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PubMedDate not supplied

Thorium in the workplace measurement intercomparison.

The monitoring of radionuclides in the nuclear industry has been recognized as the most straightforward way of assessing health and safety issues associated with the exposure of the workforce to potentially harmful radiation doses. Much of this is achieved by measurements in the workplace itself and by the bioassay and monitoring of workers in the industry. However, there also exists a significant 'non-nuclear' industry where workers are exposed to radioactive materials, for example where this involves thorium, which is made wide use of in the aerospace and other high technology industries. As such work involves the processing of thorium bearing materials, the workforce is potentially exposed to 232Th and its daughter nuclides. Thus, to monitor the workforce effectively, it is important to be able to measure both 232Th and the decay products of 232Th where they are in an unknown state of radioactive equilibrium and this is where monitoring laboratories may experience some difficulty. Accordingly, the Health and Safety Laboratory in the UK has organized a EC wide project on the monitoring of thorium in the 'non-nuclear' workplace; this project is currently ongoing. We report the results of the first intercomparison of this project involving two solutions of 232Th, one in radioactive equilibrium and one not in equilibrium with its daughters. The results are presented with some comments on how this intercomparison has progressed and how these first results will inform the rest of the project.

Evaluation Studies as Topic↗

PubMedDate not supplied

How many pharmacists are in our future? The Bureau of Health Professions Projects Supply to 2020.

OBJECTIVE: To describe a Bureau of Health Professions model for estimating the numbers and selected demographic characteristics of active pharmacists in the United States and to relate the model's findings. DESIGN: We constructed a model using as base counts data from the Pharmacy Manpower Project census of 1989 to 1991 and advancing the counts annually based on estimates of pharmacists entering and leaving the workforce. The total number of active pharmacists in any year was the sum of the male and female cohorts from age 24 through age 75. The model and its underlying assumptions included consideration of U.S. graduates through 1998, international pharmacy graduates who become licensed in the United States, new schools, type of entry-level degrees, and separation rates. A basic series and high and low alternative series were constructed based on different assumptions. RESULTS: The basic series projected 196,011 active pharmacists in 2000, 224,524 by 2010, and 249,086 by 2020. Estimated pharmacists per-100,000 population were 71.2 in 2000, 74.9 in 2010, and 76.7 in 2020. The workforce was projected to consist increasingly of women: 32% in 1991, 46% in 2000, 50% in 2003, and 64% in 2020. Percentages of graduates receiving the BS degree fell from 94% (1980) to 64.4% (1998) and were projected to decrease to 0% by 2005. Estimated U.S. graduates were 7,945 in 2000, 8,133 in 2010, and 8,452 in 2020. The mean age in 2000 was 38 years for women pharmacists, 46 for men, and 42 overall. Estimates of total pharmacists in 1998 were similar to those from other sources, increasing confidence in the model. CONCLUSION: The Bureau of Health Professions model, which can be readily revised as more and better data become available, provided estimates of active pharmacists by age and sex from 1991 to 2020. The model portrayed an increasingly female pharmacy workforce, with more pharmacists holding the PharmD degree. The model and data are useful for research, analysis, and health care planning.

Adult↗

PubMed2003

The nursing shortage: part way down the slippery slope.

The shortage of nurses has reached a crisis point for health care services. A number of issues including the effects of economic rationalism, generational differences, working conditions and nurse education are revisited in a discussion that aims to refuel the debate on workplace reform for nurses. Economic rationalism has altered the healthcare service landscape. Attempts to balance service delivery with workforce resources have led to possibly unforeseen changes. Highly skilled nurses are required in acute services, however resource allocation may prevent this. The nursing workforce is aging although the current nursing workforce consists of three generations: baby boomers, generation X and generation Y. There are significant ideological and work organisational differences between these generations leading to possible conflict between nurses. The pool of available nurses to fill employment vacancies is finite. Attracting overseas nurses to fill nurse vacancies will leave vacancies elsewhere and is not a long-term solution to the nursing shortage. Moreover, if the workplace has not addressed the reasons why nurses have left the health care workplace then there is a real danger of losing those recently attracted back into the workplace. Working conditions are a critical element within the retention puzzle. Job satisfaction dimensions such as autonomy and professional relationships are key components for improving working conditions. The final issue explored is the question of whether the tertiary education system is the most appropriate place in which to develop and educate nurses. It is suggested that workplace reforms should be the target of retention strategies rather than changes in the educational process of nursing.

Adult↗

PubMed2001

Country report: Australia.

