Implementing Sustainable Data Collection for a Cardiac Outcomes Registry in an Australian Public Hospital.

PubMed

Cox, Nicholas; Brennan, Angela; Dinh, Diem; Brien, Rita; Cowie, Kath; Stub, Dion; Reid, Christopher M; Lefkovits, Jeffrey

2018-04-01

Clinical outcome registries are an increasingly vital component of ensuring quality and safety of patient care. However, Australian hospitals rarely have additional resources or the capacity to fund the additional staff time to complete the task of data collection and entry. At the same time, registry funding models do not support staff for the collection of data at the site but are directed towards the central registry tasks of data reporting, managing and quality monitoring. The sustainability of a registry is contingent on building efficiencies into data management and collection. We describe the methods used in a large Victorian public hospital to develop a sustainable data collection system for the Victorian Cardiac Outcomes Registry (VCOR), using existing staff and resources common to many public hospitals. We describe the features of the registry and the hospital specific strategies that allowed us to do this as part of our routine business of providing good quality cardiac care. All clinical staff involved in patient care were given some data collection task with the entry of these data embedded into the staff's daily workflow. A senior cardiology registrar was empowered to allocate data entry tasks to colleagues when data were found to be incomplete. The task of 30-day follow-up proved the most onerous part of data collection. Cath-lab nursing staff were allocated this role. With hospital accreditation and funding models moving towards performance based quality indicators, collection of accurate and reliable information is crucial. Our experience demonstrates the successful implementation of clinical outcome registry data collection in a financially constrained public hospital environment utilising existing resources. Copyright © 2017. Published by Elsevier B.V.

Attitudes of Nursing Facilities' Staff Toward Pharmacy Students' Interaction with its Residents.

PubMed

Adkins, Donna; Gavaza, Paul; Deel, Sharon

2017-06-01

All Appalachian College of Pharmacy second-year students undertake the longitudinal geriatric early pharmacy practice experiences (EPPE) 2 course, which involves interacting with geriatric residents in two nursing facilities over two semesters. The study investigated the nursing staff's perceptions about the rotation and the pharmacy students' interaction with nursing facility residents. Cross-sectional study. Academic setting. 63 nursing facility staff. A 10-item attitude survey administered to nursing staff. Nursing staff attitude toward pharmacy students' interaction with geriatric residents during the course. Sixty-three responses were received (84% response rate). Most respondents were female (95.2%), who occasionally interacted with pharmacy students (54.8%) and had worked at the facilities for an average of 6.8 years (standard deviation [SD] = 6.7) years. Staff reported that pharmacy students practiced interacting with geriatric residents and nursing facility staff, learned about different medications taken by residents as well as their life as a nursing facility resident. In addition, the student visits improved the mood of residents and staff's understanding of medicines, among others. Staff suggested that students spend more time with their residents in the facility as well as ask more questions of staff. The nursing facility staff generally had favorable attitudes about pharmacy students' visits in their nursing facility. Nursing facility staff noted that the geriatric rotation was a great learning experience for the pharmacy students.

Does live music benefits patients with brain and spinal injury?

PubMed

Zhang, C-C; Mou, L; Wang, X; Guo, D

2015-09-01

The purpose of this study is to examine the feasibility and prospective success associated with implementing and evaluating a six-week live music intervention on an inpatient neurorehabilitation ward. In total 26 patients were included in this study. Out of which, 15 were patients and 11 were staff members. Staff participants completed wellbeing measures at before and after music. Patients completed an assortment of validated measures at five consecutive time points from baseline to follow-up. Staff participants experienced a minor decrease in wellbeing over time. The majority of the data collected from patients illustrated positive trends, with improvements in wellbeing, pain, cognition functioning, independent functioning, and mobility. The feasibility indicates that with modifications that this project is a viable venture. We found that live music appears to be promising new addition to neurorehabilitation.

Improving ED efficiency to capture additional revenue.

PubMed

Mandavia, Sujal; Samaniego, Loretta

2016-06-01

An increase in the number of patients visiting emergency departments (EDs) presents an opportunity for additional revenue if hospitals take four steps to optimize resources: Streamline the patient pathway and reduce the amount of time each patient occupies a bed in the ED. Schedule staff according to the busy and light times for patient arrivals. Perform registration and triage bedside, reducing initial wait times. Create an area for patients to wait for test results so beds can be freed up for new arrivals.

Integrating Intimate Partner Violence Screening and Counseling in a Family Planning Clinic: Evaluation of a Pilot Project in Conakry, Guinea.

PubMed

Samandari, Ghazaleh; Delamou, Alexandre; Traore, Pernamou; Diallo, Fatoumata Guilinty; Millimono, Sita; Camara, Bienvenu Salim; Laffe, Kira; Verani, Fabio; Tolliver, Maimouna

2016-06-01

Few programs exist to address Intimate Partner Violence (IPV) in Guinea. In 2014, Engender Health, in partnership with the local health authorities in Conakry, Guinea, piloted an integrated approach to IPV screening and counseling, within an existing family planning clinic. This article describes both the process of formulating and implementing this approach, as well as the results of an evaluation of the program. From January to June of 2014, Engender Health staff trained midwives at the Conakry International Planned Parenthood Federation family planning clinic staff in screening and counseling client for IPV. Program evaluators used project records, interview with program staff (n=3), midwives (n=3) and client exit interviews (n=53) to measure the outcomes of this pilot project. Regardless of their IPV status, clients appreciated having a venue in which to discuss IPV. Program staff also felt empowered by the additional training and support for IPV screening. The evaluation yielded valuable suggestions for improvement, including more time for staff training and mock client interview practice, additional skills in counseling, and stronger referral links for women who screen positive for IPV. Integrating IPV screening into family planning services is an important and feasible method for reaching vulnerable women with IPV services.

Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results-A Service Quality Improvement Study.

PubMed

Bowman, Brent; Smith, Scott

2010-01-01

Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff.DirectConnect-the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone-focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time.How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is "one-number" convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times.The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation-making no additions to medical office staffing levels. The efficiencies gained by directly connecting medical advice-seeking patients with their Primary Care team resulted in an estimated savings of 198 and 247 cumulative hours per week in unnecessary telephone work for Call Center and medical office staff regionwide.

Staff Nurses’ Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study

PubMed Central

Van Bogaert, Peter; Peremans, Lieve; Diltour, Nadine; Van heusden, Danny; Dilles, Tinne; Van Rompaey, Bart; Havens, Donna Sullivan

2016-01-01

The aim of the study reported in this article was to investigate staff nurses’ perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses’ involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment. PMID:27035457

Staff Nurses' Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study.

PubMed

Van Bogaert, Peter; Peremans, Lieve; Diltour, Nadine; Van heusden, Danny; Dilles, Tinne; Van Rompaey, Bart; Havens, Donna Sullivan

2016-01-01

The aim of the study reported in this article was to investigate staff nurses' perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses' involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.

Change management of mergers: the impact on NHS staff and their psychological contracts.

PubMed

Cortvriend, Penny

2004-08-01

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

Satisfaction of staff of Swiss insurance companies with medical appraisals: a cross sectional study.

PubMed

Eichler, Klaus; Imhof, Daniel; Bollag, Yvonne; Stöhr, Susanna; Gyr, Niklaus; Auerbach, Holger

2011-03-28

A high quality of timely delivered medical appraisals is crucial for social and other insurances to judge possible occupational reintegration measures for patients with medical conditions who are in danger to lose their job. However, little is known about the satisfaction of staff of insurance companies with medical appraisals that they have commissioned.Our questionnaire survey prospectively included all medical appraisals arriving at Swiss insurances from FEB to APR 2008. We assessed the satisfaction of the commissioner with medical appraisals performed by medical assessors. In addition, we evaluated the contribution of several factors to overall satisfaction. The unit of sample was the medical appraisal. We analysed 3165 medical appraisals, 2444 (77%) of them from the public disability insurance, 678 (22%) from private accident, liability and loss of income insurances and 43 (1%) from other insurances. Overall satisfaction of staff of insurance companies in Switzerland was high, but satisfaction of the disability insurance with appraisals was generally lower compared to satisfaction of private insurances. The staff of the disability insurance judged time for preparation as too long in 30%. For staff of private insurance companies 20% of appraisals were not "worth its price". Well-grounded and comprehensible conclusions were the single most important factor for high overall satisfaction (OR 10.1; 95%-CI: 1.1-89.3). From the viewpoint of staff of insurance companies, a relevant part of medical appraisals arrives too late. Medical assessors have to take the specific needs of insurances into account, to perform more appraisals with sound conclusions in due time.

Satisfaction of staff of Swiss insurance companies with medical appraisals: a cross sectional study

PubMed Central

2011-01-01

Background A high quality of timely delivered medical appraisals is crucial for social and other insurances to judge possible occupational reintegration measures for patients with medical conditions who are in danger to lose their job. However, little is known about the satisfaction of staff of insurance companies with medical appraisals that they have commissioned. Our questionnaire survey prospectively included all medical appraisals arriving at Swiss insurances from FEB to APR 2008. We assessed the satisfaction of the commissioner with medical appraisals performed by medical assessors. In addition, we evaluated the contribution of several factors to overall satisfaction. The unit of sample was the medical appraisal. Findings We analysed 3165 medical appraisals, 2444 (77%) of them from the public disability insurance, 678 (22%) from private accident, liability and loss of income insurances and 43 (1%) from other insurances. Overall satisfaction of staff of insurance companies in Switzerland was high, but satisfaction of the disability insurance with appraisals was generally lower compared to satisfaction of private insurances. The staff of the disability insurance judged time for preparation as too long in 30%. For staff of private insurance companies 20% of appraisals were not "worth its price". Well-grounded and comprehensible conclusions were the single most important factor for high overall satisfaction (OR 10.1; 95%-CI: 1.1-89.3). Conclusions From the viewpoint of staff of insurance companies, a relevant part of medical appraisals arrives too late. Medical assessors have to take the specific needs of insurances into account, to perform more appraisals with sound conclusions in due time. PMID:21443762

Building freeways: piloting communication skills in additional languages to health service personnel in Cape Town, South Africa.

PubMed

Claassen, Joel; Jama, Zukile; Manga, Nayna; Lewis, Minnie; Hellenberg, Derek

2017-06-07

This study reflects on the development and teaching of communication skills courses in additional national languages to health care staff within two primary health care facilities in Cape Town, South Africa. These courses were aimed at addressing the language disparities that recent research has identified globally between patients and health care staff. Communication skills courses were offered to staff at two Metropolitan District Health Services clinics to strengthen patient access to health care services. This study reflects on the communicative proficiency in the additional languages that were offered to health care staff. A mixed-method approach was utilised during this case study with quantitative data-gathering through surveys and qualitative analysis of assessment results. The language profiles of the respective communities were assessed through data obtained from the South African National census, while staff language profiles were obtained at the health care centres. Quantitative measuring, by means of a patient survey at the centres, occurred on a randomly chosen day to ascertain the language profile of the patient population. Participating staff performed assessments at different phases of the training courses to determine their skill levels by the end of the course. The performances of the participating staff during the Xhosa and Afrikaans language courses were assessed, and the development of the staff communicative competencies was measured. Health care staff learning the additional languages could develop Basic or Intermediate Xhosa and Afrikaans that enables communication with patients. In multilingual countries such as South Africa, language has been recognised as a health care barrier preventing patients from receiving quality care. Equipping health care staff with communication skills in the additional languages, represents an attempt to bridge a vital barrier in the South African health care system. The study proves that offering communication skills courses in additional languages, begins to equip health care staff to be multilingual, that allows patients to communicate about their illnesses within their mother tongues.

Joint Recruiting...Is the Time Right

DTIC Science & Technology

2008-03-15

headquarters staff develops strategic plans, determines policies, manages operations, and the national marketing and advertising campaigns.20 Additionally...Service does not have that function at this level ** Public affairs, marketing and advertising are all combined in one person/office for the

Video Feedback in Key Word Signing Training for Preservice Direct Support Staff.

PubMed

Rombouts, Ellen; Meuris, Kristien; Maes, Bea; De Meyer, Anne-Marie; Zink, Inge

2016-04-01

Research has demonstrated that formal training is essential for professionals to learn key word signing. Yet, the particular didactic strategies have not been studied. Therefore, this study compared the effectiveness of verbal and video feedback in a key word signing training for future direct support staff. Forty-nine future direct support staff were randomly assigned to 1 of 3 key word signing training programs: modeling and verbal feedback (classical method [CM]), additional video feedback (+ViF), and additional video feedback and photo reminder (+ViF/R). Signing accuracy and training acceptability were measured 1 week after and 7 months after training. Participants from the +ViF/R program achieved significantly higher signing accuracy compared with the CM group. Acceptability ratings did not differ between any of the groups. Results suggest that at an equal time investment, the programs containing more training components were more effective. Research on the effect of rehearsal on signing maintenance is warranted.

Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow.

PubMed

Melanson, Stacy E F; Goonan, Ellen M; Lobo, Margaret M; Baum, Jonathan M; Paredes, José D; Santos, Katherine S; Gustafson, Michael L; Tanasijevic, Milenko J

2009-12-01

Our goals were to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. Elimination of non-value-added steps and modifications to operational processes resulted in increased capacity to handle workload during peak times without adding staff. The result was a reduction of average patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make process improvements.

Building Service Delivery Networks: Partnership Evolution Among Children's Behavioral Health Agencies in Response to New Funding.

PubMed

Bunger, Alicia C; Doogan, Nathan J; Cao, Yiwen

2014-12-01

Meeting the complex needs of youth with behavioral health problems requires a coordinated network of community-based agencies. Although fiscal scarcity or retrenchment can limit coordinated services, munificence can stimulate service delivery partnerships as agencies expand programs, hire staff, and spend more time coordinating services. This study examines the 2-year evolution of referral and staff expertise sharing networks in response to substantial new funding for services within a regional network of children's mental health organizations. Quantitative network survey data were collected from directors of 22 nonprofit organizations that receive funding from a county government-based behavioral health service fund. Both referral and staff expertise sharing networks changed over time, but results of a stochastic actor-oriented model of network dynamics suggest the nature of this change varies for these networks. Agencies with higher numbers of referral and staff expertise sharing partners tend to maintain these ties and/or develop new relationships over the 2 years. Agencies tend to refer to agencies they trust, but trust was not associated with staff expertise sharing ties. However, agencies maintain or form staff expertise sharing ties with referral partners, or with organizations that provide similar services. In addition, agencies tend to reciprocate staff expertise sharing, but not referrals. Findings suggest that during periods of resource munificence and service expansion, behavioral health organizations build service delivery partnerships in complex ways that build upon prior collaborative history and coordinate services among similar types of providers. Referral partnerships can pave the way for future information sharing relationships.

Building Service Delivery Networks: Partnership Evolution Among Children’s Behavioral Health Agencies in Response to New Funding

PubMed Central

Bunger, Alicia C.; Doogan, Nathan J.; Cao, Yiwen

2014-01-01

Meeting the complex needs of youth with behavioral health problems requires a coordinated network of community-based agencies. Although fiscal scarcity or retrenchment can limit coordinated services, munificence can stimulate service delivery partnerships as agencies expand programs, hire staff, and spend more time coordinating services. This study examines the 2-year evolution of referral and staff expertise sharing networks in response to substantial new funding for services within a regional network of children’s mental health organizations. Quantitative network survey data were collected from directors of 22 nonprofit organizations that receive funding from a county government-based behavioral health service fund. Both referral and staff expertise sharing networks changed over time, but results of a stochastic actor-oriented model of network dynamics suggest the nature of this change varies for these networks. Agencies with higher numbers of referral and staff expertise sharing partners tend to maintain these ties and/or develop new relationships over the 2 years. Agencies tend to refer to agencies they trust, but trust was not associated with staff expertise sharing ties. However, agencies maintain or form staff expertise sharing ties with referral partners, or with organizations that provide similar services. In addition, agencies tend to reciprocate staff expertise sharing, but not referrals. Findings suggest that during periods of resource munificence and service expansion, behavioral health organizations build service delivery partnerships in complex ways that build upon prior collaborative history and coordinate services among similar types of providers. Referral partnerships can pave the way for future information sharing relationships. PMID:25574359

Clinic-day surgery for children: a patient and staff perspective.

PubMed

Criss, Cory N; Brown, Johnathan; Gish, Joshua S; Gadepalli, Samir K; Hirschl, Ronald B

2018-07-01

For the past 3 years, our institution has implemented a same clinic-day surgery (CDS) program, where common surgical procedures are performed the same day as the initial clinic evaluation. We sought to evaluate the patient and faculty/staff satisfaction following the implementation of this program. After IRB approval, patients presenting for the CDS between 2014 and 2017 were retrospectively reviewed. Of these, patient families who received CDS were contacted to perform a telephone survey focusing on their overall satisfaction and to obtain feedback. In addition, feedback from faculty/staff members directly involved in the program was obtained to determine barriers and satisfaction with the program. Twenty-nine patients received CDS, with the most commonly performed procedures being inguinal hernia repair (34%) and umbilical hernia repair (24%). Twenty (69%) patients agreed to perform the telephone survey. Parents were overall satisfied with the CDS program, agreeing that the instructions were easy to understand. Overall, 79% of parents indicated that it decreased overall stress/anxiety, with 75% saying it allowed for less time away from work, and 95% agreeing to pursue CDS again if offered. The most common negative feedback was an unspecified operative start time (15%). While faculty/staff members agreed the program was patient-centered, there were concerns over low enrollment and surgeon continuity, because there were different evaluating and operating surgeons. This study successfully evaluated the satisfaction of patients and faculty/staff members after implementing a clinic-day surgery program. Our results demonstrated improved patient family satisfaction, with families reporting decreased anxiety and less time away from work. Despite this, faculty and staff members reported challenges with enrollment and surgeon continuity.

Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results—A Service Quality Improvement Study

PubMed Central

Bowman, Brent; Smith, Scott

2010-01-01

Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation—making no additions to medical office staffing levels. The efficiencies gained by directly connecting medical advice-seeking patients with their Primary Care team resulted in an estimated savings of 198 and 247 cumulative hours per week in unnecessary telephone work for Call Center and medical office staff regionwide. PMID:20740112

Training direct care staff to increase positive interactions with individuals with developmental disabilities.

PubMed

Zoder-Martell, Kimberly A; Dufrene, Brad A; Tingstrom, Daniel H; Olmi, D Joe; Jordan, Sara S; Biskie, Erika M; Sherman, Julie C

2014-09-01

This study tested the effects of direct training on direct care staff's initiation of positive interactions with individuals with developmental disabilities who resided in an intermediate care facility. Participants included four direct care staff and their residents. Direct training included real-time prompts delivered via a one-way radio, and data were collected for immediate and sustained increases in rates of direct care staff's positive interactions. Additionally, this study evaluated the link between increased rates of positive interactions and concomitant decreases in residents' challenging behaviors. A multiple baseline design across participants was used and results indicated that all direct care staff increased their rates of positive interactions during direct training. Moreover, all but one participant continued to engage residents in positive interactions at levels above the criterion during the maintenance phase and follow-up phases. The direct care staff member who did not initially meet the criterion improved to adequate levels following one brief performance feedback session. With regard to residents' challenging behaviors, across phases, residents engaged in low levels of challenging behaviors making those results difficult to evaluate. However, improvements in residents' rate of positive interactions were noted. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Effects of an intensive therapy program for behaviorally disordered mentally handicapped patients on staff personnel in residential care].

PubMed

Elbing, U; Rohmann, U H

1994-03-01

This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program. The staff members rated their professional competence, quality of interaction with the client, team culture and work satisfaction before and after being engaged in the program, with additional ratings of their personal aims at the beginning of the program. Three sets of data were obtained with the program being conducted three times in a row. The testings of the related as well as the independent samples show differentiated program effects. The main effect is an increase of the professional competence and quality of interaction, especially by the qualified staff members. Trainees put emphasis on the development of their personal relationship with the client. The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome, along with institutional conditions influencing successful learning. Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations.

The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study.

PubMed

Zhou, Yuan; Ancker, Jessica S; Upadhye, Mandar; McGeorge, Nicolette M; Guarrera, Theresa K; Hegde, Sudeep; Crane, Peter W; Fairbanks, Rollin J; Bisantz, Ann M; Kaushal, Rainu; Lin, Li

2013-01-01

The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.

Staff's attitudes and reactions towards aggressive behaviour of clients with intellectual disabilities: a multi-level study.

PubMed

Knotter, Maartje H; Wissink, Inge B; Moonen, Xavier M H; Stams, Geert-Jan J M; Jansen, Gerard J

2013-05-01

Data were collected from 121 staff members (20 direct support staff teams) on background characteristics of the individual staff members and their teams (gender, age, years of work experience, position and education), the frequency and form of aggression of clients with an intellectual disability (verbal or physical), staff members' attitudes towards aggression, and the types of behavioural interventions they executed (providing personal space and behavioural boundary-setting, restricting freedom and the use of coercive measures). Additionally, client group characteristics (age of clients, type of care and client's level of intellectual disability) were assessed. Multilevel analyses (individual and contextual level) were performed to examine the relations between all studied variables and the behavioural interventions. The results showed that for providing personal space and behavioural boundary-setting as well as for restricting freedom, the proportion of variance explained by the context (staff team and client group characteristics) was three times larger than the proportion of variance explained by individual staff member characteristics. For using coercive measures, the context even accounted for 66% of the variance, whereas only 8% was explained by individual staff member characteristics. A negative attitude towards aggression of the direct support team as a whole proved to be an especially strong predictor of using coercive measures. To diminish the use of coercive measures, interventions should therefore be directed towards influencing the attitude of direct support teams instead of individual staff members. Copyright © 2013 Elsevier Ltd. All rights reserved.

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

7 CFR 500.22 - Fees and conditions for use of facilities and grounds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... is committed, including time used to set up before and clean up after an event. For after-hours usage of sites or facilities, an additional $40/hour will be added for supervision for each required staff... the planned use or event. (4) A 50 percent non-refundable deposit will be due at the time of a booking...

Prospective Trial of House Staff Time to Response and Intervention in a Surgical Intensive Care Unit: Pager vs. Smartphone.

PubMed

Tatum, James M; White, Terris; Kang, Christopher; Ley, Eric J; Melo, Nicolas; Bloom, Matthew; Alban, Rodrigo F

The objective of the study was to characterize house staff time to response and intervention when notified of a patient care issue by pager vs. smartphone. We hypothesized that smartphones would reduce house staff time to response and intervention. Prospective study of all electronic communications was conducted between nurses and house staff between September 2015 and October 2015. The 4-week study period was randomly divided into two 2-week study periods where all electronic communications between intensive care unit nurses and intensive care unit house staff were exclusively by smartphone or by pager, respectively. Time of communication initiation, time of house staff response, and time from response to clinical intervention for each communication were recorded. Outcomes are time from nurse contact to house staff response and intervention. Single-center surgical intensive care unit of Cedars-Sinai Medical Center in Los Angeles, California, an academic tertiary care and level I trauma center. All electronic communications occurring between nurses and house staff in the study unit during the study period were considered. During the study period, 205 nurse-house staff electronic communications occurred, 100 in the phone group and 105 in the pager group. House staff response to communication time was significantly shorter in the phone group (0.5 [interquartile range = 1.7] vs. 2 [3]min, p < 0.001). Time to house staff intervention after response was also significantly more rapid in the phone group (0.8 [1.7] vs. 1 [2]min, p = 0.003). Dedicated clinical smartphones significantly decrease time to house staff response after electronic nursing communications compared with pagers. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Working on the Edge: Stresses and Rewards of Work in a Front-line Mental Health Service.

PubMed

Bowden, Gillian Elaine; Smith, Joanna Christina Elizabeth; Parker, Pamela Anne; Boxall, Matthew James Christian

2015-01-01

This study sought to investigate frontline mental health professionals' perceptions of work stress and the rewards and demands associated with their work. Locally known as 'linkworkers', and from a variety of professional backgrounds, these staff worked mainly in general practice settings. Individual interviews were conducted with nine linkworkers, and the interview transcripts were analysed thematically. The main themes identified were the following: demands, coping, individual resilience, ownership and creativity, boundaries, secure base and service philosophy and ethos. Themes, categories and sub categories were presented and discussed with seven of the linkworkers in two focus groups. Focus group transcripts were analysed, and additional themes of recognizing limitations, disillusionment and the dilemma of setting boundaries were identified. These themes overlapped with those previously identified but were associated with service changes over time. The themes of ownership and creativity and service philosophy and ethos are significant, not only in relation to their impact on individual linkworkers but also in terms of their relevance for establishing and maintaining morale, engagement and a reflective culture within a service. The relevance of this work to accessible and newly developing mental health services is considered. Supporting and listening to staff and allowing time for informal contact are valued by staff and enable the provision of empathic, compassionate services. Without space for reflection, staff groups may be vulnerable to the development and effects of unhelpful organizational defences, which reduce the effectiveness, quality and efficiency of caring services and increase perceived workplace stress. Services which foster staff engagement, ownership and creativity and employ "bottom up" approaches to service development are valued by staff and appear to increase staff morale and capacity to cope adaptively to change. Copyright © 2014 John Wiley & Sons, Ltd.

76 FR 54813 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... provisions. In addition, the rule requires an independent public accountant to examine the fund's assets in... independent public accountant verify the fund's assets three times each year and prepare the certificate of examination. Commission staff estimates the annual cost for an independent public accountant to perform this...

10 CFR 2.1505 - Role of the NRC staff.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Role of the NRC staff. 2.1505 Section 2.1505 Energy... Legislative Hearings § 2.1505 Role of the NRC staff. The NRC staff shall be available to answer any Commission or presiding officer's questions on staff-prepared documents, provide additional information or...

10 CFR 2.1505 - Role of the NRC staff.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Role of the NRC staff. 2.1505 Section 2.1505 Energy... Legislative Hearings § 2.1505 Role of the NRC staff. The NRC staff shall be available to answer any Commission or presiding officer's questions on staff-prepared documents, provide additional information or...

10 CFR 2.1505 - Role of the NRC staff.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Role of the NRC staff. 2.1505 Section 2.1505 Energy... the NRC staff. The NRC staff shall be available to answer any Commission or presiding officer's questions on staff-prepared documents, provide additional information or documentation that may be available...

10 CFR 2.1505 - Role of the NRC staff.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Role of the NRC staff. 2.1505 Section 2.1505 Energy... the NRC staff. The NRC staff shall be available to answer any Commission or presiding officer's questions on staff-prepared documents, provide additional information or documentation that may be available...

10 CFR 2.1505 - Role of the NRC staff.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Role of the NRC staff. 2.1505 Section 2.1505 Energy... Legislative Hearings § 2.1505 Role of the NRC staff. The NRC staff shall be available to answer any Commission or presiding officer's questions on staff-prepared documents, provide additional information or...

Balancing nurses' workload in hospital wards: study protocol of developing a method to manage workload.

PubMed

van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

2016-11-10

Hospitals pursue different goals at the same time: excellent service to their patients, good quality care, operational excellence, retaining employees. This requires a good balance between patient needs and nursing staff. One way to ensure a proper fit between patient needs and nursing staff is to work with a workload management method. In our view, a nursing workload management method needs to have the following characteristics: easy to interpret; limited additional registration; applicable to different types of hospital wards; supported by nurses; covers all activities of nurses and suitable for prospective planning of nursing staff. At present, no such method is available. The research follows several steps to come to a workload management method for staff nurses. First, a list of patient characteristics relevant to care time will be composed by performing a Delphi study among staff nurses. Next, a time study of nurses' activities will be carried out. The 2 can be combined to estimate care time per patient group and estimate the time nurses spend on non-patient-related activities. These 2 estimates can be combined and compared with available nursing resources: this gives an estimate of nurses' workload. The research will take place in an academic hospital in the Netherlands. 6 surgical wards will be included, capacity 15-30 beds. The study protocol was submitted to the Medical Ethical Review Board of the University Medical Center (UMC) Utrecht and received a positive advice, protocol number 14-165/C. This method will be developed in close cooperation with staff nurses and ward management. The strong involvement of the end users will contribute to a broader support of the results. The method we will develop may also be useful for planning purposes; this is a strong advantage compared with existing methods, which tend to focus on retrospective analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

78 FR 7460 - Stakeholder Meeting on the Nationally Recognized Testing Laboratory Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... Laboratory (NRTL) Program policies. The meeting will focus on the following topics: NRTL independence; the... as time permits, other topics raised by participants or OSHA staff. OSHA plans to use the information..., in writing, suggestions of additional topics for the meeting is Wednesday, February 13, 2013...

Early risk assessment for viral haemorrhagic fever: experience at the Hospital for Tropical Diseases, London, UK.

PubMed

Woodrow, Charles J; Eziefula, Alice C; Agranoff, Dan; Scott, Geoffrey M; Watson, Julie; Chiodini, Peter L; Lockwood, Diana N J; Grant, Alison D

2007-01-01

To implement a policy of systematic screening for viral haemorrhagic fever (VHF) among travellers returning from African countries with fever, commencing at initial clinical contact. A protocol based on UK Advisory Committee on Dangerous Pathogens guidance was developed collaboratively by medical, nursing and laboratory staff. Audit was carried out to quantify resource demands and effects on time to diagnose malaria, the main differential diagnosis. A protocol is now implemented for all patients presenting to HTD with fever, with clear guidelines for interaction with clinical and laboratory staff at each stage. The protocol required moderate amounts of clinical and laboratory staff time and resulted in some additional hospital admissions. The time to a diagnosis of malaria increased from a median of 90 (range 50-125) min in patients without VHF risk to a median of 140 (range 101-225) min (p=0.0025) in those assessed as at risk. Although all acute medical services need to have robust procedures for early detection of patients with serious transmissible conditions, few implement such a policy. Our protocol requires increased human and other resources but has no important impact on the rapidity of diagnosis of malaria, and is now embedded in local practice.

Optimising the performance of an outpatient setting.

PubMed

Sendi, Pedram; Al, Maiwenn J; Battegay, Manuel; Al Maiwenn, J

2004-01-24

An outpatient setting typically includes experienced and novice resident physicians who are supervised by senior staff physicians. The performance of this kind of outpatient setting, for a given mix of experienced and novice resident physicians, is determined by the number of senior staff physicians available for supervision. The optimum mix of human resources may be determined using discrete-event simulation. An outpatient setting represents a system where concurrency and resource sharing are important. These concepts can be modelled by means of timed Coloured Petri Nets (CPN), which is a discrete-event simulation formalism. We determined the optimum mix of resources (i.e. the number of senior staff physicians needed for a given number of experienced and novice resident physicians) to guarantee efficient overall system performance. In an outpatient setting with 10 resident physicians, two staff physicians are required to guarantee a minimum level of system performance (42-52 patients are seen per 5-hour period). However, with 3 senior staff physicians system performance can be improved substantially (49-56 patients per 5-hour period). An additional fourth staff physician does not substantially enhance system performance (50-57 patients per 5-hour period). Coloured Petri Nets provide a flexible environment in which to simulate an outpatient setting and assess the impact of any staffing changes on overall system performance, to promote informed resource allocation decisions.

Research staff training in a multisite randomized clinical trial: Methods and recommendations from the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) trial.

PubMed

Walker, Robrina; Morris, David W; Greer, Tracy L; Trivedi, Madhukar H

2014-01-01

Descriptions of and recommendations for meeting the challenges of training research staff for multisite studies are limited despite the recognized importance of training on trial outcomes. The STRIDE (STimulant Reduction Intervention using Dosed Exercise) study is a multisite randomized clinical trial that was conducted at nine addiction treatment programs across the United States within the National Drug Abuse Treatment Clinical Trials Network (CTN) and evaluated the addition of exercise to addiction treatment as usual (TAU), compared to health education added to TAU, for individuals with stimulant abuse or dependence. Research staff administered a variety of measures that required a range of interviewing, technical, and clinical skills. In order to address the absence of information on how research staff are trained for multisite clinical studies, the current manuscript describes the conceptual process of training and certifying research assistants for STRIDE. Training was conducted using a three-stage process to allow staff sufficient time for distributive learning, practice, and calibration leading up to implementation of this complex study. Training was successfully implemented with staff across nine sites. Staff demonstrated evidence of study and procedural knowledge via quizzes and skill demonstration on six measures requiring certification. Overall, while the majority of staff had little to no experience in the six measures, all research assistants demonstrated ability to correctly and reliably administer the measures throughout the study. Practical recommendations are provided for training research staff and are particularly applicable to the challenges encountered with large, multisite trials.

Integrating Doulas Into First-Trimester Abortion Care: Physician, Clinic Staff, and Doula Experiences.

PubMed

Chor, Julie; Lyman, Phoebe; Ruth, Jean; Patel, Ashlesha; Gilliam, Melissa

2018-01-01

Balancing the need to provide individual support for patients and the need for an efficient clinic can be challenging in the abortion setting. This study explores physician, staff, and specially trained abortion doula perspectives on doula support, one approach to patient support. We conducted separate focus groups with physicians, staff members, and doulas from a high-volume, first-trimester aspiration abortion clinic with a newly established volunteer abortion doula program. Focus groups explored 1) abortion doula training, 2) program implementation, 3) program benefits, and 4) opportunities for improvement. Interviews were transcribed and computer-assisted content analysis was performed; salient findings are presented. Five physicians, 5 staff members, and 4 abortion doulas participated in separate focus group discussions. Doulas drew on both their prior personal skills and experiences in addition to their abortion doula training to provide women with support at the time of abortion. Having doulas in the clinic to assist with women's emotional needs allowed physicians and staff to focus on technical aspects of the procedure. In turn, both physicians and staff believed that introducing doulas resulted in more patient-centered care. Although staff did not experience challenges to integrating doulas, physicians and doulas experienced initial challenges in incorporating doula support into the clinical flow. Staff and doulas reported exchanging skills and techniques that they subsequently used in their interactions with patients. Physicians, clinic staff, and doulas perceive abortion doula support as an approach to provide more patient-centered care in a high-volume aspiration abortion clinic. © 2018 by the American College of Nurse-Midwives.

Nursing shortages: let's be flexible.

PubMed

Sullivan, Christine; Reading, Sonya

2002-10-01

The following paper is a report outlining a significant work pattern change in an acute cardiac ward at a large Brisbane-based private hospital. The nursing staff expressed the desire for more flexible rostering and the opportunity to work 12-hour shifts. After agreement was reached between the hospital, the union and the Industrial Relations Board, guidelines were put in place and a Flexible Rostering System was proposed and trialed. An 80% consensus of staff was required both to proceed with the trial and to implement any permanent changes. Initially, the trial was conducted for three months and extended to six months. The shifts trialed were between four and 12 hours in length with varied starting and finishing times. The Flexible Rostering System was evaluated using feedback from staff surveys and the results of a staff vote. In addition, patient feedback, incident reports, financial and managerial evaluation of staff costs, hours per patient day utilised, sick leave, and the use of permanent staff for voluntary extra shifts were also monitored. The outcome of the trial was positive with over 80% of staff voting to implement the Flexible Rostering System permanently. A significant reduction in sick leave of 41% and improved retention of skilled registered nursing staff was noted. There was no increase in the number of incident reports or patient complaints. Both patients and nurses commented on the improved continuity of care. Salaries and wages were within budget. Staff surveys showed positive feedback such as increased morale, increased flexibility with rosters, decreased fatigue levels, improved patient assessment on night duty and an increase in number of days off. In conclusion, the Flexible Rostering System has been accepted as a positive change for staff and is cost effective for the hospital. In light of nursing shortages, the outcome of this trial cannot be ignored.

Nursing staff turnover at a Swedish university hospital: an exploratory study.

PubMed

Sellgren, Stina F; Kajermo, Kerstin N; Ekvall, Göran; Tomson, Göran

2009-11-01

The aim was to explore opinions on individual needs and other factors that may influence nursing staff turnover. High staff turnover is a great problem for many hospitals. It is shown to have a negative effect on the quality of nursing care and to increase hospital costs. In 2004 in a large university hospital in Sweden five focus group discussions (FGDs) including department heads (1), nursing managers (2) and members of nursing staff (2) were carried out. The questions to be addressed were 'Why do nurses leave?' and 'Why do nurses stay?' In addition, register data of staff turnover for 2002-2003 were analysed in relation to different facts about the units, such as number of employees, type of care and medical specialty. Categories of opinions identified in the FGDs were compared with results of the statistical analyses on the relationship between staff turnover and unit parameters to identify overall factors that may influence on nurse staff turnover. Four major factors were identified as having a possible influence on staff turnover: 'intrinsic values of motivation', 'work load', 'unit size 'and 'leadership'. Smaller units had lower staff turnover as well as outpatient units and day care. It was not possible to compare statements from participants from smaller units with those from participants from larger units. Two factors had diverging data, 'salary' and 'spirit of the time'. A surprising finding was the little mention of patient care in relation to staff turnover. It is important for managers to ensure that intrinsic values of nurses are met to minimise the risk for high turnover rates. Inpatient care must receive adequate staffing and nursing care could be organised into smaller units or work teams to avoid dissatisfaction and high turnover.

[Organization of clinical care of North Fleet hospitals in XVIII century].

PubMed

Kostiuk, A V

2013-02-01

Clinical care of national navy hospitals was normed from reception of patients till hospital discharge. After admission to the hospital, patient got competent medical care and corresponding attendance. But the situation changed in XVIII century, period of wars. In conditions of war time hospitals were overcrowded with patients and wounded. The number of patients went beyond the bedspace. Deficit of vacant beds was supplied with the help of additional beds; deficit of medical staff was supplied with the help of participation of another medial staff. Huge number of patients with different diseases, including contagious diseases, conduced communication of contagious diseases inside the hospital. Diagnostics and methods of treatment of these diseases were not enough researched. Taking into account results of statistical analysis of data about the number of fatality cases (peace time--4-10%, war time--20%), we can make a conclusion that clinical care of national navy hospitals was satisfying.

Factors Affecting Communication Patterns between Oncology Staff and Family Members of Deceased Patients: A Cross-Sectional Study.

PubMed

Granot, Tal; Gordon, Noa; Perry, Shlomit; Rizel, Shulamith; Stemmer, Salomon M

Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families. This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale. Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant. Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.

Clinical Laboratory Automation: A Case Study

PubMed Central

Archetti, Claudia; Montanelli, Alessandro; Finazzi, Dario; Caimi, Luigi; Garrafa, Emirena

2017-01-01

Background This paper presents a case study of an automated clinical laboratory in a large urban academic teaching hospital in the North of Italy, the Spedali Civili in Brescia, where four laboratories were merged in a unique laboratory through the introduction of laboratory automation. Materials and Methods The analysis compares the preautomation situation and the new setting from a cost perspective, by considering direct and indirect costs. It also presents an analysis of the turnaround time (TAT). The study considers equipment, staff and indirect costs. Results The introduction of automation led to a slight increase in equipment costs which is highly compensated by a remarkable decrease in staff costs. Consequently, total costs decreased by 12.55%. The analysis of the TAT shows an improvement of nonemergency exams while emergency exams are still validated within the maximum time imposed by the hospital. Conclusions The strategy adopted by the management, which was based on re-using the available equipment and staff when merging the pre-existing laboratories, has reached its goal: introducing automation while minimizing the costs. Significance for public health Automation is an emerging trend in modern clinical laboratories with a positive impact on service level to patients and on staff safety as shown by different studies. In fact, it allows process standardization which, in turn, decreases the frequency of outliers and errors. In addition, it induces faster processing times, thus improving the service level. On the other side, automation decreases the staff exposition to accidents strongly improving staff safety. In this study, we analyse a further potential benefit of automation, that is economic convenience. We study the case of the automated laboratory of one of the biggest hospital in Italy and compare the cost related to the pre and post automation situation. Introducing automation lead to a cost decrease without affecting the service level to patients. This was a key goal of the hospital which, as public health entities in general, is constantly struggling with budget constraints. PMID:28660178

The cost of sustaining a patient-centered medical home: experience from 2 states.

PubMed

Magill, Michael K; Ehrenberger, David; Scammon, Debra L; Day, Julie; Allen, Tatiana; Reall, Andreu J; Sides, Rhonda W; Kim, Jaewhan

2015-09-01

As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these "advanced primary care" functions. A key required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. © 2015 Annals of Family Medicine, Inc.

The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States

PubMed Central

Magill, Michael K.; Ehrenberger, David; Scammon, Debra L.; Day, Julie; Allen, Tatiana; Reall, Andreu J.; Sides, Rhonda W.; Kim, Jaewhan

2015-01-01

PURPOSE As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. PMID:26371263

[Staff Satisfaction within Duty Hour Models: Longitudinal Survey on Suitability and Legal Conformity at a Surgical Maximum Care Department].

PubMed

Langelotz, C; Koplin, G; Pascher, A; Lohmann, R; Köhler, A; Pratschke, J; Haase, O

2017-12-01

Background Between the conflicting requirements of clinic organisation, the European Working Time Directive, patient safety, an increasing lack of junior staff, and competitiveness, the development of ideal duty hour models is vital to ensure maximum quality of care within the legal requirements. To achieve this, it is useful to evaluate the actual effects of duty hour models on staff satisfaction. Materials and Methods After the traditional 24-hour duty shift was given up in a surgical maximum care centre in 2007, an 18-hour duty shift was implemented, followed by a 12-hour shift in 2008, to improve handovers and reduce loss of information. The effects on work organisation, quality of life and salary were analysed in an anonymous survey in 2008. The staff survey was repeated in 2014. Results With a response rate of 95% of questionnaires in 2008 and a 93% response rate in 2014, the 12-hour duty model received negative ratings due to its high duty frequency and subsequent social strain. Also the physical strain and chronic tiredness were rated as most severe in the 12-hour rota. The 18-hour duty shift was the model of choice amongst staff. The 24-hour duty model was rated as the best compromise between the requirements of work organisation and staff satisfaction, and therefore this duty model was adapted accordingly in 2015. Conclusion The essential basis of a surgical department is a duty hour model suited to the requirements of work organisation, the Working Time Directive and the needs of the surgical staff. A 12-hour duty model can be ideal for work organisation, but only if augmented with an adequate number of staff members, the implementation of this model is possible without the frequency of 12-hour shifts being too high associated with strain on surgical staff and a perceived deterioration of quality of life. A staff survey should be performed on a regular basis to assess the actual effects of duty hour models and enable further optimisation. The much criticised 24-hour duty model seems to be much better than its reputation, if augmented by additional staff members in the evening hours. Georg Thieme Verlag KG Stuttgart · New York.

Targeting Obesity through Health Promotion Programs for School Staff

ERIC Educational Resources Information Center

Herbert, Patrick C.; Lohrmann, David K.; Hall, Cougar

2017-01-01

Health promotion programs for school staff are an overlooked and under-utilized resource that can lead to reductions in overweight and obesity among teachers and other staff members if implemented properly. In addition to increasing the overall staff wellness, boosting morale, increasing productivity, improving academic achievement, providing…

77 FR 60482 - Yankee Atomic Electric Company; Yankee Rowe Independent Spent Fuel Storage Installation, Staff...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Company; Yankee Rowe Independent Spent Fuel Storage Installation, Staff Evaluation; Exemption 1.0... exemption requests, the NRC staff believes that YAEC should be granted exemptions from the following.... Additional information regarding the NRC (staff) evaluation is documented in a Safety Evaluation Report that...

Staff Recall Travel Time for ST Elevation Myocardial Infarction Impacted by Traffic Congestion and Distance: A Digitally Integrated Map Software Study.

PubMed

Cole, Justin; Beare, Richard; Phan, Thanh G; Srikanth, Velandai; MacIsaac, Andrew; Tan, Christianne; Tong, David; Yee, Susan; Ho, Jesslyn; Layland, Jamie

2017-01-01

Recent evidence suggests hospitals fail to meet guideline specified time to percutaneous coronary intervention (PCI) for a proportion of ST elevation myocardial infarction (STEMI) presentations. Implicit in achieving this time is the rapid assembly of crucial catheter laboratory staff. As a proof-of-concept, we set out to create regional maps that graphically show the impact of traffic congestion and distance to destination on staff recall travel times for STEMI, thereby producing a resource that could be used by staff to improve reperfusion time for STEMI. Travel times for staff recalled to one inner and one outer metropolitan hospital at midnight, 6 p.m., and 7 a.m. were estimated using Google Maps Application Programming Interface. Computer modeling predictions were overlaid on metropolitan maps showing color coded staff recall travel times for STEMI, occurring within non-peak and peak hour traffic congestion times. Inner metropolitan hospital staff recall travel times were more affected by traffic congestion compared with outer metropolitan times, and the latter was more affected by distance. The estimated mean travel times to hospital during peak hour were greater than midnight travel times by 13.4 min to the inner and 6.0 min to the outer metropolitan hospital at 6 p.m. ( p  < 0.001). At 7 a.m., the mean difference was 9.5 min to the inner and 3.6 min to the outer metropolitan hospital ( p  < 0.001). Only 45% of inner metropolitan staff were predicted to arrive within 30 min at 6 p.m. compared with 100% at midnight ( p  < 0.001), and 56% of outer metropolitan staff at 6 p.m. ( p  = 0.021). Our results show that integration of map software with traffic congestion data, distance to destination and travel time can predict optimal residence of staff when on-call for PCI.

Training Out-of-School Time Staff. Part 2 in a Series on Implementing Evidence-Based Practices in Out-of-School Time Programs: The Role of Frontline Staff. Research-to-Results Brief. Publication #2009-05

ERIC Educational Resources Information Center

Metz, Allison J. R.; Burkhauser; Mary; Bowie, Lillian

2009-01-01

A skilled and sustainable workforce is one of the most important markers of high-quality out-of-school time programs. Given the links between skilled staff, high-quality programs, and better youth outcomes, staff training has become an essential part of program implementation. To expand what is known about staff training, Child Trends recently…

Improving safety and operational efficiency in residential care settings with WiFi-based localization.

PubMed

Doshi-Velez, Finale; Li, William; Battat, Yoni; Charrow, Ben; Curtis, Dorothy; Curthis, Dorothy; Park, Jun-geun; Hemachandra, Sachithra; Velez, Javier; Walsh, Cynthia; Fredette, Don; Reimer, Bryan; Roy, Nicholas; Teller, Seth

2012-07-01

To assess the effectiveness of a wireless network (WiFi-based) localization system (devices mounted on resident wheelchairs) in decreasing caretaker time spent searching for residents and providing alerts of residents going outdoors in a skilled nursing facility. A controlled study over two 2-month periods approved by the institutional review board. A long-term skilled nursing facility in Massachusetts specializing in multiple sclerosis previously instrumented with wireless network infrastructure. Nineteen residents and 9 staff members at the facility for the first 2-month period; 9 residents and 3 staff members at the facility for the second 2-month period. Software was installed on 4 staff computers to display the locations of residents enrolled in the study. This software was made available to enrolled staff for the second half of the first 2-month period and the entirety of the second 2-month study. In the second 2-month study, the software was modified to provide alerts if any 1 of 9 participating "high-risk"' residents went outdoors, and the accuracy of the alert system was evaluated. In the first 2-month study, 9 staff members recorded the amount of time it took them to locate participating residents (as and when needed during the course of their daily activities). In the second 2-month study, 3 staff members recorded whether outdoor-alerts correctly identified a resident leaving the building or if it was a false alarm. In both phases, participating staff members made frequent use of the system (44 searches and 215 outdoor alerts). Overall, the localization information decreased the average time needed to find residents by about two-thirds (from 311.1 seconds to 110.9 seconds). For outdoor alerts, the system had a false-alarm rate of 9.1% (under normal facility operations); systematic tests of the outdoor-alert system carried out by the authors had a false-negative, or missed-alarm, rate of 1.7%. Using timely resident location information can provide significant gains for both operational efficiency (finding residents) and enhanced resident safety (outdoor alerts). This approach may provide an inexpensive alternative for facilities that have sufficient wireless infrastructure; future work should assess its effectiveness in additional settings. Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Ethical and Economic Issues. An Interview Survey at Ten Universities.

