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Are BSN students changing? Merritt says they are. Further, she says educators need to change their ways. They need to design programs for the average student, not for some ideal student who doesn't exist.
The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.
The voice of adult learners is often overlooked in the design of programs that are specifically constructed to meet their learning needs. This article portrays the design of a midwifery re-registration program that commenced with a survey of non-practising midwives. The organisation of the course, together with the processes involved in curriculum building are explained. The adult learner, particularly in a situation where previous knowledge, skills and experience are vital inputs to the design of programs, have been highlighted.
The purpose of this study was to evaluate a teen parent program designed to increase parents' self-esteem, improve parenting skills, and increase parental knowledge about child development. Subjects (n = 30) in the program were referred from public health services. Control subjects (n = 30) were served by a local health department. Subjects were tested before and on completion of the program (or 6-9 months later for controls) using the Coopersmith Self-Esteem Inventory (SEI), the Inventory of Parents' Experiences (IPE), and the Denver Developmental Screening Test (DDST). Findings included (a) intervention subjects scored lower than control subjects on the pretesting in self-esteem (p less than 0.05), parental role satisfaction (p less than 0.05), and community support (p less than 0.0001); (b) control subjects scored lower on satisfaction with intimate relationships (p less than 0.0001); (c) at post-test, there were no statistically significant differences, and intervention subjects recorded self-esteem scores had increased to control levels; and (d) no developmental delays were detected in newborns at either pre- or post-testing. Implications of this study include (a) data support effectiveness of the program in enhancing self-esteem, maintaining satisfaction in parental role, and increasing community support for teen parents; and (b) evaluation of teen parent programs' effects should be done every 3-6 months to reduce subject attrition.
Training clinical preceptors in the subtleties of clinical teaching is essential to the success of precepted orientations. This paper presents a program design for the preparation of these preceptors. Emphasis is on the assumptions underlying the program, program content, and evaluation.
The concepts and goals of a program in adolescent medicine should include development of a capability to focus on current health needs of youth in a variety of settings; to plan clinical services to meet those needs with the flexibility necessary to respond to changing future requirements; and to deliver service within such a context while simulataneously creating a milieu conducive to education and investigation into the very process and definition of adolescence. The Division of Adolescent Medicine at Montefiore Hospital and Medical Center was designed 7 years ago to fulfill these goals and consequently may serve others as a functional model for health care delivery to teenagers. The Division is comprised of: (1) a 37 bed in-patient unit; (2) a hospital-based ambulatory program including general diagnostic and follow-up services, as well as a speciality service capability in the areas of gynecology and family planning, cardiology, gastroenterology and nutrition; (3) primary care health services within teenage dentention and prison facilities; (4) addictive disease diagnostic and treatment programs; (5) school health programs from intermediate school through college levels, and (6) the division also performs supportive and consultative functions for a variety of community-based agencies. Within the programatic design approximately 70,000 adolescents have been served. The cornerstone of the educational and investigative efforts has been the concept that all the above six functional units are clinical laboratories and classrooms so that training and research activities are integral parts of each of the service areas. This program design is continually undergoing revision and refinement so as to remain ever-responsive to new and emerging problems to meet additional training demands and, most importantly, to permit and encourage creativity and growth patients and staff.
The Kaiser Family Foundation's Community Health Promotion Grant Program (CHPGP) provides funding and technical assistance in support of community-based efforts to prevent major health problems. The first phase of the program was implemented in 11 communities in the western United States. This paper describes the evaluation design of the CHPGP in the West, the methods of data collection, and the baseline comparability of intervention and control communities. Major features of the evaluation design include: (1) the randomization of qualified communities making application into funded and unfunded comparison groups; (2) a second set of matched control communities for some intervention sites; (3) data gathering through repeated surveys of community residents (probability samples of adults and adolescents) and institutions (health-related organizations and randomly sampled grocery stores and restaurants); and (4) the use of secondary data to monitor health events. Selected baseline data show that intervention and control communities differ in racial/ethnic composition, but relevant health behaviors and ratings of community activation for health promotion appear comparable.
Three in-hospital educational programs for postpartum women, designed to increase the crash protection of infants in cars, were evaluated in comparison to a group that received no education. The programs consisted of (1) literature, plus making infant carriers readily accessible and convenient to purchase; (2) literature, plus a personal discussion, plus making infant carriers readily accessible and convenient to purchase; and (3) literature, plus the offer of a free infant carrier. The programs increased the extent to which infant carriers were used to transport babies in cars, but had little or no effect on the key outcome measure: use of infant carriers fastened by the car seat belt so that crash protection is provided. Rates of such use were low in all groups. It is concluded that ways of providing increased crash protection to infant and child travelers in addition to use of restraint systems requiring the active, voluntary cooperation of parents must be encouraged. "Passive" (automatic) protection techniques, such as air bags and vehicle interior modifications, have great potential in this regard.
This paper describes the counseling program implemented by a social worker and a family planning counselor for female clinic patients requesting sterilization. Rather than limiting counseling to the guidelines for informed consent established by New York City law, a comprehensive approach is utilized. The program combines the provision of information regarding the procedure and contraceptive alternatives, with an opportunity for individuals to examine the psychosocial components of their request for sterilization. It is the authors' assessment that such comprehensive counseling is essential to provide individuals with the full assistance they need in making the decision to eliminate reproductive capacity, and that legal guidelines should be expanded accordingly.