The last 10 years has been an interesting time for Australian medical education despite reduced funding. WORKFORCE: There are five main workforce trends: a rural/urban maldistribution, a need for more specialists, public hospital staffing difficulties, increasing female practitioners and under-representation of indigenous practitioners. ISSUES FACING THE DEANS: Lack of resources is a problem facing Deans, with pressure for clinical service in teaching hospitals. Entrepreneurial activities have been undertaken including the enrollment of overseas students. Medical schools have also responded to important government initiatives. DEVELOPMENTS IN MEDICAL EDUCATION: Australia's 11 medical schools have undergone significant reform in the last decade. There is a mix of four (graduate), five and six year courses. AUSTRALIA'S NEW MEDICAL SCHOOL: James Cook University opened the first medical school in northern Australia in 2000. The School admits students from rural, northern Australian and indigenous backgrounds. It has a strong regional mission. RURAL AND COMMUNITY-BASED EDUCATION: Government funding to address the maldistribution of the workforce has led to the establishment of rural clubs, Departments of Rural Health and community-based programs. THE FIRST TWO POSTGRADUATE YEARS: There have been recent moves to improve education in the two years following graduation. This includes the initiation of national projects in curriculum and assessment. POSTGRADUATE AND CONTINUING MEDICAL EDUCATION: Postgraduate programs in Australia are being reformed to build on the changes in undergraduate education. CME is also under review. CONCLUSION: Australian medical educators should build on the recent reforms and take on some of the new directions in medical education.

Australia↗

PubMed2002

Research and its relationship to nurse education: focus and capacity.

Nursing, midwifery and health visiting together form the largest professional workforce within the NHS, and the clinical activities of nurses and the outcomes of these interventions are, therefore, of critical importance to patients. In consequence, adequate preparation for practice should include evidence-based nursing interventions, education to evaluate such evidence, understanding of research methodology and exposure to educators who are engaged in clinical research and can thus act as appropriate models for learners who may aspire to clinical research careers in the future. More broadly, the achievement of these goals requires a continuing strategy to develop capacity for the understanding, undertaking, dissemination and utilisation of research within the profession. This paper argues that nursing is currently in a weak position with regard to creating a future workforce which will have this capacity. Examination of two mental health journals illustrates the lack of focus on clinical research within the profession, whilst a key Government document setting out the future of nursing contains little reference to the role of R&D either in clinical practice or the preparation of the workforce. A recent publication setting out a potential strategy for research in nursing contains considerable hope for the future, but the profession will wish to remain watchful to ensure that the document is translated into action to facilitate a future for clinical nursing research appropriate to the needs of patients.

Education, Nursing↗

PubMed2006

The development of a national bicultural and interprofessional programme in clinical teaching and supervision in New Zealand.

Throughout the world, particularly in colonized countries, the health status of indigenous people and the unequal representation of indigenous people within the health workforce is of concern. In 2002, as part of a national health workforce development strategy, a qualification was developed to provide Maori (Indigenous New Zealander) health professionals with the skills and confidence to teach and supervise students on clinical placements in Maori health environments. This project required close collaboration between two education providers, one a Maori private education provider and the other a traditional government-funded tertiary institution; and for both organizations to work cooperatively with Maori communities and Maori health providers. The Christchurch College of Education (CCE) and Mauri Ora Associates are jointly involved in the administration, design and delivery of the programme, recruitment of guest lecturers, and ongoing curriculum updates. The content for the programme is mainstream, international and interprofessional but the pedagogy is Maori, with Maori customs, values and traditions upheld and practised. A national Maori health workforce development organization contracts independently with both organizations and provides an oversight and quality monitoring role. Together, the three organizations work with other Maori health professional groups and Maori elders to deliver the qualification. This paper describes how this course was designed, how it is delivered within a Maori paradigm, and how the outcomes are achieved. It also describes the cooperation between Maori and Pakeha (white New Zealanders) across health, community and educational organizations that was required to sustain this programme over five years and identifies some themes that may be applied in a global context. In sharing our experiences, we hope to inspire others to consider ways they can meet the needs of indigenous learners within their mainstream programmes.

Clinical Competence↗

PubMed1991

Clean rooms and itchy faces.