ERIC Educational Resources Information Center

Linnell, Robert H.; Marsh, Herbert W.

As part of a project concerning policies for those activities that university administrators, faculty, or professional staff may engage in for additional income above their normal full-time salaries, this study's objectives were to determine (1) what policies existed and (2) the extent to which policies or lack of them were considered…

Rural Telecommunications: Why Your Community Isn't Connected and What You Can Do about It. Staff Paper.

ERIC Educational Resources Information Center

Rowley, Tom

Telecommunications technologies have great potential for linking rural homes, schools, businesses, and government. Experts agree that rural development depends on investment in additional telecommunications infrastructure and on local access to the Internet, but getting advanced telecommunications services to rural areas will take time. This…

Improving patient recruitment to multicentre clinical trials: the case for employing a data manager in a district general hospital-based oncology centre.

PubMed

Street, A; Strong, J; Karp, S

2001-01-01

One of the most frequently cited reasons for poor recruitment to multicentre randomized clinical trials is the additional workload placed on clinical staff. We report the effect on patient recruitment of employing a data manager to support clinical staff in an English district general hospital (DGH). In addition, we explore the effect data managers have on the quality of data collected, proxied by the number of queries arising with the trial organizers. We estimate that the cost of employing a data manager on a full-time basis is 502 per patient recruited but may amount to 326 if the appointment is part-time. Data quality is high when full responsibility lies with a data manager but falls when responsibility is shared. Whether the costs of employing a data manager to recruit patients from a DGH are worth incurring depends on the value placed on the speed at which multicentre trials can be completed, how important it is to broaden the research base beyond the traditional setting of teaching hospitals, and the amount of evaluative data required.

Economic grand rounds: Variation in staffing and activities in psychiatric inpatient units.

PubMed

Cromwell, Jerry; Maier, Jan

2006-06-01

In 1999 the Balanced Budget Refinement Act mandated the development of a per diem prospective payment for all psychiatric inpatients. To assist Medicare in developing a per diem patient-based payment system, this study surveyed a representative sample of psychiatric inpatient units in 40 facilities for one week in 2001 through 2003 to determine how units are staffed and how staff members spend their time caring for patients. On general adult units, psychiatric staff averaged ten hours per patient per 24-hour day, roughly 55 percent of staff time was involved in psychiatric care, medical-related nursing and personal care accounted for 10 percent of staff time, and milieu time took up 34 percent of staff time. Small general adult and geriatric units required 50 percent more staff time per patient than large units. More research is needed to determine how recent changes in the method of payment affect these facilities.

Extended operating times are more efficient, save money and maintain a high staff and patient satisfaction.

PubMed

Herron, Jonathan Blair Thomas; French, Rachel; Gilliam, Andrew Douglas

2018-01-01

Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as 'good' or 'excellent' by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.

Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study.

PubMed

Nesset, Merete Berg; Rossberg, Jan Ivar; Almvik, Roger; Friis, Svein

2009-03-01

The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research. To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items. The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services. The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.

Implementing health management information systems: measuring success in Korea's health centers.

PubMed

Chae, Y M; Kim, S I; Lee, B H; Choi, S H; Kim, I S

1994-01-01

This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided.

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient

PubMed Central

Minderhoud, A.L.C. (Ben); Wind, Jelte D.D.; Leenen, Luke P.H.; Hoepelman, Andy I.M.; Ellerbroek, Pauline M.

2016-01-01

The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery. PMID:26812146

Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient.

PubMed

Haverkort, J J Mark; Minderhoud, A L C Ben; Wind, Jelte D D; Leenen, Luke P H; Hoepelman, Andy I M; Ellerbroek, Pauline M

2016-02-01

The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital's preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery.

Primary caregivers' satisfaction with clinicians' response to them as informal carers of young people with first-episode psychosis: a qualitative study.

PubMed

McCann, Terence V; Lubman, Dan I; Clark, Eileen

2012-01-01

To explore first-time primary caregivers' experience of the way mental health nurses and other mental health clinicians respond to them as carers of young people with first-episode psychosis. Caregivers have a key role in supporting family members/relatives with mental illness, but their contribution is undervalued frequently by mental health nurses and other mental health clinicians. Design.  Qualitative interpretative phenomenological analysis. A qualitative interpretative design was undertaken, using semi-structured, audio-recorded interviews. Twenty primary caregivers were recruited through Orygen Youth Health, a first-episode psychosis centre in Melbourne. Interpretative phenomenological analysis was used to identify themes in the data. Two competing themes were identified in the data, highlighting caregivers' contrasting experience with mental health nurses and other mental health clinicians. First, most clinical staff were approachable and supportive. Second, several carers felt their contribution was undervalued by some clinical staff. This was as a consequence of being excluded from clinical deliberations because of clinical staffs' concerns and young people's requests about maintaining confidentiality regarding treatment, as well as carers feeling their role was not taken seriously by clinical staff. First-time primary carers have positive and negative experiences with first-episode psychosis mental health nurses and other clinicians, and these competing events are interrelated. Experiences are affected directly by the manner they are treated by clinical staff and this may, in turn, affect carers' commitment to caring, the way they engage with clinical staff on subsequent occasions and towards the first-episode psychosis service generally. Greater appreciation is needed of the contribution, experience and difficulties caregivers encounter in their role and in engaging with mental health nurses and other clinicians. Additional training is required for clinical staff in family interventions and to familiarise them with legislation and mental health policies relating to carers. © 2011 Blackwell Publishing Ltd.

Improving staff response to seizures on the epilepsy monitoring unit with online EEG seizure detection algorithms.

PubMed

Rommens, Nicole; Geertsema, Evelien; Jansen Holleboom, Lisanne; Cox, Fieke; Visser, Gerhard

2018-05-11

User safety and the quality of diagnostics on the epilepsy monitoring unit (EMU) depend on reaction to seizures. Online seizure detection might improve this. While good sensitivity and specificity is reported, the added value above staff response is unclear. We ascertained the added value of two electroencephalograph (EEG) seizure detection algorithms in terms of additional detected seizures or faster detection time. EEG-video seizure recordings of people admitted to an EMU over one year were included, with a maximum of two seizures per subject. All recordings were retrospectively analyzed using Encevis EpiScan and BESA Epilepsy. Detection sensitivity and latency of the algorithms were compared to staff responses. False positive rates were estimated on 30 uninterrupted recordings (roughly 24 h per subject) of consecutive subjects admitted to the EMU. EEG-video recordings used included 188 seizures. The response rate of staff was 67%, of Encevis 67%, and of BESA Epilepsy 65%. Of the 62 seizures missed by staff, 66% were recognized by Encevis and 39% by BESA Epilepsy. The median latency was 31 s (staff), 10 s (Encevis), and 14 s (BESA Epilepsy). After correcting for walking time from the observation room to the subject, both algorithms detected faster than staff in 65% of detected seizures. The full recordings included 617 h of EEG. Encevis had a median false positive rate of 4.9 per 24 h and BESA Epilepsy of 2.1 per 24 h. EEG-video seizure detection algorithms may improve reaction to seizures by improving the total number of seizures detected and the speed of detection. The false positive rate is feasible for use in a clinical situation. Implementation of these algorithms might result in faster diagnostic testing and better observation during seizures. Copyright © 2018. Published by Elsevier Inc.

Exploring Organizational Barriers to Strengthening Clinical Supervision of Psychiatric Nursing Staff: A Longitudinal Controlled Intervention Study.

PubMed

Gonge, Henrik; Buus, Niels

2016-05-01

This article reports findings from a longitudinal controlled intervention study of 115 psychiatric nursing staff. The twofold objective of the study was: (a) To test whether the intervention could increase clinical supervision participation and effectiveness of existing supervision practices, and (b) To explore organizational constraints to implementation of these strengthened practices. Questionnaire responses and registration of participation in clinical supervision were registered prior and subsequent to the intervention consisting of an action learning oriented reflection on staff's existing clinical supervision practices. Major organizational changes in the intervention group during the study period obstructed the implementation of strengthened clinical supervision practices, but offered an opportunity for studying the influences of organizational constraints. The main findings were that a) diminishing experience of social support from colleagues was associated with reduced participation in clinical supervision, while b) additional quantitative demands were associated with staff reporting difficulties finding time for supervision. This probably explained a negative development in the experienced effectiveness of supervision. It is concluded that organizational support is an imperative for implementation of clinical supervision.

13 CFR 120.824 - Professional management and staff.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Professional management and staff... management and staff. A CDC must have full-time professional management, including an Executive Director (or the equivalent) managing daily operations. It must also have a full-time professional staff qualified...

13 CFR 120.824 - Professional management and staff.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Professional management and staff... management and staff. A CDC must have full-time professional management, including an Executive Director (or the equivalent) managing daily operations. It must also have a full-time professional staff qualified...

13 CFR 120.824 - Professional management and staff.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Professional management and staff... management and staff. A CDC must have full-time professional management, including an Executive Director (or the equivalent) managing daily operations. It must also have a full-time professional staff qualified...

13 CFR 120.824 - Professional management and staff.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Professional management and staff... management and staff. A CDC must have full-time professional management, including an Executive Director (or the equivalent) managing daily operations. It must also have a full-time professional staff qualified...

Staff Judge Advocate Handbook. Revision

DTIC Science & Technology

1990-04-01

4H.. ERRONEOUSLY REPORTED LEAVE 4l ERRONEOUSLY RjtOIE- 41. ERRONEOUSLY REPORIED LOS1 tIME (DAY FO DAY LOST TIME (10 DAY MONTH) - 49 AMPIFI IC REMARKS...with a bad-conduct discharge ( delete if inappropriate); Confinement for months; rorfeiture of 2/3 pay per month for -_ months; and Reduction to the...organization and operational material may be amplified further or tailored through deletion , substitution, or addition within this volume to conform to the

Engaging Frontline Leaders and Staff in Real-Time Improvement.

PubMed

Phillips, Jennifer; Hebish, Linda J; Mann, Sharon; Ching, Joan M; Blackmore, C Craig

2016-04-01

The relationship of staff satisfaction and engagement to organizational success, along with the integral influence of frontline managers on this dimension, is well established in health care and other industries. To specifically address staff engagement, Virginia Mason Medical Center, an integrated, single-hospital health system, developed an approach that involved leaders, through the daily use of standard work for leaders, as well as staff, through a Lean-inspired staff idea system. Kaizen Promotion Office (KPO) staff members established three guiding principles: (1) Staff engagement begins with leader engagement; (2) Integrate daily improve- ment (kaizen) as a habitual way of life not as an add-on; and (3) Create an environment in which staff feel psycho- logically safe and valued. Two design elements--Standard Work for Leaders (SWL) and Everyday Lean Ideas (ELIs) were implemented. For the emergency department (ED), an early adopter of the staff engagement work, the challenge was to apply the guiding principles to improve staff engagement while improving quality and patient and staff satisfaction, even as patient volumes were increasing. Daily huddles for the KPO staff members and weekly leader rounds are used to elicit staff ideas and foster ELIs in real time. Overall progress to date has been tracked in terms of staff satisfaction surveys, voluntary staff turnover, adoption of SWL, and testing and implementation of staff ideas. For example, voluntary turnover of ED staff decreased from 14.6% in 2011 to 7.5% in 2012, and 2.0% in 2013. Organizationwide, at least 800 staff ideas are in motion at any given time, with finished ones posted in an idea supermarket website. A leadership and staff engagement approach that focuses on SWL and on capturing staff ideas for daily problem solving and improvement can contribute to organization success and improve the quality of health care delivery.

School interventions after the Joplin tornado.

PubMed

Kanter, Robert K; Abramson, David

2014-04-01

To qualitatively describe interventions by schools to meet children's needs after the May 2011 Joplin, Missouri tornado. Qualitative exploratory study conducted six months after the tornado. Key informant interviews with school staff (teachers, psychologists, guidance counselor, nurse, principal), public health official, and physicians. After the tornado, school staff immediately worked to contact every enrolled child to provide assistance and coordinate recovery services. Despite severe damage to half of the city's schools, the decision was made to reopen schools at the earliest possible time to provide a safe, reassuring environment and additional services. An expanded summer school session emphasized child safety and emotional wellbeing. The 2011-2012 school year began on time, less than three months after the disaster, using temporary facilities. Displaced children were bused to their usual schools regardless of their new temporary residence locations. In just-in-time training sessions, teachers developed strategies to support students and staff experiencing anxiety or depression. Certified counselors conducted school-based, small-group counseling for students. Selective referrals were made to community mental health providers for children with greatest needs. Evidence from Joplin adds to a small body of empirical experience demonstrating the important contribution of schools to postdisaster community recovery. Despite timely and proactive services, many families and children struggled after the tornado. Improvements in the effectiveness of postdisaster interventions at schools will follow from future scientific evidence on optimal approaches.

Examining Time Use of Dutch Nursing Staff in Long-Term Institutional Care: A Time-Motion Study.

PubMed

Tuinman, Astrid; de Greef, Mathieu H G; Krijnen, Wim P; Nieweg, Roos M B; Roodbol, Petrie F

2016-02-01

Increasing residents' acuity levels and available resources in long-term institutional care requires insight into the care provided by nursing staff so as to guide task allocation and optimal use of resources, and enhance quality of care. The purpose of this study was to examine the relationship between time use and type of nursing staff, residents' acuity levels, and unit type by using a standardized nursing intervention classification. A multicenter cross-sectional observational study was performed using time-motion technique. Five Dutch long-term institutional care facilities participated. In total, 4 residential care units, 3 somatic units, and 6 psycho-geriatric units were included. Data were collected from 136 nursing staff members: 19 registered nurses, 89 nursing assistants, 9 primary caregivers, and 19 health care assistants. A structured observation list was used based on the Nursing Interventions Classification (NIC). Residents' acuity levels, representing residents' needs, were based on the Dutch Care Severity Index. Medians and interquartile ranges were calculated for time spent on interventions per type of nursing staff and units. Linear mixed models were used to examine the relationship between time spent on nursing interventions and the type of nursing staff, residents' acuity levels, and unit type. Observations resulted in 52,628 registered minutes for 102 nursing interventions categorized into 6 NIC domains for 335 residents. Nursing staff spent the most time on direct care interventions, particularly in the domain of basic physiological care. Variances in time spent on interventions between types of nursing staff were minimal. Unit type was more significantly (P < .05) associated with time spent on interventions in domains than the type of nursing staff. Residents' acuity levels did not affect time spent by nursing staff (P > .05). The current study found limited evidence for task allocation between the types of nursing staff, which may suggest a blurring of role differentiation. Also, findings suggest that residents received similar care regardless of their needs, implying that care is predominantly task-oriented instead of person-centered. Managers may reconsider whether the needs of residents are adequately met by qualified nursing staff, considering the differences in education and taking into account increasing acuity levels of residents and available resources. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

75 FR 9924 - Final Comprehensive Conservation Plan for the Red Rock Lakes National Wildlife Refuge, MT

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

...-time staff of five employees and various summer temporaries manage and study the refuge habitats and... majority of fishing occurring on Red Rock. In addition, the refuge is open to limited hunting of ducks..., conducting numerous studies to determine the effects and best methods of restoration, including any effects...

47 CFR 0.465 - Request for copies of materials which are available, or made available, for public inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

... COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION General Information Public Information and Inspection... this service shall be ten cents ($0.10) per page or $5 per computer disk in addition to charges for staff time as provided in § 0.467. For copies prepared with other media, such as computer tapes...

47 CFR 0.465 - Request for copies of materials which are available, or made available, for public inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

... COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION General Information Public Information and Inspection... this service shall be ten cents ($0.10) per page or $5 per computer disk in addition to charges for staff time as provided in § 0.467. For copies prepared with other media, such as computer tapes...

47 CFR 0.465 - Request for copies of materials which are available, or made available, for public inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

... COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION General Information Public Information and Inspection... this service shall be ten cents ($0.10) per page or $5 per computer disk in addition to charges for staff time as provided in § 0.467. For copies prepared with other media, such as computer tapes...

26 CFR 53.4958-3 - Definition of disqualified person.

Code of Federal Regulations, 2011 CFR

2011-04-01

... by profession, works part-time at R, a local museum. In the first taxable year in which R employs N, R pays N a salary and provides no additional benefits to N except for free admission to the museum... responsibility for supervising Z's day-to-day operations. For example, E can hire faculty members and staff, make...

Realizing self-sufficiency. YKB clearly demonstrate the viability of fee-charging family clinics.

PubMed

Lynch, H

1993-12-01

Yayasan Kusuma Buana (YKB) is an independent nongovernmental organization (NGO) which has developed and operates 6 family planning and maternal and child health clinics in Indonesia. The clinics target middle-lower income groups as a complement to free government services for comparatively poorer segments of society and the more expensive private services for the relatively more affluent. The presently self-sufficient Pisangan Baru clinic in East Jakarta was established in 1981 and is the oldest of all. It offers family planning and maternal and child health care services in the forms of maternity care, immunizations, and regular check-ups. Friendly and competent female midwives and support staff; short waiting times; the absence of sick and injured patients; bright and clean atmospheres; and affordable prices at YKB clinics attract and hold clients. Clients benefit by receiving quality services close to home at convenient times and lower prices than found in other clinics, while increasing clientele translates into higher wages for clinic staff. Staffs are comprised of midwives and administrative personnel along with doctors who work part-time. Midwives engage in activities which are far beyond the definitions of their jobs. They are health educators, counselors, motivators, and clinicians. In addition to clinical services, most clinics have outreach activities; some provide additional services such as 24-hour delivery service and clinical surgery; and the Pisangan Baru clinic even hosts an aerobics dance class which is open to members and nonmembers alike. All clinics, however, charge fees which are affordable to the majority of the community; offer longer service hours than public clinics; offer health education in many forms; and are maintained only in communities where available services are accepted and used.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Audit of workplace walkability in an Irish healthcare setting.

PubMed

Cronin, Judy

2016-12-01

Recent studies suggest that time spent sitting is associated with greater risks of all causes of mortality and cardiovascular disease even for those who live a healthy lifestyle. As part of a healthier worksite initiative, we conducted a worksite walkability audit and staff survey of a large hospital-based administrative campus with a high proportion of health staff working in largely office-based roles. The US Centre for Disease Control (CDC) Healthier Worksite Initiative Walkability Audit Tool was used to audit 20 walking segments. The audit further examined the walkability of segments most likely to be used by outpatients and the families of residents visiting and attending the campus. The second phase of this research involved an employee electronic survey to understand staff requirements from a workplace physical activity initiative. Overall, the campus scored a medium risk to walkability on the CDC audit tool. This means that with some key minor alterations the walking route could be made safe and attractive for walking. There was a 20% (n = 151) response rate to the staff survey with 66% of respondents sitting at their desk for most of the day with the majority spending 5-7 h a day sitting at work. Evidence suggests that reducing sedentary time may be important to public health. The worksite is an ideal location for targeting a large number of individuals. Key public health messages that promote daily recommended physical activity targets should also carry additional messages about reducing occupational sitting time. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cost analysis of a novel HIV testing strategy in community pharmacies and retail clinics.

PubMed

Lecher, Shirley Lee; Shrestha, Ram K; Botts, Linda W; Alvarez, Jorge; Moore, James H; Thomas, Vasavi; Weidle, Paul J

2015-01-01

To document the cost of implementing point-of-care (POC) human immunodeficiency virus (HIV) rapid testing in busy community pharmacies and retail clinics. Providing HIV testing services in community pharmacies and retail clinics is an innovative way to expand HIV testing. The cost of implementing POC HIV rapid testing in a busy retail environment needs to be documented to provide program and policy leaders with adequate information for planning and budgeting. Cost analysis from a pilot project that provided confidential POC HIV rapid testing services in community pharmacies and retail clinics. The pharmacy sites were operated under several different ownership structures (for-profit, nonprofit, sole proprietorship, corporation, public, and private) in urban and rural areas. We included data from the initial six sites that participated in the project. We collected the time spent by pharmacy and retail clinic staff for pretest and posttest counseling in an activity log for time-in-motion for each interaction. Pharmacists and retail clinic staff. HIV rapid testing. The total cost was calculated to include costs of test kits, control kits, shipping, test supplies, training, reporting, program administration, and advertising. The six sites trained 22 staff to implement HIV testing. A total of 939 HIV rapid tests were conducted over a median time of 12 months, of which 17 were reactive. Median pretest counseling time was 2 minutes. Median posttest counseling time was 2 minutes for clients with a nonreactive test and 10 minutes for clients with a reactive test. The average cost per person tested was an estimated $47.21. When we considered only recurrent costs, the average cost per person tested was $32.17. Providing POC HIV rapid testing services required a modest amount of staff time and costs that are comparable to other services offered in these settings. HIV testing in pharmacies and retail clinics can provide an additional alternative venue for increasing the availability and accessibility of HIV testing services in the United States.

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory

PubMed Central

Mousavi, Ali; Clarkson, P. John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation. PMID:27170899

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory.

PubMed

Komashie, Alexander; Mousavi, Ali; Clarkson, P John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.

Effects of a Multicomponent Restraint Reduction Program for Korean Nursing Home Staff.

PubMed

Kong, Eun-Hi; Song, Eunjin; Evans, Lois K

2017-05-01

Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. Repeated measures analysis of variance showed significant differences between groups in knowledge (p < .001), perceptions (p < .001), and attitudes (p = .011) over time. These significant improvements in the MRRP group (EG) were sustained over the 3-month period. The MRRP effectively improved the knowledge, perceptions, and attitudes of nursing home staff about restraint use with older adults. Additional studies are recommended to evaluate effects of its components while using larger samples and rigorous research methods and measurements, and the inclusion of boosters or other supports to sustain change. These results provide valuable knowledge regarding a multicomponent intervention for changing nursing home staff attributes that likely influence clinical practice. Elements of the educational content and methods found useful for nursing home staff may also be effective in vocational and continuing education as well as for families of older nursing home residents. © 2017 Sigma Theta Tau International.

The efficiency of a dedicated staff on operating room turnover time in hand surgery.

PubMed

Avery, Daniel M; Matullo, Kristofer S

2014-01-01

To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32 minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Exploring staff perceptions and experiences of volunteers and visitors on the hospital ward at mealtimes using an ethnographic approach.

PubMed

Ottrey, Ella; Palermo, Claire; Huggins, Catherine E; Porter, Judi

2018-04-01

To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. A qualitative, ethnographic approach. Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication; "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices; and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and the importance of nutrition. The working relationship between hospital staff, volunteers and visitors should be strengthened to improve nutritional care. © 2018 John Wiley & Sons Ltd.

Additional benefit of dietitian involvement in dialysis staffs-led diet education on uncontrolled hyperphosphatemia in hemodialysis patients.

PubMed

Tsai, Wan-Chuan; Yang, Ju-Yeh; Luan, Chia-Chin; Wang, Yuh-Jiun; Lai, Yu-Chuan; Liu, Lie-Chuan; Peng, Yu-Sen

2016-10-01

Sustained adherence to dietary phosphorus (P) restriction recommendations among hemodialysis patients is questionable. The aim of this study was to evaluate the effectiveness of additional diet education delivered by a dietitian on the control of hyperphosphatemia. We conducted an 8-month prospective observational study in hemodialysis patients who had uncontrolled hyperphosphatemia. In the first half of the study (experimental) period, the dialysis nurses and physicians provided the routine dietetic education with the control group (n = 31), while the experimental group (n = 30) received the routine dietetic education plus an additional diet education delivered by dietitians. Both groups received the routine dietetic education in the rest of the study period to test whether the improvement of serum P level was sustained. The primary outcomes were changes in serum P level. At baseline, there was no significant difference in serum P levels between groups (P = 0.27). In the experimental period, monthly serum P levels decreased significantly in both groups (P < 0.001) and the magnitudes of reduction were 1.81 ± 1.46 and 0.94 ± 1.33 mg/dL in the experimental and control groups, respectively (P = 0.02), at the end. The experimental group maintained such improvement for one more month (P = 0.02), but faded out over time. Renal diet education guided either by dietitians plus dialysis staffs or dialysis staffs alone reduces serum P level and dietitian-guided diet education provides an additional benefit on controlling hyperphosphatemia in hemodialysis patients.

Further Studies of Aerodynamic Loads at Spin Entry

DTIC Science & Technology

1977-06-30

the model and the loads on the model for a research coafiguration having certain essential features of a modern fighter-bomber aircraft, since no such...percent at the tip. The model is geometrically similar to that described in reference 3 but approximately 2.4 times larger. The NASA model is designed to...measurements turned out to be extremely time consuming. Even though the V/STOL tunnel staff granted three additional days over the 10 originally scheduled for

ED Triage Process Improvement: Timely Vital Signs for Less Acute Patients.

PubMed

Falconer, Stella S; Karuppan, Corinne M; Kiehne, Emily; Rama, Shravan

2018-06-13

Vital signs can result in an upgrade of patients' Emergency Severity Index (ESI) levels. It is therefore preferable to obtain vital signs early in the triage process, particularly for ESI level 3 patients. Emergency departments have an opportunity to redesign triage processes to meet required protocols while enhancing the quality and experience of care. We performed process analyses to redesign the door-to-vital signs process. We also developed spaghetti diagrams to reconfigure the patient arrival area. The door-to-vital signs time was reduced from 43.1 minutes to 6.44 minutes. Both patients and triage staff seemed more satisfied with the new process. The patient arrival area was less congested and more welcoming. Performing activities in parallel reduces flow time with no additional resources. Staff involvement in process planning, redesign, and control ensures engagement and early buy-in. One should anticipate how changes to one process might affect other processes. Copyright © 2018. Published by Elsevier Inc.

Screening for depression: integrating training into the professional development programme for low vision rehabilitation staff.

PubMed

Rees, Gwyneth; Holloway, Edith E; Craig, Graeme; Hepi, Niky; Coad, Samantha; Keeffe, Jill E; Lamoureux, Ecosse L

2012-12-01

To describe the integration of depression screening training into the professional development programme for low vision rehabilitation staff and report on staff evaluation of this training. Pre-post intervention study, in a single population of low vision rehabilitation staff. Three hundred and thirty-six staff from Australia's largest low vision rehabilitation organization, Vision Australia. Staff completed the depression screening and referral training as part of a wider professional development programme. A pre-post-training questionnaire was administered to all staff. Descriptive and non-parametric statistics were used to determine differences in self-reported knowledge, confidence, barriers to recognition and management of depression between baseline and post training. One hundred and seventy-two participants completed both questionnaires. Following training, participants reported an increased knowledge of depression, were more likely to respond to depression in their clients and reported to be more confident in managing depression (P < 0.05). A range of barriers were identified including issues related to the client (e.g. acceptance of referrals); practitioners (e.g. skill, role); availability and accessibility of psychological services; time and contact constraints; and environmental barriers (e.g. lack of privacy). Additional training incorporating more active and 'hands-on' sessions are likely to be required. This training is a promising first step in integrating a depression screening tool into low vision rehabilitation practice. Further work is needed to determine the barriers and facilitators to implementation in practice and to assess clients' acceptability and outcomes. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Evaluation of Compliance to National Nutrition Policies in Summer Day Camps

PubMed Central

Tilley, Falon; W.Beets, Michael; Jones, Sonya; Turner-McGrievy, Gabrielle

2015-01-01

Objective The National Afterschool Association (NAA) standards specify the role of summer day camps (SDCs) in promoting healthy nutrition habits of children attending, identifying foods and beverages to be provided to children, and staff roles in promoting good nutrition habits; however, many SDCs to not provide meals. Currently, national guidelines specifying what children are allowed to bring to such settings does not exist, nor is there a solid understanding of the current landscape surrounding healthy eating within SDCs. Design A cross-sectional study design using validated measures with multiple observations was used to determine the types of foods and beverage brought to SDC programs. Setting Four large-scale, community-based SDCs participated in the study during summer 2011. Subjects The types of foods and beverages brought by children (N=766) and staff (N=87) as well as any instances of staff promoting healthy eating behaviors were examined via direct observation over 27 days. Additionally, the extent to which current foods and beverages at SDCs complied with NAA standards was evaluated. Results Less than half of the children brought water, 47% brought non-100% juices, 4% brought soda, 4% brought a vegetable, and 20% brought fruit. Staff foods/beverages modeled similar patterns. Promotion of healthy eating by staff was observed <1% of the time. Conclusions Findings suggest that foods and beverages brought to SDC by children and staff do support nutrition standards and staff do not regularly promote healthy eating habits. To assist, professional development, parent education, and organizational policies are needed. PMID:24909716

Feasibility of a web-based dementia feeding skills training program for nursing home staff.

PubMed

Batchelor-Murphy, Melissa; Amella, Elaine J; Zapka, Jane; Mueller, Martina; Beck, Cornelia

2015-01-01

Nursing home (NH) staff do not receive adequate training for providing feeding assistance to residents with dementia who exhibit aversive feeding behaviors (e.g., clamping mouth shut). The result is often low meal intake for these residents. This feasibility study tested a web-based dementia feeding skills program for staff in two United States NHs. Randomly assigned, the intervention staff received web-based dementia feeding skills training with coaching. Both groups participated in web-based pre-/post-tests assessing staff knowledge and self-efficacy; and meal observations measured NH staff and resident feeding behaviors, time for meal assistance, and meal intake. Aversive feeding behaviors increased in both groups of residents; however, the intervention NH staff increased the amount of time spent providing assistance and meal intake doubled. In the control group, less time was spent providing assistance and meal intake decreased. This study suggests that training staff to use current clinical practice guidelines improves meal intake. Copyright © 2015 Elsevier Inc. All rights reserved.

Simple Interactions: Piloting a Strengths-Based and Interaction-Based Professional Development Intervention for Out-of-School Time Programs

ERIC Educational Resources Information Center

Akiva, Thomas; Li, Junlei; Martin, Kelly M.; Horner, Christy Galletta; McNamara, Anne R.

2017-01-01

Background: Adult-child relational interactions constitute an essential component of out-of-school-time programs, and training staff to effectively interact with children is key to improving program quality. Efficient staff training, that meets the limited time availability of out-of-school time staff, is particularly needed. Objective: This pilot…

45 CFR 235.64 - FFP rates, and activities and costs matchable as training expenditures.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., travel and per diem for: (1) Staff development personnel (including support staff) assigned full time to training functions and; (2) Staff development personnel assigned part time to training functions to the... of less than four consecutive work weeks, or part-time training programs; and (4) Stipends, travel...

45 CFR 235.64 - FFP rates, and activities and costs matchable as training expenditures.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., travel and per diem for: (1) Staff development personnel (including support staff) assigned full time to training functions and; (2) Staff development personnel assigned part time to training functions to the... of less than four consecutive work weeks, or part-time training programs; and (4) Stipends, travel...

45 CFR 235.64 - FFP rates, and activities and costs matchable as training expenditures.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., travel and per diem for: (1) Staff development personnel (including support staff) assigned full time to training functions and; (2) Staff development personnel assigned part time to training functions to the... of less than four consecutive work weeks, or part-time training programs; and (4) Stipends, travel...

Cost analysis in a CMHC: determining the cost of staff time.

PubMed

Haring, A; Eckert, C

1979-06-01

The program evaluation and research unit of a community mental health center developed and field-tested a survey form to measure how employees spend their time. The form is divided into direct patient care activities, which include interviewing and testing, conducting therapy, and prescribing medications, and administrative or support activities, which include filling out charts, attending meetings, and training staff. All staff record daily, for one week, the hours and minutes they spend in each activity. Using that data as a base, the evaluation unit can determine the percentage of time staff spend in each activity and the cost of each activity based on staff members' paychecks.

Hospital employees' perceptions of fairness and job satisfaction at a time of transformational change.

PubMed

Brandis, Susan; Fisher, Ron; McPhail, Ruth; Rice, John; Eljiz, Kathy; Fitzgerald, Anneke; Gapp, Rod; Marshall, Andrea

2016-06-01

Objective This study examines the relationships between job satisfaction and organisational justice during a time of transformational change. Methods Data collection occurred immediately before a major regional hospital's move to a greenfield site. Existing measures of job satisfaction and organisational justice were used. Data were analysed (n=316) using descriptive, correlation and regression methods together with interactions between predictor variables. Results Correlation coefficients for satisfaction and organisational justice variables were high and significant at the P<0.001 level. Results of a robust regression model (adjusted R(2)=0.568) showed all three components of organisational justice contributed significantly to employee job satisfaction. Interactions between the predictor variables showed that job satisfaction increased as the interactions between the predictor variables increased. Conclusions The finding that even at a time of transformational change staff perceptions of fair treatment will in the main result in high job satisfaction extends the literature in this area. In addition, it was found that increasing rewards for staff who perceive low levels of organisational justice does not increase satisfaction as much as for staff who perceive high levels of fairness. If people feel negative about their role, but feel they are well paid, they probably still have negative feelings overall. What is known about the topic? Despite much research highlighting the importance of job satisfaction and organisational justice in healthcare, no research has examined the influence of transformational change, such as a healthcare organisational relocation, on these factors. What does this paper add? The research adds to academic literature relating to job satisfaction and organisational justice. It highlights the importance of organisational justice in influencing the job satisfaction of staff. What are the implications for practitioners? Financial rewards do not necessarily motivate staff but low rewards do demotivate. Shortages of health professionals are often linked to a lack of job satisfaction, and recruitment and retention strategies are often based on salary.

78 FR 48201 - Japan Lessons-Learned Project Directorate Interim Staff Guidance JLD-ISG-2013-01; Guidance for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

... following the earthquake and shutdown of the operating units, however, the first large tsunami wave inundated the site, followed by additional waves. The tsunami caused extensive damage to site facilities and..., and after some period of time at the other units. Unit 6 retained the function of one air-cooled EDG...

78 FR 3039 - Japan Lessons-Learned Project Directorate Interim Staff Guidance JLD-ISG-2012-06; Performing a...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

... following the earthquake and shutdown of the operating units, however, the first large tsunami wave inundated the site, followed by additional waves. The tsunami caused extensive damage to site facilities and..., and after some period of time at the other units. Unit 6 retained the function of one air-cooled EDG...

Medicare program; prospective payment system and consolidated billing for skilled nursing facilities for FY 2010; minimum data set, version 3.0 for skilled nursing facilities and Medicaid nursing facilities. Final rule.

PubMed

2009-08-11

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2010. In addition, it recalibrates the case-mix indexes so that they more accurately reflect parity in expenditures related to the implementation of case-mix refinements in January 2006. It also discusses the results of our ongoing analysis of nursing home staff time measurement data collected in the Staff Time and Resource Intensity Verification project, as well as a new Resource Utilization Groups, version 4 case-mix classification model for FY 2011 that will use the updated Minimum Data Set 3.0 resident assessment for case-mix classification. In addition, this final rule discusses the public comments that we have received on these and other issues, including a possible requirement for the quarterly reporting of nursing home staffing data, as well as on applying the quality monitoring mechanism in place for all other SNF PPS facilities to rural swing-bed hospitals. Finally, this final rule revises the regulations to incorporate certain technical corrections.

Research and Technology, 1998

NASA Technical Reports Server (NTRS)

1999-01-01

This report selectively summarizes the NASA Lewis Research Center's research and technology accomplishments for the fiscal year 1998. It comprises 134 short articles submitted by the staff scientists and engineers. The report is organized into five major sections: Aeronautics, Research and Technology, Space, Engineering and Technical Services, and Commercial Technology. A table of contents and an author index have been developed to assist readers in finding articles of special interest. This report is not intended to he a comprehensive summary of all the research and technology work done over the past fiscal year. Most of the work is reported in Lewis-published technical reports, journal articles, and presentations prepared by Lewis staff and contractors. In addition, university grants have enabled faculty members and graduate students to engage in sponsored research that is reported at technical meetings or in journal articles. For each article in this report, a Lewis contact person has been identified, and where possible, reference documents are listed so that additional information can be easily obtained. The diversity of topics attests to the breadth of research and technology being pursued and to the skill mix of the staff that makes it possible. At the time of publication, NASA Lewis was undergoing a name change to the NASA John H. Glenn Research Center at Lewis Field.

A survey of staff attitudes to increasing medical undergraduate education in a district general hospital.

PubMed

Macdonald, John

2005-07-01

Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching--their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching--as both student numbers and service workloads continue to rise. Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative.

Perspectives of emergency department staff on the triage of mental health-related presentations: Implications for education, policy and practice.

PubMed

Gerdtz, Marie F; Weiland, Tracey J; Jelinek, George A; Mackinlay, Claire; Hill, Nicole

2012-10-01

To explore ED staff perceptions of the factors that influence accuracy of triage for people with mental health problems. This qualitative learning needs analysis used a descriptive exploratory design. Participants were Australian emergency nurses and doctors. We used a criterion-based sampling approach. Recruitment was facilitated by the College of Emergency Nursing Australasia and the Australasian College for Emergency Medicine. A semi-structured interview schedule was developed. Telephone interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to identify factors perceived to affect triage outcomes and to explore strategies to optimise the accuracy of triage assessments. Thirty-six staff participated (16 nurses and 20 doctors). Four major factors were perceived to influence accuracy. These were: environmental factors (physical structure, time pressures, activity levels, and interruptions), policy and education (guidelines, training and resources), staff factors (knowledge, experience, attitudes) and patient factors (police presence, patient behaviour, clinical condition). Differences of opinion were expressed by emergency doctors about the validity of the time to treatment objectives included in the Australasian Triage Scale for mental health presentations, and the utility of the scale to differentiate urgency for psychiatric conditions. Clinical guidelines and training have been developed to support the use of the Australasian Triage Scale. Further evaluation of the application of this scale to assess mental health problems is indicated. Additional work is also required to reduce variance in urgency assignment based on staff knowledge and attitudes about the causes, assessment and early management of psychiatric disorders. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

How nursing staff spend their time on activities in a nursing home: an observational study.

PubMed

Munyisia, Esther Naliaka; Yu, Ping; Hailey, David

2011-09-01

This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. © 2011 Blackwell Publishing Ltd.

29 CFR 553.11 - Exclusion for elected officials and their appointees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... secretary to an assistant. (c) In order to qualify as personal staff members or officials in policymaking... employment of employees under civil service, except for cause, is provided. In addition, such personal staff... voters of their jurisdictions. Also excluded under this provision are personal staff members and...

29 CFR 553.11 - Exclusion for elected officials and their appointees.

Code of Federal Regulations, 2013 CFR

2013-07-01

... secretary to an assistant. (c) In order to qualify as personal staff members or officials in policymaking... employment of employees under civil service, except for cause, is provided. In addition, such personal staff... voters of their jurisdictions. Also excluded under this provision are personal staff members and...

29 CFR 553.11 - Exclusion for elected officials and their appointees.

Code of Federal Regulations, 2012 CFR

2012-07-01

... secretary to an assistant. (c) In order to qualify as personal staff members or officials in policymaking... employment of employees under civil service, except for cause, is provided. In addition, such personal staff... voters of their jurisdictions. Also excluded under this provision are personal staff members and...

29 CFR 553.11 - Exclusion for elected officials and their appointees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... secretary to an assistant. (c) In order to qualify as personal staff members or officials in policymaking... employment of employees under civil service, except for cause, is provided. In addition, such personal staff... voters of their jurisdictions. Also excluded under this provision are personal staff members and...

29 CFR 553.11 - Exclusion for elected officials and their appointees.

Code of Federal Regulations, 2014 CFR

2014-07-01

... secretary to an assistant. (c) In order to qualify as personal staff members or officials in policymaking... employment of employees under civil service, except for cause, is provided. In addition, such personal staff... voters of their jurisdictions. Also excluded under this provision are personal staff members and...

MO-DE-BRA-04: Hands-On Fluoroscopy Safety Training with Real-Time Patient and Staff Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vanderhoek, M; Bevins, N

Purpose: Fluoroscopically guided interventions (FGI) are routinely performed across many different hospital departments. However, many involved staff members have minimal training regarding safe and optimal use of fluoroscopy systems. We developed and taught a hands-on fluoroscopy safety class incorporating real-time patient and staff dosimetry in order to promote safer and more optimal use of fluoroscopy during FGI. Methods: The hands-on fluoroscopy safety class is taught in an FGI suite, unique to each department. A patient equivalent phantom is set on the patient table with an ion chamber positioned at the x-ray beam entrance to the phantom. This provides a surrogatemore » measure of patient entrance dose. Multiple solid state dosimeters (RaySafe i2 dosimetry systemTM) are deployed at different distances from the phantom (0.1, 1, 3 meters), which provide surrogate measures of staff dose. Instructors direct participating clinical staff to operate the fluoroscopy system as they view live fluoroscopic images, patient entrance dose, and staff doses in real-time. During class, instructors work with clinical staff to investigate how patient entrance dose, staff doses, and image quality are affected by different parameters, including pulse rate, magnification, collimation, beam angulation, imaging mode, system geometry, distance, and shielding. Results: Real-time dose visualization enables clinical staff to directly see and learn how to optimize their use of their own fluoroscopy system to minimize patient and staff dose, yet maintain sufficient image quality for FGI. As a direct result of the class, multiple hospital departments have implemented changes to their imaging protocols, including reduction of the default fluoroscopy pulse rate and increased use of collimation and lower dose fluoroscopy modes. Conclusion: Hands-on fluoroscopy safety training substantially benefits from real-time patient and staff dosimetry incorporated into the class. Real-time dose display helps clinical staff visualize, internalize, and ultimately utilize the safety techniques learned during the training. RaySafe/Unfors/Fluke lent us a portable version of their RaySafe i2 Dosimetry System for 6 months.« less

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes.

PubMed

Park, Yeon-Hwan; Bang, Hwal Lan; Kim, Ga Hye; Ha, Ji Yeon

2015-01-01

To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Five facilitators were identified: grouping the residents; the resident's awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident's health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident's family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents.

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes

PubMed Central

Park, Yeon-Hwan; Bang, Hwal Lan; Kim, Ga Hye; Ha, Ji Yeon

2015-01-01

Purpose To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. Patients and methods A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Results Five facilitators were identified: grouping the residents; the resident’s awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident’s health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident’s family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. Conclusion The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents. PMID:26491277

Building a leadership team that works.

PubMed

Blomenberg, Emily M

2005-01-01

Radiology administrators often are challenged to do more with less. In today's fast-paced work environment, leaders must be creative. They must surround themselves with good people in order to successfully achieve their organizations' goals. Once a radiology administrator is satisfied and comfortable that he or she has, the right staff involved, a leadership team can be formally establislished. Howard Regional Health System established an Imaging Services Leadership Team with a vision to provide leaders for the staff to "follow," just as team members learn from the radiology administrator. In addition, team members are vital in assisting the radiology administrator in managing the department The process of building the team consisted of 3 steps: selecting team members (the most challenging and time-consuming component), formalizing a functional team, and putting the team into action. Finding the right people, holding regular meetings, and making those team meetings meaningful are keys to a successful leadership team. The implementation of the team has had a positive effect on imaging services: the number of procedures has increased, the team is used as a communication tool for front-line staff, front-line staff are becoming more comfortable with making decisions.

Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions.

PubMed

Caruana, Erin L; Kuys, Suzanne S; Clarke, Jane; Brauer, Sandra G

2017-11-20

Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit. Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data. Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment. Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback. What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS. What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support. What are the implications for practitioners? Staff engagement and open communication are important to successfully implement a new service in rehabilitation.

Breast milk pumping beliefs, supports, and barriers on a university campus.

PubMed

Dinour, Lauren M; Pope, Gina A; Bai, Yeon K

2015-02-01

Compared to nonemployed mothers, employed mothers are more likely to terminate breastfeeding sooner than recommended, due in part to a lack of workplace support. The purpose of this study is to compare the beliefs of employees and students affiliated with a university regarding pumping breast milk on campus. This qualitative study used semistructured interviews grounded in the theory of planned behavior, focused on behavioral, normative, and control beliefs regarding pumping on campus. Responses were independently coded and categorized based on common themes. Response frequencies were calculated and compared between students, staff, and faculty. Thirty-two women (11 students, 8 staff, 13 faculty) participated in the interview. Overall, participants most frequently reported that maintaining milk supply/extending breastfeeding duration was an advantage to pumping on campus, and time/scheduling issues a disadvantage. The most commonly perceived supporters were peers, whereas those unaware, uninformed, and/or disapproving of breastfeeding were most commonly perceived as opponents to pumping on campus. Reporting within each category differed between students, staff, and faculty. It is notable that students most frequently identified the lack of available pumping space as a barrier, whereas faculty often reported that space availability made pumping on campus easier for them. In addition, both staff and faculty frequently stated that scheduling and time constraints were a pumping barrier. An inequality of current lactation support practice may exist at colleges and universities. It is necessary to extend this protection to all members of a workplace, regardless of their role. © The Author(s) 2014.

Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center.

PubMed

Randolph, Laura A; Walker, Cheri K; Nguyen, Ann T; Zachariah, Subi R

2018-01-01

Objective To provide a foundation to justify the presence of a full-time clinical pharmacist in the ambulatory cancer center in addition to an existing centralized pharmacist through cost avoidance calculation and patient and staff satisfaction surveys. Methods The prospective, pilot study took place in an ambulatory cancer center over four weeks in 2014. Cost avoidance values were assigned to interventions performed by a pharmacy resident, who was present in the ambulatory cancer center during clinic hours, along with a centralized oncology pharmacist routinely working with the cancer center. Anonymous patient and staff satisfaction surveys based on a 5-point Likert scale were distributed to assess the perceived benefit of a pharmacist located in the ambulatory cancer center. Results Data collection took place over approximately one month. After evaluation of 962 interventions from both pharmacists, the estimated cost avoidance was US$282,741 per pharmacist per year, yielding a net benefit of US$138,441. The most common interventions made by the resident included chemotherapy regimen review (n = 290, 69%) and patient counseling (n = 102, 24%), while the majority of the centralized pharmacist's interventions was chemotherapy regimen review (n = 525, 97%). Results from the anonymous patient and staff surveys revealed an overall positive perception of the pharmacy resident while in the ambulatory cancer center. Conclusion A full-time clinical pharmacist in an ambulatory cancer center is both financially beneficial and positively perceived by patients and staff.

M/A-COM linkabit eastern operations

NASA Astrophysics Data System (ADS)

Mills, D. L.; Avramovic, Z.

1983-03-01

This first Quarterly Project Report on LINKABIT's contribution to the Defense Advanced Research Projects Agency (DARPA) Internet Program covers the period from 22 December 1982 through 21 March 1983. LINKABIT's support of the Internet Program is concentrated in the areas of protocol design, implementation, testing, and evaluation. In addition, LINKABIT staff are providing integration and support services for certain computer systems to be installed at DARPA sites in Washington, D.C., and Stuttgart, West Germany. During the period covered by this report, LINKABIT organized the project activities and established staff responsibilities. Several computers and peripheral devices were made available from Government sources for use in protocol development and network testing. Considerable time was devoted to installing this equipment, integrating the software, and testing it with the Internet system.

Turning on the care coordination switch in rural primary care: voices from the practices--clinician champions, clinician partners, administrators, and nurse care managers.

PubMed

Fagnan, Lyle J; Dorr, David A; Davis, Melinda; McGinnis, Paul; Mahler, Jo; King, Molly McCarthy; Michaels, LeAnn

2011-01-01

This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semistructured interviews with 4 staff cohorts. Cohorts included clinician champions, clinician partners, practice administrators, and nurse care managers. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied and additional study is required to determine sustainability.

34 CFR 75.519 - Dual compensation of staff.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Dual compensation of staff. 75.519 Section 75.519... by a Grantee? Project Staff § 75.519 Dual compensation of staff. A grantee may not use its grantee to pay a project staff member for time or work for which that staff member is compensated from some other...