The following article looks at social controls on the behavior of rural women in Bangladesh that need to be considered in project designs if women are to be able to respond to development programs. Rural women in many countries are constrained by analogous social pressures, which usually have an economic basis favoring the more powerful and therefore are resistant to change. Since these pressures on rural women often have a negative effect on the goals of rural development, they need to be understood and addressed.
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The Keyes method for scoring dental caries in the rat animal model has been used as the basis for a computer-assisted scoring system on the Apple Macintosh personal computer that is described here. The program provides the ability to draw on diagrams of the rat molar dentition and to enter enamel lesion scores (L, E) and dentinal lesion scores (Ds, Dm, and Dx) for all aspects of the molars. The scores and drawings may be changed at any time. Total carious teeth and totals of L, E, Ds, Dm, and Dx are automatically calculated and presented upon user command. Error trapping for typographical errors is provided. In addition, the program provides automatic storage of the collected information, searching and sorting on any of the experimental parameters and on-disk help files that can be accessed from any place within the program. The capacity to obtain printed copy of any or all of the stored information is provided in the program. The program also enables the creation of external data files containing totals for carious teeth, in addition to L, E, Ds, Dm, and Dx totals for each animal of each group represented in the data base. These files are suitable for the transfer of data to commercially available programs for graphical and statistical analyses. The programming technique we describe could be extended to other model systems with standardized scoring for oral disease.
An intervention strategy for teaching syntax to language-disordered children is described, and the results of its use in a controlled study with 11 children are reported. The therapy program attempts to move the child from single words through a series of successive approximations to use of the construct noun + "is" + verbing + noun, incorporating auditory directions and visual stimuli in the form of cards and boards upon which the cards are sequentially ordered. The results of the experimental group who participated in this therapeutic sequence were compared to those of 11 control subjects and suggested significant gains as measured by the pre- to postprogram performance (t = 2.31, p 0.05). Advantages and limitations of this type of intervention strategy are also discussed.
1. Continual exposure to work-related stressors compounds nurses' workloads, increases their stress levels, and places increased demands on their abilities to adapt. 2. Nurses need to learn and routinely use coping measures to prevent exhaustion and burnout. 3. An in-house stress management program can help nurses learn to cope with constant exposure to work-related stressors, halt the cyclic process of stress, prevent burnout, and decrease turnover.
BACKGROUND: Longitudinal cohort studies have traditionally relied on clinic-based recruitment models, which limit cohort diversity and the generalizability of research outcomes. Digital research platforms can be used to increase participant access, improve study engagement, streamline data collection, and increase data quality; however, the efficacy and sustainability of digitally enabled studies rely heavily on the design, implementation, and management of the digital platform being used. OBJECTIVE: We sought to design and build a secure, privacy-preserving, validated, participant-centric digital health research platform (DHRP) to recruit and enroll participants, collect multimodal data, and engage participants from diverse backgrounds in the National Institutes of Health's (NIH) All of Us Research Program (AOU). AOU is an ongoing national, multiyear study aimed to build a research cohort of 1 million participants that reflects the diversity of the United States, including minority, health-disparate, and other populations underrepresented in biomedical research (UBR). METHODS: We collaborated with community members, health care provider organizations (HPOs), and NIH leadership to design, build, and validate a secure, feature-rich digital platform to facilitate multisite, hybrid, and remote study participation and multimodal data collection in AOU. Participants were recruited by in-person, print, and online digital campaigns. Participants securely accessed the DHRP via web and mobile apps, either independently or with research staff support. The participant-facing tool facilitated electronic informed consent (eConsent), multisource data collection (eg, surveys, genomic results, wearables, and electronic health records [EHRs]), and ongoing participant engagement. We also built tools for research staff to conduct remote participant support, study workflow management, participant tracking, data analytics, data harmonization, and data management. RESULTS: We built a secure, participant-centric DHRP with engaging functionality used to recruit, engage, and collect data from 705,719 diverse participants throughout the United States. As of April 2024, 87% (n=613,976) of the participants enrolled via the platform were from UBR groups, including racial and ethnic minorities (n=282,429, 46%), rural dwelling individuals (n=49,118, 8%), those over the age of 65 years (n=190,333, 31%), and individuals with low socioeconomic status (n=122,795, 20%). CONCLUSIONS: We built a participant-centric digital platform with tools to enable engagement with individuals from different racial, ethnic, and socioeconomic backgrounds and other UBR groups. This DHRP demonstrated successful use among diverse participants. These findings could be used as best practices for the effective use of digital platforms to build and sustain cohorts of various study designs and increase engagement with diverse populations in health research.
Continual exposure to work-related stressors compounds nurses' workloads, increases their stress levels, and places increased demands on their abilities to adapt. Nurses need to learn and routinely use coping measures to prevent exhaustion and burnout. This article describes the assessment, plan, implementation, and evaluation of an in-house stress management continuing education program to aid staff members in halting the cyclic process of stress.
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