Seventy-one male employees whose working environment was a temperature and dust controlled low-humidity 'Clean Room' and 144 male employees working in a natural factory environment were compared by means of period percentage prevalences of occurrence, severity and frequency of subjective symptoms of facial dermatitis. Using a cross-sectional interviewer-administered questionnaire it was possible to assess the percentage prevalence of each of 3 facial dermatitis symptoms among both low humidity exposed and non-exposed workers. The two prevalences were compared by calculating a ratio (the percentage prevalence ratio or PPR) of the prevalence of symptoms in the exposed, to that in the non-exposed workforce. A confidence interval (CI) for the PPR was also calculated. For the symptom of itching, the PPR was 1.65 (CI 1.32-2.07) in favour of the study group, whilst for the symptoms of redness and urticaria the PPRs were 1.96 (CI 1.54-2.48) and 2.53 (CI 1.40-4.59) respectively. The occurrence of a greater prevalence of all symptoms in the low-humidity exposed workforce confirms the clinical and laboratory reports of previous workers. A comparison was also made between the two groups of workers of both the severity, and the frequency of occurrence of symptoms. Whilst there was no statistically significant difference between the exposed and non-exposed groups for prevalence of one symptom, among those who had experienced two symptoms there was a PPR of 2.43 (CI 1.37-4.30) between the two groups. Furthermore, among those workers who had experienced all 3 symptoms of facial dermatitis there was a PPR of 3.38 (CI 1.18-8.93) in favour of the low-humidity exposed workforce.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

The MD-PhD researcher: what species of investigator?

Though MD-PhD programs have grown rapidly since their introduction in the mid-1960s, and are widely regarded as fostering excellent young investigators and future leaders in research and academic medicine, the types of research careers their graduates can be expected to pursue have been a point of some confusion. Some regard MD-PhD programs as a flexible approach to scientific training, producing both basic scientists and clinical investigators, while others tend to view these programs as generating either one type of researcher or the other. This range of expectations associated with dual-degree programs and their graduates has perplexed observers over the years and complicated the efforts of planners and policymakers in projecting workforce needs and generating recommendations for research training. To learn more about the research careers of MD-PhDs and how these investigators fit into the larger biomedical research workforce, the authors undertook a review of the types of research proposed by dual-degree and other investigators in 12,116 applications to the National Institutes of Health in 1993 and 1994. In comparing the types of research projects proposed by investigators of various degree types (MDs, MD-PhDs, and PhDs) the authors found that the research interests of the MD-PhDs studied were more closely aligned with the laboratory pursuits of most of their PhD counterparts than with the more clinically-oriented endeavors of those with the MD degree alone. During a time when there are persistent concerns about a shortage of investigators to conduct clinical research and growing fears that America's universities may be producing more PhDs than can be meaningfully employed in the scientific enterprise, the authors' finding indicates a need for future workforce planning to better reflect the respective roles played by MDs, MD-PhDs, and PhDs in biomedical and behavioral research.

Education, Graduate↗

PubMed1994

A summary of data on accumulated occupational radiation doses among Canadian workers.

This paper is based on work done on accumulated career doses. The data are taken from the National Dose Registry and consist of accumulated doses to the monitored workforce from the years 1970, 1975, 1980, 1985, and 1990. Four broad occupational categories are analyzed: medicine, nuclear power, uranium processing (including mining, milling, refining, and fuel fabrication), and industry. Two- and three-dimensional bar charts are used to display workforce sizes, collective accumulated doses, and average accumulated doses over time, broken down by career start. Lognormal plots are used to show the distribution of accumulated doses. Many trends are as could be expected, and some of those may be used for construction of statistical models for career-dose accumulation. The size and accumulated career doses in the workforces of the uranium processing category do not vary regularly with time, and in this case modeling is likely to be difficult.

Canada↗

PubMed2005

Impact of a workplace peer-focused substance abuse prevention and early intervention program.

BACKGROUND: PeerCare is a workplace peer intervention program that focuses on changing workplace attitudes toward on-the-job substance use and trains workers to recognize, intervene with, and refer coworkers who have a problem. METHODS: Monthly injuries at the study company (January 1983 through June 1996) were compared to counts at four other companies in the same industry. Using these panel data, fixed-effects negative binomial regression measured the association of the percentage of the workforce covered by PeerCare with the workplace injury rate. RESULTS: For every 1% increase in the workforce covered with PeerCare, the risk of injury declined by 0.9984 (95% confidence interval, 0.9975-0.9994). These findings suggest that, by June 1996, when 86% of the workforce was covered under PeerCare, the program had reduced injury rates by an average 14% per month. CONCLUSIONS: The findings support the implementation of peer intervention programs as a means to reduce workplace injuries.

Accidents, Occupational↗

PubMed2005

Effects of New Zealand's health reengineering on nursing and patient outcomes.

BACKGROUND: In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States. OBJECTIVE: The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce. RESEARCH DESIGN: The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. SUBJECTS: All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined. MEASURES: Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. RESULTS: After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. CONCLUSIONS: In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.