34 CFR 75.519 - Dual compensation of staff.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 1 2014-07-01 2014-07-01 false Dual compensation of staff. 75.519 Section 75.519... by a Grantee? Project Staff § 75.519 Dual compensation of staff. A grantee may not use its grantee to pay a project staff member for time or work for which that staff member is compensated from some other...

34 CFR 75.519 - Dual compensation of staff.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 1 2012-07-01 2012-07-01 false Dual compensation of staff. 75.519 Section 75.519... by a Grantee? Project Staff § 75.519 Dual compensation of staff. A grantee may not use its grantee to pay a project staff member for time or work for which that staff member is compensated from some other...

34 CFR 75.519 - Dual compensation of staff.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 1 2013-07-01 2013-07-01 false Dual compensation of staff. 75.519 Section 75.519... by a Grantee? Project Staff § 75.519 Dual compensation of staff. A grantee may not use its grantee to pay a project staff member for time or work for which that staff member is compensated from some other...

34 CFR 75.519 - Dual compensation of staff.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Dual compensation of staff. 75.519 Section 75.519... by a Grantee? Project Staff § 75.519 Dual compensation of staff. A grantee may not use its grantee to pay a project staff member for time or work for which that staff member is compensated from some other...

Self-scheduling with Microsoft Excel.

PubMed

Irvin, S A; Brown, H N

1999-01-01

Excessive time was being spent by the emergency department (ED) staff, head nurse, and unit secretary on a complex 6-week manual self-scheduling system. This issue, plus inevitable errors and staff dissatisfaction, resulted in a manager-lead initiative to automate elements of the scheduling process using Microsoft Excel. The implementation of this initiative included: common coding of all 8-hour and 12-hour shifts, with each 4-hour period represented by a cell; the creation of a 6-week master schedule using the "count-if" function of Excel based on current staffing guidelines; staff time-off requests then entered by the department secretary; the head nurse, with staff input, then fine-tuned the schedule to provide even unit coverage. Outcomes of these changes included an increase in staff satisfaction, time saved by the head nurse, and staff work time saved because there was less arguing about the schedule. Ultimately, the automated self-scheduling method was expanded to the entire 700-bed hospital.

Clinical care & finance: can this marriage be saved?

PubMed

Craig, Teresa R

2003-11-01

Financial staff and clinical staff do not necessarily see eye-to-eye. However, mutual understanding of one another's areas of expertise is essential to the success of a hospice. Financial and clinical staff can work together to streamline employee reporting, such as on time sheets and during annual reviews, to ensure that important data is being collected and staff don't waste time reporting on and analyzing extraneous data.

Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study.

PubMed

Kyaddondo, David; Mugerwa, Kidza; Byamugisha, Josaphat; Oladapo, Olufemi T; Bohren, Meghan A

2017-12-01

To describe the experiences, expectations, and needs of urban Ugandan women in relation to good-quality facility childbirth. Women who had given birth in the 12 months prior to the study were purposively sampled and interviewed, or included in focus groups. Thematic analysis was used, and the data were interpreted within the context of an existing quality of care framework. Forty-five in-depth interviews and six focus group discussions were conducted. Respect and dignity, timely communication, competent skilled staff, and availability of medical supplies were central to women's accounts of quality care, or a lack of it. The hope for a live baby motivated women to seek facility-based childbirth. They expected to encounter competent, respectful, and caring staff with appropriate skills. In some cases, they could only fulfill these expectations through additional personal financial payments to staff, for clinical supplies, or to guarantee that they would be attended by someone with suitable skills. Long-term improvement in quality of maternity care in Uganda requires enhancement of the interaction between women and health staff in facilities, and investment in staff and resources to ensure that safe, respectful care is not dependent on willingness and/or capacity to pay. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Integrating robotic partial nephrectomy to an existing robotic surgery program.

PubMed

Yuh, Bertram; Muldrew, Shantel; Menchaca, Anita; Yip, Wesley; Lau, Clayton; Wilson, Timothy; Josephson, David

2012-04-01

As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN. Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models. Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions. The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.

"Nothing Will Prevent Me from Doing a Good Job". The Professionalisation of Part-Time Teaching Staff in Further and Adult Education

ERIC Educational Resources Information Center

Jameson, Jill; Hillier, Yvonne

2008-01-01

Approximately 85,000 part-time teaching staff working in further education (FE) and adult and community learning (ACL) are often seen as "a problem". The intrinsic "part-timeness" of these staff tends to marginalise them: they remain under-recognised and largely unsupported. Yet this picture is over-simplified. This article…

Hospital nurse staffing models and patient and staff-related outcomes.

PubMed

Butler, Michelle; Collins, Rita; Drennan, Jonathan; Halligan, Phil; O'Mathúna, Dónal P; Schultz, Timothy J; Sheridan, Ann; Vilis, Eileen

2011-07-06

Nurse staffing interventions have been introduced across countries in recent years in response to changing patient requirements, developments in patient care, and shortages of qualified nursing staff. These include changes in skill mix, grade mix or qualification mix, staffing levels, nursing shifts or nurses' work patterns. Nurse staffing has been closely linked to patient outcomes, organisational outcomes such as costs, and staff-related outcomes. Our aim was to explore the effect of hospital nurse staffing models on patient and staff-related outcomes. We searched the following databases from inception through to May 2009: Cochrane/EPOC resources (DARE, CENTRAL, the EPOC Specialised Register), PubMed, EMBASE, CINAHL Plus, CAB Health, Virginia Henderson International Nursing Library, the Joanna Briggs Institute database, the British Library, international theses databases, as well as generic search engines. Randomised control trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of interventions relating to hospital nurse staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective measure of patient or staff-related outcome. Seven reviewers working in pairs independently extracted data from each potentially relevant study and assessed risk of bias. We identified 6,202 studies that were potentially relevant to our review. Following detailed examination of each study, we included 15 studies in the review. Despite the number of studies conducted on this topic, the quality of evidence overall was very limited. We found no evidence that the addition of specialist nurses to nursing staff reduces patient death rates, attendance at the emergency department, or readmission rates, but it is likely to result in shorter patient hospital stays, and reductions in pressure ulcers. The evidence in relation to the impact of replacing Registered Nurses with unqualified nursing assistants on patient outcomes is very limited. However, it is suggested that specialist support staff, such as dietary assistants, may have an important impact on patient outcomes. Self-scheduling and primary nursing may reduce staff turnover. The introduction of team midwifery (versus standard care) may reduce medical procedures in labour and result in a shorter length of stay without compromising maternal or perinatal safety. We found no eligible studies of educational interventions, grade mix interventions, or staffing levels and therefore we are unable to draw conclusions in relation to these interventions. The findings suggest interventions relating to hospital nurse staffing models may improve some patient outcomes, particularly the addition of specialist nursing and specialist support roles to the nursing workforce. Interventions relating to hospital nurse staffing models may also improve staff-related outcomes, particularly the introduction of primary nursing and self-scheduling. However, these findings should be treated with extreme caution due to the limited evidence available from the research conducted to date.

When work happens in the house: perceptions of how residential care staff choose to spend work time in transitional living units for people with brain injury.

PubMed

Chapparo, Christine; Shepherd, Belinda

2010-01-01

This naturalistic study explored the influence of various contextual factors on the decision making of residential care staff (RCS) who worked and lived with clients with brain injury in transitional living environments. The findings reported here arose from the results of a larger study that investigated the multiple contextual, personal, professional and theoretical influences on RCS decision making. Eleven residential care staff who were employed in brain injury transitional living units in Sydney, Australia participated. Qualitative data were derived from interviews, participant observation and reviews of videotaped staff and client interactions with the residential care staff. The RCS identified time and organisational motivators as major influences on daily decision making at work. They described how decisions were made by them about how to prioritise time at work from two personal perspectives, that of 'hospital person' and ;house person', adopted relative to contextual influences at the time. Residential care staff who are in close personal contact with clients for long periods of time make decisions about their work that is largely based on their personal notions of running a house'. Further research is required to describe the emergent phenomenon of staff 'house' behaviour.

Comparison of staff and family perceptions of causes of noise pollution in the Pediatric Intensive Care Unit and suggested intervention strategies.

PubMed

Kaur, Harsheen; Rohlik, Gina M; Nemergut, Michael E; Tripathi, Sandeep

2016-01-01

Noise and excessive, unwanted sound in the Pediatric Intensive Care Unit (PICU) is common and has a major impact on patients' sleep and recovery. Previous research has focused mostly on absolute noise levels or included only staff as respondents to acknowledge the causes of noise and to plan for its reduction. Thus far, the suggested interventions have not ameliorated noise, and it continues to serve as a barrier to recovery. In addition to surveying PICU providers through internet-based software, patients' families were evaluated through in-person interviews utilizing a pretested instrument over 3 months. Families of patients admitted for more than 24 h were considered eligible for evaluation. Participants were asked to rank causes of noise from 1 to 8, with eight being highest, and identified potential interventions as effective or ineffective. In total, 50 families from 251 admissions and 65 staff completed the survey. Medical alarms were rated highest (mean ± standard deviation [SD], 4.9 ± 2.1 [2.8-7.0]), followed by noise from medical equipment (mean ± SD, 4.7 ± 2.1 [2.5-6.8]). This response was consistent among PICU providers and families. Suggested interventions to reduce noise included keeping a patient's room door closed, considered effective by 93% of respondents (98% of staff; 88% of families), and designated quiet times, considered effective by 82% (80% of staff; 84% of families). Keeping the patient's door closed was the most effective strategy among survey respondents. Most families and staff considered medical alarms an important contributor to noise level. Because decreasing the volume of alarms such that it cannot be heard is inappropriate, alternative strategies to alert staff of changes in vital signs should be explored.

Student Enrollment, Full-time Equivalent (FTE), Staff/Faculty Information. Annual Statistical Report, 1997-98. Volume 33.

ERIC Educational Resources Information Center

North Carolina Community Coll. System, Raleigh.

This document contains statistical information for the academic year 1997-1998 collected from each of the 58 community colleges in North Carolina, as well as historical information for an 11-year period. This was the first year in which the North Carolina Community College System used the semester system. In addition, it was the first year of…

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives.

PubMed

Byron, Gerard; Ziedonis, Douglas M; McGrath, Caroline; Frazier, Jean A; deTorrijos, Fernando; Fulwiler, Carl

2015-08-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders' perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations.

Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives

PubMed Central

Byron, Gerard; Ziedonis, Douglas M.; McGrath, Caroline; Frazier, Jean A.; deTorrijos, Fernando

2014-01-01

Occupational stress and burnout adversely impacts mental health care staff well-being and patient outcomes. Mindfulness training reduces staff stress and may improve patient care. However, few studies explore mental health setting implementation. This qualitative study used focus groups to evaluate stakeholders’ perceptions of organizational factors affecting implementation of an adapted version of Mindfulness-Based Stress Reduction (MBSR) for staff on adolescent mental health units. Common facilitators included leadership securing buy-in with staff, allocating staff time to participate, and quiet space for training and practice. Other facilitators were past staff knowledge of mindfulness, local champions, and acculturating staff with mindfulness through a non-mandatory training attendance policy. Common barriers were limited staff time to attend training sessions and insufficient training coverage for some staff. Staff also reported improved focus when interacting with adolescents and improved social cohesion on the units. We conclude that a mindfulness-based program for reducing occupational stress can be successfully implemented on adolescent mental health units. Implementation appeared to change the social context of the units, including staff and patient interactions. More broadly, our findings highlight the importance of environmental factors in shaping attitudes, diffusion of innovation, and acculturation of wellness program implementations. PMID:26500708

Changes in Staff Distribution and Salaries of Full-Time Employees in Postsecondary Institutions: Fall 1993-2003. Postsecondary Education Descriptive Analysis Report. NCES 2006-152

ERIC Educational Resources Information Center

Li, Xiaojie

2006-01-01

Using data from the 1993 and 2003 Fall Staff Surveys, a component of the Integrated Postsecondary Education Data System (IPEDS), this report examines the change in the number and composition of staff in U.S. postsecondary institutions and the change in average salaries of full-time staff between fall 1993 and fall 2003. Over the decade, the…

Staff experiences of an early warning indicator for unstable patients in Australia.

PubMed

Green, Anna; Williams, Allison; Allison, William

2006-01-01

The objective of this study is to explore nursing and medical staff's perceptions of a clinical marker referral tool implemented to assist in the early identification of unstable patients in the general surgical and medical ward environment. A descriptive, exploratory survey design was undertaken 6 months after the implementation of a clinical marker referral tool. The target population for the survey was all ward nursing, junior medical staff and intensive care unit (ICU) registrars in a metropolitan tertiary referral hospital in Australia. The survey consisted of open-ended and closed-ended questions, as well as statements asking participants to explore their perceptions, attitudes and perceived understanding of the clinical marker referral tool. The surveys were sent to all targeted staff in a personally addressed envelope via the internal mail system. Overall, nursing and medical staff (n = 178) responses were positive to the clinical marker project/tool, offering clear guidelines for staff to respond to the patient's clinical condition and contact the medical staff and the ICU liaison team as appropriate. Furthermore, comments were made in relation to the ICU liaison team acting as a 'support' and 'prompt back-up' for nursing staff when needed. However, ward medical staff had reservations with the clinical markers chosen and with ward nurses being able to contact the ICU registrar after hours. Additionally, the ICU registrars commented on an increase to their workload in having to review unstable patients after hours. These results suggest that the ward nurses required additional support and guidance in caring for the unstable patient in the ward which may improve patient outcomes. Further research investigating the less-favourable responses of the ward medical staff and ICU medical staff is warranted.

Well-Being and Safety among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity

PubMed Central

Kelly, Erin L.; Fenwick, Karissa; Brekke, John S.; Novaco, Raymond W.

2015-01-01

Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual’s stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5% had experienced physical assault in the previous 12 months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences. PMID:26377816

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

PubMed

Butler, Rachel; Monsalve, Mauricio; Thomas, Geb W; Herman, Ted; Segre, Alberto M; Polgreen, Philip M; Suneja, Manish

2018-04-09

Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined. Copyright © 2018 Elsevier Inc. All rights reserved.

Writing for publication: institutional support provides an enabling environment.

PubMed

Kramer, Beverley; Libhaber, Elena

2016-04-18

Due to the excessive service delivery loads in public hospitals supported by academic institutions in developing environments, researchers at these institutions have little time to develop scientific writing skills or to write up their research. It is imperative to expand the writing skills of researchers and train the next generation of health sciences academics in order to disseminate research findings. This study reports on the implementation of approaches for writing and publication and the extent of support to staff suffering from the overload of service delivery and of heavy teaching duties. Workshops in scientific writing and writing retreats were initiated and were offered to all staff. Feedback from participants of the writing skills workshops indicated that the workshops provided an injection of confidence and proficiency. Protected writing time resulted in 132 papers submitted to journals and 95 in preparation from 230 participants of the writing retreats over a two year period. Staff commended the off-site, collegial environment, which also supported future collaboration with new-found colleagues. This enabling environment facilitates not only the development of writing skills per se, but also the dissemination of the generated scientific knowledge. In addition, the training in writing skills of this generation will be of value in the training of future cohorts in countries with similar health care deliverables.

Improving the review of standard operating procedures: a novel electronic system for compounding pharmacies.

PubMed

Brensel, Robert; Brensel, Scott; Ng, Amy

2013-01-01

Since the New England Compounding Center disaster in 2012, the importance of following correct procedures during every phase of customized pharmacy has been a focus of governmental interest and action as well as public scrutiny. Many pharmacies rely on the rote review of standard operating procedures to ensure that staff members understand and follow protocols that ensure the safety and potency of all compounds prepared, but that approach to continuing education can be cumbersome and needlessly time-consuming. In addition, documenting and retrieving evidence of employee competence can be difficult. In this article, we describe our use of online technology to improve our methods of educating staff about the full range of standard operating procedures that must be followed in our pharmacy. The system we devised and implemented has proven to be effective, easy to update and maintain, very inexpensive, and user friendly. Its use has reduced the time previously required for a read-over review of standard operating procedures from 30 or 40 minutes to 5 or 10 minutes in weekly staff meetings, and we can now easily document and access proof of employees' comprehension of that content. It is our hope that other small compounding pharmacies will also find this system of online standard operating procedure review helpful.

14 CFR 385.32 - Effective date of staff action.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Effective date of staff action. 385.32... PROCEEDINGS) ORGANIZATION STAFF ASSIGNMENTS AND REVIEW OF ACTION UNDER ASSIGNMENTS Procedure on Review of Staff Action § 385.32 Effective date of staff action. Unless, within the time provided by or pursuant to...

14 CFR 385.32 - Effective date of staff action.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Effective date of staff action. 385.32... PROCEEDINGS) ORGANIZATION STAFF ASSIGNMENTS AND REVIEW OF ACTION UNDER ASSIGNMENTS Procedure on Review of Staff Action § 385.32 Effective date of staff action. Unless, within the time provided by or pursuant to...

School Climate Improvement Action Guide for Noninstructional Staff. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that noninstructional staff--including guidance counselors, social workers, school psychologists, office staff, bus drivers, maintenance and facility staff, and food service staff--can take to support school…

14 CFR 385.32 - Effective date of staff action.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Effective date of staff action. 385.32... PROCEEDINGS) ORGANIZATION STAFF ASSIGNMENTS AND REVIEW OF ACTION UNDER ASSIGNMENTS Procedure on Review of Staff Action § 385.32 Effective date of staff action. Unless, within the time provided by or pursuant to...

A Comparison of Computer-based and Instructor-led Training for Long-term Care Staff.

ERIC Educational Resources Information Center

Harrington, Susan S.; Walker, Bonnie L.

2002-01-01

Fire safety training was provided to long-term care staff by computer (n=47) or a print-based, instructor-led program (n=47). Compared to 47 controls, both treatment groups significantly increased knowledge. The computer-trained staff were enthusiastic about the learning method and expressed greater interest in additional safety topics. (SK)

Keeping Children Safe: Afterschool Staff and Mandated Child Maltreatment Reporting

ERIC Educational Resources Information Center

Gandarilla, Maria; O'Donnell, Julie

2014-01-01

With 8.4 million children in the U.S. spending an average of eight hours a week in afterschool programs, afterschool providers are an important part of the network of caring adults who can help to keep children safe. In addition, afterschool staff are "mandated reporters." Whether or not the laws specifically mention afterschool staff,…

75 FR 5356 - Office of New Reactors; Final Interim Staff Guidance on Post-Combined License Commitments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-02

... the guidance provided to the NRC staff in Section 1.0, ``Introduction and Interfaces,'' of NUREG-0800... (COL) applications. In addition, this ISG supplements the guidance provided in Section C.III.4 of... Accession No. ML091671355) to solicit public and industry comment. The NRC staff received comments (ADAMS...

Engaging or Training Sessional Staff: Evidence from an Australian Case of Enhanced Engagement and Motivation in Teaching Delivery

ERIC Educational Resources Information Center

Byers, Philippa; Tni, Massimiliano

2014-01-01

This paper examines the effectiveness of a programme of weekly meetings between sessional staff and the unit coordinator of a large first-year class at an Australian university. Interviews with sessional staff indicate that, in addition to training and targeted professional development initiatives, management initiatives that promote engagement…

Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital.

PubMed

Best, Allyson M; Dixon, Cinnamon A; Kelton, W David; Lindsell, Christopher J; Ward, Michael J

2014-08-01

Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country. We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS). The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) LOS decrease. However, when shift start times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI, 94-98), and with the simultaneous combination of staff roles (registration and history taking), there was an overall mean LOS reduction of 152 minutes (95% CI, 150-154). Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute care in resource-limited settings. Copyright © 2014 Elsevier Inc. All rights reserved.

(Updated) NCI Fiscal 2016 Bypass Budget Proposes $25 Million for Frederick National Lab | Poster

Cancer.gov

By Nancy Parrish, Staff Writer; image by Richard Frederickson, Staff Photographer The additional funding requested for Frederick National Laboratory for Cancer Research (FNLCR) in the Fiscal 2016 Bypass Budget was $25 million, or approximately 3.5 percent of the total additional funding request of $715 million. Officially called the Professional Judgment Budget, the Bypass

Do players and staff sleep more during the pre- or competitive season of elite rugby league?

PubMed

Caia, Johnpaul; Scott, Tannath J; Halson, Shona L; Kelly, Vincent G

2017-09-01

This study establishes the sleep behaviour of players and staff during the pre- and competitive seasons of elite rugby league. For seven days during both the pre- and competitive seasons, seven rugby league players and nine full-time staff from one professional Australian rugby league club had their sleep monitored via wrist actigraphy and self-report sleep diaries. Two-way repeated measures analysis of variance determined differences between the pre- and competitive season in players and staff, with effect sizes (ES) used to interpret the practical magnitude of differences. Findings show an earlier bed time and wake time for players (-34 min, ES = 1.5; ±0.5 and -39 min, 2.1; ±0.5 respectively) and staff (-29 min, ES = 0.8; ±0.3 and -35 min, ES = 1.7; ±0.4 respectively) during pre-season when compared to the competitive season. Despite this, no differences were seen when considering the amount of time in bed, sleep duration or sleep efficiency obtained between the pre- and competitive seasons. Our results suggest that early morning training sessions scheduled during pre-season advances wake time in elite rugby league. However, both players and staff can aim to avoid reductions in sleep duration and sleep efficiency with subsequent adjustment of night time sleep patterns. This may be particularly pertinent for staff, who wake earlier than players during both the pre- and competitive seasons.

Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital.

PubMed

Roberts, Helen C

2018-05-01

This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.

Do physiotherapy staff record treatment time accurately? An observational study.

PubMed

Bagley, Pam; Hudson, Mary; Green, John; Forster, Anne; Young, John

2009-09-01

To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. Comparison of physiotherapy staff's recording of treatment sessions and video recording. Rehabilitation stroke unit in a general hospital. Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.

Ready or not: does household preparedness prevent absenteeism among emergency department staff during a disaster?

PubMed

Mercer, Mary P; Ancock, Benedict; Levis, Joel T; Reyes, Vivian

2014-01-01

During major disasters, hospitals experience varied levels of absenteeism among healthcare workers (HCWs) in the immediate response period. Loss of critical hospital personnel, including Emergency Department (ED) staff, during this time can negatively impact a facility's ability to effectively treat large numbers of ill and injured patients. Prior studies have examined factors contributing to HCW ability and willingness to report for duty during a disaster. The purpose of this study was to determine if the degree of readiness of ED personnel, as measured by household preparedness, is associated with predicted likelihood of reporting for duty. Additionally, the authors sought to elucidate other factors associated with absenteeism among ED staff during a disaster. ED staff of five hospitals participated in this survey-based study, answering questions regarding demographic information, past disaster experience, household disaster preparedness (using a novel,15-point scale), and likelihood of reporting to work during various categories of disaster. The primary outcome was personal predicted likelihood of reporting for duty following a disaster. A total of 399 subjects participated in the study. ED staffs were most likely to report for duty in the setting of an earthquake (95 percent) or other natural disaster, followed by an epidemic (90 percent) and were less likely to report for work during a biological, chemical, or a nuclear event (63 percent). Degree of household preparedness was determined to have no association with an ED HCW's predicted likelihood of reporting for duty. Factors associated with predicted absenteeism varied based on type of disaster and included having dependents in the home, female gender, past disaster relief experience, having a spouse or domestic partner, and not owning pets. Having dependents in the home was associated with predicted absenteeism for all disaster types (OR 0.30-0.66). However, when stratified by gender, the presence of dependents at home was only a significantly associated with predicted absenteeism among women as opposed to men (OR 0.07-0.59 versus OR 0.41-1.02). Personal household preparedness, while an admirable goal, appears to have no effect on predicted absenteeism among ED staff following a disaster. Having responsibilities for dependents is the most consistent factor associated with predicted absenteeism among female staff. Hospital and ED disaster planners should consider focusing preparedness efforts less toward household preparedness for staff and instead concentrate on addressing dependent care needs in addition to professional preparedness.

A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System.

PubMed

Beidas, Rinad S; Marcus, Steven; Wolk, Courtney Benjamin; Powell, Byron; Aarons, Gregory A; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Adams, Danielle R; Walsh, Lucia M; Babbar, Shaili; Barg, Frances; Mandell, David S

2016-09-01

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout.

Exploring the Impact of a Dual Occupancy Neonatal Intensive Care Unit on Staff Workflow, Activity, and Their Perceptions.

PubMed

Broom, Margaret; Kecskes, Zsuzsoka; Kildea, Sue; Gardner, Anne

2018-01-01

In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.

On the feasibility of utilizing active personal dosimeters worn on the chest to estimate occupational eye lens dose in x-ray angiography.

PubMed

Omar, Artur; Marteinsdottir, Maria; Kadesjö, Nils; Fransson, Annette

2015-06-01

The International Commission on Radiological Protection (ICRP) has recommended that the occupational dose limit to the eye lens be substantially reduced. To ensure compliance with these recommendations, monitoring of the occupational eye lens dose is essential in certain hospital work environments. For assessment of the eye lens dose it is recommended to use a supplementary dosimeter placed at a position adjacent to the eye(s). Wearing a dosimeter at eye level can, however, be impractical and distributing and managing additional dosimeters over long periods of time is cumbersome and costly for large clinical sites. An attractive alternative is to utilize active personal dosimeters (APDs), which are routinely used by clinical staff for real-time monitoring of the personal dose equivalent rate (H(p)(10)). In this work, a formalism for the determination of eye lens dose from the response of such APD's worn on the chest is proposed and evaluated. The evaluation is based on both phantom and clinical measurements performed in an x-ray angiography suite for interventional cardiology. The main results show that the eye lens dose to the primary operator and to the assisting clinical staff can be conservatively estimated from the APD response as D(eye)(conductor) = 2.0 APD chest and D(eye)(assisting) = 1.0 APD chest, respectively. However, care should be exercised for particularly short assisting staff and if radiation protection shields are misused. These concerns can be greatly mitigated if the clinical staff are provided with adequate radiation protection training.

Successful implementation of a neonatal pain and sedation protocol at 2 NICUs.

PubMed

Deindl, Philipp; Unterasinger, Lukas; Kappler, Gregor; Werther, Tobias; Czaba, Christine; Giordano, Vito; Frantal, Sophie; Berger, Angelika; Pollak, Arnold; Olischar, Monika

2013-07-01

To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation. Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.

Activities of an ethics consultation service in a Tertiary Military Medical Center.

PubMed

Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

2000-07-01

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

The Association between Attitude towards the Implementation of Staff Development Training and the Practice of Knowledge Sharing among Lecturers

ERIC Educational Resources Information Center

Kassim, Abd. Latif; Raman, Arumugam; Don, Yahya; Daud, Yaakob; Omar, Mohd Sofian

2015-01-01

This study was aimed to identify the association of teachers' attitude towards the implementation of Staff Development Training with Knowledge Sharing Practices among the lecturers of the Teacher Training Institution (TTI). In addition, this study was also to examine the differences in attitudes towards the implementation of Staff Development…

The Principal as a Key Actor in Promoting Teachers' Innovativeness--Analyzing the Innovativeness of Teaching Staff with Variance-Based Partial Least Square Modeling

ERIC Educational Resources Information Center

Buske, Ramona

2018-01-01

The study examines the correlation between collective innovativeness of the teaching staff and the principal's leadership style as well as additional school structure characteristics. The construct of collective innovativeness is examined as a precondition of successful school improvement processes driven by the teaching staff. Based on…

Pediatric patient and staff dose measurements in barium meal fluoroscopic procedures

NASA Astrophysics Data System (ADS)

Filipov, D.; Schelin, H. R.; Denyak, V.; Paschuk, S. A.; Porto, L. E.; Ledesma, J. A.; Nascimento, E. X.; Legnani, A.; Andrade, M. E. A.; Khoury, H. J.

2015-11-01

This study investigates patient and staff dose measurements in pediatric barium meal series fluoroscopic procedures. It aims to analyze radiographic techniques, measure the air kerma-area product (PKA), and estimate the staff's eye lens, thyroid and hands equivalent doses. The procedures of 41 patients were studied, and PKA values were calculated using LiF:Mg,Ti thermoluminescent dosimeters (TLDs) positioned at the center of the patient's upper chest. Furthermore, LiF:Mg,Cu,P TLDs were used to estimate the equivalent doses. The results showed a discrepancy in the radiographic techniques when compared to the European Commission recommendations. Half of the results of the analyzed literature presented lower PKA and dose reference level values than the present study. The staff's equivalent doses strongly depends on the distance from the beam. A 55-cm distance can be considered satisfactory. However, a distance decrease of ~20% leads to, at least, two times higher equivalent doses. For eye lenses this dose is significantly greater than the annual limit set by the International Commission on Radiological Protection. In addition, the occupational doses were found to be much higher than in the literature. Changing the used radiographic techniques to the ones recommended by the European Communities, it is expected to achieve lower PKA values ​​and occupational doses.

Surgical specimen handover from the operating theatre to laboratory-Can we improve patient safety by learning from aviation and other high-risk organisations?

PubMed

Brennan, Peter A; Brands, Marieke T; Caldwell, Lucy; Fonseca, Felipe Paiva; Turley, Nic; Foley, Susie; Rahimi, Siavash

2018-02-01

Essential communication between healthcare staff is considered one of the key requirements for both safety and quality care when patients are handed over from one clinical area to other. This is particularly important in environments such as the operating theatre and intensive care where mistakes can be devastating. Health care has learned from other high-risk organisations (HRO) such as aviation where the use of checklists and human factors awareness has virtually eliminated human error and mistakes. To our knowledge, little has been published around ways to improve pathology specimen handover following surgery, with pathology request forms often conveying the bare minimum of information to assist the laboratory staff. Furthermore, the request form might not warn staff about potential hazards. In this article, we provide a brief summary of the factors involved in human error and introduce a novel checklist that can be readily completed at the same time as the routine pathology request form. This additional measure enhances safety, can help to reduce processing and mislabelling errors and provides essential information in a structured way assisting both laboratory staff and pathologists when handling head and neck surgical specimens. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Computer Simulations Improve University Instructional Laboratories1

PubMed Central

2004-01-01

Laboratory classes are commonplace and essential in biology departments but can sometimes be cumbersome, unreliable, and a drain on time and resources. As university intakes increase, pressure on budgets and staff time can often lead to reduction in practical class provision. Frequently, the ability to use laboratory equipment, mix solutions, and manipulate test animals are essential learning outcomes, and “wet” laboratory classes are thus appropriate. In others, however, interpretation and manipulation of the data are the primary learning outcomes, and here, computer-based simulations can provide a cheaper, easier, and less time- and labor-intensive alternative. We report the evaluation of two computer-based simulations of practical exercises: the first in chromosome analysis, the second in bioinformatics. Simulations can provide significant time savings to students (by a factor of four in our first case study) without affecting learning, as measured by performance in assessment. Moreover, under certain circumstances, performance can be improved by the use of simulations (by 7% in our second case study). We concluded that the introduction of these simulations can significantly enhance student learning where consideration of the learning outcomes indicates that it might be appropriate. In addition, they can offer significant benefits to teaching staff. PMID:15592599

NRRI summary of New York Public Service Commission: Staff investigation of Orange and Rockland Utilities, Inc.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-12-31

In June 1995, the New York Public Service Commission (NYPSC) released a Staff investigation of Orange and Rockland Utilities, Inc. (O&R). The primary focus of the Staffs investigation was the Corporate Policy and External Affairs Department, a restricted disbursements account, the Internal Auditing Department, and O&R officer malfeasance. The Staffs` investigation uncovered widespread, alleged instances of lax internal controls, unethical and illegal actions, and lavish officer behavior. In addition, the Staff investigated O&R`s internal control and purchasing functions. The Staff proposed a series of recommendations to improve the Company`s internal control, purchasing, ethical, climate and addressed the issue of amore » New York ratepayer reimbursement. The Staffs findings and recommendations were presented in the form of a report, entitled Staff Investigation of Orange and Rockland Utilities, Inc. This article summarizes the Report.« less

Treatment staff turnover in organizations implementing evidence-based practices: Turnover rates and their association with client outcomes

PubMed Central

Garner, Bryan R.; Hunter, Brooke D.; Modisette, Kathryn C.; Ihnes, Pamela C.; Godley, Susan H.

2011-01-01

High staff turnover has been described as a problem for the substance use disorder treatment field. This assertion is based primarily on the assumption that staff turnover adversely impacts treatment delivery and effectiveness. This assumption, however, has not been empirically tested. In this study, we computed annualized rates of turnover for treatment staff (n=249) participating in an evidence-based practice implementation initiative and examined the association between organizational-level rates of staff turnover and client-level outcomes. Annualized rates of staff turnover were 31% for clinicians and 19% for clinical supervisors. Additionally, multilevel analyses did not reveal the expected relationship between staff turnover and poorer client-level outcomes. Rather, organizational-level rates of staff turnover were found to have a significant positive association with two measures of treatment effectiveness: less involvement in illegal activity and lower social risk. Possible explanations for these findings are discussed. PMID:22154040

78 FR 30345 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

...-dealers will spend an average of two hours of clerical staff time and one hour of managerial staff time... Salaries in the Securities Industry 2012, modified by Commission staff to account for an 1,800 hour work-year and multiplied by 2.93 to account for bonuses, firm size, employee benefits and overhead. \\2\\ The...

Characteristics of Illinois Public Community College Faculty and Staff, Fall Term 1984.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

Data on Illinois community college faculty and staff characteristics are presented and analyzed in this report for fall 1984. Tables provide statistics on faculty and staff employment classification by college; full-time employment classification by sex and ethnic origin; full-time teaching faculty by highest degree held, age, sex, tenure status,…

Quantitative and qualitative processes of change during staff-coaching sessions: an exploratory study.

PubMed

van Oorsouw, Wietske M W J; Embregts, Petri J C M; Bosman, Anna M T

2013-05-01

Staff training is one of the interventions that managers can embed in their organizations to help staff improve their professional competences related to challenging behaviour of clients with intellectual disabilities. Individual coaching adds learning opportunities that are feasible but difficult to achieve in an in-service setting. In the present study, we have followed the coaching process of three staff members. Based on differences in the Linell balance of power across sessions, we explored the question: do different coaching processes have similar patterns in the development of dominance and coherence in interactions between coach and staff? Additionally, a qualitative approach was conducted to illustrate and enrich the meaning of quantitative outcomes. Processes were different regarding the balance of power at the start of the coaching, probably due to differences in resistance and insecurity. As a consequence of different starting points and differences in learning styles, each coaching process had its unique development over time. At the end, all dyads were comparable in the sense that all dyads were highly satisfied about the outcomes and process of coaching. This is in line with similar levels of power at the end of the coaching sessions suggesting equal contributions and leadership. The present findings suggest some relevant competencies of coaches within health-care services. Due to the small number of participants, the results have to be interpreted with caution. The present study provides suggestions for future research and clinical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effects of a Staff Training Intervention on Seclusion Rates on an Adult Inpatient Psychiatric Unit.

PubMed

Newman, Julie; Paun, Olimpia; Fogg, Louis

2018-06-01

The current article presents the effects of a 90-minute staff training intervention aimed at reducing inpatient psychiatric seclusion rates through strengthened staff commitment to seclusion alternatives and improved de-escalation skills. The intervention occurred at an 18-bed adult inpatient psychiatric unit whose seclusion rates in 2015 were seven times the national average. Although the project's primary outcome compared patient seclusion rates before and after the intervention, anonymous staff surveys measured several secondary outcomes. Seclusion rates were reduced from a 6-month pre-intervention average of 2.95 seclusion hours per 1,000 patient hours to a 6-month post-intervention average of 0.29 seclusion hours per 1,000 patient hours, a 90.2% reduction. Completed staff surveys showed significant staff knowledge gains, non-significant changes in staff attitudes about seclusion, non-significant changes in staff de-escalation skill confidence, and use of the new resource sheet by only 17% of staff. The key study implication is that time-limited, focused staff training interventions can have a measurable impact on reducing inpatient seclusion rates. [Journal of Psychosocial Nursing and Mental Health Services, 56(6), 23-30.]. Copyright 2018, SLACK Incorporated.

1301155

NASA Image and Video Library

2013-10-29

KEN COOPER GIVES AN OVERVIEW OF ADDITIVE MANUFACTURING TO STATE SENATOR BILL HOLTZCLAW, REPRESENTATIVE MAC MCCUTCHEON, GREG CANFIELD OF THE ALABAMA DEPARTMENT OF COMMERCE, GOVERNOR BENTLEY’S CHIEF OF STAFF, DAVID PERRY, AND LT. GOVERNOR STRANGES CHIEF OF STAFF, STEVE PELHAM.

Assessment of adolescent mental health and behavioral problems in institutional care: discrepancies between staff-reported CBCL scores and adolescent-reported YSR scores.

PubMed

Gearing, Robin E; Schwalbe, Craig S J; MacKenzie, Michael J; Brewer, Kathryne B; Ibrahim, Rawan W

2015-05-01

For children residing in institutional settings, staff act as primary caregivers and often provide assessment of child psychopathology. Minimal research exists on how and when staff-caregivers are best positioned to report on youth mental health. This study examines differences between 60 staff-reported and 60 adolescent-reported Child Behavioral Checklist/Youth Self-Report (CBCL/YSR) scores in Jordanian care centers, and the associations between adolescent-staff agreement, demographic characteristics and child-caregiver relationship factors. Results indicated small to modest correlations between informant scores. Additionally, staff-caregivers who know the child over 1 year and have a high perceived fit are better able to approximate the adolescent's self-report of psychopathology.

Time Together: A nursing intervention in psychiatric inpatient care: Feasibility and effects.

PubMed

Molin, Jenny; Lindgren, Britt-Marie; Graneheim, Ulla Hällgren; Ringnér, Anders

2018-04-25

The facilitation of quality time between patients and staff in psychiatric inpatient care is useful to promote recovery and reduce stress experienced by staff. However, interventions are reported to be complex to implement and are poorly described in the literature. This multisite study aimed to evaluate the feasibility and effects of the nursing intervention Time Together, using mixed methods. Data consisted of notes from participant observations and logs to evaluate feasibility, and questionnaires to evaluate effects. The primary outcome for patients was quality of interactions, and for staff, it was perceived stress. The secondary outcome for patients was anxiety and depression symptom levels, and for staff, it was stress of conscience. Data were analysed using visual analysis, percentage of nonoverlapping data, and qualitative content analysis. The results showed that Time Together was a feasible intervention, but measurements showed no effects on the two patient outcomes: quality of interactions and anxiety and depressive symptoms and, questionable effects on perceived stress and stress of conscience among staff. Shared responsibility, a friendly approach, and a predictable structure enabled Time Together, while a distant approach and an unpredictable structure hindered the intervention. In conclusion, the intervention proved to be feasible with potential to enable quality interactions between patients and staff using the enabling factors as supportive components. It also had some effects on perceived stress and stress of conscience among staff. Further evaluation is needed to build on the evidence for the intervention. © 2018 Australian College of Mental Health Nurses Inc.

A prospective examination of clinician and supervisor turnover within the context of implementation of evidence-based practices in a publicly-funded mental health system

PubMed Central

Marcus, Steven; Wolk, Courtney Benjamin; Powell, Byron; Aarons, Gregory A.; Evans, Arthur C.; Hurford, Matthew O.; Hadley, Trevor; Adams, Danielle R.; Walsh, Lucia M.; Babbar, Shaili; Barg, Frances; Mandell, David S.

2015-01-01

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout. PMID:26179469

The integration of technology into the middle and high school science curriculum

NASA Astrophysics Data System (ADS)

Corbin, Jan Frederic

This study was to determine the level of technology implementation into the middle and high school science curriculum by beginning teachers. Research was conducted in two phases. The first phase was a survey that provided demographic data and determined the Level of Technology Implementation, Personal Computer Use, and Current Instructional Practice. Dr. Christopher Moersch developed the survey, Level of Technology Implementation (LoTi(c) ). The data provided insight into what technology teachers use, barriers associated with technology integration, teacher training and development, and technical support. Follow-up interviews were conducted to gather additional qualitative data and information. Analysis of the data found beginning teachers have not received enough technology training to integrate technology seamlessly into the science curriculum. Conclusions cite the need for more technology courses during preservice education, more time during the day for beginning teachers to learn to use the technology available at their schools, consolidation of inservice staff development offerings, and more technical support staff readily available. Recommendations were made to expand the study group to all science teachers, assess the technology capacity of all schools, and conduct needs assessment of inservice staff development.

Transition from an open-plan to a two-cot neonatal intensive care unit: a participatory action research approach.

PubMed

Broom, Margaret; Gardner, Anne; Kecskes, Zsuzsoka; Kildea, Sue

2017-07-01

To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. A participatory action research approach. A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture. A supportive work environment for staff is critical in providing high-quality health care. © 2016 John Wiley & Sons Ltd.

Using Coaching to Provide Ongoing Support and Supervision to Out-of-School Time Staff. Part 3 in a Series on Implementing Evidence-Based Practices in Out-of-School Time Programs: The Role of Frontline Staff. Research-to-Results Brief. Publication #2009-06

ERIC Educational Resources Information Center

Burkhauser, Mary; Metz, Allison J. R.

2009-01-01

Although skills needed by out-of-school time practitioners can be introduced during training, many skills can only really be learned on the job with ongoing support and supervision provided by a "coach." Research from both the education and out-of-school time fields supports the value of staff coaching as a professional development tool, and staff…

Time management behaviors of head nurses and staff nurses employed in Tehran Social Security Hospitals, Iran in 2011.

PubMed

Ebrahimi, Hossein; Hosseinzadeh, Rahele; Tefreshi, Mansoreh Zaghari; Hosseinzadeh, Sadaf

2014-03-01

Effective time management is considered important for managers for achieving the goals in an organization. Head nurses can improve their efficiency and performance with effective use of time. There has always been a lot of disagreement in understanding time management behaviors of head nurses; therefore, the present study was conducted with an aim to compare the understanding of head nurses and staff nurses of the time management behaviors of head nurses employed in Social Security Hospitals in Tehran, Iran in 2011. This was a comparative descriptive study in which 85 head nurses were selected through census and 170 staff nurses were also selected through simple random sampling method from hospitals covered by the Social Security. Data collection was done through a standard inventory with high validity and reliability, which consisted of two parts: Socio-demographic characteristics and time management inventory. The obtained data were analyzed by descriptive and inferential statistics through SPSS software version 13. Mean score of time management in head nurses' viewpoint was 143.22 (±18.66) and in staff nurses' viewpoint was 136.04 (±21.45). There was a significant correlation between the mean scores of head nurses' time management and some of their socio-demographic characteristics such as gender, clinical experience, passing a time management course, and book reading (P < 0.05). There was a significant correlation between the mean scores of staff nurses' time management and their clinical working experience, education, using time management approach, and type of hospital (P < 0.05). The majority of head nurses (52.9%) believed that their time management was in a high level; besides, most of the staff nurses also (40%) believed that time management of their head nurses was high. However, there was a significant difference between the perceptions of both groups on using Mann-Whitney test (P < 0.05). With regard to the importance of time management and its vital role in the quality of nursing care for clients, and also the fact that head nurses believed more in their time management behaviors, they are expected to improve organization's goals and developments in order to modify the weaknesses and shortages and promote the skills and capabilities of their staffs and also resolve the disagreement on the understanding of time management. Moreover, effective time management training programs can be an important step for staff nurses and their head nurses.

Time management behaviors of head nurses and staff nurses employed in Tehran Social Security Hospitals, Iran in 2011

PubMed Central

Ebrahimi, Hossein; Hosseinzadeh, Rahele; Tefreshi, Mansoreh Zaghari; Hosseinzadeh, Sadaf

2014-01-01

Background: Effective time management is considered important for managers for achieving the goals in an organization. Head nurses can improve their efficiency and performance with effective use of time. There has always been a lot of disagreement in understanding time management behaviors of head nurses; therefore, the present study was conducted with an aim to compare the understanding of head nurses and staff nurses of the time management behaviors of head nurses employed in Social Security Hospitals in Tehran, Iran in 2011. Materials and Methods: This was a comparative descriptive study in which 85 head nurses were selected through census and 170 staff nurses were also selected through simple random sampling method from hospitals covered by the Social Security. Data collection was done through a standard inventory with high validity and reliability, which consisted of two parts: Socio-demographic characteristics and time management inventory. The obtained data were analyzed by descriptive and inferential statistics through SPSS software version 13. Results: Mean score of time management in head nurses’ viewpoint was 143.22 (±18.66) and in staff nurses’ viewpoint was 136.04 (±21.45). There was a significant correlation between the mean scores of head nurses’ time management and some of their socio-demographic characteristics such as gender, clinical experience, passing a time management course, and book reading (P < 0.05). There was a significant correlation between the mean scores of staff nurses’ time management and their clinical working experience, education, using time management approach, and type of hospital (P < 0.05). The majority of head nurses (52.9%) believed that their time management was in a high level; besides, most of the staff nurses also (40%) believed that time management of their head nurses was high. However, there was a significant difference between the perceptions of both groups on using Mann–Whitney test (P < 0.05). Conclusion: With regard to the importance of time management and its vital role in the quality of nursing care for clients, and also the fact that head nurses believed more in their time management behaviors, they are expected to improve organization's goals and developments in order to modify the weaknesses and shortages and promote the skills and capabilities of their staffs and also resolve the disagreement on the understanding of time management. Moreover, effective time management training programs can be an important step for staff nurses and their head nurses. PMID:24834090

Influence of environmental factors on mental health within prisons: focus group study.

PubMed

Nurse, Jo; Woodcock, Paul; Ormsby, Jim

2003-08-30

To increase understanding of how the prison environment influences the mental health of prisoners and prison staff. Qualitative study with focus groups. A local prison in southern England. Prisoners and prison staff. Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families. Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.

Predictors of Burnout in Children's Residential Treatment Center Staff

ERIC Educational Resources Information Center

Lakin, Brittany L.; Leon, Scott C.; Miller, Steven A.

2008-01-01

This study explored burnout among frontline staff within a children's residential treatment center (RTC) population. Data were collected from 375 full-time, frontline, children's RTC staff employed at 21 RTCs in Illinois. Using hierarchical linear modeling (HLM), results indicated that frontline staff age, training, empathic concern, communicative…

Planning Staff and Space Capacity Requirements during Wartime.

PubMed

Kepner, Elisa B; Spencer, Rachel

2016-01-01

Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.

Durable improvements in efficiency, safety, and satisfaction in the operating room.

PubMed

Heslin, Martin J; Doster, Barbara E; Daily, Sandra L; Waldrum, Michael R; Boudreaux, Arthur M; Smith, A Blair; Peters, Glenn; Ragan, Debbie B; Buchalter, Scott; Bland, Kirby I; Rue, Loring W

2008-05-01

Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.

Developing emotional intelligence ability in oncology nurses: a clinical rounds approach.

PubMed

Codier, Estelle; Freitas, Beth; Muneno, Lynn

2013-01-01

To explore the feasibility and impact of an emotional intelligence ability development program on staff and patient care. A mixed method, pre/post-test design. A tertiary care hospital in urban Honolulu, HI. Rounds took place on a 24-bed inpatient oncology unit. 33 RNs in an oncology unit. After collection of baseline data, the emotional intelligence rounds were conducted in an inpatient oncology nursing unit on all shifts during a 10-month period. Demographic information, emotional intelligence scores, data from rounds, chart reviews of emotional care documentation, and unit-wide satisfaction and safety data. The ability to identify emotions in self and others was demonstrated less frequently than expected in this population. The low test response rate prevented comparison of scores pre- and postintervention. The staff's 94% participation in rounds, the positive (100%) evaluation of rounds, and poststudy improvements in emotional care documentation and emotional care planning suggest a positive effect from the intervention. Additional research is recommended over a longer period of time to evaluate the impact emotional intelligence specifically has on the staff's identification of emotions. Because the intervention involved minimal time and resources, feasibility for continuation of the intervention poststudy was rated "high" by the research team. Research in other disciplines suggests that improvement in emotional intelligence ability in clinical staff nurses may improve retention, performance, and teamwork in nursing, which would be of particular significance in high-risk clinical practice environments. Few research studies have explored development of emotional intelligence abilities in clinical staff nurses. Evidence from this study suggests that interventions in the clinical environment may be used to develop emotional intelligence ability. Impact from such development may be used in the future to not only improve the quality of nursing care, but also potentially limit the negative effects of high-stress environments on nurses.

