem, describes sporadic successes that have been achieved, and offers practical suggestions for improvement.

Developing Countries↗

GenePING: secure, scalable management of personal genomic data.

BACKGROUND: Patient genomic data are rapidly becoming part of clinical decision making. Within a few years, full genome expression profiling and genotyping will be affordable enough to perform on every individual. The management of such sizeable, yet fine-grained, data in compliance with privacy laws and best practices presents significant security and scalability challenges. RESULTS: We present the design and implementation of GenePING, an extension to the PING personal health record system that supports secure storage of large, genome-sized datasets, as well as efficient sharing and retrieval of individual datapoints (e.g. SNPs, rare mutations, gene expression levels). Even with full access to the raw GenePING storage, an attacker cannot discover any stored genomic datapoint on any single patient. Given a large-enough number of patient records, an attacker cannot discover which data corresponds to which patient, or even the size of a given patient's record. The computational overhead of GenePING's security features is a small constant, making the system usable, even in emergency care, on today's hardware. CONCLUSION: GenePING is the first personal health record management system to support the efficient and secure storage and sharing of large genomic datasets. GenePING is available online at http://ping.chip.org/genepinghtml, licensed under the LGPL.

Confidentiality↗

All preregistration students should develop skills in learning disabilities.

In the light of ongoing service developments and government legislation it is important that preregistration nurses from all branches have the opportunity to develop their confidence and skills in the care of people who have learning disabilities. This article outlines the development of strategies employed by one institute of higher education in order to reflect the principles of "Valuing People" from a health perspective in non-learning disability nursing programmes. The particular challenges that have been encountered in the implementation of these strategies over the last 3 years are discussed, as are issues faced in the evaluation of the effectiveness of such strategies.

Clinical Competence↗

Traumatic injuries in agriculture.

The National Coalition for Agricultural Safety and Health (NCASH) in 1988 addressed issues in agriculture and noted "a sense of urgency... arose from the recognition of the unabating epidemic of traumatic death and injury in American farming . . ." This article provides an update to the NCASH conference on traumatic injuries in agriculture, a history on how the facts and figures were arrived at for the NCASH conference, and a current report on the status of traumatic injuries in agriculture in the U.S. Fatal and nonfatal injuries are addressed along with national and regional surveillance systems. The Census of Fatal Occupational Injuries (CFOI) was used for reporting national agricultural production fatal injuries from 1992-1998 (25.8 deaths per 100,000 workers), the Traumatic Injury Surveillance of Farmers (TISF) 1993-1995 was used to report nonfatal injuries occurring nationally (7.5/100 workers), and Regional Rural Injury Studies I and II (RRIS-I and RRIS-II) were used to illustrate a regional approach along with in-depth, specific analyses. Fatality rates, which showed some decline in the 1980s, were fairly constant during the 1990s. Changes in nonfatal injury rates for this sector could not be assessed due to a lack of benchmark data. The main concerns identified in the 1989 NCASH report continue today: tractors are the leading cause of farm-related death due mostly to overturns; older farmers continue to be at the highest risk for farm fatalities; and traumatic injuries continue to be a major concern for youth living or working on U.S. farms. Fatal and nonfatal traumatic injuries associated with agricultural production are a major public health problem that needs to be addressed through comprehensive approaches that include further delineation of the problem, particularly in children and older adults, and identification of specific risk factors through analytic efforts. Continued development of relevant surveillance systems and implementation of appropriate interventions are the primary challenges for the current decade.

Accidents, Occupational↗

Robotic devices for movement therapy after stroke: current status and challenges to clinical acceptance.

Robotic devices for movement therapy are moving closer to becoming commercially available tools for aiding in stroke rehabilitation. Robotic technology offers a range of functions that will augment current clinical practice by leveraging therapists' time, cost effectively extending therapy programs, providing new measures of impairment, and offering new therapy protocols. In this article, we review work from several research laboratories that supports the clinical value of stroke therapy systems. A commercialization effort based on these results is described. We also discuss challenges to achieving clinical acceptance and practical implementation of these devices.

Journal Article↗

Human rights and maternal-fetal HIV transmission prevention trials in Africa.

The human rights issues raised by the conduct of maternal-fetal human immunodeficiency virus transmission trials in Africa are not unique to either acquired immunodeficiency syndrome or Africa, but public discussion of these trials presents an opportunity for the United States and other wealthy nations to take the rights and welfare of impoverished populations seriously. The central issue at stake when developed countries perform research on subjects in developing countries is exploitation. The only way to prevent exploitation of a research population is to insist not only that informed consent be obtained but also that, should an intervention be proven beneficial, the intervention will be delivered to the impoverished population. Human rights are universal and cannot be compromised solely on the basis of beliefs or practices of any one country or group. The challenge to the developed countries is to implement programs to improve the health of the people in developing countries both by improving public health infrastructure and by delivering effective drugs and vaccines to the people.

Africa↗

Utilisation of pharmacokinetic-pharmacodynamic modelling and simulation in regulatory decision-making.