Adult↗

PubMed2005

A national survey of adult placement schemes in England: recruitment and retention of adult placement carers.

Adult placement (AP) schemes and the carers they support have been, up to now, a largely invisible part of the social care workforce. Carers in particular fail to appear in workforce statistics. They provide a unique form of care to vulnerable people, under-pinned by values of extended family ('kinship') support. Little is known about the range of current activities of AP schemes and the carers they support. This study of AP schemes in England aimed to provide baseline data about the workforce, care provision, qualification levels, training and support issues, and recruitment and retention problems. Questionnaires were sent to all known schemes in England in both statutory and independent sectors. A final database of 130 schemes was compiled and of these, 124 contributed to the survey with complete or partial information. Variables relating to carers, and recruitment and retention problems experienced by schemes were analysed in detail. Age, gender and ethnic profiles of AP carers were described. Anecdotal evidence had suggested that the current regulatory system was leading to a loss of AP carers and/or an increasingly unregulated sector. Results from analyses supported this as the major reason given by schemes for the problems they had experienced in the last 12 months. Estimates of both the current level of registration and the numbers of carers cancelling their registration in the previous 12 months were made. Recently agreed regulatory changes aim to shift the burden of regulation from individual carers to AP schemes, and thereby ensure a consistent standard of assessment, training and support across England. Evidence from the survey provided support for such a move.

Adolescent↗

PubMed2006

Education needs for integrated care: a literature review.

AIM: This paper reports a systematic review to identify the education needs of the workforce within primary care to promote the effective delivery of integrated health and social care services. BACKGROUND: The need for different professionals to work more closely dominates global health policy. The drive to develop a workforce prepared for the future is crucial to the success of integrated services. However, some have argued that nurses are ill-equipped to meet the challenges of integrated service provision. The ability to work interprofessionally is an important skill which needs to be developed to support integrated working. METHODS: Structured searches were undertaken on organizational websites and the Caredata, CINAHL, Cochrane Library, MEDLINE, Sociofile databases between December 2002 and April 2004 to identify policy documents and primary research studies. The robustness of identified research studies were appraised using recognized appraisal tools. FINDINGS: Six themes were identified which indicate essential elements needed for integrated care. The need for effective communication between professional groups within teams and an emphasis on role awareness are central to the success of integrated services. In addition, education about the importance of partnership working and the need for professionals to develop skills in relation to practice development and leadership through professional and personal development is needed to support integrated working. CONCLUSION: Education which embeds essential attributes to integrated working is needed to advance nursing practice for interprofessional working. Further research exploring this and its impact on integrated provision is essential to ensure that evidence-based services are provided. The reinforcement of partnerships between higher education institutions and health and social care organizations should ensure that the workforce is educated to manage continuous change in service delivery. Innovative ways of teaching and learning which promote inter-professional working need to be explored.

Attitude of Health Personnel↗

PubMed2004

Mental health survivors: your colleagues.

An increasing number of mental health survivors or people who have episodes of mental illness (EOMI) are seeking employment and training as mental health workers (Health Workforce Advisory Committee 2002). Problems for such individuals, as students and in the workforce, will be discussed with special reference to those who are training to complete the New Zealand National Certification in Mental Health Support Work. This article seeks to encourage health professionals to reassess their roles in regard to supported employment for people who have EOMI and to alert them as to the rising number of people who successfully work as trained professionals within mental health areas and have EOMI. The reader is encouraged to reflect on the recovery approach itself and the journey that people who have EOMI encounter when they choose to enter the workforce. This is especially useful to health professionals working in mental health such as consumer groups and nurses. An example of a student who has EOMI is included and the pseudonym "Joe" is applied to this student to protect his identity.

Career Choice↗

PubMed2006

The evolution of the emergency care practitioner role in England: experiences and impact.

BACKGROUND: The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. OBJECTIVE: To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs. METHODS: There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study. RESULTS: Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling. CONCLUSION: Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.

Delivery of Health Care↗

PubMed2003

Fluid losses and hydration status of industrial workers under thermal stress working extended shifts.