[Comparison of two access portals of an employee assistance program at an insurance corporation targeted to reduce stress levels of employees].

PubMed

Burnus, M; Benner, V; Kirchner, D; Drabik, A; Stock, St

2012-03-01

Support programmes for stress reduction were offered independently in two departments (650 employees in total) of an insurance group. Both departments, referred to as comparison group 1 and 2 (CG1 and CG2), offered an Employee Assistance Programme (EAP) featuring individual consultations. The employees were addressed through different channels of communication, such as staff meetings, superiors and email. In CG1, a staff adviser additionally called on all employees at their workplace and showed them a brief relaxing technique in order to raise awareness of stress reduction. By contacting employees personally it was also intended to reduce the inhibition threshold for the following individual talks. In CG2 individual talks were done face-to-face, whereas CG1 used telephone counselling. By using the new access channel with an additional personal contact at the workplace, an above average percentage of employees in CG1 could be motivated to participate in the following talks. The rate of participants was five times as high as in CG1, with lower costs for the consultation in each case.

The Role of an Early Head Start Mental Health Coordinator: Screening for Maternal Depression in a Comprehensive Approach to Mental Health Care

ERIC Educational Resources Information Center

Canuso, Regina

2007-01-01

Screening for maternal depression was a core component of the P.E.A.C.E., Inc., Early Head Start program's comprehensive approach to supporting the mental health needs of low-income pregnant women and families with infants and toddlers. The addition of a mental health coordinator as a full-time staff member created an opportunity to develop a…

A Visitor Control Policy for Martin Army Hospital,

DTIC Science & Technology

1978-04-05

gathered at York Hospital resulted in the limitation of two visitors per patient at one time. This was not an arbitrary decision by management but...management is required to receive input from the consumer on many management decisions . Even discounting the above, the patient was felt to be a logical...proximity of the parking areas to the primary entrances, no additional staff entrances ,4 are needed, therefore no special locking devices for any auxillary

Master plan nurse duty roster using the 0-1 goal programming technique

NASA Astrophysics Data System (ADS)

Ismail, Wan Rosmanira; Jenal, Ruzzakiah

2013-04-01

The scheduling of nurses is particularly challenging because of the nature of the work which is around the clock. In addition, inefficient duty roster can have an effect on the nurses well being as well as their job satisfaction. In nurse scheduling problem (NSP), nurses are generally allocated to periods of work over a specified time horizon. A typical length of the schedule varies from a few weeks to a month. The schedule will be consistently rebuilt after the specified time period and will result in a time-consuming task for the administrative staff involved. Moreover, the task becomes overwhelming when the staff needs to consider the previous duty rosters in order to maintain the quality of schedules. Therefore, this study suggests the development of a master plan for a nurse duty roster for approximately one year. The master plan starts with the development of a blue print for the nurse duty roster using a 0-1 goal programming technique. The appropriate working period for this blue print is formulated based on the number of night shifts and the number of required nurses for night shift per schedule. Subsequently, the blue print is repeated to complete the annual nurse duty roster. These newly developed procedures were then tested on several data sets. The test results found that the master plan has successfully distributed the annual workload evenly among nurses. In addition, the master plan allows nurses to arrange their career and social activities in advance.

SmartStaff: A Support Concept for Staff Planning

DTIC Science & Technology

2000-11-01

facilitated time management and decreased the ambiguities of the plans presented. However, the quality of the final plan did not improve. Team decision making, Team Planning, Group Support Systems, Task Group Staff

11 CFR 5.6 - Fees.

Code of Federal Regulations, 2011 CFR

2011-01-01

...—Paper Print Machine—$.05 per frame/page Reels of Microfilm Daily film (partial or complete roll)—$2.85... Plus cost of staff research time after first 1/2 hour (see Research Time) Publications: (available... ($25) and professional staff time (see Research Time). The cost varies based upon request. Computer...

11 CFR 5.6 - Fees.

Code of Federal Regulations, 2010 CFR

2010-01-01

...—Paper Print Machine—$.05 per frame/page Reels of Microfilm Daily film (partial or complete roll)—$2.85... Plus cost of staff research time after first 1/2 hour (see Research Time) Publications: (available... ($25) and professional staff time (see Research Time). The cost varies based upon request. Computer...

Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34+0 weeks of gestation?

PubMed

Reif, P; Pichler, G; Griesbacher, A; Lehner, G; Schöll, W; Lang, U; Hofmann, H; Ulrich, D

2018-06-01

We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34 +0 weeks of gestation. Population-based prospective cohort study. Ten public hospitals in the Austrian province of Styria. A total of 87 065 neonates delivered in the period 2004-2015. Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. Neonatal composite adverse and severely adverse outcome measures. The odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. Deliveries during night time lead to a greater number of neonates experiencing severely adverse events. © 2017 Royal College of Obstetricians and Gynaecologists.

Characteristics of Professional Staff in California Public Schools: A Five-Year Comparison. Data Compiled from CBEDS, the California Basic Educational Data System.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento.

This document provides the results of a 5-year comparison of characteristics of professional staff between the years of 1982-83 and 1987-88 in the California Public Schools. Professional staff members include all certificated personnel employed full-time or part-time and noncertificated personnel serving at the level of superintendent, deputy,…

The Burn-Out Syndrome in the Day Care Setting

ERIC Educational Resources Information Center

Maslach, Christina; Pines, Ayala

1977-01-01

Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…

Managing the Academic Library Cataloging Department in Changing Times: A State of the Art Bibliography.

ERIC Educational Resources Information Center

Sibley, Brenda Parris

This paper presents an annotated bibliography of articles that provide information on managing the academic library cataloging department. Topics include: hiring tests for technical services support staff; changing roles for professional, paraprofessional staff and support staff; motivating and rewarding cataloging staff; a study of entry level…

Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention.

PubMed

Arnetz, J E; Hasson, H

2007-07-01

Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. The study was a prospective, non-randomized, controlled intervention. Nursing staff in two municipal elderly care organizations in western Sweden. In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

[ICF-Checklist to Evaluate Inclusion of Elderlies with Intellectual Disability - Psychometric Properties].

PubMed

Queri, Silvia; Eggart, Michael; Wendel, Maren; Peter, Ulrike

2017-11-28

Background An instrument should have been developed to measure participation as one possible criterion to evaluate inclusion of elderly people with intellectual disability. The ICF was utilized, because participation is one part of health related functioning, respectively disability. Furthermore ICF includes environmental factors (contextual factors) and attaches them an essentially influence on health related functioning, in particular on participation. Thus ICF Checklist additionally identifies environmental barriers for elimination. Methodology A linking process with VINELAND-II yielded 138 ICF items for the Checklist. The sample consists of 50 persons with a light or moderate intellectual disability. Two-thirds are female and the average age is 68. They were directly asked about their perceived quality of life. Additionally, proxy interviews were carried out with responsible staff members concerning necessary support and behavioral deviances. The ICF Checklist was administered twice, once (t2) the current staff member should rate health related functioning at the given time and in addition, a staff member who knows the person at least 10 years before (t1) should rate the former functioning. Content validity was investigated with factor analysis and criterion validity with correlational analysis related to supports need, behavioral deviances and perceived quality of life. Quantitative analysis was validated by qualitative content analysis of patient documentation. Results Factor analysis shows logical variable clusters across the extracted factors but neither interpretable factors. The Checklist is reliable, valid related to the chosen criterions and shows the expected age-related shifts. Qualitative analysis corresponds with quantitative data. Consequences/Conclusion ICF Checklist is appropriate to manage and evaluate patient-centered care. © Georg Thieme Verlag KG Stuttgart · New York.

Use of Interview and Observation to Clarify Reported Practices of Head Start Staff Concerning Problem Behavior: Implications for Programs and Training

ERIC Educational Resources Information Center

Snell, Martha E.; Voorhees, Mary D.; Berlin, Rebecca A.; Stanton-Chapman, Tina L.; Hadden, Sarah; McCarty, Jane

2012-01-01

This study used interviews and classroom observation to follow up a survey of 78 Head Start staff from five programs in the mid-Atlantic region. The purpose of the study was to collect additional details about administrator and staff needs in regard to addressing children's challenging behavior in order to design a PBS in-service intervention.…

Combating Terrorism: A Compendium of Recent Counterterrorism Recommendations From Authoritative Commissions and Subject Matter Experts

DTIC Science & Technology

2001-09-16

technologies to improve airport security - e.g. biometrics systems and explosive detections systems (Page 5) 4. Allocate additional resources to airport and...been debated are the policy of allowing knives on aircraft, weak cockpit security, and the possibility of federalizing airport security staff.6 A...Improve staff selection and training Airport security staff, and particularly screeners, who are responsible for identifying weapons and explosive

Workloads in Australian emergency departments a descriptive study.

PubMed

Lyneham, Joy; Cloughessy, Liz; Martin, Valmai

2008-07-01

This study aimed to identify the current workload of clinical nurses, managers and educators in Australian Emergency Departments according to the classification of the department Additionally the relationship of experienced to inexperienced clinical staff was examined. A descriptive research method utilising a survey distributed to 394 Australian Emergency departments with a 21% response rate. Nursing workloads were calculated and a ratio of nurse to patient was established. The ratios included nurse to patient, management and educators to clinical staff. Additionally the percentage of junior to senior clinical staff was also calculated. Across all categories of emergency departments the mean nurse:patient ratios were 1:15 (am shift), 1:7 (pm shift) and 1:4 (night shift). During this period an average of 17.1% of attendances were admitted to hospital. There were 27 staff members for each manager and 23.3 clinical staff for each educator. The percentage of junior staff rostered ranged from 10% to 38%. Emergency nurses cannot work under such pressure as it may compromise the care given to patients and consequently have a negative effect on the nurse personally. However, emergency nurses are dynamically adjusting to the workload. Such conditions as described in this study could give rise to burnout and attrition of experienced emergency nurses as they cannot resolve the conflict between workload and providing quality nursing care.

[Approaches for suicide prevention in Osaka Psychiatric Medical Center: the importance of multi-disciplinary cooperation and partnerships with other organizations].

PubMed

Iwata, Kazuhiko

2012-01-01

Suicide is a very common problem in psychiatric practice today. Therefore, almost all staff of psychiatric hospitals have encountered the suicide of one or more of their patients. Our hospital, Osaka Psychiatric Medical Center, is a public psychiatric hospital in Japan. We provide treatment and support for patients from the acute to chronic phases of psychiatric disorders, and patients range from children to the elderly. Because we accept many patients with severe mental illness from other hospitals, many of our staff are routinely confronted with patients' violence or suicidal attempts. If a patient commits suicide, the relevant staff immediately have a conference to implement measures for preventing a recurrence. At the same time, information about the incident is conveyed to the medical safety management office and made known to all staff in our hospital. This office was established in 2007. Currently, all information about incidents and accidents in our hospital (e.g., suicide, problems between patients, problems with hospital facilities) is aggregated in the office and distributed to all staff members through the hospital intranet. This system makes it possible for staff to consider countermeasures against similar incidents and accidents, even if not involved in the incident. Additionally, we make an effort to develop cooperative relationships with organizations including the police, public health centers, and the fire department. The social welfare council in Hirakata City, where our hospital is located, provides some services to prevent suicide (e.g., telephone counseling, meetings with bereaved family members). Our hospital cooperates with these services by providing lecturers. The partnerships with these organizations help regarding the mental crises of patients in our hospital and fulfill a role to prevent suicide. Multi-disciplinary cooperation and partnerships with community organizations are not special approaches to suicide prevention, but ordinary approaches in everyday clinical practice. The most important factor is the relationship between staff and organizations relevant to preventing suicide.

Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study.

PubMed

Mitchell, Marion L; Aitken, Leanne M

2017-03-01

The admission of a relative to intensive care is stressful for families. To help them support the patient, families need assurance, information and an ability to be near their sick relative. Flexible visiting enables patient access but the impact of this on patients, families and staff is not clear. To assess the impact of flexible visiting from the perspective of patients, families, and Intensive Care Unit (ICU) staff. A before-after mixed method study was used with interviews, focus groups and surveys. Patients were interviewed, family members completed the Family Satisfaction in ICU survey and ICU staff completed a survey and participated in focus groups following the introduction of 21h per day visiting in a tertiary ICU. The study was conducted within a philosophy of family-centred care. All interviewed patients (n=12) positively evaluated the concept of extended visiting hours. Family members' (n=181) overall 'satisfaction with care' did not change; however 85% were 'very satisfied' with increased visiting flexibility. Seventy-six percent of family visits continued to occur within the previous visiting hours (11am-8pm) with the remaining 24% taking place during the newly available visiting hours. Families recognised the priority of patient care with their personal needs being secondary. Three-quarters of ICU staff were 'satisfied' with flexible visiting and suggested any barriers could be overcome by role modelling family inclusion. Patients, families and ICU staff positively evaluated flexible visiting hours in this ICU. Although only a minority of families took advantage of the increased hours they indicated appreciation for the additional opportunities. Junior staff may benefit from peer-support to develop family inclusion skills. More flexible visiting times can be incorporated into usual ICU practice in a manner that is viewed positively by all stakeholders. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Secretion clearance strategies in Australian and New Zealand Intensive Care Units.

PubMed

Ntoumenopoulos, George; Hammond, Naomi; Watts, Nicola R; Thompson, Kelly; Hanlon, Gabrielle; Paratz, Jennifer D; Thomas, Peter

2017-06-26

To describe the processes of care for secretion clearance in adult, intubated and mechanically ventilated patients in Australian and New Zealand Intensive Care Units (ICUs). A prospective, cross-sectional study was conducted through the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) Point Prevalence Program. Forty-seven ICUs collected data from 230 patients intubated and ventilated on the study day. Secretion clearance techniques beyond standard suctioning were used in 84/230 (37%) of patients during the study period. Chest wall vibration 34/84 (40%), manual lung hyperinflation 24/84 (29%), chest wall percussion 20/84 (24%), postural drainage/patient positioning 17/84 (20%) and other techniques including mobilisation 15/84 (18%), were the most common secretion clearance techniques employed. On average (SD), patients received airway suctioning 8.8 (5.0) times during the 24-h study period. Mucus plugging events were infrequent (2.7%). The additional secretion clearance techniques were provided by physiotherapy staff in 24/47 (51%) ICUs and by both nursing and physiotherapy staff in the remaining 23/47 (49%) ICUs. One-third of intubated and ventilated patients received additional secretion clearance techniques. Mucus plugging events were infrequent with these additional secretion clearance approaches. Prospective studies must examine additional secretion clearance practices, prevalence of mucus plugging episodes and impact on patient outcomes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Steam sterilization costs: a guide for the central service manager.

PubMed

O'Shaughnessy, K L

1993-07-01

The Nassau County Medical Center CS department, East Meadow, New York, was faced with a staff layoff and an increased workload. With some hard thinking and strong staff support, new processes/systems were designed to save time and money. These included outsourcing the sterilization of "easy" trays, instituting a case cart program and developing custom packs. In order to determine where savings could be had, it was first important to examine current costs. By breaking the costs of sterilization processing down into an average cost per load, a formula was developed that helped determine many additional cost comparisons for the department. For example, the cost analysis formula could be used by CS departments to determine the cost-effectiveness of off-site sterilization, to compare using disposable vs. reusable items and to determine costs for EtO sterilization and aeration.

Patient and staff satisfaction with 'day of admission' elective surgery.

PubMed

Sofela, Agbolahan A; Laban, James T; Selway, Richard P

2013-04-01

To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.

Resident Reactions to Person-Centered Communication by Long-Term Care Staff.

PubMed

Savundranayagam, Marie Y; Sibalija, Jovana; Scotchmer, Emma

2016-09-01

Long-term care staff caregivers who are person centered incorporate the life history, preferences, and feelings of residents with dementia during care interactions. Communication is essential for person-centered care. However, little is known about residents' verbal reactions when staff use person-centered communication. Accordingly, this study investigated the impact of person-centered communication and missed opportunities for such communication by staff on resident reactions. Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded for person-centered communication and missed opportunities. Resident utterances were coded for positive reactions, such as cooperation, and negative reactions, such as distress. Linear regression analyses revealed that the more staff used person-centered communication, the more likely that residents reacted positively. Additionally, the more missed opportunities in a conversation, the more likely that the residents reacted negatively. Conversation illustrations elaborate on the quantitative findings and implications for staff training are discussed. © The Author(s) 2016.

Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

PubMed

Weigl, Matthias; Müller, Andreas; Holland, Stephan; Wedel, Susanne; Woloshynowych, Maria

2016-07-01

Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. We applied a mixed-methods design in a two-step procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Adoption, reach, implementation, and maintenance of a behavioral and mental health assessment in primary care.

PubMed

Krist, Alex H; Phillips, Siobhan M; Sabo, Roy T; Balasubramanian, Bijal A; Heurtin-Roberts, Suzanne; Ory, Marcia G; Johnson, Sallie Beth; Sheinfeld-Gorin, Sherri N; Estabrooks, Paul A; Ritzwoller, Debra P; Glasgow, Russell E

2014-01-01

Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care. As part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)-an electronic or paper-based health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach). Most practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higher reach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P <.001). No practices were able to sustain the complete MOHR assessment without adaptations after study completion. Fielding MOHR increased staff and clinician time an average of 28 minutes per visit. Primary care practices can implement health behavior and mental health assessments, but counseling patients effectively requires effort. Practices will need more support to implement and sustain assessments. © 2014 Annals of Family Medicine, Inc.

Piloting a fiber optics and electronic theory curriculum with high school students

NASA Astrophysics Data System (ADS)

Gilchrist, Pamela O.; Carpenter, Eric D.; Gray-Battle, Asia

2014-07-01

Previous participants from a multi-year blended learning intervention focusing on science, technology, engineering and mathematics (STEM) content knowledge, technical, college, and career preparatory skills were recruited to pilot a new module designed by the project staff. Participants met for a total of 22 contact hours receiving lectures from staff and two guest speakers from industries relevant to photonics, fiber optics hands-on experimentation, and practice with documenting progress. Activities included constructing a fiber optics communication system, troubleshooting breadboard circuits and diagrammed circuits as well as hypothesis testing to discover various aspects of fiber optic cables. Participants documented their activities, wrote reflections on the content and learning endeavor and gave talks about their research experiences to staff, peers, and relatives during the last session. Overall, it was found that a significant gain in content knowledge occurred between the time of pre-testing (Mean=0.54) and post-testing time points for the fiber optics portion of the curriculum via the use of a paired samples t-test (Mean=0.71), t=-2.72, p<.05. Additionally, the electronic theory test results were not a normal distribution and for this reason non-parametric testing was used, specifically a Wilcoxon signed-ranks test. Results indicated a significant increase in content knowledge occurred over time between the pre- (Mdn=0.35) and post-testing time points (Mdn=0.80) z=-2.49, p<,05, r=-0.59 for the electronic theory portion of the curriculum. An equivalent control group was recruited from the remaining participant pool, allowing for comparison between groups. The program design, findings, and lessons learned will be reported in this paper.

Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour: A further examination and partial replication.

PubMed

Deveau, Roy; McGill, Peter

2016-09-01

Practice leadership (PL) style of frontline management has been shown to be associated with better experiences for staff working with people who may exhibit challenging behaviours (Deveau & McGill, 2014). This study aimed to examine additional staff experience factors with a different, larger sample and to partially replicate the findings of (Deveau & McGill, 2014). This study was a survey of staff self-reported data collected as part of a larger study. Information was collected on PL and staff experiences of: stress, turnover, job satisfaction and positive work experiences. The results broadly supported Deveau and McGill (2014) and demonstrated an association between PL and greater job satisfaction and positive experiences for staff. Results on staff turnover were inconsistent. The positive impact of PL on staff experience was further supported by this study. Suggestions are made for further research. These findings suggest further research is needed to examine the potential of interventions in frontline management/leadership practice to improve staff experience of working in challenging environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

Examining the temporal relationship between psychological climate, work attitude, and staff turnover

PubMed Central

Garner, Bryan R.; Hunter, Brooke D.

2012-01-01

Relative to the broader industrial-organizational (I-O) psychology field, research on the turnover of substance use disorder (SUD) treatment staff is in its infancy. Despite its long and rich history, recent reviews of the turnover literature within I-O psychology have noted there remains considerable room for improvement. In particular, recommendations have been made for research that considers time in the turnover process and explores more distal causes of staff turnover. Addressing these gaps, this paper examined the temporal relationship between latent measures of psychological climate, work attitude, and staff turnover. Using data from 95 SUD treatment staff clustered within 29 treatment organizations, multilevel discrete-time survival analyses revealed that a latent measure of work attitude (e.g., job satisfaction, pay satisfaction, turnover intentions) fully mediated the temporal relationship between latent measures of psychological climate (e.g., supervisor support, coworker support, role conflict) and subsequent staff turnover. PMID:22658290

Mental health inpatients' and staff members' suggestions for reducing physical restraint: A qualitative study.

PubMed

Wilson, C; Rouse, L; Rae, S; Kar Ray, M

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and staff. Restraint reduction interventions have been developed (e.g., "Safewards"). Limited qualitative research has explored suggestions on how to reduce physical restraint (and feasibility issues with implementing interventions) from those directly involved. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper explores mental health patients' and staff members' suggestions for reducing physical restraint, whilst addressing barriers to implementing these. Findings centred on four themes: improving communication and relationships; staffing factors; environment and space; and activities and distraction. Not all suggestions are addressed by currently available interventions. Barriers to implementation were identified, centring on a lack of time and/or resources; with the provision of more time for staff to spend with patients and implement interventions seen as essential to reducing physical restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. Fundamental issues related to understaffing, high staff turnover, and lack of time and resources need addressing in order for suggestions to be successfully implemented. Introduction Physical restraint has negative consequences for all involved, and international calls for its reduction have emerged. Some restraint reduction interventions have been developed, but limited qualitative research explores suggestions on how to reduce physical restraint (and feasibility issues with implementation) from those directly involved. Aims To explore mental health patients' and staff members' suggestions for reducing physical restraint. Methods Interviews were conducted with 13 inpatients and 22 staff members with experience of restraint on adult mental health inpatient wards in one UK National Health Service Trust. Results Findings centred on four overarching themes: improving communication and relationships between staff/patients; making staff-related changes; improving ward environments/spaces; and having more activities. However, concerns were raised around practicalities/feasibility of their implementation. Discussion Continued research is needed into best ways to reduce physical restraint, with an emphasis on feasibility/practicality and how to make time in busy ward environments. Implications for Practice Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. However, fundamental issues related to understaffing, high staff turnover and lack of time/resources need addressing in order for these suggestions to be successfully implemented. © 2018 John Wiley & Sons Ltd.

Front-line managers as boundary spanners: effects of span and time on nurse supervision satisfaction.

PubMed

Meyer, Raquel M; O'Brien-Pallas, Linda; Doran, Diane; Streiner, David; Ferguson-Paré, Mary; Duffield, Christine

2011-07-01

To examine the influence of nurse manager span (number of direct report staff), time in staff contact, transformational leadership practices and operational hours on nurse supervision satisfaction. Increasing role complexity has intensified the boundary spanning functions of managers. Because work demands and scope vary by management position, time in staff contact rather than span may better explain managers' capacity to support staff. A descriptive, correlational design was used to collect cross-sectional survey and prospective work log and administrative data from a convenience sample of 558 nurses in 51 clinical areas and 31 front-line nurse managers from four acute care hospitals in 2007-2008. Data were analysed using hierarchical linear modelling. Span, but not time in staff contact, interacted with leadership and operational hours to explain supervision satisfaction. With compressed operational hours, supervision satisfaction was lower with highly transformational leadership in combination with wider spans. With extended operational hours, supervision satisfaction was higher with highly transformational leadership, and this effect was more pronounced under wider spans. Operational hours, which influence the manager's daily span (average number of direct report staff working per weekday), should be factored into the design of front-line management positions. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients’ Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda

PubMed Central

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-01-01

This study aimed at analyzing the effect of 5S practice on staff motivation, patients’ waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement. PMID:28299136

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

PubMed

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-03-31

This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

Staff Development: Finding the Right Fit

ERIC Educational Resources Information Center

Standerfer, Leslie

2005-01-01

Three years ago, when the author joined the staff of Agua Fria High School in Phoenix, Arizona, as an assistant principal, she was excited to find that the students' school day started an hour and a half later than normal each Wednesday to provide staff development time for the teaching staff. That first year, however, neither the principal, Bryce…

Operational evaluation of high-throughput community-based mass prophylaxis using Just-in-time training.

PubMed

Spitzer, James D; Hupert, Nathaniel; Duckart, Jonathan; Xiong, Wei

2007-01-01

Community-based mass prophylaxis is a core public health operational competency, but staffing needs may overwhelm the local trained health workforce. Just-in-time (JIT) training of emergency staff and computer modeling of workforce requirements represent two complementary approaches to address this logistical problem. Multnomah County, Oregon, conducted a high-throughput point of dispensing (POD) exercise to test JIT training and computer modeling to validate POD staffing estimates. The POD had 84% non-health-care worker staff and processed 500 patients per hour. Post-exercise modeling replicated observed staff utilization levels and queue formation, including development and amelioration of a large medical evaluation queue caused by lengthy processing times and understaffing in the first half-hour of the exercise. The exercise confirmed the feasibility of using JIT training for high-throughput antibiotic dispensing clinics staffed largely by nonmedical professionals. Patient processing times varied over the course of the exercise, with important implications for both staff reallocation and future POD modeling efforts. Overall underutilization of staff revealed the opportunity for greater efficiencies and even higher future throughputs.

The importance of staff in the facial plastic surgical practice: dynamic staff interface with patients in support of the surgeon's objectives.

PubMed

Patseavouras, Louie L

2008-05-01

This article addresses how staff can support surgeons in practical terms, making a business more efficient, seamless, and less costly (in terms of emotional and time components). This article addresses (1) using staff as a first line of defense against misperceptions, false expectations, and general problems; (2) recognizing that effective staff are highly intuitive and can be trained to troubleshoot and intervene; (3) encouraging staff to rely on gut instinct; (4) learning that body language and the nonverbal are powerful indicators; (5) training staff concerning nonverbal communication; and (6) realizing that a great deal of communication is within surgeon and staff control.

Creating an effort tracking tool to improve therapeutic cancer clinical trials workload management and budgeting.

PubMed

James, Pam; Bebee, Patty; Beekman, Linda; Browning, David; Innes, Mathew; Kain, Jeannie; Royce-Westcott, Theresa; Waldinger, Marcy

2011-11-01

Quantifying data management and regulatory workload for clinical research is a difficult task that would benefit from a robust tool to assess and allocate effort. As in most clinical research environments, The University of Michigan Comprehensive Cancer Center (UMCCC) Clinical Trials Office (CTO) struggled to effectively allocate data management and regulatory time with frequently inaccurate estimates of how much time was required to complete the specific tasks performed by each role. In a dynamic clinical research environment in which volume and intensity of work ebbs and flows, determining requisite effort to meet study objectives was challenging. In addition, a data-driven understanding of how much staff time was required to complete a clinical trial was desired to ensure accurate trial budget development and effective cost recovery. Accordingly, the UMCCC CTO developed and implemented a Web-based effort-tracking application with the goal of determining the true costs of data management and regulatory staff effort in clinical trials. This tool was developed, implemented, and refined over a 3-year period. This article describes the process improvement and subsequent leveling of workload within data management and regulatory that enhanced the efficiency of UMCCC's clinical trials operation.

Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities.

PubMed

Adsul, Prajakta; Wray, Ricardo; Gautam, Kanak; Jupka, Keri; Weaver, Nancy; Wilson, Kristin

2017-11-01

Background Integrating health literacy into primary care institutional policy and practice is critical to effective, patient centered health care. While attributes of health literate organizations have been proposed, approaches for strengthening them in healthcare systems with limited resources have not been fully detailed. Methods We conducted key informant interviews with individuals from 11 low resourced health care organizations serving uninsured, underinsured, and government-insured patients across Missouri. The qualitative inquiry explored concepts of impetus to transform, leadership commitment, engaging staff, alignment to organization wide goals, and integration of health literacy with current practices. Findings Several health care organizations reported carrying out health literacy related activities including implementing patient portals, selecting easy to read patient materials, offering community education and outreach programs, and improving discharge and medication distribution processes. The need for change presented itself through data or anecdotal staff experience. For any change to be undertaken, administrators and medical directors had to be supportive; most often a champion facilitated these changes in the organization. Staff and providers were often resistant to change and worried they would be saddled with additional work. Lack of time and funding were the most common barriers reported for integration and sustainability. To overcome these barriers, managers supported changes by working one on one with staff, seeking external funding, utilizing existing resources, planning for stepwise implementation, including members from all staff levels and clear communication. Conclusion Even though barriers exist, resource scarce clinical settings can successfully plan, implement, and sustain organizational changes to support health literacy.

Reported municipal costs from outdoor smoke-free by-laws-experience from Ontario, Canada

PubMed Central

2014-01-01

Background In 2006, enclosed public and workplaces in Ontario were made smoke-free by the Smoke-free Ontario Act (SFOA). Numerous area municipalities across the province have since developed local by-laws that are more restrictive than the SFOA and ban smoking in outdoor environments including parks, beaches, and patios. The current study measured reported costs associated with the implementation and enforcement of smoke-free outdoor municipal by-laws including materials and staffing costs. The study also assessed the number of warnings or tickets issued to smokers. Ontario communities with a by-law in force for at least 2 years were included in the sample (n = 42). The study was completed by 88% of area municipalities (n = 37). Municipal staff and managers completed a survey by telephone between June-September 2012. Findings No area municipality surveyed reported that they hired additional enforcement staff as a result of their community’s smoke-free by-law. Most municipalities (95%) posted signage to support awareness of their by-law; signs costs ranged from $40-$150/sign with most municipalities reporting signs were made in-house. Most communities reported actively enforcing the by-law; six communities reported they had issued tickets to people not in compliance with outdoor smoking restrictions. Conclusions The implementation, promotion, and enforcement of outdoor smoke-free by-laws have required municipal staff time and in most cases have promotional costs, but these have come from existing budgets and using existing staff. Outdoor smoke-free by-laws have not created significant burdens on municipal enforcement staff or on municipal budgets. PMID:24581326

THE EFFECTS OF VIDEO MODELING WITH VOICEOVER INSTRUCTION ON ACCURATE IMPLEMENTATION OF DISCRETE-TRIAL INSTRUCTION

PubMed Central

Vladescu, Jason C; Carroll, Regina; Paden, Amber; Kodak, Tiffany M

2012-01-01

The present study replicates and extends previous research on the use of video modeling (VM) with voiceover instruction to train staff to implement discrete-trial instruction (DTI). After staff trainees reached the mastery criterion when teaching an adult confederate with VM, they taught a child with a developmental disability using DTI. The results showed that the staff trainees' accurate implementation of DTI remained high, and both child participants acquired new skills. These findings provide additional support that VM may be an effective method to train staff members to conduct DTI. PMID:22844149

The effects of video modeling with voiceover instruction on accurate implementation of discrete-trial instruction.

PubMed

Vladescu, Jason C; Carroll, Regina; Paden, Amber; Kodak, Tiffany M

2012-01-01

The present study replicates and extends previous research on the use of video modeling (VM) with voiceover instruction to train staff to implement discrete-trial instruction (DTI). After staff trainees reached the mastery criterion when teaching an adult confederate with VM, they taught a child with a developmental disability using DTI. The results showed that the staff trainees' accurate implementation of DTI remained high, and both child participants acquired new skills. These findings provide additional support that VM may be an effective method to train staff members to conduct DTI.

[A listening support group for nursing staff].

PubMed

Lemoine, Dominique

2016-05-01

The feedback from a consultant nurse in a listening support group for health professionals shows that, for hospital nursing staff, the phenomenon of suffering in the workplace is a reality. In addition to providing help to professionals who request it, the missions of such a group are to promote discussion around psycho-social risks in the framework of a policy of compassionate care for staff. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

78 FR 63458 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-24

..., access to conduct research involving DoDEA students, staff, parents or data. Additionally will establish researcher accountability, enable future contact with researchers, and support preparation of statistical and... students, staff, parents or data. To establish researcher accountability, enable future contact with...

Part-Time Work and Advancement: A Study of Female Professional Staff in Australian Universities

ERIC Educational Resources Information Center

Bailey, Janis; Troup, Carolyn; Strachan, Glenda

2017-01-01

One focus of gender equity policies in universities has been the creation of "retention" part-time work for professional staff, which allows employees to move between full-time and part-time hours at their request. This paper examines whether such "good" part-time jobs can contribute to or at least not impede women's career…

A Critical Challenge: The Engagement and Assessment of Contingent, Part-Time Adjunct Faculty Professors in United States Community Colleges

ERIC Educational Resources Information Center

Jolley, Michael R.; Cross, Emily; Bryant, Miles

2014-01-01

In 2011, according to a National Center for Education Statistics report, part-time instructional staff in all higher education institutions exceeded full-time faculty members for the first time, accounting for 50% of all instructional staff (National Center for Education Statistics [NCES], 2012). The same report indicates part-time faculty in…

How to create high-performing teams.

PubMed

Lam, Samuel M

2010-02-01

This article is intended to discuss inspirational aspects on how to lead a high-performance team. Cogent topics discussed include how to hire staff through methods of "topgrading" with reference to Geoff Smart and "getting the right people on the bus" referencing Jim Collins' work. In addition, once the staff is hired, this article covers how to separate the "eagles from the ducks" and how to inspire one's staff by creating the right culture with suggestions for further reading by Don Miguel Ruiz (The four agreements) and John Maxwell (21 Irrefutable laws of leadership). In addition, Simon Sinek's concept of "Start with Why" is elaborated to help a leader know what the core element should be with any superior culture. Thieme Medical Publishers.

Readiness for organisational change among general practice staff.

PubMed

Christl, B; Harris, M F; Jayasinghe, U W; Proudfoot, J; Taggart, J; Tan, J

2010-10-01

Increasing demands on general practice to manage chronic disease may warrant organisational change at the practice level. Staff's readiness for organisational change can act as a facilitator or barrier to implementing interventions aimed at organisational change. To explore general practice staff readiness for organisational change and its association with staff and practices characteristics. This is a cross-sectional study of practices in three Australian states involved in a randomised control trial on the effectiveness of an intervention to enhance the role of non-general practitioner staff in chronic disease management. Readiness for organisational change, job satisfaction and practice characteristics were assessed using questionnaires. 502 staff from 58 practices completed questionnaires. Practice characteristics were not associated with staff readiness for change. A multilevel regression analysis showed statistically significant associations between staff readiness for organisational change (range 1 to 5) and having a non-clinical staff role (vs general practitioner; B=-0.315; 95% CI -0.47 to -0.16; p<0.001), full-time employment (vs part-time; B=0.175, 95% CI 0.06 to 0.29; p<0.01) and lower job satisfaction (B=-0.277, 95% CI -0.40 to -0.15; p<0.001). The results suggest that different approaches are needed to facilitate change which addresses the mix of practice staff. Moderately low job satisfaction may be an opportunity for organisational change.

Evaluation and refinement of a handheld health information technology tool to support the timely update of bedside visual cues to prevent falls in hospitals.

PubMed

Teh, Ruth C-A; Visvanathan, Renuka; Ranasinghe, Damith; Wilson, Anne

2018-06-01

To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital. This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (post-trial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P ≤ 0.05). Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or effectively preventing hospital falls (odds ratio 0.12). Clinicians' recommendations resulted in subsequent technological refinement of the tool, and provision of an additional iPad device for more efficient use. This study adds to the limited pool of knowledge about clinicians' attitudes toward health technology use in falls avoidance. Clinicians were willing to use the HIT tool, and their concerns about its usability were addressed in ongoing tool improvement. Including end-users in the development and refinement processes, as well as having high staff uptake of new technologies, is important in improving their acceptance and usage, and in maximizing beneficial feedback to further inform tool development.

Referral and timing of referral to hospice care in nursing homes: the significant role of staff members.

PubMed

Welch, Lisa C; Miller, Susan C; Martin, Edward W; Nanda, Aman

2008-08-01

Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for >7 days,

Global Health Diplomacy, Monitoring & Evaluation, and the Importance of Quality Assurance & Control: Findings from NIMH Project Accept (HPTN 043): A Phase III Randomized Controlled Trial of Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand.

PubMed

Kevany, Sebastian; Khumalo-Sakutukwa, Gertrude; Singh, Basant; Chingono, Alfred; Morin, Stephen

2016-01-01

Provision and scale-up of high quality, evidence-based services is essential for successful international HIV prevention interventions in order to generate and maintain intervention uptake, study integrity and participant trust, from both health service delivery and diplomatic perspectives. We developed quality assurance (QAC) procedures to evaluate staff fidelity to a cluster-randomized trial of the NIMH Project Accept (HPTN 043) assessing the effectiveness of a community-based voluntary counseling and testing strategy. The intervention was comprised of three components-Mobile Voluntary Counseling and Testing (MVCT), Community Mobilization (CM) and Post-Test Support Services (PTSS). QAC procedures were based on standardized criteria, and were designed to assess both provider skills and adherence to the intervention protocol. Supervisors observed a random sample of 5% to 10% of sessions each month and evaluated staff against multiple criteria on scales of 1-5. A score of 5 indicated 100% adherence, 4 indicated 95% adherence, and 3 indicated 90% adherence. Scores below 3 were considered unsatisfactory, and protocol deviations were discussed with the respective staff. During the first year of the intervention, the mean scores of MVCT and CM staff across the 5 study sites were 4 (95% adherence) or greater and continued to improve over time. Mean QAC scores for the PTSS component were lower and displayed greater fluctuations. Challenges to PTSS staff were identified as coping with the wide range of activities in the PTSS component and the novelty of the PTSS process. QAC fluctuations for PTSS were also associated with new staff hires or changes in staff responsibilities. Through constant staff monitoring and support, by Year 2, QAC scores for PTSS activities had reached those of MVCT and CM. The implementation of a large-sale, evidence based HIV intervention requires extensive QAC to ensure implementation effectiveness. Ongoing appraisal of study staff across sites ensures consistent and high quality delivery of all intervention components, in keeping with the goals of the study protocol, while also providing a forum for corrective feedback, additional supervision and retraining of staff. QAC ensures staff fidelity to study procedures and is critical to the successful delivery of multi-site HIV prevention interventions, as well as the delivery of services scaled up in programmatic situations.

Transcultural nursing. A source guide.

PubMed

Mahon, P Y

1997-01-01

The concept of transcultural nursing is relatively new to the nursing literature. It had been less than 30 years since Madeleine Leininger first began to develop a theory of transcultural nursing as part of a doctoral study in anthropology. Much has changed in that time, and nursing staff development and inservice educators need to provide educational offerings within a multicultural context in a timely manner. Cultural diversity is the standard in the mid-1990s, and those nursing staff development programs that are sensitive to this fact produce employees with advantages over those from settings that do not prepare staff for practice in a constantly changing world. This annotated bibliography about transcultural nursing details key references for staff development and inservice programs. It is not intended as an exhaustive review but rather focuses on the most relevant, timely, and useful of the ever increasing number of publications concerning this important subject. Six major books and four of the most pertinent recent journal articles are included. Conclusions and implications for nursing staff educators are offered.

NRC Consultation and Monitoring at the Savannah River Site: Focusing Reviews of Two Different Disposal Actions - 12181

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ridge, A. Christianne; Barr, Cynthia S.; Pinkston, Karen E.

Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA) requires the U.S. Department of Energy (DOE) to consult with the U.S. Nuclear Regulatory Commission (NRC) for certain non-high level waste determinations. The NDAA also requires NRC to monitor DOE's disposal actions related to those determinations. In Fiscal Year 2011, the NRC staff reviewed DOE performance assessments for tank closure at the F-Tank Farm (FTF) Facility and salt waste disposal at the Saltstone Disposal Facility (SDF) at the Savannah River Site (SRS) as part of consultation and monitoring, respectively. Differences in inventories, waste forms,more » and key barriers led to different areas of focus in the NRC reviews of these two activities at the SRS. Because of the key role of chemically reducing grouts in both applications, the evaluation of chemical barriers was significant to both reviews. However, radionuclide solubility in precipitated metal oxides is expected to play a significant role in FTF performance whereas release of several key radionuclides from the SDF is controlled by sorption or precipitation within the cementitious wasteform itself. Similarly, both reviews included an evaluation of physical barriers to flow, but differences in the physical configurations of the waste led to differences in the reviews. For example, NRC's review of the FTF focused on the modeled degradation of carbon steel tank liners while the staff's review of the SDF performance included a detailed evaluation of the physical degradation of the saltstone wasteform and infiltration-limiting closure cap. Because of the long time periods considered (i.e., tens of thousands of years), the NRC reviews of both facilities included detailed evaluation of the engineered chemical and physical barriers. The NRC staff reviews of residual waste disposal in the FTF and salt waste disposal in the SDF focused on physical barriers to flow and chemical barriers to radionuclide release from the waste. Because the waste inventory and concentration at both sites is sufficient to generate unacceptable doses to an off-site member of the public or inadvertent intruder in the absence of engineered barriers, the NRC staff review focused on the engineering features DOE plans to put in place to limit radionuclide release. At the FTF, DOE expects that peak doses are delayed beyond a 10,000 year performance period by a combination of (1) the flow-limiting effect of the steel tank liner and (2) chemical conditions created by the stabilizing grout overlying the waste that limit the solubility of key radionuclides for tens of thousands of years. At the SDF, DOE expects that flow will be significantly limited by water shedding along the closure cap lower drainage layer and that radionuclide release will be further limited by radionuclide precipitation or sorption within the high pH, chemically reducing conditions created within the saltstone waste form. Because the performance of both facilities depends on the performance of engineered barriers for thousands of years, the reviews included a detailed evaluation of the expected long-term behavior of these barriers. As previously discussed, NRC staff reviews of DOE waste determinations during consultation are designed to evaluate the three NDAA criteria, whereas the review of an updated PA during monitoring only addresses whether the NRC staff has reasonable assurance that the planned disposal action will meet the performance objectives of 10 CFR Part 61. The NRC staff review of the Waste Determination for the FTF did not include conclusions about whether the planned disposal of residual waste at the FTF would meet the NDAA criteria because of the substantial uncertainties in the degree of waste removal DOE would achieve and other technical uncertainties. The main product of the NRC staff review of the planned FTF disposal action is the recommendation that DOE should conduct waste release experiments to increase support for key modeling assumptions related to: (1) the evolution of pH and Eh in the grouted tank system over time; (2) identification of HRR association with solid phases comprising the residual wastes; and (3) expected solubility of HRRs under a range of environmental or service conditions that the residual wastes in the contaminated zone are expected to be exposed to over time. Implementation of this recommendation is deemed crucial for NRC staff to have reasonable assurance that the performance objectives in 10 CFR Part 61, Subpart C can be met. Given the risk-significance of Tank 18 to the overall PA and the short timeline for closure of this tank, the NRC staff recommended that DOE should initiate discussions with NRC staff regarding implementation of this recommendation for Tank 18 as soon as practical. The NRC staff also recommended that experiments to address this recommendation should be conducted prior to final closure of Tank 18. Results of the Tank 18 residual waste experiments, if conducted, will be evaluated by NRC staff to determine the need for additional data collection, experiments, and modeling for Tank 18, as well as other FTF tanks. Additional information regarding the NRC staff's recommendations in this area, including details on the suggested implementation of other recommendations will be provided in the NRC staff's plan for monitoring the FTF later in FY 2012, after DOE makes a final decision on the waste determination. The NRC staff's review of waste disposal at the SDF is ongoing. When complete, the SDF TER will indicate whether the NRC staff continues to have reasonable assurance that waste disposal at the SDF will meet the performance objectives of 10 CFR Part 61 (NDAA Criterion 3). The TER also will include risk insights that will form the basis of the NRC staff's revised monitoring plan for the SDF. The NRC staff will publish an updated monitoring plan for the SDF later in FY 2012. (authors)« less

Los Alamos National Laboratory JOWOG 31 Weapons Engineering Education & Training

DOE Office of Scientific and Technical Information (OSTI.GOV)

Domzalski, Mark W.

The objectives of this report are to recruit talented staff, invest in new and early/mid career staff, retain trained and talented staff and future leaders, and shorten the ~5-10 year time line to realize new Weaponeers.

A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital.

PubMed

Kelly, Erin L; Subica, Andrew M; Fulginiti, Anthony; Brekke, John S; Novaco, Raymond W

2015-05-01

To understand staff factors associated with patient aggression towards the staff of an inpatient forensic psychiatric hospital. Violence by patients is a serious concern in psychiatric hospitals and staff are the most frequent targets of physical and verbal assault. Assault and its consequences can severely disrupt the hospital environment and impair the functioning of staff members and patients. This study examined the interplay of staff dispositional and interpersonal factors associated with patient violence. This cross-sectional study surveyed the staff of a large public forensic hospital. A sample of 348 psychiatric staff participated in an online survey about their workplace experiences, psychosocial characteristics and well-being. Data were collected from November - December 2011. Nearly all staff reported verbal conflict with patients (99%) and 70% reported being assaulted during the previous 12 months. Verbal conflict with other staff (92%) was also high. Multiple regression analyses indicated that in addition to static risk factors (i.e. staff position, years of experience and gender), the risk of assault was associated with the frequency of conflicts with staff and patients, which in turn was moderated by personal stress reactivity. Physical violence by patients was a pervasive threat for a high proportion of staff. Frequent conflict interactions with volatile patients contributed the most risk, but reactivity to conflict was a dynamic risk factor. The strain associated with assault risk and stress reactivity could be prospectively mitigated by resilience enhancement programming for staff. © 2014 John Wiley & Sons Ltd.

Severe forms of fibromyalgia with acute exacerbation of pain: costs, comorbidities, and length of stay in inpatient care.

PubMed

Romeyke, Tobias; Noehammer, Elisabeth; Scheuer, Hans Christoph; Stummer, Harald

2017-01-01

As a disease of the musculoskeletal system, fibromyalgia is becoming increasingly important, because of the direct and indirect costs to health systems. The purpose of this study of health economics was to obtain information about staff costs differentiated by service provider, and staff and material costs of the nonmedical infrastructure in inpatient care. This study looked at 263 patients who received interdisciplinary inpatient treatment for severe forms of fibromyalgia with acute exacerbation of pain between 2011 and 2014. Standardized cost accounting and an analysis of additional diagnoses were performed. The average cost per patient was €3,725.84, with staff and material costs of the nonmedical infrastructure and staff costs of doctors and nurses accounting for the highest proportions of the costs. Each fibromyalgia patient had an average of 6.1 additional diagnoses. Severe forms of fibromyalgia are accompanied by many concomitant diseases and associated with both high clinical staff costs and high medical and nonmedical infrastructure costs. Indication-based cost calculations provide important information for health policy and hospital managers if they include all elements that incur costs in both a differentiated and standardized way.

Hope for successful implementation of psychosocial/psychiatric rehabilitation in the forensic mental health setting.