Modelling and simulation (M&S) play an important role in regulatory decision-making that affects both the public and industry. Technological advances in various fields related to drug development call for more focus on ways to optimise current drug development practices. Recognition of the potential of M&S by regulatory agencies inevitably has a substantial impact on drug development. The objective of the current review is to present the various regulatory initiatives for application of M&S to clinical drug development. The relevant parts of the various recommendations issued by the US Food and Drug Administration (FDA), via guidance documents and advisory committee meeting proceedings, are highlighted. Application of M&S to a variety of activities, such as integrating pharmacokinetic-pharmacodynamic knowledge across a new drug application and designing efficient trials, is discussed. Some of the challenges that pharmaceutical institutions currently face when implementing M&S projects, such as team structure, communication with regulators, training and time constraints, are also presented, and solutions are proposed.

Adult↗

Comparison of oncology nurse and physician use of the Internet for continuing education.

BACKGROUND: In the past 10 years, there has been a dramatic increase in published literature on the topic of Internet use by healthcare professionals. Learners and organizations providing grants to the continuing education (CE) division of a medical education and publishing company have expressed increasing interest in the area of Internet CE. To quantify and analyze this trend, the company began using surveys to evaluate this growing area of interest. METHOD: Since 1998, annual surveys at the annual meetings of the Oncology Nursing Society and the American Society of Clinical Oncology were used to determine trends in educational use of the Internet for CE. FINDINGS: Internet use and frequency of use, including use of the Internet for CE among both nurses and physicians, have been increasing. When asked what would make these professionals more likely to use the Internet for CE, both indicated making the activities low cost or free and easier access. CONCLUSIONS: Nurses and physicians are looking to the Internet for quick access to reliable information, thus challenging CE educators to develop ways to implement Internet CE activities quickly. Ongoing needs assessment of target audiences and evaluation of the effectiveness of Internet CE is essential to optimizing the role of this educational format for healthcare professionals.

Attitude of Health Personnel↗

Developing individualized care in nursing homes: integrating the views of nurses and certified nurse aides.

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Aged↗

Nursing elective: balancing caregiving in oppressive systems.

This course was developed when health care reform was being birthed in local hospitals under the slogan "Patient First." Architects of the change promised to involve nursing in all decisions. In the end, nursing leaders and advocates were terminated or squeezed out of the organizations. No one there now speaks for nurses at an executive level. Returning registered nurses experience this lack of voice in their organizations and come to class feeling powerless to stop the emergence of unsafe or fraudulent practices in health care (i.e. use of unlicensed assistants, altering of diagnostic codes to lengthen stays, etc.). Nurses want to take action but lack the political knowledge and skills to know where to start. Developing and implementing a course in oppression in nursing challenged this author to face the ways nursing education continues to oppress students and prepares them to blend into the status quo. Students graduate to practice in systems consumed with restructuring health care, lowering patient costs, and providing the least amount of qualified staff. Learning about oppression and how to withstand domination of one's nursing practice in deviant health care systems is not part of the regular language of teaching. The course was an attempt to flush out, articulate, and confront the meta-world of the curriculum that silently instructs students to accept oppressive practices in the workplace. The course labeled the beast and served as a catalyst for many interesting discussions. Oppression and tactics to counter oppression must be actively taught to our students. Oppressed nurses equal oppressed nursing care. Based on my learning and a critical eye to the scary realities of practice, this course marks for me my intent to support Jane Hardens (1996) call to teach for peaceful revolution.

Assertiveness↗

Conceptual framework, critical questions, and practical challenges in conducting research on the financial impact of worksite health promotion.

A conceptual framework to guide research on the financial impact of health promotion programs is described. Important questions that must be answered within this framework are discussed and brief summaries of the research addressing these questions are summarized. Key issues and challenges that are encountered in designing and implementing financial outcome research are reviewed.

Cost-Benefit Analysis↗

Implementing preventive health measures: a pilot study.

OBJECTIVE: Implementation of preventive services guidelines is performed inconsistently. In an attempt to reduce variation in guideline implementation, we developed a patient questionnaire based on the US Preventive Services Task Force Guide and the Health Plan Employer Data and Information Set 3.0 performance measures of the National Committee on Quality Assurance. SUBJECTS: 100 hospitalized patients of five primary-care physicians. METHODS: In a pilot study, 100 hospitalized patients of five primary-care physicians were questioned about their compliance with evidence-based, preventive healthcare recommendations. Information was requested on blood pressure measurement, cholesterol screening, fecal occult blood testing, smoking-cessation counseling, Pap testing, mammography, postmenopausal hormonal replacement therapy counseling, prostate examination and prostate-specific antigen (PSA) testing, use of aspirin and beta-blockers following an acute myocardial infarction, testing of diabetics for hemoglobin A1c and retinal eye examinations, questioning of the elderly for auditory and visual problems, and receipt of influenza and pneumococcal vaccines. Information on variations from the recommended preventive service was fed back to their physicians. Six months after the initial survey, the patients were requestioned to determine if compliance had improved with the recommendations. RESULTS: We found significant improvement in fecal occult blood testing, smoking cessation, Pap smear testing, mammography use, prostate examinations and PSA testing, hemoglobin A1c testing, seeing or hearing loss follow-up, and the administration of influenza and pneumococcal vaccines. CONCLUSIONS: Improving implementation of preventive services recommendations is a challenge. This pilot study suggests that involving the patient more in the process and informing the physician of the results may improve the process.

Adult↗