AIMS: To assess whether workers under significant thermal stress necessarily dehydrated during their exposure and whether "involuntary dehydration" was inevitable, as supported by ISO 9866 and other authorities. Other objectives were to quantify sweat rates against recommended occupational limits, to develop a dehydration protocol to assist with managing heat exposures, and to understand the role of meal breaks on extended shifts in terms of fluid replacement. METHODS: A field investigation to examine the fluid consumption, sweat rates, and changes in the hydration state of industrial workers on extended (10, 12, and 12.5 hour) shifts under significant levels of thermal stress (wet bulb globe temperature (WBGT) >28 degrees C) was conducted on 39 male underground miners. Urinary specific gravity was measured before, during, and at the completion of the working shift. Environmental conditions were measured hourly during the shift. Fluid replacement was measured during the working periods and during the meal breaks. RESULTS: Average environmental conditions were severe (WBGT 30.9 degrees C (SD 2.0 degrees C), range 25.7-35.2 degrees C). Fluid intake averaged 0.8 l/h during exposure (SD 0.3 l/h, range 0.3-1.5 l/h). Average urinary specific gravity at start, mid, and end of shift was 1.0251, 1.0248, and 1.0254 respectively; the differences between start and mid shift, mid and end shift, and start and end shift were not significant. However, a majority of workers were coming to work in a moderately hypohydrated state (average urinary specific gravity 1.024 (SD 0.0059)). A combined dehydration and heat illness protocol was developed. Urinary specific gravity limits of 1.022 for start of shift and 1.030 for end of shift were selected; workers exceeding these values were not allowed into the workplace (if the start of shift limit was exceeded) or were retested prior to their next working shift (if the end of shift limit was exceeded). A target of 1.015 as a euhydrated state for start of shift was adopted for workforce education. CONCLUSIONS: This study found that "involuntary dehydration" did not occur in well informed workers, which has implications for heat stress standards that do not make provision for full fluid replacement during heat exposure. Fluid replacement during meal breaks was not significantly increased above fluid replacement rates during work time, with implications for the duration and spacing of meal breaks on long shifts. Testing of urinary specific gravity was found to be a good indication of hydration status and a practical method of improving workforce awareness and understanding of this important risk factor. Approximately 10 000 dehydration tests have been conducted under the dehydration protocol in a workforce of 2000 persons exposed to thermal stress and has proved practical and reliable.

Adult↗

PubMed1998

Linking public health education and practice: the Australian experience.

The public health workforce in Australia is highly skilled, multifunctional, and drawn from a variety of backgrounds, including clinical practice and non-health areas. A wide range of activities is needed to meet the educational and training requirements of this workforce, including on the job inservice training, context specific continuing education programs and short courses, distance and self-directed learning packages, and postgraduate University level courses. The core components of public health today include: a social and political commitment to health, a shared responsibility between government and the public, and a multidisciplinary field of action. The challenge for those providing education and training for the public health workforce is to ensure graduates have the broad range of knowledge and skills needed in this climate. A system-wide approach to learning, where knowledge and skill development is related to the practices and settings of service and program delivery, will ensure strong links between education and practice.

Australia↗

PubMed2005

Challenges in teacher preparation for school health education and promotion.

The health education and promotion profession is facing a series of teacher preparation challenges related to the delivery of quality school health education/promotion programmes. The challenges occurring in the United States are also present in a variety of other regions as the education structure attempts to ensure that students receive a sound preparation in health education and promotion during their school experience. The challenges can be categorised into the following areas: Quality and quantity of professional preparation for teachers during their pre-service university training; Need for in-service of teachers already in the K-12 workforce (in the USA grades K-12 are broadly equivalent to ages five to 17 years); University faculty workforce professional development needs; Research to provide baseline data for future standards development. Because there is a direct connection between community and school and parents and teachers at the K-12 level of education, the demand for highly skilled teachers and professional development is playing out at that level much more rapidly than at the university level. The relative isolation of some university faculty and programmes has developed an interesting situation in which many administrators and master teachers at the K-12 level of education have a better grasp and understanding of new teaching and learning strategies and tools than professors at the university level. This has happened at the same time when there is also a shortage of university professors entering school health education/promotion teacher education. This confluence of realities may predicate the need for a radical change in university based teacher preparation in health education/promotion. The overwhelming challenge for many countries including the United States remains the large number of teachers in the current workforce who must be provided professional development experiences. Currently both the National Health Education Standards for K-12 students and teacher preparation standards in health education reflect best practice theory only. There is no national data to support the standards. During the next ten years it is imperative that nationwide data be collected, compiled and analysed on actual learning outcomes for both K-12 students and health education teacher candidates. This will allow the next set of standards at both of the above-mentioned levels to reflect the knowledge and skills that have been actually attained and demonstrated. It will also be a basis for creating revisions and expansions in such a way that national standards can be an actual measure by which student performance can be judged. It is hoped that the rising tide of both national and international interest in having an increasingly health literate population will inspire members of the profession to be creative in the development of educational approaches, strategic partnerships, and funding to put strong systems of teacher preparation in place for the future.

Faculty↗