PubMed

Brown, Stephanie A; Lewis, Kent

2015-12-01

To explore staff perceptions of the successes and barriers to implementation of the psychosocial/psychiatric rehabilitation (PSR) model in the forensic mental health setting and identify staff supports needed for greater implementation. A qualitative descriptive design was used and staff focus group data was analyzed using the constant comparative method. All aspects of PSR are being implemented in the forensic setting. Barriers limiting comprehensive implementation include hospital processes and functions, legal components, client clinical presentation, staff attributes and interactions, and lack of resources. To foster greater implementation, employees require support to improve interprofessional interactions and acquire additional resources and education. Strengthening existing successes and addressing barriers identified will foster greater PSR implementation in the forensic setting. Adjusting the physical environment, streamlining documentation, shifting focus from security to rehabilitation goals, and adapting PSR principles to various levels of illness acuity and stages of treatment would enhance PSR implementation. A management focus on improving staff morale, self-care, peer support, team cohesion, and communication would limit burnout and increase successful implementation of PSR. Additional educational opportunities and ongoing training are suggested to support a unified understanding and sustained approach to PSR implementation in the forensic setting. (c) 2015 APA, all rights reserved).

Leadership Development

ERIC Educational Resources Information Center

Mallon, Melissa

2017-01-01

This issue's column focuses on online tools and resources available for leadership development of academic, public services staff. The resources are not targeted solely to professional librarians, but rather to all levels of library staff engaged with the public. In addition to inspirational and coaching videos, reviewers recommend resource guides…

Care homes and the Mental Capacity Act 2005: Changes in understanding and practice over time.

PubMed

Manthorpe, Jill; Samsi, Kritika

2016-07-01

The Mental Capacity Act 2005 provides the legal framework in England and Wales for the making of decisions in respect of people who have never had or have lost decision-making capacity. As part of a 5-year research program investigating the implementation and adoption of the Mental Capacity Act in dementia practice, we interviewed staff working in different care homes at two time points (32 staff at Time 1 in 2008 and 27 staff at Time 2 in 2012) in South East England. At baseline Time 1, daily practice seemed to resonate with Mental Capacity Act principles of respecting decisions and trying to act in a person's best interests. This paper reports Time 2 findings. We found that few care home staff interviewed specifically reported finding the Mental Capacity Act helpful in crystallizing the legal basis of their work. Most continued to offer illustrations of day-to-day practice in which they paid attention to individual choices, took account of the wishes of residents' families, and tried to act in residents' best interests but referred major decisions to their seniors. This study highlights the potential of referring to specific day-to-day practice in care homes when offering training or scrutinizing practice in dementia care more generally so that the work is set in its legal as well as moral framework. Care home staff in this study reported that advanced planning and pre-specifying preferences were more common among new care home residents, especially those with dementia, indicating that greater understanding of these is required by staff. © The Author(s) 2014.

Role of a service corridor in ICU noise control, staff stress, and staff satisfaction: environmental research of an academic medical center.

PubMed

Wang, Zhe; Downs, Betsy; Farell, Ashley; Cook, Kimberly; Hourihan, Peter; McCreery, Shimby

2013-01-01

To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction. Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented. A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic. Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU (p < 0.01). Analyses of acoustical data confirmed that the new ICU was significantly quieter (p < 0.02). Observations revealed how the service corridor impacted patient care services and traffic. The addition of a dedicated service corridor works in the new unit for improving noise control and staff stress and satisfaction. Critical care/intensive care, noise, satisfaction, staff, work environment.

The influence of organizational factors on patient safety: Examining successful handoffs in health care.

PubMed

Richter, Jason P; McAlearney, Ann Scheck; Pennell, Michael L

2016-01-01

Although patient handoffs have been extensively studied, they continue to be problematic. Studies have shown poor handoffs are associated with increased costs, morbidity, and mortality. No prior research compared perceptions of management and clinical staff regarding handoffs. Our aims were (a) to determine whether perceptions of organizational factors that can influence patient safety are positively associated with perceptions of successful patient handoffs, (b) to identify organizational factors that have the greatest influence on perceptions of successful handoffs, and (c) to determine whether associations between perceptions of these factors and successful handoffs differ for management and clinical staff. A total of 515,637 respondents from 1,052 hospitals completed the Hospital Survey on Patient Safety Culture that assessed perceptions about organizational factors that influence patient safety. Using weighted least squares multiple regression, we tested seven organizational factors as predictors of successful handoffs. We fit three separate models using data collected from (a) all staff, (b) management only, and (c) clinical staff only. We found that perceived teamwork across units was the most significant predictor of perceived successful handoffs. Perceptions of staffing and management support for safety were also significantly associated with perceived successful handoffs for both management and clinical staff. For management respondents, perceptions of organizational learning or continuous improvement had a significant positive association with perceived successful handoffs, whereas the association was negative for clinical staff. Perceived communication openness had a significant association only among clinical staff. Hospitals should prioritize teamwork across units and strive to improve communication across the organization in efforts to improve handoffs. In addition, hospitals should ensure sufficient staffing and management support for patient safety. Different perceptions between management and clinical staff with respect to the importance of organizational learning are noteworthy and merit additional study.

Tracheal intubation by novice staff: the direct vision laryngoscope or the lighted stylet (Trachlight)?

PubMed Central

Soh, C; Kong, C; Kong, C; Ip-Yam, P; Chin, E; Goh, M

2002-01-01

Objective: To compare the ease of use of the direct vision laryngoscope and the lighted stylet (Trachlight) by novice staff. Methods: Ten novice medical officers (MOs) performed orotracheal intubations using either the conventional direct vision laryngoscope (DL) or a lighted stylet device (Trachlight). They performed their DL intubations during the first phase of the study, followed by the Trachlight intubations in the subsequent phase. Results: 51 of 54 (94%) of the DL intubation attempts were successful compared with 36 of 54 (67%) of the Trachlight intubations (p<0.001). The mean (SEM) time for intubation was 44 (7) seconds in the DL group and 66 (13) seconds in the Trachlight group (p=0.004). In addition 45 of 54 (83%) of the DL intubations were successful at the first attempt versus 15 of 54 (28%) in the Trachlight group (p<0.001). Conclusion: The results show that the use of the conventional direct vision laryngoscope in novices is associated with significantly shorter mean intubation times and higher success rates on the first attempt compared with the Trachlight. PMID:12101133

Influence of staff infection control training on infection-related quality measures in US nursing homes.

PubMed

Kaur, Jasjit; Stone, Patricia W; Travers, Jasmine L; Cohen, Catherine C; Herzig, Carolyn T A

2017-09-01

Health care-associated infections are a leading cause of morbidity and mortality in US nursing home residents. Ongoing training of nursing home staff is vital to the implementation of infection prevention and control processes. Our aim was to describe associations between methods, frequency, and timing of staff infection prevention and control training and infection-related quality measures. In this national survey of nursing homes, timing of staff infection prevention and control training was associated with reduced indwelling urinary catheter use. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Selling the OR: strategies to compete in the marketplace.

PubMed

Lee, M G

1989-07-01

1. OR directors are expected to be successful business managers in addition to their usual management responsibilities. 2. To complete with other health-care facilities, it is essential to incorporate marketing as part of the management strategy. 3. Marketing includes developing the skill level of all staff members, including middle managers, staff nurses, and ancillary personnel. 4. OR directors must create a work environment where the physician and staff are partners in providing quality patient care.

Staff Efficiency Trends Among Pediatric Hospices, 2002–2011

PubMed Central

Cozad, Melanie J.; Lindley, Lisa C.; Mixer, Sandra J.

2016-01-01

Delivering care for children at end of life often takes considerable time and effort by the hospice staff. The purpose of this study was to examine trends in staff technical efficiency among California pediatric hospice providers from 2002 and 2011. PMID:27265950

Time to audit.

PubMed

Smyth, L G; Martin, Z; Hall, B; Collins, D; Mealy, K

2012-09-01

Public and political pressures are increasing on doctors and in particular surgeons to demonstrate competence assurance. While surgical audit is an integral part of surgical practice, its implementation and delivery at a national level in Ireland is poorly developed. Limits to successful audit systems relate to lack of funding and administrative support. In Wexford General Hospital, we have a comprehensive audit system which is based on the Lothian Surgical Audit system. We wished to analyse the amount of time required by the Consultant, NCHDs and clerical staff on one surgical team to run a successful audit system. Data were collected over a calendar month. This included time spent coding and typing endoscopy procedures, coding and typing operative procedures, and typing and signing discharge letters. The total amount of time spent to run the audit system for one Consultant surgeon for one calendar month was 5,168 min or 86.1 h. Greater than 50% of this time related to work performed by administrative staff. Only the intern and administrative staff spent more than 5% of their working week attending to work related to the audit. An integrated comprehensive audit system requires a very little time input by Consultant surgeons. Greater than 90% of the workload in running the audit was performed by the junior house doctors and administrative staff. The main financial implications for national audit implementation would relate to software and administrative staff recruitment. Implementation of the European Working Time Directive in Ireland may limit the time available for NCHD's to participate in clinical audit.

A growing need - HIV education in long-term care.

PubMed

Siou, Kaitlin; Mahan, Maureen; Cartagena, Rod; Chan Carusone, Soo

As people living with HIV (PLHIV) age, knowledge of HIV and the associated care of those aging with HIV will become an increasingly important component of education for long-term care (LTC) providers. This descriptive study piloted two different approaches to distribute narrative-based HIV educational videos. Four LTC facilities were assigned to receive the videos to implement 'as usual' or to receive the videos in addition to blended learning sessions where the videos were shown with facilitated discussion with a nurse educator and a PLHIV. In LTC facilities where external educators were provided, a larger proportion of staff watched the videos. However, increases in staff comfort level providing care to PLHIV were comparable between both groups. Narratives of PLHIV, administrator engagement and coordination of online education were identified as facilitators to improving HIV knowledge and compassion in LTC, while fear of HIV transmission and limited time for education, especially when not mandated or identified as immediately applicable, were identified as barriers. From our findings, HIV-related stigma still exists in LTC and these videos may be a strategy for disseminating basic knowledge about HIV transmission and sensitizing staff to the experience of living with HIV. Copyright © 2016 Elsevier Inc. All rights reserved.

Applied Operations Research: Augmented Reality in an Industrial Environment

NASA Technical Reports Server (NTRS)

Cole, Stuart K.

2015-01-01

Augmented reality is the application of computer generated data or graphics onto a real world view. Its use provides the operator additional information or a heightened situational awareness. While advancements have been made in automation and diagnostics of high value critical equipment to improve readiness, reliability and maintenance, the need for assisting and support to Operations and Maintenance staff persists. AR can improve the human machine interface where computer capabilities maximize the human experience and analysis capabilities. NASA operates multiple facilities with complex ground based HVCE in support of national aerodynamics and space exploration, and the need exists to improve operational support and close a gap related to capability sustainment where key and experienced staff consistently rotate work assignments and reach their expiration of term of service. The initiation of an AR capability to augment and improve human abilities and training experience in the industrial environment requires planning and establishment of a goal and objectives for the systems and specific applications. This paper explored use of AR in support of Operation staff in real time operation of HVCE and its maintenance. The results identified include identification of specific goal and objectives, challenges related to availability and computer system infrastructure.

Culture and spirituality: essential components of palliative care.

PubMed

Speck, Peter

2016-06-01

Palliative care advocates a holistic, multiprofessional approach to the care of people with life-threatening disease. In addition to the control of physical symptoms attention should also be paid to psychosocial, cultural and spiritual aspects of the patient's experience of illness. Guidance documents and research evidence reflect the complexity of the patient's journey and the need to regularly assess these areas of need over time. Cultural background can shape how patients respond to life-threatening illness, as can the beliefs held by the patients, whether religious or more broadly spiritual. Research evidence shows the importance of identifying and addressing cultural and spiritual aspects of care held by patients, families and staff. These are often neglected in clinical practice due to the focus on biomedical concerns and staff discomfort in engaging with beliefs and culture. Recent studies have highlighted gaps in the research, and some methodological difficulties and indicate many patients welcome healthcare staff enquiring about the importance of their beliefs and culture. Identifying research priorities is necessary to guide future research and strengthen the evidence base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Improving efficiency, reducing infection, and enhancing experience.

PubMed

Massa, Judith

For health professionals to make an informed choice and tailor each bed bath to the individual needs of the patient, they must firstly understand the different bed bath options available, their impact on skin integrity, and any associated risks they may pose to the patient in terms of cross-infection. Only with this knowledge can health professionals determine the appropriate form and frequency of the bed bath. Specialist wipes offer significant improvements in skin care and a reduced risk of cross-infection, compared with the traditional soap and water bed bath. Use of these wipes also improves the efficiency of the process, which links to the Productive Ward Initiative and results in clinical staff (i.e. nursing staff, healthcare assistants) having more time available to undertake additional patient care activities. This product focus highlights the benefits of moving to a wipe-based bed bath method, and the significant efficiency savings that can be realized as a result.

Casemix Funding Optimisation: Working Together to Make the Most of Every Episode.

PubMed

Uzkuraitis, Carly; Hastings, Karen; Torney, Belinda

2010-10-01

Eastern Health, a large public Victorian Healthcare network, conducted a WIES optimisation audit across the casemix-funded sites for separations in the 2009/2010 financial year. The audit was conducted using existing staff resources and resulted in a significant increase in casemix funding at a minimal cost. The audit showcased the skill set of existing staff and resulted in enormous benefits to the coding and casemix team by demonstrating the value of the combination of skills that makes clinical coders unique. The development of an internal web-based application allowed accurate and timely reporting of the audit results, providing the basis for a restructure of the coding and casemix service, along with approval for additional staffing resources and inclusion of a regular auditing program to focus on the creation of high quality data for research, health services management and financial reimbursement.

Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp.

PubMed

Wani, Shabeer Ahmad; Rabah, Sari M; Alfadil, Sara; Dewanjee, Nancy; Najmi, Yahya

2013-09-01

The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate.

Counter Action Procedure Generation in an Emergency Situation of Nuclear Power Plants

NASA Astrophysics Data System (ADS)

Gofuku, A.

2018-02-01

Lessons learned from the Fukushima Daiichi accident revealed various weak points in the design and operation of nuclear power plants at the time although there were many resilient activities made by the plant staff under difficult work environment. In order to reinforce the measures to make nuclear power plants more resilient, improvement of hardware and improvement of education and training of nuclear personnel are considered. In addition, considering the advancement of computer technology and artificial intelligence, it is a promising way to develop software tools to support the activities of plant staff.This paper focuses on the software tools to support the operations by human operators and introduces a concept of an intelligent operator support system that is called as co-operator. This paper also describes a counter operation generation technique the authors are studying as a core component of the co-operator.

Using employee experts to offer an interprofessional diabetes risk reduction program to fellow employees.

PubMed

Lenz, Thomas L; Gillespie, Nicole D; Skrabal, Maryann Z; Faulkner, Michele A; Skradski, Jessica J; Ferguson, Liz A; Pagenkemper, Joni J; Moore, Geri A; Jorgensen, Diane

2013-03-01

A recent increase in the incidence of diabetes and pre-diabetes is causing many employers to spend more of their healthcare benefit budgets to manage the conditions. A self-insured university in the USA has implemented an interprofessional diabetes mellitus risk reduction program using its own employee faculty and staff experts to help fellow employees manage their diabetes and pre-diabetes. The interprofessional team consists of five pharmacists, a dietitian, an exercise physiologist, a health educator and a licensed mental health practitioner. In addition, the participant's physician serves as a consultant to the program, as does a human resources healthcare benefits specialist and a wellness coordinator. The volunteer program takes place at the worksite during regular business hours and is free of charge to the employees. The faculty and staff delivering the program justify the cost of their time through an interprofessional educational model that the program will soon provide to university students.

A Staff-Training Program to Increase Spontaneous Vocal Requests in Children With Autism

PubMed Central

Karp, Rebecca

2013-01-01

This study evaluated a staff-training and feedback program to increase (a) staff use of naturalistic language training techniques, and (b) child production of spontaneous vocal requests in a school setting for young children with autism. Training was conducted in integrated preschool centers and in an art group. The results revealed that the training and feedback procedure was successful in increasing staff use of naturalistic language training techniques. Further, these increased strategies were associated with corresponding increases in spontaneous vocal requests for all children during embedded training and ongoing feedback conditions. In addition, probes collected by an unobtrusive observer revealed durability of child requesting when staff feedback was discontinued. Social validity measures from front-line staff regarding the intervention revealed positive ratings. The results are discussed in relation to the continued search for effective service-delivery systems to improve communication for children with autism in the public school setting. PMID:27999635

Work-related accidents and occupational diseases in veterinarians and their staff.

PubMed

Nienhaus, Albert; Skudlik, Christoph; Seidler, Andreas

2005-04-01

We assessed the occupational hazards in veterinary practice by analysing accident insurance data in order to stimulate strategies to prevent occupational accidents and diseases in veterinarians and their staff. Approximately 10,000 veterinary practices comprising about 27,500 veterinarians and their staff are covered by the Institution of Statutory Accident Insurance of the Health and Welfare Service (BGW). Each year about 2,000 accident and occupational disease claims are filed by these veterinarians and their staff. The claims for the 5-year period from 1998 to 2002 are analysed in this paper. For 2002, the incidence rate for accidents in the workplace was 105.4 per 1,000 full-time workers, a rate 2.9-times higher than for general practitioners of human medicine. When only severe accidents resulting in a loss of work time of more than 3 days were analysed, the relative risk increased to 9.2. Approximately 66% of the reported accidents are due to scratches, bites, or kicks from animals. Claims of occupational disease are filed 2.7-times more often by veterinarians and their staff than by general practitioners and their staff. The occupational diseases filed most often concern the skin (39%), followed by allergic respiratory diseases (30.5%), and infectious diseases (19.1%). Prevention strategies for veterinarians should focus on accidents caused by animals. The prevention of occupational diseases should focus on skin diseases, respiratory disease, and infections.

Analysis of sickness absence among employees of four NHS trusts

PubMed Central

Ritchie, K. A.; Macdonald, E. B.; Gilmour, W. H.; Murray, K. J.

1999-01-01

OBJECTIVES: To determine the value of using routinely collected sickness absence data as part of a health needs assessment of healthcare workers. METHOD: Sickness absence records of almost 12900 NHS staff for one calendar year were analysed. Three measures of absence, the absence rate, the absence frequency rate, and the mean duration of absence, were assessed for the population and comparisons made between men and women, full and part time and different occupational groups of staff. Also, the main causes of sickness absence were found. RESULTS: Almost 60% of the study population had no spells of sickness absence in the year of study and almost 20% had only one spell of sickness absence. Female staff were more likely to have experienced sickness absence than male staff. Although absence due to conditions related to pregnancy were included in the analysis, the incidence of these was not sufficient to account for the higher rates of absence among female staff. In general, full time staff had greater rates of sickness absence than part time staff. 71% of all absences were of < 1 week duration. The main known causes of sickness absence were respiratory disorders, digestive disorders, and musculoskeletal disorders. CONCLUSIONS: The transition from units managed directly from the health board to trusts with individual responsibility for personnel issues at the time of data collection resulted in variations in the quality of data available for analysis. This together with the use of "dump" codes has influenced the quality of the analysis. However, such data should be available for analysis to tailor occupational health care to the needs of the population.   PMID:10658551

Staff Development Needs Assessment.

ERIC Educational Resources Information Center

College of the Canyons, Valencia, CA. Office of Institutional Development.

In September 1993, California's College of the Canyons surveyed a total of 415 faculty and staff regarding their satisfaction with their employment at the college and their perceptions of opportunities for development. Responses were received from 41% (n=170) of the employees, including 56 full-time and 58 part-time faculty and 41 full-time and 13…

Attitudes and beliefs of emergency department staff regarding alcohol-related presentations.

PubMed

Indig, Devon; Copeland, Jan; Conigrave, Katherine M; Rotenko, Irene

2009-01-01

This study examined emergency department (ED) staff attitudes and beliefs about alcohol-related ED presentations in order to recommend improved detection and brief intervention strategies. The survey was conducted at two inner-Sydney hospital EDs in 2006 to explore ED clinical staff's attitudes, current practice and barriers for managing alcohol-related ED presentations. The sample included N=78 ED staff (54% nurses, 46% doctors), representing a 30% response rate. Management of alcohol-related problems was not routine among ED staff, with only 5% usually formally screening for alcohol problems, only 16% usually conducting brief interventions, and only 27% usually providing a referral to specialist treatment services. Over 85% of ED staff indicated that lack of patient motivation made providing alcohol interventions very difficult. Significant predictors of good self-reported practice among ED staff for patients with alcohol problems included: being a doctor, being confident and having a sense of responsibility towards managing patients with alcohol-related problems. This study reported that many staff lack the confidence or sense of clinical responsibility to fully and appropriately manage ED patients with alcohol-related problems. ED staff appear to require additional training, resources and support to enhance their management of patients with alcohol-related problems.

Patient and staff assessment of an audiovisual education tool for head and neck radiation therapy.

PubMed

Morley, Lyndon; McAndrew, Alison; Tse, Karen; Rakaric, Peter; Cummings, Bernard; Cashell, Angela

2013-09-01

The purpose of this study was to understand and compare patient and staff perceptions of a video-based preparatory education tool for head and neck radiotherapy. Patients and staff completed a questionnaire assessing their perceptions of whether the education tool was relevant, clear, complete and reassuring. Staff rated the video's accuracy and anticipated impact on future patient information needs. Demographic information was collected. Open-ended questions were used to elicit additional feedback. Quantitative responses from 50 patients and 48 staff were very positive and not significantly different between the two groups. Content analysis of the qualitative data provided insight into the information and approaches valued by patients and staff and how these differed. Staff members were more critical of the production quality and completeness of information related to procedures and treatment side effects. Patients valued seeing procedures acted out and desired more information about what these experiences would feel like and how to engage in self-care. Although staff-driven development may be an effective method of designing the content and approach of a preparatory education video, care should be taken to consider differences between patient and staff perceptions of information needs.

Examining the temporal relationship between psychological climate, work attitude, and staff turnover.

PubMed

Garner, Bryan R; Hunter, Brooke D

2013-02-01

Relative to the broader industrial-organizational (I-O) psychology field, research on the turnover of substance use disorder (SUD) treatment staff is in its infancy. Despite its long and rich history, recent reviews of the turnover literature within I-O psychology have noted that there remains considerable room for improvement. In particular, recommendations have been made for research that considers time in the turnover process and explores more distal causes of staff turnover. Addressing these gaps, this article examined the temporal relationship between latent measures of psychological climate, work attitude, and staff turnover. Using data from 95 SUD treatment staff clustered within 29 treatment organizations, multilevel discrete-time survival analyses revealed that a latent measure of work attitude (e.g., job satisfaction, pay satisfaction, turnover intentions) fully mediated the temporal relationship between latent measures of psychological climate (e.g., supervisor support, coworker support, role conflict) and subsequent staff turnover. Copyright © 2013 Elsevier Inc. All rights reserved.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People's Republic of China.

PubMed

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception. A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics.

Factors influencing the perception of medical staff and outpatients of dual practice in Shanghai, People’s Republic of China

PubMed Central

Chen, Haiping; Li, Meina; Dai, Zhixin; Deng, Qiangyu; Zhang, Lulu

2016-01-01

Objective Dual practice is defined as a physician’s performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people’s perception. Methods A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis. Results The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals’ human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients. Conclusion This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals’ human resource would promote physicians’ willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics. PMID:27621600

Predictors of Staff Turnover and Turnover Intentions within Addiction Treatment Settings: Change Over Time Matters.

PubMed

Garner, Bryan R; Hunter, Brooke D

2014-01-01

This study examined the extent to which changes over time in clinicians' responses to measures of work attitude (eg, job satisfaction) and psychological climate (eg, supervisor support) could predict actual turnover and turnover intentions above and beyond absolute levels of these respective measures. Longitudinal data for this study were collected from a sample of clinicians (N = 96) being trained to implement an evidence-based treatment for adolescent substance use disorders. Supporting findings from a recent staff turnover study, we found job satisfaction change was able to predict actual turnover above and beyond average levels of job satisfaction. Representing new contributions to the staff turnover literature, we also found that change over time in several other key measures (eg, job satisfaction, role manageability, role clarity) explained a significant amount of variance in turnover intentions above and beyond the absolute level of each respective measure. A key implication of the current study is that organizations seeking to improve their ability to assess risk for staff turnover may want to consider assessing staff at multiple points in time in order to identify systematic changes in key employee attitudes like turnover intentions and job satisfaction.

Predictors of Staff Turnover and Turnover Intentions within Addiction Treatment Settings: Change Over Time Matters

PubMed Central

Garner, Bryan R; Hunter, Brooke D

2014-01-01

This study examined the extent to which changes over time in clinicians’ responses to measures of work attitude (eg, job satisfaction) and psychological climate (eg, supervisor support) could predict actual turnover and turnover intentions above and beyond absolute levels of these respective measures. Longitudinal data for this study were collected from a sample of clinicians (N = 96) being trained to implement an evidence-based treatment for adolescent substance use disorders. Supporting findings from a recent staff turnover study, we found job satisfaction change was able to predict actual turnover above and beyond average levels of job satisfaction. Representing new contributions to the staff turnover literature, we also found that change over time in several other key measures (eg, job satisfaction, role manageability, role clarity) explained a significant amount of variance in turnover intentions above and beyond the absolute level of each respective measure. A key implication of the current study is that organizations seeking to improve their ability to assess risk for staff turnover may want to consider assessing staff at multiple points in time in order to identify systematic changes in key employee attitudes like turnover intentions and job satisfaction. PMID:25336960

A feasibility study comparing UK older adult mental health inpatient wards which use protected engagement time with other wards which do not: study protocol.

PubMed

Nolan, Fiona M; Fox, Chris; Cheston, Richard; Turner, David; Clark, Allan; Dodd, Emily; Khoo, Mary-Ellen; Gray, Richard

2016-01-01

Protected engagement time (PET) is a concept of managing staff time on mental health inpatient wards with the aim of increasing staff and patient interaction. Despite apparent widespread use of PET, there remains a dearth of evidence as to how it is implemented and whether it carries benefits for staff or patients. This protocol describes a study which is being carried out on mental health wards caring for older adults (aged over 65) in England. The study shares a large proportion of the procedures, measures and study team membership of a recently completed investigation of the impact of PET in adult acute mental health wards. The study aims to identify prevalence and components of PET to construct a model for the intervention, in addition to testing the feasibility of the measures and procedures in preparation for a randomised trial. The study comprises four modules and uses a mixed methods approach. Module 1 involves mapping all inpatient wards in England which provide care for older adults, including those with dementia, ascertaining how many of these provide PET and in what way. Module 2 uses a prospective cohort method to compare five older adult mental health wards that use PET with five that do not across three National Health Service (NHS) Foundation Trust sites. The comparison comprises questionnaires, observation tools and routinely collected clinical service data and combines validated measures with questions developed specifically for the study. Module 3 entails an in-depth case study evaluation of three of the participating PET wards (one from each NHS Trust site) using semi-structured interviews with patients, carers and staff. Module 4 describes the development of a model and fidelity scale for PET using the information derived from the other modules with a working group of patients, carers and staff. This is a feasibility study to test the application of the measures and methods in inpatient wards for older adults and develop a draft model for the intervention. The next stage will prospectively involve testing of the model and fidelity scale in randomised conditions to provide evidence for the effectiveness of PET as an intervention. ISRCTN31919196.

Formative assessment in mathematics for engineering students

NASA Astrophysics Data System (ADS)

Ní Fhloinn, Eabhnat; Carr, Michael

2017-07-01

In this paper, we present a range of formative assessment types for engineering mathematics, including in-class exercises, homework, mock examination questions, table quizzes, presentations, critical analyses of statistical papers, peer-to-peer teaching, online assessments and electronic voting systems. We provide practical tips for the implementation of such assessments, with a particular focus on time or resource constraints and large class sizes, as well as effective methods of feedback. In addition, we consider the benefits of such formative assessments for students and staff.

Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis.

PubMed

Simmons, Sandra F; Hollingsworth, Emily K; Long, Emily A; Liu, Xulei; Shotwell, Matthew S; Keeler, Emmett; An, Ruopeng; Silver, Heidi J

2017-02-01

To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. Randomized, controlled trial. Five community NHs. Long-stay NH residents with an order for caloric supplementation (N = 122). Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Impact of relational coordination on staff and patient outcomes in outpatient surgical clinics.

PubMed

Gittell, Jody Hoffer; Logan, Caroline; Cronenwett, Jack; Foster, Tina C; Freeman, Richard; Godfrey, Marjorie; Vidal, Dale Collins

2018-01-05

Pressures are increasing for clinicians to provide high-quality, efficient care, leading to increased concerns about staff burnout. This study asks whether staff well-being can be achieved in ways that are also beneficial for the patient's experience of care. It explores whether relational coordination can contribute to both staff well-being and patient satisfaction in outpatient surgical clinics where time constraints paired with high needs for information transfer increase both the need for and the challenge of achieving timely and accurate communication. We studied relational coordination among surgeons, nurses, residents, administrators, technicians, and secretaries in 11 outpatient surgical clinics. Data were combined from a staff and a patient survey to conduct a cross-sectional study. Data were analyzed using ordinary least squares and random effects regression models. Relational coordination among all workgroups was significantly associated with staff outcomes, including job satisfaction, work engagement, and burnout. Relational coordination was also significantly associated with patients' satisfaction with staff and their overall visit, though the association between relational coordination and patients' satisfaction with their providers did not reach statistical significance. Even when patient-staff interactions are relatively brief, as in outpatient settings, high levels of relational coordination among interdependent workgroups contribute to positive outcomes for both staff and patients, and low levels tend to have the opposite effect. Clinical leaders can increase the expectation of positive outcomes for both staff and their patients by implementing interventions to strengthen relational coordination.

Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

PubMed

Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

2017-12-01

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

Defense Manpower Commission Staff Studies and Supporting Papers. Volume 3. Military Recruitment and Accessions and Future of the All Volunteer Force

DTIC Science & Technology

1976-05-01

active duty end additional Reserve recruiters were assigned to large ustropeliten areas. * The relationship of AF Reserve recruiting functions io...headquarters. There Also is a marked contrast between the Services in the comand relationship between recruiting and the initial training of recruits...the Deputy Chief of Staff, Personnel. Thus, the only formal command relationship between the two waste st the Office of the Chief of Staff. The sm

STAFF REPORT ON CONFERENCE FINDINGS. APPENDIX II.

ERIC Educational Resources Information Center

National Council on the Aging, Inc., New York, NY.

CONFERENCE SPEAKERS, PANELISTS, AND WORKSHOPS WERE ASKED TO FOCUS ON THE PROBLEMS OF THE 45-PLUS AGE GROUP AND TO MAKE SPECIFIC RECOMMENDATIONS ON PUBLIC POLICY, LEGISLATION, AND PUBLIC AND PRIVATE RESEARCH, PROGRAM AND ACTION. IN ADDITION, STAFF RECOMMENDATIONS WHICH WERE IMPLICIT IN THE PROCEEDINGS WERE INCLUDED. UNDER EACH SUB-HEADING,…

The Staff of Life.

ERIC Educational Resources Information Center

Jones, Rebecca

1994-01-01

Some children have chronic illnesses that require diet modifications as part of their medical treatment. Advises school districts to hire a registered dietitian or look for resources at a local hospital or public health office. In addition, schools should work with parents, improve staff training, and conduct spot checks of school cafeterias. (MLF)

What's Wrong with Reference: Coping with Success and Failure at the Reference Desk.

ERIC Educational Resources Information Center

Miller, William

1984-01-01

This essay on problems associated with library reference service and personnel discusses the pros and cons of four approaches designed to improve staff utilization and quality of performance--hiring additional staff, automation, alternative staffing arrangements, and planning and rearrangement of priorities. Fourteen sources are given. (EJS)

Imaging Prostatic Lipids to Distinguish Aggressive Prostate Cancer

DTIC Science & Technology

2015-09-01

Martinez), another from PVAMC (Ms. Palma ). The addition of staff has increased our capacity for assuring subjects have project staff with them/ in...Woodward, G. Thomas, E. Dacey, X. Wang, P. Farris, W. Stoller, A. M. Acevedo, A. Palma , M. Sammi, W. D. Rooney, F. V. Coakley, J. Purnell

Climate Study, Spring 1995.

ERIC Educational Resources Information Center

Mohammadi, John; And Others

In January 1995, Patrick Henry Community College (PHCC), in Virginia, surveyed faculty and staff regarding their perceptions related to job satisfaction, organizational communication, management, and work environment. Questionnaires were sent to 128 full-time faculty, administrative faculty, classified staff, and part-time employees with 30 hours…

Improvement of Clinical Skills through Pharmaceutical Education and Clinical Research.

PubMed

Ishizaki, Junko

2017-01-01

Professors and teaching staff in the field of pharmaceutical sciences should devote themselves to staying abreast of relevant education and research. Similarly those in clinical pharmacies should contribute to the advancement of pharmaceutical research and the development of next generation pharmacists and pharmaceuticals. It is thought that those who work in clinical pharmacies should improve their own skills and expertise in problem-finding and -solving, i.e., "clinical skills". They should be keen to learn new standard treatments based on the latest drug information, and should try to be in a position where collecting clinical information is readily possible. In the case of pharmacists in hospitals and pharmacies, they are able to aim at improving their clinical skills simply through performing their pharmaceutical duties. On the other hand, when a pharmaceutical educator aims to improve clinical skills at a level comparable to those of clinical pharmacists, it is necessary to devote or set aside considerable time for pharmacist duties, in addition to teaching, which may result in a shortage of time for hands-on clinical practice and/or in a decline in the quality of education and research. This could be a nightmare for teaching staff in clinical pharmacy who aim to take part in such activities. Nonetheless, I believe that teaching staff in the clinical pharmacy area could improve his/her clinical skills through actively engaging in education and research. In this review, I would like to introduce topics on such possibilities from my own experiences.

Communication skills training in a nursing home: effects of a brief intervention on residents and nursing aides

PubMed Central

Sprangers, Suzan; Dijkstra, Katinka; Romijn-Luijten, Anna

2015-01-01

Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents. Several communication intervention studies have been conducted to improve communication between nursing home staff and nursing home residents with dementia. These studies have shown that communication skills training can improve nursing aides’ communication with nursing home residents. However, these studies tended to be time-consuming and fairly difficult to implement. Moreover, these studies focused on the communicative benefits for the nursing home residents and their well-being, while benefits and well-being for the nursing aides were neglected. The current study focused on implementing a brief communication skills training program to improve nursing aides’ (N=24) communication with residents with dementia (N=26) in a nursing home. The effects of the training on nursing aides’ communication, caregiver distress, and job satisfaction and residents’ psychopathology and agitation were assessed relative to a control group condition. Nursing aides in the intervention group were individually trained to communicate effectively with residents during morning care by using short instructions, positive speech, and biographical statements. Mixed ANOVAs showed that, after training, nursing aides in the intervention group experienced less caregiver distress. Additionally, the number of short instructions and instances of positive speech increased. Providing nursing aides with helpful feedback during care aids communication and reduces caregiver burden, even with a brief intervention that requires limited time investments for nursing home staff. PMID:25653513

Evaluation of implementation of fasting guidelines for enterally fed critical care patients.

PubMed

Jenkins, Bethan; Calder, Philip C; Marino, Luise V

2018-02-15

Critically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fasting guidelines in addition to characterizing staff knowledge of the guidelines. Retrospective data were collected on n = 74 patients at two different time points; prior to launch of fasting guidelines and post launch, with regards to estimated nutritional requirements, nutritional targets, volume of enteral nutrition (EN) delivered and periods of fasting. Clinical variables of interest were collected for up to 14 days. Questionnaires assessing staff knowledge/barriers to usage of the fasting guidelines were administered to ICU staff. 3 ICUs (General, Cardiac and Neurosciences) within University Hospital Southampton NHS Foundation Trust. Mechanically ventilated adults in an ICU and receiving exclusive EN. Comparison was made between pre- and post-guideline implementation with statistically significant improvements in the % EN delivered (76.4 ± 11.8 vs. 84.1 ± 10.8 (p = 0.0009)) and duration of feeds withheld (41.5 ± 26.6 vs. 27.6 ± 20.8 h (p = 0.02)). There were non-significant improvements pre- and post-implementation in the % of energy and protein delivered (80.7 ± 16.4 vs. 86.5 ± 17.3 (p = 0.15 (NS)); 74 ± 18.3 vs. 79 ± 18.5 (p = 0.15 (NS))). 77% of staff were familiar with the guidelines, whilst 42% requested further education. The main barriers to guideline compliance were delays and unpredictable timing of procedures, and differing guidance from senior staff and non-ICU teams. Implementation of fasting guidelines led to significant improvements in EN delivery and reduced duration of feed breaks. The use of fasting guidelines is a positive step towards increasing nutrition delivery in the ICU. Further staff education and better planning around procedures is required to promote further adherence to the fasting guidelines. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Take care! The evaluation of a team-based burnout intervention program for oncology care providers.

PubMed

Le Blanc, Pascale M; Hox, Joop J; Schaufeli, Wilmar B; Taris, Toon W; Peeters, Maria C W

2007-01-01

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time. 2007 APA, all rights reserved

'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings.

PubMed

Drummond, C; Simpson, A

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing. Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. © 2017 John Wiley & Sons Ltd.

Use of an administrative data set to determine optimal scheduling of an alcohol intervention worker.

PubMed

Peterson, Timothy A; Desmond, Jeffrey S; Cunningham, Rebecca

2012-06-01

Brief alcohol interventions are efficacious in reducing alcohol-related consequences among emergency department (ED) patients. Use of non-clinical staff may increase alcohol screening and intervention; however, optimal scheduling of an alcohol intervention worker (AIW) is unknown. Determine optimal scheduling of an AIW based on peak discharge time of alcohol-related ED visits. Discharge times for consecutive patients with an alcohol-related diagnosis were abstracted from an urban ED's administrative data set from September 2005 through August 2007. Queuing theory was used to identify optimal scheduling. Data for weekends and weekdays were analyzed separately. Stationary independent period-by-period analysis was performed for hourly periods. An M/M/s queuing model, for Markovian inter-arrival time/Markovian service time/and potentially more than one server, was developed for each hour assuming: 1) a single unlimited queue; 2) 75% of patients waited no longer than 30 min for intervention; 3) AIW spent an average 20 min/patient. Estimated average utilization/hour was calculated; if utilization/hour exceeded 25%, AIW staff was considered necessary. There were 2282 patient visits (mean age 38 years, range 11-84 years). Weekdays accounted for 45% of visits; weekends 55%. On weekdays, one AIW from 6:00 a.m.-9:00 a.m. (max utilization 42%/hour) would accommodate 28% of weekday alcohol-related patients. On weekends, 5:00 a.m.-11:00 a.m. (max utilization 50%), one AIW would cover 54% of all weekend alcohol-related visits. During other hours the utilization rate falls below 25%/hour. Evaluating 2 years of discharge data revealed that 30 h of dedicated AIW time--18 weekend hours (5:00 a.m.-11:00 a.m.), 12 weekday hours (6:00 a.m.-9:00 a.m.)--would allow maximal patient alcohol screening and intervention with minimal additional burden to clinical staff. Copyright © 2012 Elsevier Inc. All rights reserved.

A decision-analytic approach to the optimal allocation of resources for endangered species consultation

USGS Publications Warehouse

Converse, Sarah J.; Shelley, Kevin J.; Morey, Steve; Chan, Jeffrey; LaTier, Andrea; Scafidi, Carolyn; Crouse, Deborah T.; Runge, Michael C.

2011-01-01

The resources available to support conservation work, whether time or money, are limited. Decision makers need methods to help them identify the optimal allocation of limited resources to meet conservation goals, and decision analysis is uniquely suited to assist with the development of such methods. In recent years, a number of case studies have been described that examine optimal conservation decisions under fiscal constraints; here we develop methods to look at other types of constraints, including limited staff and regulatory deadlines. In the US, Section Seven consultation, an important component of protection under the federal Endangered Species Act, requires that federal agencies overseeing projects consult with federal biologists to avoid jeopardizing species. A benefit of consultation is negotiation of project modifications that lessen impacts on species, so staff time allocated to consultation supports conservation. However, some offices have experienced declining staff, potentially reducing the efficacy of consultation. This is true of the US Fish and Wildlife Service's Washington Fish and Wildlife Office (WFWO) and its consultation work on federally-threatened bull trout (Salvelinus confluentus). To improve effectiveness, WFWO managers needed a tool to help allocate this work to maximize conservation benefits. We used a decision-analytic approach to score projects based on the value of staff time investment, and then identified an optimal decision rule for how scored projects would be allocated across bins, where projects in different bins received different time investments. We found that, given current staff, the optimal decision rule placed 80% of informal consultations (those where expected effects are beneficial, insignificant, or discountable) in a short bin where they would be completed without negotiating changes. The remaining 20% would be placed in a long bin, warranting an investment of seven days, including time for negotiation. For formal consultations (those where expected effects are significant), 82% of projects would be placed in a long bin, with an average time investment of 15. days. The WFWO is using this decision-support tool to help allocate staff time. Because workload allocation decisions are iterative, we describe a monitoring plan designed to increase the tool's efficacy over time. This work has general application beyond Section Seven consultation, in that it provides a framework for efficient investment of staff time in conservation when such time is limited and when regulatory deadlines prevent an unconstrained approach. ?? 2010.

Stakeholder Perspectives on the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) Project.

PubMed

Ersek, Mary; Hickman, Susan E; Thomas, Anne C; Bernard, Brittany; Unroe, Kathleen T

2017-10-17

The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption. Nineteen nursing homes participated in OPTIMISTIC. We conducted semistructured, qualitative interviews with 63 stakeholders: 23 nursing home staff and leaders, 4 primary care providers, 10 family members, and 26 OPTIMISTIC clinical staff. We used directed content analysis to analyze the data. We found universal endorsement of the value of in-depth advance care planning (ACP) discussions in reducing hospitalizations and improving care. Similarly, all stakeholder groups emphasized that nursing home access to specially trained, project registered nurses (RNs) and nurse practitioners (NPs) with time to focus on ACP, comprehensive resident assessment, and staff education was particularly valuable in identifying residents' goals for care. Challenges to implementation included inadequately trained facility staff and resistance to changing practice. In addition, the program sometimes failed to communicate its goals and activities clearly, leaving facilities uncertain about the OPTIMISTIC clinical staff's roles in the facilities. These findings are important for dissemination efforts related to the OPTIMISTIC care model and may be applicable to other innovations in nursing homes. Published by Oxford University Press on behalf of The Gerontological Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Infection prevention and control in nursing homes: a qualitative study of decision-making regarding isolation-based practices.

PubMed

Cohen, Catherine Crawford; Pogorzelska-Maziarz, Monika; Herzig, Carolyn T A; Carter, Eileen J; Bjarnadottir, Ragnhildur; Semeraro, Patricia; Travers, Jasmine L; Stone, Patricia W

2015-10-01

Isolation-based practices in nursing homes (NHs) differ from those in acute care. NHs must promote quality of life while preventing infection transmission. Practices used in NHs to reconcile these goals of care have not been characterised. To explore decision-making in isolation-based infection prevention and control practices in NHs. A qualitative study was conducted with staff (eg, staff nurses, infection prevention directors and directors of nursing) employed in purposefully sampled US NHs. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus. We inferred from 73 interviews in 10 NHs that there was variation between NHs in practices regarding who was isolated, when isolation-based practices took place, how they were implemented, and how they were tailored for each resident. Interviewees' decision-making depended on staff perceptions of acceptable transmission risk and resident quality of life. NH resources also influenced decision-making, including availability of private rooms, extent to which staff can devote time to isolation-based practices and communication tools. A lack of understanding of key infection prevention and control concepts was also revealed. Current clinical guidelines are not specific enough to ensure consistent practice that meets care goals and resource constraints in NHs. However, new epidemiological research regarding effectiveness of varying isolation practices in this setting is needed to inform clinical practice. Further, additional infection prevention and control education for NH staff may be required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Negative Impact of Employment on Engineering Student Time Management, Time to Degree, and Retention: Faculty, Administrator, and Staff Perspectives

ERIC Educational Resources Information Center

Tyson, Will

2012-01-01

Interviews with faculty, administrators, staff, and students at four engineering programs reveal the role of undergraduate student employment on retention and timely degree completion among engineering students. Dueling narratives reveal how student approaches to earning an engineering degree differ greatly from faculty, administrator, and staff…

Academic Workload and Working Time: Retrospective Perceptions versus Time-Series Data

ERIC Educational Resources Information Center

Kyvik, Svein

2013-01-01

The purpose of this article is to examine the validity of perceptions by academic staff about their past and present workload and working hours. Retrospective assessments are compared with time-series data. The data are drawn from four mail surveys among academic staff in Norwegian universities undertaken in the period 1982-2008. The findings show…

Behavioral Emergency Response Team: Implementation Improves Patient Safety, Staff Safety, and Staff Collaboration.

PubMed

Zicko, Cdr Jennifer M; Schroeder, Lcdr Rebecca A; Byers, Cdr William S; Taylor, Lt Adam M; Spence, Cdr Dennis L

2017-10-01

Staff members working on our nonmental health (non-MH) units (i.e., medical-surgical [MS] units) were not educated in recognizing or deescalating behavioral emergencies. Published evidence suggests a behavioral emergency response team (BERT) composed of MH experts who assist with deescalating behavioral emergencies may be beneficial in these situations. Therefore, we sought to implement a BERT on the inpatient non-MH units at our military treatment facility. The objectives of this evidence-based practice process improvement project were to determine how implementation of a BERT affects staff and patient safety and to examine nursing staffs' level of knowledge, confidence, and support in caring for psychiatric patients and patients exhibiting behavioral emergencies. A BERT was piloted on one MS unit for 5 months and expanded to two additional units for 3 months. Pre- and postimplementation staff surveys were conducted, and the number of staff assaults and injuries, restraint usage, and security intervention were compared. The BERT responded to 17 behavioral emergencies. The number of assaults decreased from 10 (pre) to 1 (post); security intervention decreased from 14 to 1; and restraint use decreased from 8 to 1. MS staffs' level of BERT knowledge and rating of support between MH staff and their staff significantly increased. Both MS and MH nurses rated the BERT as supportive and effective. A BERT can assist with deescalating behavioral emergencies, and improve staff collaboration and patient and staff safety. © 2017 Sigma Theta Tau International.

Digital life storybooks for people with dementia living in care homes: an evaluation

PubMed Central

Subramaniam, Ponnusamy; Woods, Bob

2016-01-01

Background and aim There is increasing interest in using information and communication technology to help older adults with dementia to engage in reminiscence work. Now, the feasibility of such approaches is beginning to be established. The purpose of this study was to establish an evidence-base for the acceptability and efficacy of using multimedia digital life storybooks with people with dementia in care homes, in comparison with conventional life storybooks, taking into account the perspectives of people with dementia, their relatives, and care staff. Methods Participatory design was used to create a life story movie based on a previously completed conventional life storybook with six older adults with dementia (four females; mean age 82 years). Relatives were involved in helping the participant to provide additional information and materials for the digital life storybook. In this multiple case study design, both quantitative and qualitative approaches were used. For quantitative purposes, a set of questionnaires that had been completed three times before and after the conventional life storybook was developed were repeated 4 weeks after the life story movie was completed. Semistructured interview questions were designed to collect feedback from participants, relatives, and care staff. Results The result indicated that five of the six participants showed additional improvement in measures of quality of life and autobiographical memory. All participants showed improvement or stability in depression scores. Thematic analysis showed that, participants, relatives, and care home staff viewed digital life storybooks as a very useful tool triggering memories and (largely) positive emotions. Participants’ case vignettes were presented to document the impact of digital life storybook. PMID:27698556

Digital life storybooks for people with dementia living in care homes: an evaluation.

PubMed

Subramaniam, Ponnusamy; Woods, Bob

2016-01-01

There is increasing interest in using information and communication technology to help older adults with dementia to engage in reminiscence work. Now, the feasibility of such approaches is beginning to be established. The purpose of this study was to establish an evidence-base for the acceptability and efficacy of using multimedia digital life storybooks with people with dementia in care homes, in comparison with conventional life storybooks, taking into account the perspectives of people with dementia, their relatives, and care staff. Participatory design was used to create a life story movie based on a previously completed conventional life storybook with six older adults with dementia (four females; mean age 82 years). Relatives were involved in helping the participant to provide additional information and materials for the digital life storybook. In this multiple case study design, both quantitative and qualitative approaches were used. For quantitative purposes, a set of questionnaires that had been completed three times before and after the conventional life storybook was developed were repeated 4 weeks after the life story movie was completed. Semistructured interview questions were designed to collect feedback from participants, relatives, and care staff. The result indicated that five of the six participants showed additional improvement in measures of quality of life and autobiographical memory. All participants showed improvement or stability in depression scores. Thematic analysis showed that, participants, relatives, and care home staff viewed digital life storybooks as a very useful tool triggering memories and (largely) positive emotions. Participants' case vignettes were presented to document the impact of digital life storybook.

Engaging Vulnerable Adolescents in a Pregnancy Prevention Program: Perspectives of Prime Time Staff

PubMed Central

Tanner, Amanda E.; Secor-Turner, Molly; Garwick, Ann; Sieving, Renee; Rush, Kayci

2011-01-01

Introduction Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff. Method Structured individual interviews were conducted with the entire Prime Time program staff (N=7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy recruited from school and community clinics. Results Program staff described different capacities of adolescents to engage with the program (easy, middle and difficult connecting adolescents) and provided specific recommendations for working with different connectors. Discussion Findings from this study support the notion that preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers, nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations and supports needed for healthy behavior change. PMID:22726710

Preventing and managing aggression and violence in the NHS.

PubMed

Bleetman, Anthony; Fayeye, Oloruntoba O

2003-12-01

Streaming in emergency departments reduces waiting times and stress, and removes the causes of most violent attacks against staff. In spite of this some people will still attack staff. Staff must be protected by a sound trust policy and effective and realistic training, monitored by a good reporting system.

Negative Emotional Reactions to Challenging Behaviour and Staff Burnout: Two Replication Studies

ERIC Educational Resources Information Center

Rose, David; Horne, Sharon; Rose, John L.; Hastings, Richard P.

2004-01-01

Background: Hastings, R. P. ["American Journal on Mental Retardation" (2002) Vol. 107, pp. 455-467] hypothesized that staff negative emotional reactions to challenging behaviour might accumulate over time to affect staff well-being. Only one previous study (Mitchell, G.& Hastings, R. P. ["American Journal on Mental…

First Steps to Talking with Families and Staff: Guidelines for Listening Effectively.

ERIC Educational Resources Information Center

Eisenberg, Eileen

2002-01-01

Presents guidelines for child care administrators to become more effective in communicating with families and staff. Suggestions for beginning a dialogue include being visible and accessible, familiar, personable, professional, ethical, and timely. Details procedures for facilitating parent and staff meeting in a confident manner. Reiterates that…

Are Your IT Staff Working Too Hard?

ERIC Educational Resources Information Center

Oxley, Alan

2008-01-01

How do IT managers protect their staff from working excessively long hours? To begin addressing the problem of overworked staff, IT managers should educate themselves about legal regulations governing time spent at work. Failure to meet such requirements can expose a university to potentially expensive and embarrassing lawsuits. In this article,…

Boundary-Spanner Role Conflict in Public Urban Universities

ERIC Educational Resources Information Center

Gauntner, Joseph; Hansman, Catherine A.

2017-01-01

It is common for universities that seek community partnerships to employ full-time staff, formally sanctioned as boundary spanners, to develop and manage such partnerships. These staff are frequently administrative or allied staff rather than tenure-track faculty or academic unit administrators. Given the multiple interests of universities and…

Experiences of nursing home staff using the targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms (TIME) - a qualitative study.

PubMed

Lichtwarck, Bjørn; Myhre, Janne; Goyal, Alka R; Rokstad, Anne Marie Mork; Selbaek, Geir; Kirkevold, Øyvind; Bergh, Sverre

2018-04-19

Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.

The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.

PubMed

McKay, Virginia R; Margaret Dolcini, M; Hoffer, Lee D

2017-12-01

Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.

PubMed

Mahmud, Salaheddin M; Thompson, Laura H; Nowicki, Deborah L; Plourde, Pierre J

2013-11-01

Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents. We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks. © 2012 John Wiley & Sons Ltd.

AVERT2 (a very early rehabilitation trial, a very effective reproductive trigger): retrospective observational analysis of the number of babies born to trial staff.

PubMed

Bernhardt, Julie; Lindley, Richard I; Lalor, Erin; Ellery, Fiona; Chamberlain, Jan; Van Holsteyn, John; Collier, Janice M; Dewey, Helen M; Parsons, Brooke; Moodie, Marjory; Lennon, Sheila; Donnan, Geoffrey A; Thrift, Amanda G; Churilov, Leonid; Langhorne, Peter

2015-12-11

To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Retrospective observational analysis. 56 acute stroke hospitals in eight countries. 1074 trial physiotherapists, nurses, and other clinicians. Number of babies born during trial recruitment per trial participant recruited. With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group. Australian New Zealand Clinical Trials Registry no 12606000185561. Participation in a rehabilitation trial does not guarantee successful reproductive activity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A smartphone-based system for the automated management of point-of-care test results in hospitals.

PubMed

Jang, Dasom; Shin, Soo-Yong; Seo, Dong-Woo; Joo, Segyeong; Huh, Soo-Jin

2015-04-01

Managing test results is an important issue in hospitals because of the increasing use of point-of-care testing (POCT). Here, we propose a smartphone-based system for automatically managing POCT test results. We developed the system to provide convenience to the medical staffs. The system recognizes the patient identification or prescription number of the test by reading barcodes and provides a countdown to indicate when the results will be ready. When the countdown in finished, a picture of the test result is transferred to the electronic medical record server using the Health Level 7 protocol. Human immunodeficiency virus (HIV) kits were selected in this research because HIV is a life-threatening infectious virus, especially for the medical staff who treat undiagnosed patients. The performance of the system was verified from a survey of the users. The performance of the system was tested at the emergency room (ER) for 10 months using commercially available POCT kits for detecting HIV. The survey showed that, in total, 80% and 0% of users reported positive or negative feedback, respectively. The staff also reported that the system reduced total processing time by approximately 32 min, in addition to reducing workload. The developed automated management system was successfully tested at an ER for 10 months. The survey results show that the system is effective and that medical staff members who used the system are satisfied with using the system at the ER.

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

PubMed

Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

2010-01-01

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

Protected engagement time on older adult mental health wards: A thematic analysis of the views of patients, carers, and staff.

PubMed

Dodd, Emily; Cheston, Richard; Procter, Charlie; Heneker, Sarah; Gray, Richard; Fox, Chris; Nolan, Fiona

2018-04-01

During protected engagement time (PET), ward routines are adjusted so that staff can spend time together with patients without interruption. The aim of PET is to increase staff and patient interaction on wards, and ultimately patient well-being. Although PET has been implemented on inpatient wards within the UK, including older adult wards, there is no systematic evidence as to how PET is carried out or how it is experienced by staff, patients, and families. Semistructured interviews were conducted with 28 participants (8 patients, 10 family members, and 10 ward staff) from three different wards with PET, and transcriptions were analysed using thematic analysis. Three themes were identified: (i) the patient is at the heart of care; (ii) PET depends on staff; and (iii) tensions in how PET operates. There was support in our sample for the principles of PET and its potential for a positive impact on patient well-being. However, the implementation of PET was identified as challenging, highlighting an existing tension between an individual's needs and the wider needs of patients on the ward as a whole. The impact of PET was generally described as being dependent on how PET was organized and the level of staff commitment to PET. Participants emphasized that if PET is to be successful, then it should be a fluid process that fits in with the local context. © 2017 Australian College of Mental Health Nurses Inc.

Just-in-Time Training: A Novel Approach to Quality Improvement Education.

PubMed

Knutson, Allison; Park, Nesha D; Smith, Denise; Tracy, Kelly; Reed, Danielle J W; Olsen, Steven L

2015-01-01

Just-in-time training (JITT) is accepted in medical education as a training method for newer concepts or seldom-performed procedures. Providing JITT to a large nursing staff may be an effective method to teach quality improvement (QI) initiatives. We sought to determine if JITT could increase knowledge of a specific nutrition QI initiative. Members of the nutrition QI team interviewed staff using the Frontline Contextual Inquiry to assess knowledge regarding the specific QI project. The inquiry was completed pre- and post-JITT. A JITT educational cart was created, which allowed trainers to bring the educational information to the bedside for a short, small group educational session. The results demonstrated a marked improvement in the knowledge of the frontline staff regarding our Vermont Oxford Network involvement and the specifics of the nutrition QI project. Just-in-time training can be a valuable and effective method to disseminate QI principles to a large audience of staff members.

Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Li, Zhicheng; Cunich, Michelle M; Thomas, Tamsin H; Chenoweth, Lynn; Kendig, Hal L

2015-07-01

To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52; P = .01); and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56; P = .001) as well as individual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety. While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost. Copyright © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Improving end of life care in care homes; an evaluation of the six steps to success programme.

PubMed

O'Brien, Mary; Kirton, Jennifer; Knighting, Katherine; Roe, Brenda; Jack, Barbara

2016-06-03

There are approximately 426,000 people residing within care homes in the UK. Residents often have complex trajectories of dying, which make it difficult for staff to manage their end-of-life care. There is growing recognition for the need to support care homes staff in the care of these residents with increased educational initiatives. One educational initiative is The Six Steps to Success programme. In order to evaluate the implementation of Six Steps with the first cohort of care homes to complete the end-of-life programme in the North West of England., a pragmatic evaluation methodology was implemented in 2012-2013 using multiple methods of qualitative data collection; online questionnaire with facilitators (n = 16), interviews with facilitators (n = 9) and case studies of care homes that had completed the programme (n = 6). The evaluation explored the implementation approach and experiences of the programme facilitators and obtain a detailed account of the impact of Six Steps on individual care homes. Based upon the National Health Service (NHS) End of Life Care (EoLC) Programme, The Route to Success in EoLC - Achieving Quality in Care Homes. The programme was flexibly designed so that it could be individually tailored to the geographical location and the individual cohort requirements. Facilitators provided comprehensive and flexible support to care homes. Challenges to programme success were noted as; lack of time allocated to champions to devote to additional programme work, inappropriate staff selected as 'Champions' and staff sickness/high staff turnover presented challenges to embedding programme values. Benefits to completing the programme were noted as; improvement in Advance Care Planning, improved staff communication/confidence when dealing with multi-disciplinary teams, improved end-of-life processes/documentation and increased staff confidence through acquisition of new knowledge and new processes. The findings suggested an overall positive impact from the programme. This flexibly designed programme continues to be dynamic, iteratively amended and improved which may affect the direct transferability of the results to future cohorts.

Research Experiences of Staff within a Specialist UK Higher Education Institution: Challenges, Opportunities and Priorities

ERIC Educational Resources Information Center

Hemmings, Brian; Hill, Doug; Sharp, John

2013-01-01

The study discussed here was based on a collective case approach involving a specialist UK higher education institution. Six individual interviews were carried out with a cross-sectional sample of the institution's staff members. Additional information was gained through observations and examination of relevant documents. These data were…

78 FR 31941 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... burden 810 RISE Staff Pre-Test 157 1 .25 39 RISE Staff Post-Test 157 1 .25 39 RISE burden 78 Estimated... addition, evaluation plans were developed to support rigorous site-specific and cross-site studies to... and Lesbian Center's Recognize Intervene Support Empower (RISE) project. A third phase of the study...

K-3 Support: Blending Teaching, Counseling, and Social Services.

ERIC Educational Resources Information Center

Derrington, Mary Lynne; Mendonsa, Cathie

1992-01-01

To meet student needs, the Port Angeles School District (Washington) K-3 Support Program has certified staff that serve as a blend of social service providers, counselors, and teachers. They provide in-class lessons, staff consultation, direct student services, and parenting classes. Appended is a list of eight additional resources. (MLF)

Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model.

PubMed

Melas, Christos D; Zampetakis, Leonidas A; Dimopoulou, Anastasia; Moustakis, Vassilis

2011-08-01

Recent empirical research has utilized the Technology Acceptance Model (TAM) to advance the understanding of doctors' and nurses' technology acceptance in the workplace. However, the majority of the reported studies are either qualitative in nature or use small convenience samples of medical staff. Additionally, in very few studies moderators are either used or assessed despite their importance in TAM based research. The present study focuses on the application of TAM in order to explain the intention to use clinical information systems, in a random sample of 604 medical staff (534 physicians) working in 14 hospitals in Greece. We introduce physicians' specialty as a moderator in TAM and test medical staff's information and communication technology (ICT) knowledge and ICT feature demands, as external variables. The results show that TAM predicts a substantial proportion of the intention to use clinical information systems. Findings make a contribution to the literature by replicating, explaining and advancing the TAM, whereas theory is benefited by the addition of external variables and medical specialty as a moderator. Recommendations for further research are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

Predictors of organizational commitment among staff in assisted living.

PubMed

Sikorska-Simmons, Elzbieta

2005-04-01

This study examines the role of organizational culture, job satisfaction, and sociodemographic characteristics as predictors of organizational commitment among staff in assisted living. It is particularly important to examine organizational commitment, because of its close links to staff turnover. Data were collected from 317 staff members in 61 facilities, using self-administered questionnaires. The facilities were selected from licensed assisted living programs and were stratified into small, traditional, and new-model homes. Staff questionnaires were distributed by a researcher during 1-day visits to each facility. Organizational commitment was measured by the extent of staff identification, involvement, and loyalty to the organization. Organizational culture, job satisfaction, and education were strong predictors of commitment, together explaining 58% of the total variance in the dependent variable. Higher levels of organizational commitment were associated with more favorable staff perceptions of organizational culture and greater job satisfaction. In addition, more educated staff members tended to report higher levels of organizational commitment. Other than education, sociodemographic characteristics failed to account for a significant amount of variance in organizational commitment. Because job satisfaction and organizational culture were strong predictors of commitment, interventions aimed at increasing job satisfaction and creating an organizational culture that values and respects staff members could be most effective in producing higher levels of organizational commitment.

The use of subcutaneous infusion in medication administration.

PubMed

Gabriel, Janice

The subcutaneous administration of medications is an area that receives little attention compared with other types of parenteral therapy. Parenteral administration is used by many thousands of patients who self-administer their medication on a daily basis-for example, those using insulin to manage diabetes, recipients of some types of hormone therapy and so on. It is also an effective route for the continuous administration of medication(s) in individuals who are terminally ill. Patients approaching the end of their life may be unable to tolerate the administration of oral medication to control their symptoms and make them more comfortable. This paper will discuss how subcutaneous infusion can be used to deliver these medications, but at the same time how important the selection of the most appropriate subcutaneous infusion device is to the overall comfort of the patient, and to reduce the potential for sharps-related injuries to healthcare workers. Appropriate device selection, together with its management, is an important contributing factor to patient safety and comfort. It will diminish the potential for premature device loss, which can lead to repeated insertion procedures for the patient, as well as delaying their medication. There is also a resource implication for the NHS, as the replacement of any device involves the use of additional equipment and staff time. Additionally, the use of any infusion device poses a risk to healthcare workers of acquiring a bloodborne infection should they experience a percutaneous injury. Knowledge of what equipment is available will reduce the potential risk to these staff.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nyflot, MJ; Kusano, AS; Zeng, J

Purpose: Interest in incident learning systems (ILS) for improving safety and quality in radiation oncology is growing, as evidenced by the upcoming release of the national ILS. However, an institution implementing such a system would benefit from quantitative metrics to evaluate performance and impact. We developed metrics to measure volume of reporting, severity of reported incidents, and changes in staff attitudes over time from implementation of our institutional ILS. Methods: We analyzed 2023 incidents from our departmental ILS from 2/2012–2/2014. Incidents were prospectively assigned a near-miss severity index (NMSI) at multidisciplinary review to evaluate the potential for error ranging frommore » 0 to 4 (no harm to critical). Total incidents reported, unique users reporting, and average NMSI were evaluated over time. Additionally, departmental safety attitudes were assessed through a 26 point survey adapted from the AHRQ Hospital Survey on Patient Safety Culture before, 12 months, and 24 months after implementation of the incident learning system. Results: Participation in the ILS increased as demonstrated by total reports (approximately 2.12 additional reports/month) and unique users reporting (0.51 additional users reporting/month). Also, the average NMSI of reports trended lower over time, significantly decreasing after 12 months of reporting (p<0.001) but with no significant change at months 18 or 24. In survey data significant improvements were noted in many dimensions, including perceived barriers to reporting incidents such as concern of embarrassment (37% to 18%; p=0.02) as well as knowledge of what incidents to report, how to report them, and confidence that these reports were used to improve safety processes. Conclusion: Over a two-year period, our departmental ILS was used more frequently, incidents became less severe, and staff confidence in the system improved. The metrics used here may be useful for other institutions seeking to create or evaluate their own incident learning systems.« less

The Impact of Staff Turnover and Staff Density on Treatment Quality in a Psychiatric Clinic

PubMed Central

Brandt, Wolfram A.; Bielitz, Christoph J.; Georgi, Alexander

2016-01-01

Intuition suggests that improving stability of the health workforce brings benefits to staff, the organization and, most importantly, the patients. Unfortunately, there is limited research available to support this, and how health workforce stability can contribute to reduced costs and better treatment outcomes. To help to rectify this situation, we investigated the effects of staff turnover and staff density (staff members per patient) on the treatment outcome of inpatients in a psychiatric clinic. Our data come from the standard assessment of 1429 patients who sought treatment in our clinic from January 2011 to August 2013. Correlation analysis shows no significant effect of raw staff turnover (the total number of psychiatrists, physicians and psychologists starting or quitting work per month) on treatment quality. However, we do find two significant beneficial effects: first, a higher staff consistency (time without staff turnover) and second, a higher staff density lead to an improvement of treatment quality. Our findings underline the dire need for an extended effort to achieve optimal staff retention, both to improve patient’s outcomes and to reduce health expenses. PMID:27065925

Health and Safety Intervention with First-Time Mothers

ERIC Educational Resources Information Center

Culp, Anne McDonald; Culp, R. E.; Anderson, J. W.; Carter, S.

2007-01-01

A health education program was evaluated which used child development specialists as home visitors and served a population of first-time mothers living in rural communities. The evaluation compared health and safety outcomes between intervention and control groups. The research staff, separate from the intervention staff, collected data in the…

Exploring the Effectiveness of a Retreat Method for Extension Staff

ERIC Educational Resources Information Center

Worker, Steven M.; Hill, Russell D.; Miller, JoLynn C.; Go, Charles G.; Boyes, Rita J.

2015-01-01

The California 4-H Association hosted two retreats to support its members with goals of balancing professional development with intentional relationship building. Evaluations demonstrated that staff found the intentional balance of time spent in unstructured, semi-structured, and structured time offered opportunities to grow professionally while…

Effects of Individual and Group Contingency Interventions on Attendance in Adolescent Part-Time Employees

ERIC Educational Resources Information Center

Berkovits, Shira Melody; Sturmey, Peter; Alvero, Alicia M.

2012-01-01

This study examined the effects of individual and group monetary contingencies on the attendance of adolescent part-time employees. Attendance increased in both individual and group contingency phases; however staff questionnaire responses indicated a preference for the individual contingencies. Future research should consider staff acceptability…

Ask Here PA: Large-Scale Synchronous Virtual Reference for Pennsylvania

ERIC Educational Resources Information Center

Mariner, Vince

2008-01-01

Ask Here PA is Pennsylvania's new statewide live chat reference and information service. This article discusses the key strategies utilized by Ask Here PA administrators to recruit participating libraries to contribute staff time to the service, the importance of centralized staff training, the main aspects of staff training, and activating the…

Accreditation Surveys: Administrators, Managers & Supervisors, Faculty, and Staff, Spring 2002. Revised. Report.

ERIC Educational Resources Information Center

Gribbons, Barry C.; Dixon, P. Scott; Meuschke, Daylene M.

The Office of Institutional Development and Technology (IDT), in cooperation with regional accreditation committees, surveyed all administrators, managers, supervisors, full-time faculty, and classified staff at the College of the Canyons, California, in spring 2002. The purpose of the survey was to gather information useful to college staff in…

Staff Development Needs in Pakistan Higher Education

ERIC Educational Resources Information Center

Ullah, Muhammad Hameed; Khan, Muhammad Naeem Ullah; Murtaza, Ali; Ud Din, Muhammad Naseer

2011-01-01

Staff development is very significant for the achievement of overall goals of higher education in Pakistan. The success of innovations depends largely upon the skills of instructors; but in Pakistan, the people with a simple masters degree (without any pedagogical training) are inducted as teaching staff at the university level, so it is time to…

Pharmacy staff perceptions and self-reported behaviors related to providing contraceptive information and counseling.

PubMed

Batra, Peter; Aquilino, Mary L; Farris, Karen B

2015-01-01

To evaluate pharmacy staff perspectives of a 2-year pharmacy intervention aimed at reducing unintended pregnancy in 18- to 30-year-old women. Pharmacy staff completed a 48-item, self-administered paper survey consisting of scaled and open-ended questions. 55 community pharmacies in 12 Iowa counties. All pharmacy staff participated, including pharmacists, pharmacy technicians, and other pharmacy employees. Online continuing education (CE) training was made available to all pharmacy staff. Promotional materials including posters, brochures, and shelf talkers were displayed in all of the pharmacies. Pharmacy staff perceptions and self-reported behaviors related to displaying posters, brochures, and shelf talkers in their pharmacies and providing contraceptive information and counseling to patients/customers. A total of 192 (43% return rate) pharmacy staff responded. Only 44% of respondents consistently provided contraceptive information and counseling, yet more than 90% felt that talking with patients/customers about contraceptives was easy, and more than 50% could do so privately. The study showed increased pharmacy staff desire to make this topic a priority. Community pharmacy staff can play a key role in educating and counseling young adult women about contraceptive health and pregnancy planning. This study indicates that staff are comfortable providing this service and that patients/customers are open to receiving guidance from pharmacists. However, pharmacy staff are missing additional opportunities to provide information and counseling. There is also a need for greater attention to provision of nonprescription contraceptive education.

Thinking on your feet: understanding the immediate responses of staff to adults who challenge intellectual disability services.

PubMed

Ravoux, Peggy; Baker, Peter; Brown, Hilary

2012-05-01

A gap prevails between the conceptualization of good practice in challenging behaviour management and its implementation in intellectual disability services. This study aimed to investigate staff members' perspectives of managing clients with challenging behaviours in residential services. Semi-structured interviews were conducted with eleven staff in two services. Additionally, service documents on challenging behaviour management were examined in these services. A qualitative methodology was used to investigate staff members' immediate responses to clients' difficult behaviours and their decision-making processes. The immediate responses of staff were conceptualized as the result of complex appraisals shaped by their service context involving the core processes of making the right choice and prioritizing the best interests of all involved. Staff members' responses were understood as a dynamic and retroactive process, where their past and current challenging behaviour management experiences in the service influenced their responses to clients in the future. © 2011 Blackwell Publishing Ltd.

[Recommendations for the structure and equipment of pediatric oncologic centers].

PubMed

Göbel, U; Kornhuber, B; Schellong, G; Winkler, K

1991-01-01

The yearly incidence of cancer in children and adolescents within Germany is about 2200. The regular medical care for these children is effected within prospective multicenter trials of the DAL and GPO respectively. These trials achieved excellent results and gained high international reputation. Following an initial funding by the Bundesministerium für Forschung und Technology the continuation of these trials nowadays is fully dependent on private third parties financial aid especially from the Deutsche Krebshilfe. Guarantee of progress in clinical research and of improvement in patient care as well is closely related to establishing pediatric cancer centers. Accruing about 80 new patients per year such centers have an optimum size justifying establishing stabile substructures. Integrated basic research and organization of special clinical domaines need a differentiated structure of management and a sufficient number of qualified personnel in time nonlimited positions. The recommendation of the Arbeitsgemeinschaft Deutscher Tumorzentren from 1979 for personnel equipment is largely insufficient with respect to the inpatients nursing staff for pediatric oncology units. A basic equipment of 1.75 nurses per patient and additional nursing staff with specific functions would seem appropriate as demonstrated by analyses and calculations within the last part of our recommendations. The ADT recommendations are also insufficient with respect to secretaries and documentation assistants. Concerning the physicians staff the ADT recommendations just need an adaption to the changes in working time in accordance with the tariffe. These recommendations, however, urgently need to be realized. The necessary staff for psycho-social work has been incorporated into our recommendations for the first time. The ratio of patient rooms to function rooms (excluding laboratories) in pediatric oncology centers diposing of an outpatient area and a day clinic should be about 1:3. Deficiencies in the personnel equipment and the generally pronounced lack in function rooms as well are hampering the daily work and have negative impact on the quality of care as experienced by the patient on the safety of medical and nursing practice and on the quality of teaching, medical education and advanced training.

Experiences of mental health nursing staff working with voice hearers in an acute setting: An interpretive phenomenological approach.

PubMed

McMullan, E; Gupta, A; Collins, S C

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: Community mental health staff and their service users have reported mixed views on the importance of talking about the content of voices. Community staff have reported feeling that they do not have the skills to explore voice content and worry about making things worse. Voice hearers experiencing extreme distress due to the content of their voices can access support through acute inpatient mental health services. No previous studies have focused on the experiences of staff who nurse voice hearers at a time of acute distress. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: MHNs and HSWs working with voice hearers in acute distress report feeling powerless and helpless, as they feel that they cannot lessen the distress experienced by the voice hearer. Despite these difficult feelings, staff report finding ways of coping, including using structured tools to help make sense of their service users' voice-hearing experiences and accessing reflective practice forums. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Due to the current context of increased acuity and limited resources in acute services, there may be a need to further protect time for staff to access reflective practice groups and supervision forums to help them manage the difficult feelings arising from their work with voice hearers. Introduction Mental health nursing (MHN) staff in acute settings work with voice hearers at times of crises when they experience high levels of distress. Previous research has focused on community mental health staff's experiences and their service users views on exploring the content of voices. No studies have explored this from an acute mental health service perspective. Aim This study therefore sought to explore the experiences of staff working with voice hearers in an acute mental health service. Method Due to the exploratory nature of the research, a qualitative design was chosen. Three MHNs and five healthcare support workers (HSWs) were interviewed. The data were analysed using Interpretative Phenomenological Analysis. Results A group analysis elicited three master themes: "It's quite scary really, not unlike a horror movie;" "I can only influence what's in front of me;" and "Just chipping away". Discussion Staff working with voice hearers in acute settings experience feelings of powerlessness and helplessness, as they feel unable to reduce the distress experienced by voice hearers in their care. Staff employ coping strategies to help manage these difficult feelings, including using structured tools in their work with voice hearers and attending reflective practice forums. Implications for Practice Acute mental health services may need to protect time for staff to access regular reflective practice and other supervision forums to help manage their feelings of powerlessness and helplessness arising from their work with voice hearers. © 2017 John Wiley & Sons Ltd.

Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis

PubMed Central

Awenat, Yvonne; Peters, Sarah; Shaw-Nunez, Emma; Gooding, Patricia; Pratt, Daniel; Haddock, Gillian

2017-01-01

Background Suicidal behaviour is frequent in psychiatric in-patients and much staff time and resources are devoted to assessing and managing suicide risk. However, little is known about staff experiences of working with in-patients who are suicidal. Aims To investigate staff experiences of working with in-patients who are suicidal. Method Qualitative study guided by thematic analysis of semi-structured interviews with mental health staff with experience of psychiatric in-patient care. Results Twenty staff participated. All had encountered in-patient suicide deaths or attempts. Three key themes were identified: (a) experiences of suicidality, (b) conceptualising suicidality and (c) talking about suicide. Conclusions Suicidal behaviour in psychiatric wards has a large impact on staff feelings, practice and behaviour. Staff felt inadequately equipped to deal with such behaviours, with detrimental consequences for patients and themselves. Organisational support is lacking. Training and support should extend beyond risk assessment to improving staff skills in developing therapeutic interactions with in-patients who are suicidal. PMID:28642259

An estimate of the cost of administering intravenous biological agents in Spanish day hospitals

PubMed Central

Nolla, Joan Miquel; Martín, Esperanza; Llamas, Pilar; Manero, Javier; Rodríguez de la Serna, Arturo; Fernández-Miera, Manuel Francisco; Rodríguez, Mercedes; López, José Manuel; Ivanova, Alexandra; Aragón, Belén

2017-01-01

Objective To estimate the unit costs of administering intravenous (IV) biological agents in day hospitals (DHs) in the Spanish National Health System. Patients and methods Data were obtained from 188 patients with rheumatoid arthritis, collected from nine DHs, receiving one of the following IV therapies: infliximab (n=48), rituximab (n=38), abatacept (n=41), or tocilizumab (n=61). The fieldwork was carried out between March 2013 and March 2014. The following three groups of costs were considered: 1) structural costs, 2) material costs, and 3) staff costs. Staff costs were considered a fixed cost and were estimated according to the DH theoretical level of activity, which includes, as well as personal care of each patient, the DH general activities (complete imputation method, CIM). In addition, an alternative calculation was performed, in which the staff costs were considered a variable cost imputed according to the time spent on direct care (partial imputation method, PIM). All costs were expressed in euros for the reference year 2014. Results The average total cost was €146.12 per infusion (standard deviation [SD] ±87.11; CIM) and €29.70 per infusion (SD ±11.42; PIM). The structure-related costs per infusion varied between €2.23 and €62.35 per patient and DH; the cost of consumables oscillated between €3.48 and €20.34 per patient and DH. In terms of the care process, the average difference between the shortest and the longest time taken by different hospitals to administer an IV biological therapy was 113 minutes. Conclusion The average total cost of infusion was less than that normally used in models of economic evaluation coming from secondary sources. This cost is even less when the staff costs are imputed according to the PIM. A high degree of variability was observed between different DHs in the cost of the consumables, in the structure-related costs, and in those of the care process. PMID:28356746

For Better or Worse: Using Wikis and Blogs for Staff Communication in an Academic Library

ERIC Educational Resources Information Center

Costello, Kristen; Del Bosque, Darcy

2010-01-01

This case study from the University of Nevada, Las Vegas, University Libraries, which has one main library, three branches, and more than 110 staff, illustrates one approach to using new technologies as additional methods for internal communication. At large academic libraries, communication within the organization can be challenging. The…

A Forgotten Sector; The Training of Ancillary Staff in Hospitals.

ERIC Educational Resources Information Center

Smith, Duncan N.

A study was made, in England and Wales, of training needs of hospital ancillary staff; it concentrated on a group of hospitals in each of six Hospital Regions. In addition, information was collected at the national level and brief visits were made in other regions. Findings showed large differences in staffing between hospitals of similar types,…

Attitudes of Staff Nurse Preceptors Related to the Education of Nurses with Learning Disabilities in Clinical Settings

ERIC Educational Resources Information Center

L'Ecuyer, Kristine Marie

2014-01-01

This dissertation presents a quantitative study of the attitudes of staff nurse preceptors toward nursing students with learning disabilities. There are an increased number of nursing students with learning disabilities. These students may have additional challenges in clinical settings, particularly if clinical settings do not understand or…

Case Study: Review of Operating Room Utilization at Mayo Clinic Arizona (MCA)

DTIC Science & Technology

2008-05-01

or CRNA in training. The training of staff and the use of advanced technology, such as the Davinci Surgical Robot, may lead to an increase in time...gynecology performed during block-time will involve the use of the Davinci robot. When using the robot for a case, the set-up and prep-time before...1999). It is because of the cost of surgical staff that block-time lost to delays is concerning. MCA implemented block-time because it provides a tool

Lessons Learned Recruiting Minority Participants for Research in Urban Community Health Centers.

PubMed

Fam, Elizabeth; Ferrante, Jeanne M

2018-02-01

To help understand and mitigate health disparities, it is important to conduct research with underserved and underrepresented minority populations under real world settings. There is a gap in the literature detailing real-time research staff experience, particularly in their own words, while conducting in-person patient recruitment in urban community health centers. This paper describes challenges faced at the clinic, staff, and patient levels, our lessons learned, and strategies implemented by research staff while recruiting predominantly low-income African-American women for an interviewer-administered survey study in four urban Federally Qualified Health Centers in New Jersey. Using a series of immersion-crystallization cycles, fieldnotes and research reflections written by recruiters, along with notes from team meetings during the study, were qualitatively analyzed. Clinic level barriers included: physical layout of clinic, very low or high patient census, limited private space, and long wait times for patients. Staff level barriers included: unengaged staff, overburdened staff, and provider and staff turnover. Patient level barriers included: disinterested patients, patient mistrust and concerns over confidentiality, no-shows or lack of patient time, and language barrier. We describe strategies used to overcome these barriers and provide recommendations for in-person recruitment of underserved populations into research studies. To help mitigate health disparities, disseminating recruiters' experiences, challenges, and effective strategies used will allow other researchers to build upon these experience in order to increase recruitment success of underserved and underrepresented minority populations into research studies. Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.

Observing the work of an urban safety-net psychiatric emergency room: managing the unmanageable

PubMed Central

Lincoln, Alisa K.; White, Andrew; Aldsworth, Casandra; Johnson, Peggy; Strunin, Lee

2010-01-01

Staff in the psychiatric emergency room (PER) have demanding jobs requiring a complex balance between the needs and safety of the individual and the community, systemic resources, and job responsibilities while providing timely, effective care. Little research exists concerning day-to-day work activities of PER staff, their interaction, and their perceptions of their work. This study explored the work of PER staff and the organisational context of the PER work setting. Observations of staff were conducted in the public spaces of a public urban PER using two observational techniques. The first was designed to measure the types of work activities staff engaged in and the time spent in these work activities (work task data). The second technique was the gathering of observational data by a peripheral-member-researcher (participant observation data). Analyses were conducted of both the work task and participant observation data. Results indicate that most PER staff time is spent in administrative and phone tasks, while less than a third is spent on direct clinical work. Four important issues for PER work were identified: a workload that is unmanageable, managing the unmanageable, bogus referrals and dumping and insurance problems. The PER remains the front-line of the medical and social service systems. Work done in these settings is of critical importance; however little attention is paid to the content and nature of the work. Our study demonstrates that staff of the PER face challenges on many levels as they struggle with the task of working with people presenting in psychiatric and social crisis. PMID:20149148

Improvement of emergency department patient flow using lean thinking.

PubMed

Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

2018-05-01

To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

Hospital Smoke-Free Policy: Compliance, Enforcement, and Practices. A Staff Survey in Two Large Public Hospitals in Australia.

PubMed

McCrabb, Sam; Baker, Amanda L; Attia, John; Balogh, Zsolt J; Lott, Natalie; Palazzi, Kerrin; Naylor, Justine; Harris, Ian A; Doran, Christopher M; George, Johnson; Wolfenden, Luke; Skelton, Eliza; Bonevski, Billie

2017-11-08

Background: Smoke-free hospital policies are becoming increasingly common to promote good health and quit attempts among patients who smoke. This study aims to assess: staff perceived enforcement and compliance with smoke-free policy; the current provision of smoking cessation care; and the characteristics of staff most likely to report provision of care to patients. Methods: An online cross-sectional survey of medical, nursing, and allied staff from two Australian public hospitals was conducted. Staff report of: patient and staff compliance with smoke-free policy; perceived policy enforcement; the provision of the 5As for smoking cessation (Ask, Assess, Advise, Assist, and Arrange follow-up); and the provision of stop-smoking medication are described. Logistic regressions were used to determine respondent characteristics related to the provision of the 5As and stop-smoking medication use during hospital admission. Results: A total of 805 respondents participated. Self-reported enforcement of smoke-free policy was low (60.9%), together with compliance for both patients (12.9%) and staff (23.6%). The provision of smoking cessation care was variable, with the delivery of the 5As ranging from 74.7% (ask) to 18.1% (arrange follow-up). Medical staff (odds ratio (OR) = 2.09, CI = 1.13, 3.85, p = 0.018) and full time employees (OR = 2.03, CI = 1.06, 3.89, p = 0.033) were more likely to provide smoking cessation care always/most of the time. Stop-smoking medication provision decreased with increasing age of staff (OR = 0.98, CI = 0.96, 0.99, p = 0.008). Conclusions: Smoke-free policy enforcement and compliance and the provision of smoking cessation care remains low in hospitals. Efforts to improve smoking cessation delivery by clinical staff are warranted.

Factors to consider in the introduction of huddles on clinical wards: perceptions of staff on the SAFE programme.

PubMed

Stapley, Emily; Sharples, Evelyn; Lachman, Peter; Lakhanpaul, Monica; Wolpert, Miranda; Deighton, Jessica

2018-02-01

To explore paediatric hospital staff members' perceptions of the emerging benefits and challenges of the huddle, a new safety improvement initiative, as well as the barriers and facilitators to its implementation. A qualitative study was conducted using semi-structured interviews to explore staff perspectives and experiences. Situation Awareness For Everyone (SAFE), a safety improvement programme, was implemented on a sample of National Health Service (NHS) paediatric wards from September 2014 to June 2016. Previously untested in England, the huddle was a central component of the programme. Semi-structured interviews were conducted with 76 staff members on four wards ~4 months after the start of the programme. A thematic analysis showed that staff perceived the huddle as helping to increase their awareness of important issues, improve communication, facilitate teamwork, and encourage a culture of increased efficiency, anticipation and planning on the ward. Challenges of the huddle included added pressure on staff time and workload, and the potential for junior nurses to be excluded from involvement, thus perhaps inadvertently reinforcing medical hierarchies. Staff also identified several barriers and facilitators to the huddle process, including the importance of senior nursing and medical staff leadership and managing staff time and capacity issues. The findings point towards the potential efficacy of the huddle as a way of improving hospital staff members' working environments and clinical practice, with important implications for other sites seeking to implement such safety improvement initiatives. © The Author(s) 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The Impact of Computerization on Library Support Staff: A Study of Support Staff in Academic Libraries in Wisconsin.

ERIC Educational Resources Information Center

Palmini, Cathleen C.

1994-01-01

Describes a survey of Wisconsin academic library support staff that explored the effects of computerization of libraries on work and job satisfaction. Highlights include length of employment; time spent at computer terminals; training; computer background; computers as timesavers; influence of automation on effectiveness; and job frustrations.…

Evaluation of a Bereavement Training Program for Staff in an Intellectual Disabilities Service

ERIC Educational Resources Information Center

Reynolds, Sile; Guerin, Suzanne; McEvoy, John; Dodd, Philip

2008-01-01

The impact of a staff-training program on knowledge and confidence in supporting people with intellectual disabilities (ID) at the time of bereavement was examined. Thirty-three staff members from a Dublin, Ireland-based ID support service participated in the study. Both the training (n = 17) and control (n = 16) groups completed measures of…

Imagined and Emerging Career Patterns: Perceptions of Doctoral Students and Research Staff

ERIC Educational Resources Information Center

McAlpine, Lynn; Turner, Gill

2012-01-01

Increasingly, research staff positions rather than lectureships are the reality for social sciences PhD graduates wishing academic work. Within this context, our longitudinal study examined how social science doctoral students and research staff in two UK universities imagined their futures in and out of academia. The variation over time in how…

Modernisation of Higher Education in Europe: Academic Staff--2017. Eurydice Report

ERIC Educational Resources Information Center

Crosier, David; Birch, Peter; Davydovskaia, Olga; Kocanova, Daniela; Parveva, Teodora

2017-01-01

This report aims to provide insight into the realities faced by higher education academic staff at a time of fast-moving change and increasing societal demand. Fluctuating student numbers, new funding and steering mechanisms are among the features of today's European higher education landscape, but not enough is known about how academic staff are…

University of Tokyo, Institute of Astronomy

NASA Astrophysics Data System (ADS)

Murdin, P.

2000-11-01

Founded in 1987, the Institute of Astronomy, University of Tokyo, is located at Ohsawa, Mitaka, Japan, 30 km west of central Tokyo. Its objectives are research and education in observational astronomy. It has a staff of 3 professors; 5 associate professors; 8 research associates, 2 technical support staff, 2 administrative officers and several part-time staff (secretary, catering etc). Its major ...

Why are they leaving? Causes of actual turnover in the Danish eldercare services.

PubMed

Clausen, Thomas; Tufte, Pernille; Borg, Vilhelm

2014-07-01

To investigate reasons for actual turnover among eldercare staff and to investigate changes in job design that could prevent turnover. Many Western countries have difficulties in recruiting healthcare staff to provide care for an ageing population. Knowledge on the causes of turnover among healthcare staff is therefore important. In a prospective cohort study (n = 7025) baseline characteristics were compared for employees who respectively quit, retired and worked in eldercare at follow-up. Additionally, a survey was conducted among those employees who left their jobs during follow-up. Employees who quit their jobs (n = 461) primarily stated that psychosocial work conditions caused them to quit, whereas retirees (n = 265) primarily stated reasons related to health and physical job demands. Improvements in the time available for the contact with the elderly, increased skill discretion and improved social relations could prompt employees to reconsider quitting or retiring. Work in eldercare has some 'core' aspects that appear desirable to employees who quit or retired. Building on those aspects offers a strategy for enhanced recruitment potential. To reduce turnover managers should improve psychosocial work conditions in eldercare and ensure that physical demands do not exceed the capacities of employees. © 2012 John Wiley & Sons Ltd.

The continuing problem of missed test results in an integrated health system with an advanced electronic medical record.

PubMed

Wahls, Terry; Haugen, Thomas; Cram, Peter

2007-08-01

Missed results can cause needless treatment delays. However, there is little data about the magnitude of this problem and the systems that clinics use to manage test results. Surveys about potential problems related to test results management were developed and administered to clinical staff in a regional Veterans Administration (VA) health care network. The provider survey, conducted four times between May 2005 and October 2006, sampling VA staff physicians, physician assistants, nurse practitioners, and internal medicine trainees, asked questions about the frequency of missed results and diagnosis or treatment delays seen in the antecedent two weeks in their clinics, or if a trainee, the antecedent month. Clinical staff survey response rate was 39% (143 of 370), with 40% using standard operating procedures to manage test results. Forty-four percent routinely reported all results to patients. The provider survey response rate was 50% (441 of 884) overall, with responses often (37% overall; range 29% to 46%) indicating they had seen patients with diagnosis or treatment delays attributed to a missed result; 15% reported two or more such encounters. Even in an integrated health system with an advanced electronic medical record, missed test results and associated diagnosis or treatment delays are common. Additional study and measures of missed results and associated treatment delays are needed.

The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support?

PubMed

Friend, Sarah; Flattum, Colleen F; Simpson, Danielle; Nederhoff, Dawn M; Neumark-Sztainer, Dianne

2014-05-01

This study examined the sustainability of New Moves, a school-based program aimed at decreasing weight-related problems in adolescent girls. The National Cancer Institute recognizes New Moves as a research-tested intervention program that produced positive behavioral and psychosocial outcomes. Ten schools participated in the sustainability study. Teachers completed a survey and interview, and research staff observed 1 physical education (PE) class within 2 years of the study's completion. Qualitative data were grouped by themes. Frequencies were calculated using quantitative data. All schools continued all-girls PE classes using New Moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Program components were sustained in both New Moves intervention schools and control schools. Programs are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue program components if staff perceived the program was important for students' health and compatible within the school's existing infrastructure. © 2014, American School Health Association.

When Service Matters: Library Budgets 2010

ERIC Educational Resources Information Center

London, Charles

2010-01-01

There is a surging need for library services, placing high demands on staff time just as staff time and resources are shrinking. The increased demand coupled with decreased resources puts stress on those on the front lines and on administrators, many of whom are themselves suffering the same financial anxieties as their patrons. Nationwide, public…

Ideologies of care in community residential services: what do caregivers believe?

PubMed

Heaney, C A; Burke, A C

1995-10-01

Ideologies of care, or systems of beliefs about the importance of particular goals and activities, help guide how care is provided. One currently pervasive ideology of care is that of normalization. In this paper, the ideologies of care of both house managers and direct care staff in group homes are contrasted. Results indicate that the ideology of direct care staff is less differentiated than that of the house managers. In addition, house managers are more likely to subscribe to a normalization ideology and less likely to subscribe to a family orientation ideology than are direct care staff. Ideological differences between house managers and direct care staff are only partially explained by differences in the demographic composition of the two groups.

Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study.

PubMed

Isbister, Geoffrey K; Calver, Leonie A; Page, Colin B; Stokes, Barrie; Bryant, Jenni L; Downes, Michael A

2010-10-01

We determine whether droperidol, midazolam, or the combination is more effective for intramuscular sedation in violent and acute behavioral disturbance in the emergency department (ED). We conducted a blinded randomized controlled trial of intramuscular sedation for violent and acute behavioral disturbance, comparing droperidol (10 mg), midazolam (10 mg), and droperidol (5 mg)/midazolam (5 mg). Inclusion criteria were patients requiring physical restraint and parenteral sedation. The primary outcome was the duration of the violent and acute behavioral disturbance, defined as the time security staff were required. Secondary outcomes included time until additional sedation was administered, staff and patient injuries, further episodes of violent and acute behavioral disturbance, and drug-related adverse effects. From 223 ED patients with violent and acute behavioral disturbance, 91 patients were included; 33 received droperidol, 29 received midazolam, and 29 received the combination. There was no difference in the median duration of the violent and acute behavioral disturbance: 20 minutes (interquartile range [IQR] 11 to 37 min) for droperidol, 24 minutes (IQR 13 to 35 minutes) for midazolam, and 25 minutes (IQR 15 to 38 minutes) for the combination. Additional sedation was required in 11 (33%; 95% confidence interval [CI] 19% to 52%) droperidol patients, 18 (62%; 95% CI 42% to 79%) midazolam patients, and 12 (41%; 95% CI 24% to 61%) in the combination group. The hazard ratio for additional sedation in the midazolam versus droperidol group was 2.31 (95% credible interval 1.01 to 4.71); for the combination versus droperidol, 1.18 (95% credible interval 0.46 to 2.50). Patient and staff injuries and number of further episodes of violent and acute behavioral disturbance did not differ between groups. There were two adverse effects for droperidol (6%; 95% CI 1% to 22%), 8 for midazolam (28%; 95% CI 13% to 47%), and 2 for the combination (7%; 95% CI 1% to 24%). An abnormal QT occurred in 2 of 31 (6%; 95% CI 1% to 23%) droperidol patients, which was not different from the other groups. Intramuscular droperidol and midazolam resulted in a similar duration of violent and acute behavioral disturbance, but more additional sedation was required with midazolam. Midazolam caused more adverse effects because of oversedation, and there was no evidence of QT prolongation associated with droperidol compared with midazolam. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

University-Community-Hospice Partnership to Address Organizational Barriers to Cultural Competence.

PubMed

Reese, Dona J; Buila, Sarah; Cox, Sarah; Davis, Jessica; Olsen, Meaghan; Jurkowski, Elaine

2017-02-01

Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in 1 rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach. Results indicated that students can provide a valuable service in addressing organizational barriers through a hospice field placement.

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.

PubMed

Malec, J F; Buffington, A L; Moessner, A M; Degiorgio, L

2000-08-01

To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. Five levels of Vocational Independence Scale (VIS). Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.

Perceptions of Australasian emergency department staff of the impact of alcohol-related presentations.

PubMed

Egerton-Warburton, Diana; Gosbell, Andrew; Wadsworth, Angela; Moore, Katie; Richardson, Drew B; Fatovich, Daniel M

2016-03-07

To survey emergency department (ED) clinical staff about their perceptions of alcohol-related presentations. A mixed methods online survey of ED clinicians in Australia and New Zealand, conducted from 30 May to 7 July 2014. The frequency of aggression from alcohol-affected patients or their carers experienced by ED staff; the perceived impact of alcohol-related presentations on ED function, waiting times, other patients and staff. In total, 2002 ED clinical staff completed the survey, including 904 ED nurses (45.2%) and 1016 ED doctors (50.7%). Alcohol-related verbal aggression from patients had been experienced in the past 12 months by 97.9% of respondents, and physical aggression by 92.2%. ED nurses were the group most likely to have felt unsafe because of the behaviour of these patients (92% reported such feelings). Alcohol-related presentations were perceived to negatively or very negatively affect waiting times (noted by 85.5% of respondents), other patients in the waiting room (94.4%), and the care of other patients (88.3%). Alcohol-affected patients were perceived to have a negative or very negative impact on staff workload (94.2%), wellbeing (74.1%) and job satisfaction (80.9%). Verbal and physical aggression by alcohol-affected patients is commonly experienced by ED clinical staff. This has a negative impact on the care of other patients, as well as on staff wellbeing. Managers of health services must ensure a safe environment for staff and patients. More importantly, a comprehensive public health approach to changing the prevailing culture that tolerates alcohol-induced unacceptable behaviour is required.

Promoting Breastfeeding-Friendly Hospital Practices: A Washington State Learning Collaborative Case Study.

PubMed

Freney, Emily; Johnson, Donna; Knox, Isabella

2016-05-01

Hospital breastfeeding support practices can affect breastfeeding outcomes. Learning collaboratives are an increasingly common strategy to improve practices in health care and have been applied to breastfeeding in many cases. The aims of this study of the Evidence-Based Hospital Breastfeeding Support Learning Collaborative (EBBS LC) were to describe the perceptions of participants regarding the process and effectiveness of the EBBS LC, describe perceived barriers and facilitators to implementing the Ten Steps to Successful Breastfeeding, and identify additional actions and resources needed in future learning collaboratives. Qualitative, semistructured telephone interviews were conducted with 13 key staff who represented 16 of the 18 participating hospitals. The learning collaborative was perceived positively by participants, meeting the expectations of 9 and exceeding the expectations of 4 persons interviewed. The most beneficial aspect of the program was its collaborative nature, and the most difficult aspect was the time required to participate as well as technological difficulties. The key barriers were staff time, staff changes, cost, and the difficulty of changing the existing practices of hospitals and communities. The key facilitating factors were supportive management, participation in multiple breastfeeding quality improvement projects, collecting data on breastfeeding outcomes, tangible resources regarding the Ten Steps, and positive community response. Participants in the EBBS LC stated that they would like to see the Washington State Department of Health create a resource-rich, centralized source of information for participants. This learning collaborative approach was valued by participants. Future efforts can be guided by these evaluation findings. © The Author(s) 2015.

Automation in an addiction treatment research clinic: computerised contingency management, ecological momentary assessment and a protocol workflow system.

PubMed

Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H; Preston, Kenzie L

2009-01-01

A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients' treatment needs and to accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with the provision of seamless methods for exporting, mining and querying the data. We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialised applications: the Automated Contingency Management (ACM) system for the delivery of behavioural interventions, the transactional electronic diary (TED) system for the management of behavioural assessments and the Protocol Workflow System (PWS) for computerised workflow automation and guidance of each participant's daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorised staff. ACM and the TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80 patient capacity, having an annual average of 18,000 patient visits and 7300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarise participant safety data for research oversight. When developed in consultation with end users, automation in treatment research clinics can enable more efficient operations, better communication among staff and expansions in research methods.

The unannounced patient in the corridor: trust, friction and person-centered care.

PubMed

Carlström, Eric D; Hansson Olofsson, Elisabeth; Olsson, Lars-Eric; Nyman, Jan; Koinberg, Inga-Lill

2017-01-01

In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full-time employment, and the intervention group staffed with nurses spent 30% of their full-time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5-point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Assessing for domestic violence in sexual health environments: a qualitative study.

PubMed

Horwood, Jeremy; Morden, Andrew; Bailey, Jayne E; Pathak, Neha; Feder, Gene

2018-03-01

Domestic violence and abuse (DVA) is a major clinical challenge and public health issue. Sexual health services are an important potential site of DVA intervention. The Assessing for Domestic Violence in Sexual Health Environments (ADViSE) intervention aimed to improve identification and management of DVA in sexual healthcare settings and is a modified version of the Identification and Referral to Improve Safety (IRIS) general practice programme. Our qualitative evaluation aimed to explore the experiences of staff participating in an IRIS ADViSE pilot. Interviews were conducted with 17 sexual health clinic staff and DVA advocate workers. Interviews were audio recorded, transcribed, anonymised and analysed thematically. Staff prioritised enquiring about DVA and tailored their style of enquiry to the perceived characteristics of patients, current workload and individual clinical judgements. Responding to disclosures of abuse was divided between perceived low-risk cases (with quick onwards referral) and high-risk cases (requiring deployment of institution safeguarding procedures), which were viewed as time consuming and could create tensions with patients. Ongoing training and feedback, commissioner recognition, adequate service-level agreements and reimbursements are required to ensure sustainability and wider implementation of IRIS ADViSE. Challenges of delivering and sustaining IRIS ADViSE included the varied styles of enquiry, as well as tensions and additional time pressure arising from disclosure of abuse. These can be overcome by modifying initial training, providing regular updates and stronger recognition (and resources) at policy and commissioning levels. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of electronic healthcare-associated infection surveillance software on infection prevention resources: a systematic review of the literature.

PubMed

Russo, P L; Shaban, R Z; Macbeth, D; Carter, A; Mitchell, B G

2018-05-01

Surveillance of healthcare-associated infections is fundamental for infection prevention. The methods and practices for surveillance have evolved as technology becomes more advanced. The availability of electronic surveillance software (ESS) has increased, and yet adoption of ESS is slow. It is argued that ESS delivers savings through automation, particularly in terms of human resourcing and infection prevention (IP) staff time. To describe the findings of a systematic review on the impact of ESS on IP resources. A systematic search was conducted of electronic databases Medline and the Cumulative Index to Nursing and Allied Health Literature published between January 1 st , 2006 and December 31 st , 2016 with analysis using the Newcastle-Ottawa Scale. In all, 2832 articles were reviewed, of which 16 studies met the inclusion criteria. IP resources were identified as time undertaken on surveillance. A reduction in IP staff time to undertake surveillance was demonstrated in 13 studies. The reduction proportion ranged from 12.5% to 98.4% (mean: 73.9%). The remaining three did not allow for any estimation of the effect in terms of IP staff time. None of the studies demonstrated an increase in IP staff time. The results of this review demonstrate that adopting ESS yields considerable dividends in IP staff time relating to data collection and case ascertainment while maintaining high levels of sensitivity and specificity. This has the potential to enable reinvestment into other components of IP to maximize efficient use of scarce IP resources. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Challenging times ahead.

PubMed

While, Alison

2008-07-01

The global economic challenges will not only affect the banks but also healthcare staff and their patients. Indeed, no-one will be unaffected. At this moment community nurses are not being properly reimbursed for the cost of using their cars to deliver care in the home as the price of petrol rises ever higher and older people are counting the cost of ever rising energy and food costs. Additionally there will be less extra money available to fund public services as the government attempts to balance its expenditure against tax receipts without further increasing government debt.

Savings sharing: rewarding staff for responsible decision-making.

PubMed

Jones, Debi

2005-04-01

Shortages of professional nurses create a "buyer's market" in which nurses accept temporary assignments for the highest rates and offer little additional time to the primary employer. Use of temporary personnel use salary dollars at an inordinate rate while offering little continuity or support for the organization's standards. Methods for placing decision-making in the hands of the nurses are needed along with a reward system for establishing a pattern of sound decision-making. The author describes a savings sharing program that is gaining credibility in one organization for addressing both objectives.

Airport electrotechnology resource guide. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Geba, V.; Nesbit, M.

1998-06-01

Electrotechnologies offer utilities a cutting edge marketing tool to work with airport customers to increase passenger comfort, and achieve environmental and economic goals. At the same time, utility objectives such as customer retention, and revenue and sales goals can be enhanced. This guide provides electric utility marketing staff with the necessary information to market electrotechnologies in airport applications. The airport industry is profiled and an overview of airport building, infrastructure technologies and electric vehicles is provided. In addition, the guide offers market strategies for customer targeting, market research, market plan development and development of trade ally partnerships.

Policies and practices on competing interests of academic staff in Australian universities.

PubMed

Chapman, Simon; Morrell, Bronwen; Forsyth, Rowena; Kerridge, Ian; Stewart, Cameron

2012-04-16

To document the existence and provisions of Australian universities' policies on the competing interests of academic staff and university practices in recording, updating and making these declarations publicly accessible. A 14-item survey was sent to the vice-chancellors of 39 Australian universities and university websites were searched for relevant policies. Twelve universities declined to provide any information. Of the 27 that did, all had policies on staff competing interests. Fifteen did not require regular declarations from staff and only four required annual declarations. Eight universities maintained a centralised register of COIs of all staff and six had a mechanism in place that allowed members of the public to access information on COIs. None reported that they required that staff place their COI declarations on their website profiles and none had policies that indicated that staff should declare COIs when making a public comment. Australian universities vary significantly in their approaches to the declaration and management of competing interests. While two-thirds of Australian universities require staff to declare competing interests, this information is mostly inaccessible to the public. Australian universities should adopt a standard approach to the declaration and management of competing interests and commit to meaningful transparency and public accountability. This could include frequently updated declarations on website profiles of all staff. In addition, dialogue about what is needed to effectively deal with competing interests should be encouraged.

Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study

PubMed Central

Wadley, Greg; Sanci, Lena Amanda

2018-01-01

Background Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. PMID:29691209

Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study.

PubMed

Webb, Marianne Julie; Wadley, Greg; Sanci, Lena Amanda

2018-04-24

Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app's administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. ©Marianne Julie Webb, Greg Wadley, Lena Amanda Sanci. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.04.2018.

An institutional staff training and self-management program for developing multiple self-care skills in severely/profoundly retarded individuals.

PubMed Central

Kissel, R C; Whitman, T L; Reid, D H

1983-01-01

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implications for future research and continued development of effective staff training and management programs. PMID:6654771

Penile hygiene: puberty, paraphimosis and personal care for men and boys with an intellectual disability.

PubMed

Wilson, N J; Cumella, S; Parmenter, T R; Stancliffe, R J; Shuttleworth, R P

2009-02-01

Supporting men and boys with an intellectual disability (ID) to meet their penile hygiene needs is perhaps one of the least acknowledged but most confronting issues facing care staff. The delivery of intimate hygiene can be a challenging topic particularly as it has been drawn into the emerging sexuality discourse and the ongoing abuse narrative. Compounding this challenge is the lack of guidance in intimate care for support staff. In addition, whereas the male with an ID outnumber the female, female care staff greatly outnumber male staff. Whether this situation affects outcomes for men and boys with an ID is unknown but it is an issue which should be examined. This paper reports data from two separate studies, one quantitative the other qualitative, which sought to explore penile hygiene as a male health issue. Results show the practice of care staff to be inconsistent, the views and values of care staff to be divergent. Some patterns and contextual differences were identified depending upon the gender of care staff. An emerging dialogue described some of the positive contributions that male staff make to men and boys with an ID. The penile health needs of men and boys with an ID are being compromised by a lack of guidance, training, knowledge and limited gender-sensitive care.

Outcomes in knowledge, attitudes and confidence of nursing staff working in nursing and residential care homes following a dementia training programme.

PubMed

Scerri, Anthony; Scerri, Charles

2017-11-08

Dementia training programmes for staff working in long-term care settings have been found to be effective in improving staff outcomes. This study investigated the impact of a dementia training programme for all Maltese nursing staff working in public nursing/residential homes on their knowledge, attitudes and confidence. Additionally, we identified the predictors of these domains before and after the programme. A 14-hour training programme focusing on dementia management, care and policy was developed for all nursing staff working in public nursing and residential homes in Malta. A pretest-posttest design was used to evaluate the participants' knowledge of dementia, attitudes and confidence in working with residents with dementia using validated tools. Demographic variables were measured and compared with each staff domain. The majority of nursing staff attended the training programme with 261 fully completed questionnaires being collected pre-training and 214 post-training. The programme significantly improved nursing staff knowledge, attitudes and confidence. Stepwise regression analysis of each staff domain showed that the strongest predictor in all models at pre-training was the intensity of previous training programmes. Furthermore, staff who attended previous training continued to improve in their attitudes and confidence following programme completion. The study continues to shed further evidence on the impact of dementia training programs on staff outcomes. It also indicated that the intensity of previous participation in dementia training programmes was related to the participants' knowledge, attitudes and confidence and that continual exposure to training had a cumulative effect.

78 FR 18372 - TUV Rheinland of North America, Inc.; Expansion of Recognition

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... covers the addition of a new site and the use one additional test standard. OSHA's current scope of..., and one additional test standard. In response to OSHA's requests for clarification, TUV amended its... NRTL Program staff determined that the additional test standard is an ``appropriate test standard...

An authentication scheme to healthcare security under wireless sensor networks.

PubMed

Hsiao, Tsung-Chih; Liao, Yu-Ting; Huang, Jen-Yan; Chen, Tzer-Shyong; Horng, Gwo-Boa

2012-12-01

In recent years, Taiwan has been seeing an extension of the average life expectancy and a drop in overall fertility rate, initiating our country into an aged society. Due to this phenomenon, how to provide the elderly and patients with chronic diseases a suitable healthcare environment has become a critical issue presently. Therefore, we propose a new scheme that integrates healthcare services with wireless sensor technology in which sensor nodes are employed to measure patients' vital signs. Data collected from these sensor nodes are then transmitted to mobile devices of the medical staff and system administrator, promptly enabling them to understand the patients' condition in real time, which will significantly improve patients' healthcare quality. As per the personal data protection act, patients' vital signs can only be accessed by authorized medical staff. In order to protect patients', the system administrator will verify the medical staff's identity through the mobile device using a smart card and password mechanism. Accordingly, only the verified medical staff can obtain patients' vital signs data such as their blood pressure, pulsation, and body temperature, etc.. Besides, the scheme includes a time-bounded characteristic that allows the verified staff access to data without having to have to re-authenticate and re-login into the system within a set period of time. Consequently, the time-bounded property also increases the work efficiency of the system administrator and user.

Selection of population controls for a Salmonella case-control study in the UK using a market research panel and web-survey provides time and resource savings.

PubMed

Mook, P; Kanagarajah, S; Maguire, H; Adak, G K; Dabrera, G; Waldram, A; Freeman, R; Charlett, A; Oliver, I

2016-04-01

Timely recruitment of population controls in infectious disease outbreak investigations is challenging. We evaluated the timeliness and cost of using a market research panel as a sampling frame for recruiting controls in a case-control study during an outbreak of Salmonella Mikawasima in the UK in 2013. We deployed a web-survey by email to targeted members of a market research panel (panel controls) in parallel to the outbreak control team interviewing randomly selected public health staff by telephone and completing paper-based questionnaires (staff controls). Recruitment and completion of exposure history web-surveys for panel controls (n = 123) took 14 h compared to 15 days for staff controls (n = 82). The average staff-time cost per questionnaire for staff controls was £13·13 compared to an invoiced cost of £3·60 per panel control. Differences in the distribution of some exposures existed between these control groups but case-control studies using each group found that illness was associated with consumption of chicken outside of the home and chicken from local butchers. Recruiting market research panel controls offers time and resource savings. More rapid investigations would enable more prompt implementation of control measures. We recommend that this method of recruiting controls is considered in future investigations and assessed further to better understand strengths and limitations.

A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland

PubMed Central

2012-01-01

Background NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. Methods A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. Results Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. Conclusions Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks. PMID:22958309

Local health department epidemiologic capacity: a stratified cross-sectional assessment describing the quantity, education, training, and perceived competencies of epidemiologic staff.

PubMed

O'Keefe, Kaitlin A; Shafir, Shira C; Shoaf, Kimberley I

2013-01-01

Local health departments (LHDs) must have sufficient numbers of staff functioning in an epidemiologic role with proper education, training, and skills to protect the health of communities they serve. This pilot study was designed to describe the composition, training, and competency level of LHD staff and examine the hypothesis that potential disparities exist between LHDs serving different sized populations. Cross-sectional surveys were conducted with directors and epidemiologic staff from a sample of 100 LHDs serving jurisdictions of varied sizes. Questionnaires included inquiries regarding staff composition, education, training, and measures of competency modeled on previously conducted studies by the Council of State and Territorial Epidemiologists. Number of epidemiologic staff, academic degree distribution, epidemiologic training, and both director and staff confidence in task competencies were calculated for each LHD size strata. Disparities in measurements were observed in LHDs serving different sized populations. LHDs serving small populations reported a smaller average number of epidemiologic staff than those serving larger jurisdictions. As size of population served increased, percentages of staff and directors holding bachelors' and masters' degrees increased, while those holding RN degrees decreased. A higher degree of perceived competency of staff in most task categories was reported in LHDs serving larger populations. LHDs serving smaller populations reported fewer epidemiologic staff, therefore might benefit from additional resources. Differences observed in staff education, training, and competencies suggest that enhanced epidemiologic training might be particularly needed in LHDs serving smaller populations. RESULTS can be used as a baseline for future research aimed at identifying areas where training and personnel resources might be particularly needed to increase the capabilities of LHDs.

Strategic planning for clinical services: St. Joseph Hospital and Health Care Center.

PubMed

Linggi, A; Pelham, L D

1986-09-01

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.

Improving Efficiency Using Time-Driven Activity-Based Costing Methodology.

PubMed

Tibor, Laura C; Schultz, Stacy R; Menaker, Ronald; Weber, Bradley D; Ness, Jay; Smith, Paula; Young, Phillip M

2017-03-01

The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology. In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process. The team used Pareto charts to understand the highest cost and most time-consuming activities, brainstormed opportunities, and assessed impact. Plan-do-study-act cycles were developed to test the changes, and run charts were used to monitor progress. The process changes consisted of revising the workflow associated with the preparation and administration of glucagon, with completed implementation in November 2015. The time-driven activity-based costing methodology allowed the radiology department to develop a process to more accurately identify the costs of providing MR enterography. The primary process modification was reassigning responsibility for the administration of glucagon from nurses to technologists. After implementation, the improvements demonstrated success by reducing non-value-added steps and cost by 13%, staff time by 16%, and patient process time by 17%. The saved process time was used to augment existing examination time slots to more accurately accommodate the entire enterographic examination. Anecdotal comments were captured to validate improved staff satisfaction within the multidisciplinary team. This process provided a successful outcome to address daily workflow frustrations that could not previously be improved. A multidisciplinary team was necessary to achieve success, in addition to the use of a structured problem-solving approach. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Performance Indicators: Sickness and Absence Rates as Indicators of Staff Morale.

ERIC Educational Resources Information Center

Parker, Sandra

Employee absenteeism is a problem faced by all library and information service managers as it erodes both salary budgets and productivity. It can have an undermining effect on staff morale, and may be an indicator of low staff motivation levels. There are two types of absence, unavoidable and avoidable, which can be measured using lost time and…

Attributions of Agency and the Construction of Moral Order: Dementia, Death, and Dignity in Nursing-Home Care

ERIC Educational Resources Information Center

Rodriquez, Jason

2009-01-01

Using evidence gathered during 18 months of participant-observation in 2 nursing homes and 65 interviews with staff, this article examines how nursing-home staff use agency as a rhetorical resource to construct a dignified workplace. Staff attribute agency to dying residents, saying they choose the timing and conditions of their death. Staff…

Telling Tales: A Narrative Research Study of the Experiences of New International Academic Staff at an Australian University

ERIC Educational Resources Information Center

Green, Wendy; Myatt, Paula

2011-01-01

As the transnational movement of academics continues to increase, some are arguing it is time to look more closely at the challenges faced by new international academic staff. This article reports on a narrative research study exploring the experiences and perceptions of eight international academic staff at a large, research-intensive university…

Maximizing People Power in Schools: Motivating and Managing Teachers and Staff. Successful Schools: Guidebooks to Effective Educational Leadership. Volume 5.

ERIC Educational Resources Information Center

Frase, Larry E.

Ways to motivate and manage teachers and staff are presented in this guidebook. Chapter 1 describes ways to staff a school and get it right the first time. Checklists for recruiting, screening, and hiring are included. Chapter 2 offers suggestions for operating successful teacher induction, professional development,and motivation programs to…

Beyond the fringe benefits.

PubMed

Moore, Alison

2009-09-03

NHS employers will be looking for savings on staff costs--but room to cut wages is limited. Perks such as cheap staff parking and workplace nurseries could be targeted for cuts. Trusts will be keen to avoid the debacle of 2006 when frontline staff were laid off. As NHS spending is fixed till 2011, trusts have time to prepare--and find new ways of working.

Does Improving Joint Attention in Low-Quality Child-Care Enhance Language Development?

ERIC Educational Resources Information Center

Rudd, Loretta C.; Cain, David W.; Saxon, Terrill F.

2008-01-01

This study examined effects of professional development for child-care staff on language acquisition of children ages 14-36 months. Child-care staff from 44 child-care centres agreed to participate in the study. Child-care staff from one-half of the child-care centres were randomly assigned to a one-time, four-hour workshop followed by three…

Factors Challenging and Supporting Scholarly Activity for Academic Staff in a Regional Australian University Environment

ERIC Educational Resources Information Center

Hurley, John; Bowling, Alison; Griffiths, Jean; Blair, Duncan

2015-01-01

With expectations of academic staff to achieve high quality teaching and research outputs as performance measures it is timely to explore how staff perceive they are being supported to meet these ends. This article presents findings of a multi-method study that explored influences impacting on the quality and quantity of scholarly activity being…

Employment Shifts in the TAFE Workforce in Victoria, 1993-98. Working Paper.

ERIC Educational Resources Information Center

Shah, Chandra

Data on the work force in Technical and Further Education (TAFE) institutes in Victoria, Australia, for 1993-1998 reveal a number of structural changes. First, the number of women staff increased from 46% to 53%, although men still constitute 54% of the teaching staff. As full-time staff employment dropped an average of 1.1% annually, part-time…

Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.

PubMed

Koning, Kate Louise; McNaught, Angela; Tuffin, Keith

2017-11-03

To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcripts was carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.

Development of a staff recall system for mass casualty incidents using cell phone text messaging.

PubMed

Epstein, Richard H; Ekbatani, Ali; Kaplan, Javier; Shechter, Ronen; Grunwald, Zvi

2010-03-01

After a mass casualty incident (MCI), rapid mobilization of hospital personnel is required because of an expected surge of victims. Risk assessment of our department's manual phone tree recall system revealed multiple weaknesses that would limit an effective response. Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging. We sent test text messages to anesthesia staff members' cell phone numbers, determined the distance from their home to the hospital, and stored this information in our AIMS. Latency testing for the time from transmission of SMS test messages from the server to return of an e-mail reply was determined at 2 different times on 2 different dates, 1 of which was a busy holiday weekend, using volunteers within the department. Two unannounced simulated disaster recall drills were conducted, with text messages sent asking for the anticipated time to return to the hospital. A timeline of available staff on site was determined. Reasons for failure to respond to the disaster notification message were tabulated. Latency data were fit by a log-normal distribution with an average of 82 seconds from message transmission to e-mail reply. Replies to the simulated disaster alert were received from approximately 50% of staff, with 16 projecting that they would have been able to be back at the hospital within 30 minutes on both dates. There would have been 21 and 23 staff in-house at 30 minutes, and 32 and 37 staff in-house at 60 minutes on the first and second test date, respectively, including in-house staff. Of the nonresponders to the alert, 48% indicated that their cell phone was not with them or was turned off, whereas 22% missed the message. Our SMS staff recall system is likely to be able to rapidly mobilize sufficient numbers of anesthesia personnel in response to an MCI, but actual performance cannot be predicted with confidence. Using our AIMS as the source for contact information and from which to send messages was simple, inexpensive, and easy to implement. Updating contact information, periodic testing, and analysis of responses to simulated disaster alerts are essential for the effective functioning of such a system. However, maintenance of alternative methods of communication is recommended, because there may be more significant message transmission delays and failures during an actual MCI, and not all staff will receive the text message in a timely fashion.

Creating pharmacy staffing-to-demand models: predictive tools used at two institutions.

PubMed

Krogh, Paul; Ernster, Jason; Knoer, Scott

2012-09-15

The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

Safety of clinical and non-clinical decision makers in telephone triage: a narrative review.

PubMed

Wheeler, Sheila Q; Greenberg, Mary E; Mahlmeister, Laura; Wolfe, Nicole

2015-09-01

Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard. © The Author(s) 2015.

Focus groups for allied health professionals and professions allied to technical services in the NHS--marketing opportunities, lessons learnt and recommendations.

PubMed

Chamberlain, David; Brook, Richard

2011-09-01

Worcestershire Health Libraries provides services to all NHS and social care staff in Worcestershire. Despite intensive marketing, statistics showed low usage of the library service for professions allied to technical services and allied health professionals. To discover why there was low usage of the library services using qualitative techniques and to use focus groups as a marketing opportunity. This article also aims to outline the processes involved in delivering focus groups, the results gained, and the actions taken in response to the results. Focus groups were conducted in two departments, Pathology and Occupational Therapy. The Biochemistry department (part of Pathology) had two focus groups. An additional focus group was conducted for all the Pathology education leads. Occupational Therapy had two meetings, one for hospital based staff, and the other for community staff. Issues centred on registration, inductions, time, library ambience, multi-disciplinary service and resources. The findings raised marketing opportunities and the process identified potential candidates for the role of team knowledge officer, to act as library champions within departments. It also identified areas in which the library service was not meeting user needs and expectations, and helped focus service development. Focus groups allowed an opportunity to speak to non-users face to face and to discover, and where appropriate challenge both their, and library staff's pre-conceived ideas about the service. The information revealed gave an opportunity to market services based on user needs. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

Total staff costs to implement a decision support system in nursing.

PubMed

Castilho, Valéria; Lima, Antônio Fernandes Costa; Fugulin, Fernanda Maria Togeiro; Peres, Heloisa Helena Ciqueto; Gaidzinski, Raquel Rapone

2014-01-01

to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

ESO Helps Antofagasta Region after the Earthquake

NASA Astrophysics Data System (ADS)

2007-11-01

On November 14 at 12:41 local time, a major earthquake with magnitude 7.7 on the Richter scale affected the north of Chile. The epicentre was located 35 km from the city of Tocopilla and 170 km of Antofagasta. Two persons died and tens were injured, while buildings were damaged in several cities. In the Maria Elena-Tocopilla area, several thousand homes were destroyed or damaged. In an act of solidarity with the local community and its authorities, ESO immediately announced a donation of 30 millions Chilean pesos (around 40,000 euros) to Antofagasta's Regional Government to support reconstruction in the Region II. ESO and its staff have been shocked by the earthquake and its impact on local communities, especially on the people of Tocopilla. The ESO Representation in Chile formally contacted the regional authorities to explore with them possible ways to collaborate in this difficult moment. In addition, many of ESO staff are personally cooperating with the victims, under the coordination of Cruz Roja, the organisation currently in charge of implementing individual efforts.

Engaging participants in a complex intervention trial in Australian General Practice

PubMed Central

Perkins, David; Harris, Mark F; Tan, Jocelyn; Christl, Bettina; Taggart, Jane; Fanaian, Mahnaz

2008-01-01

Background The paper examines the key issues experienced in recruiting and retaining practice involvement in a large complex intervention trial in Australian General Practice. Methods Reflective notes made by research staff and telephone interviews with staff from general practices which expressed interest, took part or withdrew from a trial of a complex general practice intervention. Results Recruitment and retention difficulties were due to factors inherent in the demands and context of general practice, the degree of engagement of primary care organisations (Divisions of General Practice), perceived benefits by practices, the design of the trial and the timing and complexity of data collection. Conclusion There needs to be clearer articulation to practices of the benefits of the research to participants and streamlining of the design and processes of data collection and intervention to fit in with their work practices. Ultimately deeper engagement may require additional funding and ongoing participation through practice research networks. Trial Registration Current Controlled Trials ACTRN12605000788673 PMID:18700984

Managing Evaluation: A Community Arts Organisation Perspective.

PubMed

Swan, Peter; Atkinson, Sarah

2012-09-01

Arts and health organisations must increasingly provide measurable evidence of impact to stakeholders, which can pose both logistical and ideological challenges. This paper examines the relationship between the ethos of an arts and health organisation with external demands for evaluation. Research involved an ethnographic engagement where the first author worked closely with the organisation for a year. In addition to informal discussions, twenty semi-structured interviews were conducted with core staff and participants. Transcribed interviews were coded and emerging themes were identified. Staff considered evaluation to be necessary and useful, yet also to be time consuming and a potential threat to their ethos. Nevertheless, they were able to negotiate the terms of evaluation to enable them to meet their own needs as well as those of funders and other stakeholders. While not completely resisting outside demands for evaluation, the organisation was seen to intentionally rework demands for evidence into processes they felt they could work with, thus enabling their ethos to be maintained.

Managing Evaluation: A Community Arts Organisation Perspective

PubMed Central

Swan, Peter; Atkinson, Sarah

2014-01-01

Background Arts and health organisations must increasingly provide measurable evidence of impact to stakeholders, which can pose both logistical and ideological challenges. This paper examines the relationship between the ethos of an arts and health organisation with external demands for evaluation. Methods Research involved an ethnographic engagement where the first author worked closely with the organisation for a year. In addition to informal discussions, twenty semi-structured interviews were conducted with core staff and participants. Transcribed interviews were coded and emerging themes were identified. Results Staff considered evaluation to be necessary and useful, yet also to be time consuming and a potential threat to their ethos. Nevertheless, they were able to negotiate the terms of evaluation to enable them to meet their own needs as well as those of funders and other stakeholders. Conclusions While not completely resisting outside demands for evaluation, the organisation was seen to intentionally rework demands for evidence into processes they felt they could work with, thus enabling their ethos to be maintained. PMID:25429306

A case of iatrogenic stress? Results of the RCOG August rotation survey.

PubMed

Cooke, M; Morris, E

2014-10-01

Although there are a number of studies of patient safety during the August rotation, they often focus on newly qualified doctors. It remains unclear whether negative impacts are due to doctors' inexperience, lack of technical skill or other aspects of rotation. This study used an electronic survey to seek the views of doctors working in obstetrics and gynaecology in the UK. A total of 1,879 responses were received. The August rotation was felt to be a stressful time, with a negative effect on patient care (82%) and safety (73%), lasting up to 1 month (62%). Although reducing services was thought to be helpful, there was strong support for staggering the rotation by grade (80%). This would ensure availability of doctors to cover services during the induction period, which should improve patient care and reduce staff stress. In addition, intensive skills training for junior staff and a supportive culture during the 1st month could optimise the integration and performance of doctors of all grades.

Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp

PubMed Central

Wani, Shabeer Ahmad; Rabah, Sari M.; AlFadil, Sara; Dewanjee, Nancy; Najmi, Yahya

2013-01-01

Objective: The objective of this study is to assess the efficacy of smartphone and its WhatsApp application as a communication method amongst the staff of plastic and reconstructive surgery section at tertiary care health facility. Materials and Methods: From January 2012 onwards, the authors used smartphones and its WhatsApp application as a communication method amongst their team for various aspects of patient management and as a tool for academic endorsements. Results: During the period of this study, there were 116 episodes regarding patient management, which were handled, in a timely fashion by using this application. In addition opinion of rotating residents in the section was sought regarding the efficacy of this method of communication. Overall majority of residents were satisfied with this mode of communication. Conclusions: This new method of communication is an effective method for clinical and academic endorsements. The method is cheap and quick and easy to operate. PMID:24459338

Enhancing collaborative communication of nurse and physician leadership in two intensive care units.

PubMed

Boyle, Diane K; Kochinda, Chiemi

2004-02-01

To test an intervention to enhance collaborative communication among nurse and physician leaders (eg, nurse manager, medical director, clinical nurse specialist) in two diverse intensive care units (ICUs). Collaborative communication is associated with positive patient, nurse, and physician outcomes. However, to date, intervention-focused research that seeks to improve collaborative communication is lacking. A pretest-posttest repeated measures design incorporated baseline data collection, implementation of the intervention over 8 months, and immediate and 6-months-post data collection. Communication skills of ICU nurse and physician leaders improved significantly. Leaders also reported increased satisfaction with their own communication and leadership skills. In addition, staff nurse and physician perceptions of nursing leadership and problem solving between groups increased. Staff nurses reported lower personal stress (eg, more respect from co-workers, physicians, and managers), even though they perceived significantly more situational stress (eg, less staffing and time). Study findings provide evidence that nurse-physician collaborative communication can be improved.

Hazard-evaluation and technical assistance report TA 78-12, Oregon State University, Corvallis, Oregon

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

A hazard evaluation and technical assistance survey of the biology-botany science building at the University of Oregon, Corvallis Campus to determine a possible etiologic agent responsible for nervous-system complaints among employees was conducted. Upon occupation of the new building formerly healthy plants transplanted to the new laboratories died. Since that time, a plant pathologist died of a neurological disease and three other professors contracted a similar progressive neurological disease. The ventilation system of the building was studied. Fume-hood rates were measured and air-inlet filters were analyzed. In addition, medical interviews of employees were conducted, medical histories obtained, and consultations withmore » their physicians held. If there is a single process endemic among the present staff, it could not be identified, although there are definitely similarities in complaints. No pathophysiological link between the fatal neurological diseases and current complaints among the staff was found. No clear-cut etiologic relationship between the work environment and symptoms was apparent.« less

Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care

PubMed Central

Williams, Kristine N.; Ayyagari, Padmaja; Perkhounkova, Yelena; Bott, Marjorie J.; Herman, Ruth; Bossen, Ann

2017-01-01

CONTEXT Persons with Alzheimer’s disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC). OBJECTIVE This analysis evaluates the cost-effectiveness of the CHAT intervention to reduce elderspeak communication by staff and RTC behaviors of NH residents with dementia. DESIGN Costs to provide the intervention were determined in eleven NHs that participated in the CHAT study during 2011–2013 using process-based costing. Each NH provided data on staff wages for the quarter before and for two quarters after the CHAT intervention. An incremental cost-effectiveness analysis was completed. ANALYSIS An average cost per participant was calculated based on the number and type of staff attending the CHAT training, plus materials and interventionist time. Regression estimates from the parent study then were applied to determine costs per unit reduction in staff elderspeak communication and resident RTC. RESULTS A one percentage point reduction in elderspeak costs $6.75 per staff member with average baseline elderspeak usage. Assuming that each staff cares for 2 residents with RTC, a one percentage point reduction in RTC costs $4.31 per resident using average baseline RTC. CONCLUSIONS Costs to reduce elderspeak and RTC depend on baseline levels of elderspeak and RTC, as well as the number of staff participating in CHAT training and numbers of residents with dementia-related behaviors. Overall, the 3-session CHAT training program is a cost-effective intervention for reducing RTC behaviors in dementia care. PMID:28503675

The response to challenging behaviour by care staff: emotional responses, attributions of cause and observations of practice.

PubMed

Bailey, B A; Hare, D J; Hatton, C; Limb, K

2006-03-01

Previous studies have attempted to apply Weiner's attributional model of helping behaviour to care staff who work with service users with intellectual disabilities and challenging behaviours by using studies based on vignettes. The aims of the current study were to investigate the application of Weiner's model to 'real' service users with intellectual disabilities and challenging behaviours and to observe the care staff's actual responses to challenging behaviours displayed by service users. Also, to compare care staff attributions, emotions, optimism, willingness to help and observed helping behaviours for self-injurious behaviours in comparison to other forms of challenging behaviours. A total of 27 care staff completed two sets of measures, one set regarding a self-injurious behaviour and the other regarding other forms of challenging behaviour. An additional 16 staff completed one set of measures. The measures focused on care staff attributions, emotions, optimism and willingness to help. Also, 16 of the care staff were observed interacting with the service users to collect data regarding their responses to challenging behaviours. For both self-injurious behaviours and other forms of challenging behaviour, associations were found between the care staff internal, stable and uncontrollable attribution scores and care staff negative emotion scores. However, no associations were found between the care staff levels of emotion, optimism and willingness to help. Some associations were found between the care staff levels of willingness to help and observed helping behaviours. There were significant differences between the care staff attribution scores with higher scores being obtained for uncontrollable and stable attributions for other forms of challenging behaviours. No significant differences were found between the care staff emotions, optimism, willingness to help and observed helping behaviours. The results did not provide support for Weiner's attributional model of helping behaviour. However, a preliminary model of negative care staff behaviour was derived from the exploratory analyses completed. This model proposes that there are associations between internal, stable and uncontrollable attributions and negative emotions in care staff and also between negative emotions and negative behaviours displayed by care staff in response to the actions of service users.

Improving induction of labour - a quality improvement project addressing Caesarean section rates and length of process in women undergoing induction of labour

PubMed Central

O'Dwyer, Sabrina; Raniolo, Caterina; Roper, Janice; Gupta, Manish

2015-01-01

Induction of labour (IOL) in maternity care is often not an area of priority in maternity services, which often results in protracted delays, a poor patient experience, and patient complaints. Caesarean section (CS) rates among women undergoing IOL at this inner city district general hospital were noted to be higher than other units nationwide. We collected pre and post-intervention data of the following outcome measures: time taken to administer prostaglandin after arrival, time taken to achieve established labour, mode of delivery, and user satisfaction scores. Our introduction of a dedicated IOL Suite, promotion of out-patient IOL, use of a single administration prostaglandin (as opposed to traditional six hourly prostaglandin), widespread staff engagement and rolling audit has resulted in positive change in the maternity unit. CS rates for women undergoing IOL have been reduced from 29% to 22% (p=0.05), time taken to administer the induction medication has decreased from 6.3h to 2.7h (p=0.0001), and out-patient induction rates have increased from 3% to 33% (p=0.001). We have achieved a reduction in the overall length of in-patient stay. We have also received positive feedback from both staff and patients. We used a bottom-up approach, engaging frontline staff in problem identification and pathway design. Our staff engagement questionnaire showed other benefits such as increased staff morale as a result. Collection of simple performance data and sharing of this in real time with staff acts as a valuable tool for acceptance of change and continuous improvement. Communicating plans to a large body of people is important in ensuring the success of an intervention. Staff showing disengagement may require specific detailed information to allay their concerns. Following initial successes, ongoing vigilance, and collection of audit data is key to sustaining any improvement. PMID:26734422

Managed Care, Time Pressure, and Physician Job Satisfaction: Results from the Physician Worklife Study

PubMed Central

Linzer, Mark; Konrad, Thomas R; Douglas, Jeffrey; McMurray, Julia E; Pathman, Donald E; Williams, Eric S; Schwartz, Mark D; Gerrity, Martha; Scheckler, William; Bigby, JudyAnn; Rhodes, Elnora

2000-01-01

OBJECTIVE To assess the association between HMO practice, time pressure, and physician job satisfaction. DESIGN National random stratified sample of 5,704 primary care and specialty physicians in the United States. Surveys contained 150 items reflecting 10 facets (components) of satisfaction in addition to global satisfaction with current job, one's career and one's specialty. Linear regression–modeled satisfaction (on 1–5 scale) as a function of specialty, practice setting (solo, small group, large group, academic, or HMO), gender, ethnicity, full-time versus part-time status, and time pressure during office visits. “HMO physicians” (9% of total) were those in group or staff model HMOs with>50% of patients capitated or in managed care. RESULTS Of the 2,326 respondents, 735 (32%) were female, 607 (26%) were minority (adjusted response rate 52%). HMO physicians reported significantly higher satisfaction with autonomy and administrative issues when compared with other practice types (moderate to large effect sizes). However, physicians in many other practice settings averaged higher satisfaction than HMO physicians with resources and relationships with staff and community (small to moderate effect sizes). Small and large group practice and academic physicians had higher global job satisfaction scores than HMO physicians (P < .05), and private practice physicians had quarter to half the odds of HMO physicians of intending to leave their current practice within 2 years (P < .05). Time pressure detracted from satisfaction in 7 of 10 satisfaction facets (P < .05) and from job, career, and specialty satisfaction (P < .01). Time allotted for new patients in HMOs (31 min) was less than that allotted in solo (39 min) and academic practices (44 min), while 83% of family physicians in HMOs felt they needed more time than allotted for new patients versus 54% of family physicians in small group practices (P < .05 after Bonferroni's correction). CONCLUSIONS HMO physicians are generally less satisfied with their jobs and more likely to intend to leave their practices than physicians in many other practice settings. Our data suggest that HMO physicians' satisfaction with staff, community, resources, and the duration of new patient visits should be assessed and optimized. Whether providing more time for patient encounters would improve job satisfaction in HMOs or other practice settings remains to be determined. PMID:10940129

(Updated) NCI Fiscal 2016 Bypass Budget Proposes $25 Million for Frederick National Lab | Poster

Cancer.gov

By Nancy Parrish, Staff Writer; image by Richard Frederickson, Staff Photographer The additional funding requested for Frederick National Laboratory for Cancer Research (FNLCR) in the Fiscal 2016 Bypass Budget was $25 million, or approximately 3.5 percent of the total additional funding request of $715 million. Officially called the Professional Judgment Budget, the Bypass Budget is a result of the National Cancer Act of 1971, which authorizes NCI to submit a budget directly to the president, to send to Congress. With a focus on NCI’s research priorities and areas of cancer research with potential for investment, the Bypass Budget specifies additional funding, over and above the current budget, that is needed to advance

The Influence of Faculty and Staff Messaging on Black Male Community College and Transfer Student Success

ERIC Educational Resources Information Center

Bauer, Kara Lyn

2016-01-01

The exploratory research in this dissertation examined the need for faculty and staff to take additional measures to support and encourage Black males utilizing their services and learning in their classrooms. The focus is on messaging that can come from these campus leaders, and how it can influence Black male community college and transfer…

Privacy and Confidentiality: Using Scenarios to Teach Your Staff about Patron's Rights

ERIC Educational Resources Information Center

Snowman, Ann Mackay

2013-01-01

Every U.S. state and the District of Columbia has a law on the books that protects a library borrower's privacy, both an ethical and legal obligation of the library. In addition, FERPA further restricts access to users' records. Getting the message across to staff can be a challenge, especially if you employ students or volunteers who may not…

Careers of Professional Staff in Australian and UK Universities: A Mixed Methods Pilot Study

ERIC Educational Resources Information Center

Gander, Michelle

2017-01-01

This article confirms the reliability of a protean and boundaryless career attitudes scale, tested in a pilot study. Additionally, it summarises the results of this study into the career attitudes of professional staff in Australian and UK universities. A mixed methods approach was taken using a survey consisting of both closed questions on a…

The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in People with Intellectual Disabilities

ERIC Educational Resources Information Center

Costello, Helen; Bouras, Nick; Davis, Hilton

2007-01-01

Background: Care staff play a key role in identifying individuals with intellectual disabilities and additional mental health problems. Yet, few receive training in mental health, and evidence about the effectiveness of training is scant. Materials and Methods: A pre-post study is reported, using a mental health screen and a self-report…

Measuring Child-Staff Ratios in Child Care Centers: Balancing Effort and Representativeness

ERIC Educational Resources Information Center

Le, Vi-Nhuan; Perlman, Michal; Zellman, Gail L.; Hamilton, Laura S.

2006-01-01

Child-staff ratios are an important quality indicator. They are often collected by observing one randomly selected classroom several times during a 2-h period on a single day. However, it is unclear whether these measures represent the ratios that children actually experience during most of their time in care. This study compared ratio data…

A Quantitative Study on Organisational Commitment and Communication Satisfaction of Professional Staff at a Master's Institution in the United States

ERIC Educational Resources Information Center

Bray, Nathaniel J.; Williams, Laine

2017-01-01

This study examined communication satisfaction and organisational commitment for professional staff at an American Master's institution using two quantitative surveys: Downs and Hazen's Communication Satisfaction Questionnaire and Meyer and Allen's TCM Employee Commitment Survey. One hundred and sixty-eight full-time and part-time staff…

21 CFR 20.41 - Time limitations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... shall begin as of the time at which a request for records is logged in by the Freedom of Information... is redirected to the Freedom of Information Staff and is logged in there in accordance with § 20.40(c... for records is logged in at the Freedom of Information Staff, the agency shall send a letter to the...

Applying RUG-III in Japanese Long-Term Care Facilities.

ERIC Educational Resources Information Center

Ikegami, Naoki; And Others

1994-01-01

Tested U.S. nursing home case-mix system, Resource Utilization Groups, Version III (RUG-III) in Japanese long-term care facilities. Measured staff time and resident characteristics for 871 patients. Found acceptable reliability for items defining RUG-III, and system explained 44% of variance in wage-weighted staff time (cost). Japanese and U.S.…

Dispersed Web Content Management in Higher Education

ERIC Educational Resources Information Center

Arendt, Anne; Gerber, Nathan

2009-01-01

Higher education institutions often have large, complex websites, necessitated by the many services, divisions, and areas involved in campus operations. The fall 2008 enrollment at Utah Valley University (UVU), for example, was 26,696 students in over 50 different degree areas. UVU also has 1,455 full-time staff and another 3,285 part-time staff.…

Advanced Nuclear Technology. Using Technology for Small Modular Reactor Staff Optimization, Improved Effectiveness, and Cost Containment, 3002007071

DOE Office of Scientific and Technical Information (OSTI.GOV)

Loflin, Leonard

Through this grant, the U.S. Department of Energy (DOE) will review several functional areas within a nuclear power plant, including fire protection, operations and operations support, refueling, training, procurement, maintenance, site engineering, and others. Several functional areas need to be examined since there appears to be no single staffing area or approach that alone has the potential for significant staff optimization at new nuclear power plants. Several of the functional areas will require a review of technology options such as automation, remote monitoring, fleet wide monitoring, new and specialized instrumentation, human factors engineering, risk informed analysis and PRAs, component andmore » system condition monitoring and reporting, just in time training, electronic and automated procedures, electronic tools for configuration management and license and design basis information, etc., that may be applied to support optimization. Additionally, the project will require a review key regulatory issues that affect staffing and could be optimized with additional technology input. Opportunities to further optimize staffing levels and staffing functions by selection of design attributes of physical systems and structures need also be identified. A goal of this project is to develop a prioritized assessment of the functional areas, and R&D actions needed for those functional areas, to provide the best optimization« less

Web-based learning in professional development: experiences of Finnish nurse managers.

PubMed

Korhonen, Teija; Lammintakanen, Johanna

2005-11-01

The aim of this article is to describe the nurse managers' expectations, attitudes and experiences on web-based learning before and after participation in a web-based course. Information technology has rapidly become more common in health care settings. However, little is known about nurse managers' experiences on web-based learning, although they have a crucial role in promoting the professional development of their staff. Diagnostic assignments (n = 18) written before and interviews (n = 8) taken after the web-based education. The data were analysed by inductive content analysis. Nurse managers found web-based education to be a suitable and modern method of learning. On the basis of their experience they found multiple ways to utilize web-based learning environments in health care. Information technology skills, equipment, support and time were considered essential in web-based learning. Additionally, they found that their own experience might lead to more widespread implementation of web-based learning in health care settings. Information technology skills of nurse managers and staff need to be developed in order to use information technology effectively. In order to learn in a web-based environment, everyone needs the opportunity and access to required resources. Additionally, nurse managers' own experiences are important to promote wider utilization of web-based learning.

The challenges of training, support and assessment of healthcare support workers: A qualitative study of experiences in three English acute hospitals.

PubMed

Sarre, Sophie; Maben, Jill; Aldus, Clare; Schneider, Justine; Wharrad, Heather; Nicholson, Caroline; Arthur, Antony

2018-03-01

Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority. This paper examines: healthcare support workers' access to training, support and assessment; perceived gaps in training provision; and barriers and facilitators to implementation of relevant policies in acute care. We undertook a qualitative study of staff caring for older inpatients at ward, divisional or organisational-level in three acute National Health Service hospitals in England in 2014. 58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads. One-to-one semi-structured interviews included: views and experiences of training and support; translation of training into practice; training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes. Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment; managing the emotions of patients, families and themselves; and having difficult conversations. Access to ongoing training was affected by: lack of time; infrequent provision; attitudes of ward managers to additional support workforce training, and their need to balance this against patients' and other staff members' needs; and the use of e-learning as a default mode of training delivery. With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training; formalising the provision and availability of on-ward support; and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India.

PubMed

Deering, Kathleen N; Boily, Marie-Claude; Lowndes, Catherine M; Shoveller, Jean; Tyndall, Mark W; Vickerman, Peter; Bradley, Jan; Gurav, Kaveri; Pickles, Michael; Moses, Stephen; Ramesh, Banadakoppa M; Washington, Reynold; Rajaram, S; Alary, Michel

2011-12-29

The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs' sexual partners, including a dose-response relationship. Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables. FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs' husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner. Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners.

A dose-response relationship between exposure to a large-scale HIV preventive intervention and consistent condom use with different sexual partners of female sex workers in southern India

PubMed Central

2011-01-01

Background The Avahan Initiative, a large-scale HIV preventive intervention targeted to high-risk populations including female sex workers (FSWs), was initiated in 2003 in six high-prevalence states in India, including Karnataka. This study assessed if intervention exposure was associated with condom use with FSWs’ sexual partners, including a dose-response relationship. Methods Data were from a cross-sectional study (2006-07) of 775 FSWs in three districts in Karnataka. Survey methods accounted for the complex cluster sampling design. Bivariate and multivariable logistic regression was used to separately model the relationships between each of five intervention exposure variables and five outcomes for consistent condom use (CCU= always versus frequently/sometimes/never) with different sex partners, including with: all clients; occasional clients; most recent repeat client; most recent non-paying partner; and the husband or cohabiting partner. Linear tests for trends were conducted for three continuous intervention exposure variables. Results FSWs reported highest CCU with all clients (81.7%); CCU was lowest with FSWs’ husband or cohabiting partner (9.6%). In multivariable analysis, the odds of CCU with all clients and with occasional clients were 6.3-fold [95% confidence intervals, CIs: 2.8-14.5] and 2.3-fold [95% CIs: 1.4-4.1] higher among FSWs contacted by intervention staff and 4.9-fold [95% CIs: 2.6-9.3] and 2.3-fold [95% CIs: 1.3-4.1] higher among those who ever observed a condom demonstration by staff, respectively, compared to those who had not. A significant dose-response relationship existed between each of these CCU outcomes and increased duration since first contacted by staff (P=0.001; P=0.006) and numbers of condom demonstrations witnessed (P=0.004; P=0.026); a dose-response relationship was also observed between condom use with all clients and number of times contacted by staff (P=0.047). Intervention exposure was not associated with higher odds of CCU with the most recent repeat client, most recent non-paying partner or with the husband or cohabiting partner. Conclusion Study findings suggest that exposure to a large-scale HIV intervention for FSWs was associated with increased CCU with commercial clients. Moreover, there were dose-response relationships between CCU with clients and increased duration since first contacted by staff, times contacted by staff and number of condom demonstrations. Additional program effort is required to increase condom use with non-commercial partners. PMID:22375863

Training telescope operators and support astronomers at Paranal

NASA Astrophysics Data System (ADS)

Boffin, Henri M. J.; Gadotti, Dimitri A.; Anderson, Joe; Pino, Andres; de Wit, Willem-Jan; Girard, Julien H. V.

2016-07-01

The operations model of the Paranal Observatory relies on the work of efficient staff to carry out all the daytime and nighttime tasks. This is highly dependent on adequate training. The Paranal Science Operations department (PSO) has a training group that devises a well-defined and continuously evolving training plan for new staff, in addition to broadening and reinforcing courses for the whole department. This paper presents the training activities for and by PSO, including recent astronomical and quality control training for operators, as well as adaptive optics and interferometry training of all staff. We also present some future plans.

"Wish we would have known that!" Communication Breakdown Impedes Person-Centered Care.

PubMed

Kolanowski, Ann; Van Haitsma, Kimberly; Penrod, Janice; Hill, Nikki; Yevchak, Andrea

2015-06-01

To understand how nursing home staff obtain information needed for implementing person-centered care (PCC) to residents with dementia who exhibit behavioral and psychological symptoms of dementia (BPSD), and how they communicate this information to other staff. Barriers to PCC and information exchange were also explored. Participants were 59 staff from two nursing homes. Focus group methodology captured discussions in eight 1-hr sessions. Sessions were audiotaped and transcribed. Data were analyzed using qualitative content analysis to provide a comprehensive summary of real world context of implementing PCC. To deliver PCC staff identified a need for access to psychosocial/medical history of the resident and knowledge of strategies families used for managing BPSD in the past. However, resident information is not routinely shared with all staff and written documentation systems for communicating resident-specific information do not support the time-pressured work pattern of certified nursing assistants (CNAs). Word-of-mouth was considered more reliable and expedient than educational sessions. CNAs described themselves as visual learners who prefer educational programs addressing individual resident emergent behaviors and programs that are scheduled at dedicated times. To improve PCC the flow of information exchange requires: inclusion of all staff, particularly CNAs; systems of communication that consider the time and resource constraints of nursing homes; development of educational programs for BPSD that are responsive to staff learning styles; administrative investment in nursing leadership to effect these changes; and reimbursement approaches to encourage culture change investments. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Outbreak of mumps in a school setting, United Kingdom, 2013.

PubMed

Aasheim, Erlend T; Inns, Thomas; Trindall, Amy; Emmett, Lynsey; Brown, Kevin E; Williams, Chris J; Reacher, Mark

2014-01-01

Effective protection against mumps can be achieved through 2 doses of the measles-mumps-rubella (MMR) vaccine. However, outbreaks of mumps have recently been described among populations with high vaccination coverage, including 2 doses of MMR. Here we describe an outbreak at a school in the East of England, UK. The school was attended by 540 pupils aged 10-19 years and had 170 staff. In total, 28 cases of mumps (24 pupils and 4 staff) were identified during 10 January to 16 March 2013. Vaccination status was known in 25 of the cases, and among these 21 (84.0%) had a documented history of 2 doses of MMR while the remaining had a history of one dose (2/25 cases, 8.0%) or no doses (2/25, 8.0%) of MMR. An outbreak control team recommended that MMR vaccine should be offered to all pupils whose parents consented to it, regardless of previous vaccination status. Additional MMR vaccines were administered to 103 pupils, including 76 (73.8%) third doses of MMR. Offering an additional dose of MMR appeared to be acceptable to parents, and we found it feasible to administer the intervention in a timely manner with resources from the local Public Health Centre (Primary Care Trust). An additional dose of MMR to all individuals at risk can be considered as an acceptable control measure for mumps outbreaks in schools even if the vaccination coverage is high. However, further evidence on the effectiveness, acceptability, and safety of this intervention is needed.

Goal-Directed Transthoracic Echocardiography During Advanced Cardiac Life Support: A Pilot Study Using Simulation to Assess Ability.

PubMed

Greenstein, Yonatan Y; Martin, Thomas J; Rolnitzky, Linda; Felner, Kevin; Kaufman, Brian

2015-08-01

Goal-directed echocardiography (GDE) is used to answer specific clinical questions that provide invaluable information to physicians managing a hemodynamically unstable patient. We studied perception and ability of house staff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated advanced cardiac life support (ACLS); we compared their results with those of expert echocardiographers. Eleven pulmonary and critical care medicine fellows, 7 emergency medicine residents, and 5 cardiologists board certified in echocardiography were enrolled. Baseline ability to acquire 4 transthoracic echocardiography views was assessed, and participants were exposed to 6 simulated cardiac arrests and were asked to perform a GDE during ACLS. House staff performance was compared with the performance of 5 expert echocardiographers. Average baseline and scenario views by house staff were of good or excellent quality 89% and 83% of the time, respectively. Expert average baseline and scenario views were always of good or excellent quality. House staff and experts made the correct diagnosis in 68% and 77% of cases, respectively. On average, participants required 1.5 pulse checks to make the correct diagnosis. Of house staff, 94% perceived this study as an accurate assessment of ability. In an ACLS-compliant manner, house staff are capable of diagnosing management-altering pathologies the majority of the time, and they reach similar diagnostic conclusions in the same amount of time as expert echocardiographers in a simulated cardiac arrest scenario.

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings.

PubMed

Anskär, Eva; Lindberg, Malou; Falk, Magnus; Andersson, Agneta

2018-03-07

Over the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings. This descriptive, multicentre, cross-sectional study was performed in 2014-2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively. All health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff. This study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.

PEL Staff Together for the First Time | Poster

Cancer.gov

By Ashley DeVine, Staff Writer John-Paul Denson and Troy Taylor of the Protein Expression Laboratory (PEL) used to pack liters of Escherichia coli lysates on ice, put them in the back of a microvan, and drive across campus to deliver the samples for protein purification. Now that all PEL staff members are working under the same roof at the Advanced Technology Research Facility (ATRF), transferring samples is just a walk down the hall. Staff members were previously spread out in five buildings across the Fort Detrick campus.

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study.

PubMed

Stumbo, Scott P; Ford, James H; Green, Carla A

2017-11-01

A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of original study outcome goals. Available quantitative data on wait-time reduction demonstrated general concordance between agency perceptions of, and evidence for, sustainment 2 years following the end of the intervention. Additional quantitative data suggested that greater engagement during the intervention period showed some association with sustainment. Factors identified in QI frameworks as important for short-term sustainment-organizational capacity (e.g. staffing and leadership) and intervention characteristics (e.g. flexibility and fit)-are also important to long-term sustainment.

Is task-shifting a solution to the health workers' shortage in Northern Ghana?

PubMed

Okyere, Eunice; Mwanri, Lillian; Ward, Paul

2017-01-01

To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana. Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers' in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting. Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members' are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening. Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised.

Is task-shifting a solution to the health workers’ shortage in Northern Ghana?

PubMed Central

Okyere, Eunice; Mwanri, Lillian; Ward, Paul

2017-01-01

Objective To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana. Methods Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers’ in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting. Findings Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members’ are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening. Conclusion Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised. PMID:28358841

Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices.

PubMed

Pollak, Kathryn I; Nagy, Paul; Bigger, John; Bilheimer, Alicia; Lyna, Pauline; Gao, Xiaomei; Lancaster, Michael; Watkins, R Chip; Johnson, Fred; Batish, Sanjay; Skelton, Joseph A; Armstrong, Sarah

2016-02-01

Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

49 CFR 40.131 - How does the MRO or DER notify an employee of the verification process after receiving laboratory...

Code of Federal Regulations, 2010 CFR

2010-10-01

... result. In making this contact, you must explain to the employee that, if he or she declines to discuss... staff person must document the employee's decision, including the date and time. (2) A staff person must... numbers listed on the CCF. If you or your staff cannot reach the employee directly after making these...

Hellos and How Are Yous: Predictors and Correlates of Communication between Staff and Families during Morning Drop-Off in Child Care Centers

ERIC Educational Resources Information Center

Perlman, Michal; Fletcher, Brooke A.

2012-01-01

Research Findings: The amount and quality of communication between staff and guardians in child care centers was examined using extensive naturalistic observations. Interactions between staff and more than 1,000 guardians who dropped their child off at their child care center were captured through a series of 20-s time-sampled observations.…

PEL Staff Together for the First Time | Poster

Cancer.gov

By Ashley DeVine, Staff Writer John-Paul Denson and Troy Taylor of the Protein Expression Laboratory (PEL) used to pack liters of Escherichia coli lysates on ice, put them in the back of a microvan, and drive across campus to deliver the samples for protein purification. Now that all PEL staff members are working under the same roof at the Advanced Technology Research Facility

A Descriptive Analysis of Nursing Staff Behaviors in a Teaching Nursing Home: Differences among NAs, LPNs, and RNs.

ERIC Educational Resources Information Center

Burgio, Louis D.; And Others

1990-01-01

Various staff behaviors in nursing home were sampled 7 times a day, 5 days a week over 37 months and were coded separately for registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs). Found LPNs displayed significantly more patient care behaviors and NAs significantly more nonwork behaviors than other nursing staff. RNs…

A quick and effective method of limb preparation with health, safety and efficiency benefits.

PubMed

Naderi, N; Maw, K; Thomas, M; Boyce, D E; Shokrollahi, K

2012-03-01

Pre-operative limb preparation (PLP) usually involves lifting the limb and holding it in a fixed 'static' posture for several minutes. This is hazardous to theatre staff. Furthermore, 'painting' the limb can be time consuming and difficult areas such as between toes and fingers may remain unsterile. We demonstrate the time efficiency and asepsis achieved using the 'sterile bag' preparation technique. An additional advantage is the ability to prepare and anaesthetise a limb prior to theatre, increasing efficiency substantially for units with a large throughput of cases, such as day-case hand surgery lists. We monitored the duration of PLP in 20 patients using the 'sterile bag' technique compared to 20 patients using a conventional 'painting' method. Additionally, microbiology samples acquired from prepared upper limbs of 27 sequential patients operated on by a single surgeon over a two-month period were sent for culture immediately prior to commencement of surgery. The mean duration of the 'sterile bag' PLP was significantly lower than that of the conventional method (24 seconds vs 85 seconds, p=0.045). The technique can take as little as ten seconds (n=1). Final microbiology reports showed no growth for any of the 27 patients from whom a culture sample was taken. The sterile bag technique is effective in achieving asepsis, has the potential to increase theatre efficiency and reduces manual handling hazards compared to the conventional method. It is now taught to all theatre staff in our hospital during manual handling training. It can be undertaken in approximately ten seconds with practice for the upper limb.

Perceptions Among Psychiatric Staff of Creating a Therapeutic Alliance With Patients on Community Treatment Orders.

PubMed

Jansson, Susanne; Fridlund, Bengt

2016-10-01

A therapeutic alliance with a continuing collaboration between a patient and psychiatric staff is a resource for helping patients cope with the demands of coercive legislation. Knowledge exists describing coercion in inpatient care while the knowledge regarding the perceptions of creating a therapeutic alliance with patients on Community Treatment Orders (CTO) among psychiatric staff is scarce. To describe perceptions among psychiatric staff of creating a therapeutic alliance with patients on CTOs, an exploratory design using a phenomenographic method was employed. Thirteen semi-structured audio-taped interviews were conducted with psychiatric staff responsible for patients on CTOs. The staff worked in five different outpatient clinics and the interviews were conducted at their workplaces. The analysis resulted in in four metaphors: the persevering psychiatric staff, the learning psychiatric staff, the participating psychiatric staff, and the motivating psychiatric staff. Patients on CTOs were more time-consuming for psychiatric staff in care and treatment. Long-term planning is required in which the creation of a therapeutic alliance entails the patient gradually gaining greater self-awareness and wanting to visit the outpatient clinic. The professional-patient relationship is essential and if a therapeutic alliance is not created, the patient's continued care and treatment in the community is vulnerable.

Strategies for a successful organizational transition. Identifying staff roles and fulfilling their needs during changing times.

PubMed

Herbst, D S; Dimmick, J E

1995-01-01

For a successful reorganization of the laboratory, there is a role for each staff member to play during the transition. The role of those in laboratory administration is that of leading change agent. Corporate support staff, such as those in a human resources department, can advise the laboratory director in their areas of expertise. The role of the medical and technical supervisory staff is that of chief implementers of the plan. General laboratory staff has a confusing dual role--not only must they continue to provide laboratory services during the transition, but they also may have to change what they are doing and how they are doing it. Success also depends on meeting the individual personal needs of staff. Laboratory directors and administrators want to make a meaningful contribution to health care. Corporate support staff need to feel that they are a part of the change process. Supervisors' needs vary--coping with the loss of identity, position, or territory will be difficult for some; others will want to be involved in all stages of planning and implementation. The major need of the general laboratory staff is stability. Strategies are listed for each staff grouping to help the laboratory director coordinate staff roles and satisfy staff needs during the transition period.

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics

PubMed Central

Rollins, Angela L.; Salyers, Michelle P.; Tsai, Jack; Lydick, Jennifer M.

2010-01-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature. PMID:20012481

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics.

PubMed

Rollins, Angela L; Salyers, Michelle P; Tsai, Jack; Lydick, Jennifer M

2010-09-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.

Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study.

PubMed

Kumar, Narendra; Rajendra, Rajagopal; Majgi, Sumanth Mallikarjuna; Krishna, Murali; Keenan, Paul; Jones, Steve

2016-01-01

There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

Administrative simplification, simplified for Hawai'i.

PubMed

Sakamoto, David

2012-04-01

The American health care system contains a layer of administrative controls that has become increasingly burdensome to medical practices in terms of uncompensated physician and staff time and practice costs. A primary care physician in solo practice spends between 4 and 10 hours a week directly interacting with health insurance companies and his or her staff will spend an additional 60 hours a week. This reduces patient-care availability, net practice income and physician job satisfaction. A literature review was conducted to determine possible solutions to administrative burdens physicians face in Hawai'i. A total of 51 articles were found matching search criteria with five being reports from major organizations. Twenty-seven articles were found that related to administrative simplification. The "administrative complexity" problem has been defined and its financial impact quantified. Promising solutions have been developed and proposed by private not-for-profit organizations and by the government, both state and federal. A successful administrative simplification plan would: (1) Provide rapid access to insurance information; (2) Allow medical practices to readily track specific claims; (3) Streamline the preauthorization process through the use of decision-support tools at the practice level and by directing interactions through real-time network connections between insurers and provider electronic health records, thus minimizing phone time; (4) Adopt the Universal Provider Datasource system for provider credentialing; and (5) Standardize (to the greatest degree possible) provider/insurer contracts. These solutions are outlined in detail.

Examining youth and program predictors of engagement in out-of-school time programs.

PubMed

Greene, Kaylin M; Lee, Bora; Constance, Nicole; Hynes, Kathryn

2013-10-01

Prior research suggests that youths' engagement in out-of-school time programs may be a crucial factor linking program participation to positive outcomes during adolescence. Guided by the theoretical concept of flow and by stage-environment fit theory, the present study explored correlates of engagement in youth programs. Engagement was conceptualized as the extent to which youth found the program activities enjoyable, interesting, and challenging. The current study examined how program content, monetary incentives, and youth demographic characteristics were linked to youth engagement among a sample of primarily low-income middle and high school youth attending 30 out-of-school programs (n = 435, 51 % female). Results from multilevel models suggested that program content and staff quality were strongly associated with youth engagement. Youth who reported learning new skills, learning about college, and learning about jobs through activities in the program were more engaged, as were youth who found the staff caring and competent. Results demonstrated that the link between learning content for the future and engagement was stronger for older youth than younger youth. In addition, there was a trend suggesting that providing a monetary incentive was associated negatively with youth engagement. Taken as a whole, these findings have important implications for researchers, practitioners, and policymakers interested in understanding the characteristics of out-of-school time programs that engage older youth.

Clinic flow for STI, HIV, and TB patients in an urban infectious disease clinic offering point-of-care testing services in Durban, South Africa.

PubMed

Stime, Katrina J; Garrett, Nigel; Sookrajh, Yukteshwar; Dorward, Jienchi; Dlamini, Ntuthu; Olowolagba, Ayo; Sharma, Monisha; Barnabas, Ruanne V; Drain, Paul K

2018-05-11

Many clinics in Southern Africa have long waiting times. The implementation of point-of-care (POC) tests to accelerate diagnosis and improve clinical management in resource-limited settings may improve or worsen clinic flow and waiting times. The objective of this study was to describe clinic flow with special emphasis on the impact of POC testing at a large urban public healthcare clinic in Durban, South Africa. We used time and motion methods to directly observe patients and practitioners. We created patient flow maps and recorded individual patient waiting and consultation times for patients seeking STI, TB, or HIV care. We conducted semi-structured interviews with 20 clinic staff to ascertain staff opinions on clinic flow and POC test implementation. Among 121 observed patients, the total number of queues ranged from 4 to 7 and total visit times ranged from 0:14 (hours:minutes) to 7:38. Patients waited a mean of 2:05 for standard-of-care STI management, and approximately 4:56 for STI POC diagnostic testing. Stable HIV patients who collected antiretroviral therapy refills waited a mean of 2:42 in the standard queue and 2:26 in the fast-track queue. A rapid TB test on a small sample of patients with the Xpert MTB/RIF assay and treatment initiation took a mean of 6:56, and 40% of patients presenting with TB-related symptoms were asked to return for an additional clinic visit to obtain test results. For all groups, the mean clinical assessment time with a nurse or physician was 7 to 9 min, which accounted for 2 to 6% of total visit time. Staff identified poor clinic flow and personnel shortages as areas of concern that may pose challenges to expanding POC tests in the current clinic environment. This busy urban clinic had multiple patient queues, long clinical visits, and short clinical encounters. Although POC testing ensured patients received a diagnosis sooner, it more than doubled the time STI patients spent at the clinic and did not result in same-day diagnosis for all patients screened for TB. Further research on implementing POC testing efficiently into care pathways is required to make these promising assays a success.

Reduction of Clostridium Difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods

PubMed Central

Eckstein, Brittany C; Adams, Daniel A; Eckstein, Elizabeth C; Rao, Agam; Sethi, Ajay K; Yadavalli, Gopala K; Donskey, Curtis J

2007-01-01

Background Contaminated environmental surfaces may play an important role in transmission of some healthcare-associated pathogens. In this study, we assessed the adequacy of cleaning practices in rooms of patients with Clostridium difficile-associated diarrhea (CDAD) and vancomycin-resistant Enterococcus (VRE) colonization or infection and examined whether an intervention would result in improved decontamination of surfaces. Methods During a 6-week period, we cultured commonly touched surfaces (i.e. bedrails, telephones, call buttons, door knobs, toilet seats, and bedside tables) in rooms of patients with CDAD and VRE colonization or infection before and after housekeeping cleaning, and again after disinfection with 10% bleach performed by the research staff. After the housekeeping staff received education and feedback, additional cultures were collected before and after housekeeping cleaning during a 10-week follow-up period. Results Of the 17 rooms of patients with VRE colonization or infection, 16 (94%) had one or more positive environmental cultures before cleaning versus 12 (71%) after housekeeping cleaning (p = 0.125), whereas none had positive cultures after bleach disinfection by the research staff (p < 0.001). Of the 9 rooms of patients with CDAD, 100% had positive cultures prior to cleaning versus 7 (78%) after housekeeping cleaning (p = 0.50), whereas only 1 (11%) had positive cultures after bleach disinfection by research staff (p = 0.031). After an educational intervention, rates of environmental contamination after housekeeping cleaning were significantly reduced. Conclusion Our findings provide additional evidence that simple educational interventions directed at housekeeping staff can result in improved decontamination of environmental surfaces. Such interventions should include efforts to monitor cleaning and disinfection practices and provide feedback to the housekeeping staff. PMID:17584935

Qualitative and quantitative evaluation of EHR-integrated mobile patient questionnaires regarding usability and cost-efficiency.

PubMed

Fritz, Fleur; Balhorn, Sebastian; Riek, Markus; Breil, Bernhard; Dugas, Martin

2012-05-01

The objective of this evaluation study is to assess a web-based application, currently available on iPad, to document questionnaires regarding patient reported outcomes such as quality of life. Based on the single source approach, the results of these questionnaires are available in the electronic health record to be used for treatment and research purposes. The assessment focuses on the usability and efficiency of the system. The system usability scale questionnaire with seven additional items was used to rate the usability by the patients. It was formally validated by a Cronbach Alpha test. In addition, semi-structured interviews were conducted with patients and medical staff. Time and cost measures, based on official tables of costs, were taken through workflow observations. This study was conducted in the department of dermatology at the University Hospital of Münster, Germany from April to June 2011. Using the web-based application questionnaire, results about patient reported outcomes like quality of life are immediately available in the electronic health record and can be used for treatment or research purposes. 118 patients and four staff members participated in the study. The usability score reached 80 from 100 points and patients as well as medical staff stated in the interviews that the usability of the web-based system was high, and they preferred it to the previously used paper-based questionnaires. In the setting of our pilot department the mobile devices amortized their costs after 6.7 months. In general, depending on the professional group who are going to post process the paper-based forms, the earliest break-even point to use mobile questionnaires is at 1737 paper sheets per year. The mobile patient questionnaires, integrated into the electronic health record, were well accepted in our pilot setting with high usability scores from patients and medical staff alike. The system has also proved to be cost-efficient compared to the paper-based workflow, given that a certain number of questionnaires is used per year. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Alternative considerations for environmental oversight training: Results from a needs assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Young, C.; Hensley, J.

1995-11-01

For staff to perform their jobs effectively and efficiently, they must be adequately trained. Well-trained staff are also more likely to be satisfied with their jobs and to remain with a given organization. In addition to hiring staff with relevant backgrounds and skills, critical steps in maintaining adequately trained staff are to analyze skill levels needed for the various tasks that personnel are required to perform and to provide training to improve staff s skill base. This first analysis is commonly referred to as a training needs assessment. Training needs are usually determined by defining the tasks required for amore » particular job and the associated knowledge, skills, and abilities necessary to adequately accomplish these tasks. The Office of Northwestern Area Programs of the U.S. Department of Energy`s (DOE`s) Office of Environmental Management (EM) oversees environmental remediation activities in the Chicago, Idaho, Oakland, and Richland Operations Offices. For this organization to effectively carry out its mission, its staff need to be as proficient as possible in the appropriate knowledge and skills. Therefore, a training needs assessment was conducted to determine staff`s level of knowledge and proficiency in various skills. The purpose of the assessment was to: (1) Examine the types of activities or tasks in which staff are involved, (2) Determine the skills needed to perform relevant tasks, and (3) Assess gaps in knowledge and skills for the tasks performed in order to suggest opportunities for skill development.« less

Productivity and turnover in PCPs: the role of staff participation in decision-making.

PubMed

Hung, Dorothy Y; Rundall, Thomas G; Cohen, Deborah J; Tallia, Alfred F; Crabtree, Benjamin F

2006-10-01

Efforts to redesign primary care practices are beginning to address how decisions are made in the practice setting. This study contributes to these efforts by examining associations between staff participation in decision-making, productivity, and turnover in primary care practices. The study is informed by organizational theories of participation that emphasize cognitive and affective influences on employee output and behavior. This research used data collected from primary care practices involved in a national initiative sponsored by the Robert Wood Johnson Foundation. Cross-sectional survey data on organizational structures and attributes among 49 practices were analyzed. Regression analysis was used to examine associations among practice productivity, staff participation in decision-making, and formal structures such as staff meetings. Associations between staff turnover and participative decision-making were also examined. Staff participation in decisions regarding quality improvement, practice change, and clinical operations was positively associated with practice productivity, whereas formal structures such as staff meetings were not. In addition, higher levels of participation in decision-making were associated with reduced turnover among nonclinicians and administrative staff. Examination of organizational features is increasingly recognized as a key to improving primary care performance. Study findings suggest that one important strategy may be implementation of a participative model emphasizing greater staff involvement in practice decisions. This may enhance information-sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices.

Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities.

PubMed

Beer, Christopher; Horner, Barbara; Almeida, Osvaldo P; Scherer, Samuel; Lautenschlager, Nicola T; Bretland, Nick; Flett, Penelope; Schaper, Frank; Flicker, Leon

2009-08-12

Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of person centred care, system factors and the multidisciplinary team were consistently and frequently cited. Small group education which is flexible, individualized, practical and case based was sought. The effectiveness and sustainability of an educational intervention based on these findings needs to be tested. In addition, future interventions should focus on supporting cultural change to facilitate sustainable improvements in care.

Dosimetric evaluation of the staff working in a PET/CT department

NASA Astrophysics Data System (ADS)

Dalianis, K.; Malamitsi, J.; Gogou, L.; Pagou, M.; Efthimiadou, R.; Andreou, J.; Louizï, A.; Georgiou, E.

2006-12-01

The dosimetric literature data concerning the medical personnel working in positron emission tomography/computed tomography (PET/CT) departments are limited. Therefore, we measured the radiation dose of the staff working in the first PET/CT department in Greece at the Diagnostic and Therapeutic Center of Athens HYGEIA—Harvard Medical International. As, for the time being, only 2-deoxy-2-[ 18F]fluoro-d-glucose (FDG) PET studies are performed, radiation dose measurements concern those derived from dispensing of the radiopharmaceutical as well as from the patients undergoing FDG-PET imaging. Our aim is to develop more effective protective measures against radionuclide exposure. To estimate the effective dose from external exposure, all seven members of the staff (two nurses, two medical physicists, two technologists, one secretary) had TLD badges worn at the upper pocket of their overall, TLD rings on the right hand and digital dosimeters at their upper side pocket. In addition, isodose curves were measured with thermoluminescence detectors for distances of 20, 50, 70 and 100 cm away from patients who had been injected with 18F-FDG. Dose values of the PET/CT staff were measured with digital detectors, TLD badges and TLD rings over the first 8 months for a total of 160 working days of the department's operation, consisting of a workload of about 10-15 patients/week who received 250-420 MBq of 18F-FDG each. Whole - body collective doses and hand doses for the staff were the following: Nurse #1 received 1.6 mSv as a whole body dose and 2,1 as a hand dose, Nurse #2 received 1.9 and 2.4 mSv respectively. For medical physicist #1 the dose values were 1.45 mSv whole body and 1.7 mSv hand dose, for medical physicist #2 1.67 mSv wholebody dose and 1.55 mSv hand dose and for technologists #1 & #2 the whole body doses were 0.7 and 0.64 mSv respectively. Lastly, the secretary received 0.1 mSv whole body dose. These preliminary data have shown that the dose levels of our PET/CT staff are within acceptable limits.

Healthcare system cost evaluation of antiviral stockpiling for pandemic influenza preparedness.

PubMed

Li, Yang; Hsu, Edbert B; Links, Jonathan M

2010-06-01

Healthcare workers need to be protected during a severe influenza outbreak; therefore, we evaluated 4 different antiviral strategies: (1) using antiviral medication for outbreak prophylaxis of all hospital employees; (2) using antiviral medication for postexposure prophylaxis (PEP) or treatment of all hospital employees; (3) using a combination of antiviral medication for outbreak prophylaxis of high-risk clinical staff and postexposure prophylaxis or treatment for all other staff; and (4) using antiviral medication for postexposure prophylaxis or treatment of high-risk clinical staff only. Three different purchasing options were applied to each of the 4 antiviral strategies: (1) just-in-time purchase during a severe influenza outbreak, (2) prepandemic stockpiling, or (3) stockpiling through contracts with pharmaceutical manufacturers to reserve a predetermined antiviral supply. Although outbreak prophylaxis of all hospital employees would offer the maximum protection, the large costs associated with such a purchase make this option unrealistic and impractical. In addition, even though postexposure prophylaxis or treatment of only high-risk clinical staff would incur the least expense, the assumed level of protection if these options were offered only to high-risk clinical staff may not be sufficient to maintain routine hospital operations, since needed non-high-risk staff would not be protected. Considering the potential benefits and drawbacks of stockpiling antiviral medication from a cost perspective, it does not appear feasible for hospitals to stockpile antiviral medication in large quantities prior to a severe influenza outbreak. This article focuses on the financial viability of stockpiling antiviral medication, but the potential impact of other factors on the decision to stockpile was also considered and will be explored in future analyses. While legal hurdles related to prescribing, storing, and dispensing antiviral medication can be addressed, unavailability of a suitable vaccine supply may strongly support a decision to stockpile antiviral medication. Other issues to be addressed include antiviral resistance specifically related to the efficacy of oseltamivir, coupled with a high frequency of secondary bacterial infections; uncertainties about the degree of government assistance; potential government seizures of stockpiled assets; and legal and ethical concerns related to fair access to stockpiled medication. These issues may all be perceived as barriers to the feasibility of stockpiling antiviral medication.

Thinking Big for 25 Years: Astronomy Camp Research Projects

NASA Astrophysics Data System (ADS)

Hooper, Eric Jon; McCarthy, D. W.; Benecchi, S. D.; Henry, T. J.; Kirkpatrick, J. D.; Kulesa, C.; Oey, M. S.; Regester, J.; Schlingman, W. M.; Camp Staff, Astronomy

2013-01-01

Astronomy Camp is a deep immersion educational adventure for teenagers and adults in southern Arizona that is entering its 25th year of existence. The Camp Director (McCarthy) is the winner of the 2012 AAS Education Prize. A general overview of the program is given in an accompanying contribution (McCarthy et al.). In this presentation we describe some of the research projects conducted by Astronomy Camp participants over the years. Many of the Camps contain a strong project-oriented emphasis, which reaches its pinnacle in the Advanced Camps for teenagers. High school students from around the world participate in a microcosm of the full arc of astronomy research. They plan their own projects before the start of Camp, and the staff provide a series of "key projects." Early in the Camp the students submit observing proposals to utilize time on telescopes. (The block of observing time is secured in advance by the staff.) The participants collect, reduce and analyze astronomical data with the help of staff, and they present the results to their peers on the last night of Camp, all in a span of eight days. The Camps provide research grade telescopes and instruments, in addition to amateur telescopes. Some of the Camps occur on Kitt Peak, where we use an ensemble of telescopes: the 2.3-meter (University of Arizona) with a spectrograph; the WIYN 0.9-meter; the McMath-Pierce Solar Telescope; and the 12-meter millimeter wave telescope. Additionally the Camp has one night on the 10-meter Submillimeter Telescope on Mt. Graham. Campers use these resources to study stars, galaxies, AGN, transiting planets, molecular clouds, etc. Some of the camper-initiated projects have led to very high level performances in prestigious international competitions, such as the Intel International Science and Engineering Fair. The key projects often contribute to published astronomical research (e.g., Benecchi et al. 2010, Icarus, 207, 978). Many former Campers have received Ph.D. degrees in astronomy and other sciences and are now faculty members, a current Hubble Fellow, the PI of a facility class instrument on an 11-meter telescope (SALT), etc.

The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study.

PubMed

Hollingworth, William; Devine, Emily Beth; Hansen, Ryan N; Lawless, Nathan M; Comstock, Bryan A; Wilson-Norton, Jennifer L; Tharp, Kathleen L; Sullivan, Sean D

2007-01-01

Electronic prescribing has improved the quality and safety of care. One barrier preventing widespread adoption is the potential detrimental impact on workflow. We used time-motion techniques to compare prescribing times at three ambulatory care sites that used paper-based prescribing, desktop, or laptop e-prescribing. An observer timed all prescriber (n = 27) and staff (n = 42) tasks performed during a 4-hour period. At the sites with optional e-prescribing >75% of prescription-related events were performed electronically. Prescribers at e-prescribing sites spent less time writing, but time-savings were offset by increased computer tasks. After adjusting for site, prescriber and prescription type, e-prescribing tasks took marginally longer than hand written prescriptions (12.0 seconds; -1.6, 25.6 CI). Nursing staff at the e-prescribing sites spent longer on computer tasks (5.4 minutes/hour; 0.0, 10.7 CI). E-prescribing was not associated with an increase in combined computer and writing time for prescribers. If carefully implemented, e-prescribing will not greatly disrupt workflow.

Staff attributions of the causes of challenging behaviour in children and adults with profound intellectual and multiple disabilities.

PubMed

Poppes, P; van der Putten, A A J; ten Brug, A; Vlaskamp, C

2016-01-01

A study has shown that staff do not generally perceive challenging behaviour in people with profound intellectual and multiple disabilities (PIMD) as being of serious consequence. In this study we aimed to gain a better understanding of the causal explanations that direct care and support staff give for challenging behaviour in this group. The purpose of this study was twofold: (1) to determine the way staff attribute challenging behaviour in children and adults with PIMD; and (2) to analyse whether more experienced staff attribute challenging behaviour in children and adults with PIMD differently than less experienced staff. In total, 195 direct support staff and an equal number of children and adults with PIMD participated in the study. Direct support staff filled out the Challenging behaviour Attribution Scale (five causal explanatory models of challenging behaviour) to explain challenging behaviour in one individual that they supported. The results show that direct support staff as a whole report the biomedical model as the most plausible explanation for challenging behaviour in children and adults with PIMD. However, in the present study the mean scores on all models are low. This might indicate that a large number of staff found none of the models particularly useful as possible explanations of challenging behaviour in people with PIMD. This could mean that staff have difficulties stating the cause of challenging behaviour in this group. Another possible explanation could be that there is little scientific knowledge about causing and maintaining factors of challenging behaviour in people with PIMD. It could also mean that staff have additional explanations for challenging behaviour in this target group that are not mentioned in the instrument used. Future research should address these issues. No differences were found between more experienced and less experienced direct support staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection.

PubMed

Weidle, Paul J; Lecher, Shirley; Botts, Linda W; Jones, LaDawna; Spach, David H; Alvarez, Jorge; Jones, Rhondette; Thomas, Vasavi

2014-01-01

To test the feasibility of offering rapid point-of-care human immunodeficiency virus (HIV) testing at community pharmacies and retail clinics. Pilot program to determine how to implement confidential HIV testing services in community pharmacies and retail clinics. 21 community pharmacies and retail clinics serving urban and rural patients in the United States, from August 2011 to July 2013. 106 community pharmacy and retail clinic staff members. A model was developed to implement confidential HIV counseling and testing services using community pharmacy and retail clinic staff as certified testing providers, or through collaborations with organizations that provide HIV testing. Training materials were developed and sites selected that serve patients from urban and rural areas to pilot test the model. Each site established a relationship with its local health department for HIV testing policies, developed referral lists for confirmatory HIV testing/care, secured a CLIA Certificate of Waiver, and advertised the service. Staff were trained to perform a rapid point-of-care HIV test on oral fluid, and provide patients with confidential test results and information on HIV. Patients with a preliminary positive result were referred to a physician or health department for confirmatory testing and, if needed, HIV clinical care. Number of HIV tests completed and amount of time required to conduct testing. The 21 participating sites administered 1,540 HIV tests, with 1,087 conducted onsite by staff during regular working hours and 453 conducted at 37 different HIV testing events (e.g., local health fairs). The median amount of time required for pretest counseling/consent, waiting for test results, and posttest counseling was 4, 23, and 3 minutes, respectively. A majority of the sites (17) said they planned to continue HIV testing after the project period ended and would seek assistance or support from the local health department, a community-based organization, or an AIDS service organization. This pilot project established HIV testing in several community pharmacies and retail clinics to be a feasible model for offering rapid, point-of-care HIV testing. It also demonstrated the willingness and ability of staff at community pharmacies and retail clinics to provide confidential HIV testing to patients. Expanding this model to additional sites and evaluating its feasibility and effectiveness may serve unmet needs in urban and rural settings.

Improving OR Efficiency.

PubMed

Vassell, Patricia

2016-08-01

The high-cost/high-revenue environment of the OR requires special attention from managers to scrutinize and reduce costs. In the OR, nonlabor cost savings (ie, no staff member will be laid off or reclassified to realize cost savings) can typically be identified most readily. Operational costs in the OR are affected by start times, turnover times, cancellation rates, and adequate supplies, equipment, and staffing. Inefficiency in the OR can increase costs and lead to dissatisfied patients, physicians, and staff members. This article describes concepts that contribute to efficiency in the OR and illustrates the importance of staff member engagement in achieving desired outcomes. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Automatic pattern identification of rock moisture based on the Staff-RF model

NASA Astrophysics Data System (ADS)

Zheng, Wei; Tao, Kai; Jiang, Wei

2018-04-01

Studies on the moisture and damage state of rocks generally focus on the qualitative description and mechanical information of rocks. This method is not applicable to the real-time safety monitoring of rock mass. In this study, a musical staff computing model is used to quantify the acoustic emission signals of rocks with different moisture patterns. Then, the random forest (RF) method is adopted to form the staff-RF model for the real-time pattern identification of rock moisture. The entire process requires only the computing information of the AE signal and does not require the mechanical conditions of rocks.

Los Angeles City College Celebrates Fifty Years of Bringing-Forth, 1929-1979: An Anthology of the Work of Faculty, Staff and Students.

ERIC Educational Resources Information Center

Eisenstein, Sam A., Ed.

Works by faculty, emeriti, staff, students, and alumni of Los Angeles City College (LACC) commemorate the 50th anniversary of the school. The anthology contains graphics, poetry, fiction, manifesto, reminiscences, humor, and essays. Certain essays focus on the history of LACC and individuals prominent in its history. In addition, short histories…

Evaluating the Inter-Respondent (Consumer vs. Staff) Reliability and Construct Validity (SIS vs. Vineland) of the Supports Intensity Scale on a Dutch Sample

ERIC Educational Resources Information Center

Claes, C.; Van Hove, G.; van Loon, J.; Vandevelde, S.; Schalock, R. L.

2009-01-01

Background: Despite various reliability studies on the Supports Intensity Scale (SIS), to date there has not been an evaluation of the reliability of client vs. staff judgments. Such determination is important, given the increasing consumer-driven approach to services. Additionally, there has not been an evaluation of the instrument's construct…

Interventions to improve communication between people with dementia and nursing staff during daily nursing care: A systematic review.

PubMed

Machiels, Mariska; Metzelthin, Silke F; Hamers, Jan P H; Zwakhalen, Sandra M G

2017-01-01

To provide adequate nursing care it is important for nursing staff to communicate effectively with people with dementia. Due to their limited communication skills, people with dementia have difficulties in understanding communication and expressing themselves verbally. Nursing staff members often report communication difficulties with people with dementia, which emphasises the urgent need for interventions to improve their communication with people in this specific target group. To provide an up-to-date overview of communication interventions that are applicable during daily nursing care activities, irrespective of care setting, and to describe the effects on communication outcomes in people with dementia and nursing staff. Systematic literature review DATA SOURCES: The Cochrane Library, CINAHL, PsycINFO, and Pubmed databases were searched for all articles published until the 23rd of February 2016. Papers were included, if: (1) interventions focused on communication between nursing staff and people with dementia and were applicable during daily nursing care; (2) studies were (randomised) controlled trials; (3) papers were written in English, Dutch, or German. Data were extracted on content and communication outcomes of interventions, and on methodological quality of the studies. The data extraction form and methodological quality checklist were based on the Method Guidelines for Systematic Reviews for the Cochrane Back Review Group. Six studies on communication interventions were included. All of the studies incorporated a communication skills training for nursing staff with a broad range in frequency, duration and content. In addition, there was wide variation in the communication outcome measures used. Four studies measured non-verbal communication, all found positive effects on at least some of the communication outcomes. Four studies measured verbal communication, of which three found positive effects on at least one of the measured outcomes. Methodological quality assessment demonstrated a high risk of bias in five of the six studies. Few studies have been identified with wide variation in interventions and outcome measures. In addition, the methodological shortcomings make it difficult, to draw conclusions about the effectiveness. More research is needed to develop and evaluate communication interventions. Additionally, it is useful to reach consensus on defining and measuring communication. Copyright © 2017 Elsevier Ltd. All rights reserved.

Antenatal Clinic and Stop Smoking Services Staff Views on “Opt-Out” Referrals for Smoking Cessation in Pregnancy: A Framework Analysis

PubMed Central

Campbell, Katarzyna Anna; Bowker, Katharine Anna; Naughton, Felix; Sloan, Melanie; Cooper, Sue; Coleman, Tim

2016-01-01

Introduction: UK guidance recommends routine exhaled carbon monoxide (CO) screening for pregnant women and “opt-out” referrals to stop smoking services (SSS) of those with CO ≥ 4 ppm. We explored staff views on this referral pathway when implemented in one UK hospital Trust. Methods: Seventeen semi-structured interviews with staff involved in the implementation of the new referral pathway: six antenatal clinic staff (before and after implementation); five SSS staff (after). Data were analyzed using framework analysis. Results: Two themes were identified: (1) views on implementation of the pathway and (2) impact of the pathway on the women. Generally, staff felt that following training, referrals were less arduous to implement and better received than expected. The majority believed this pathway helped engage women motivated to quit and offered a unique chance to impart smoking cessation knowledge to hard-to-reach women, who might not otherwise contact SSS. An unexpected issue arose during implementation—dealing with non-smokers with high CO readings. Conclusions: According to staff, the “opt-out” referral pathway is an acceptable addition to routine antenatal care. It can help engage hard-to-reach women and educate them about the dangers of smoking in pregnancy. Incorporating advice on dealing with non-smokers with high CO into routine staff training could help future implementations. PMID:27754352

Nursing teamwork, staff characteristics, work schedules, and staffing.

PubMed

Kalisch, Beatrice J; Lee, Hyunhwa

2009-01-01

This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.

How much is not enough? Human resources requirements for primary health care: a case study from South Africa.

PubMed

Daviaud, Emmanuelle; Chopra, Mickey

2008-01-01

To quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. We use a model to estimate staffing requirements at primary health care facilities. The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility. We also calculate the number of HIV-related consultations per district. The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing. Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres. Overall the number of doctors is only 7% of the required amount. There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages. The number of enrolled nurses is 60% of what it should be. There are 17% too few enrolled nurse assistants. Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff. The application of an adapted WHO workload tool identified important human resource planning issues.

Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals.

PubMed

Petersen Williams, Petal; Petersen, Zaino; Sorsdahl, Katherine; Mathews, Catherine; Everett-Murphy, Katherine; Parry, Charles D H

2015-01-01

Despite the negative consequences of alcohol and other drug use during pregnancy, few interventions for pregnant women are implemented, and little is known about their feasibility and acceptability in primary health care settings in South Africa. As part of the formative phase of screening, brief intervention, and referral to treatment for substance use among women presenting for antenatal care, the present study explored health care workers' attitudes and perceptions about screening, brief intervention, and referral to treatment among this population. Forty-three health care providers at 2 public sector midwife obstetric units in Cape Town, South Africa, were interviewed using an open-ended, semistructured interview schedule designed to identify factors that hinder or support the implementation of screening, brief intervention, and referral to treatment for substance use in these settings. Transcribed interviews were analyzed using the framework approach. Health care providers agreed that there is a substantial need for screening, brief intervention, and referral to treatment for substance use among pregnant women and believe such services potentially could be integrated into routine care. Several women-, staff-, and clinic-level barriers were identified that could hinder the successful implementation in antenatal services. These barriers included the nondisclosure of alcohol and other drug use, the intervention being considered as an add-on service or additional work, negative staff attitudes toward implementation of an intervention, poor staff communication styles such as berating women for their behavior, lack of interest from staff, time constraints, staff shortages, overburdened workloads, and language barriers. The utility of screening, brief intervention, and referral to treatment for addressing substance use among pregnant women in public health midwife obstetric units was supported, but consideration will need to be given to addressing a variety of barriers that have been identified. © 2015 by the American College of Nurse-Midwives.

GIS management system of power plant staff based on wireless fidelity indoor location technology

NASA Astrophysics Data System (ADS)

Zhang, Ting

2017-05-01

The labor conditions and environment of electric power production are quite complicated. It is very difficult to realize the real-time supervision of the employees' working conditions and safety. Using the existing base stations in the power plant, the wireless fidelity network is established to realize the wireless coverage of the work site. We can use mobile phone to communicate and achieve positioning. The main content of this project is based on the special environment of the power plant, designed a suitable for ordinary Android mobile phone indoor wireless fidelity positioning system, real-time positioning and record the scene of each employee's movement trajectory, has achieved real-time staff check Gang, Staff in place, and for the safety of employees to provide a guarantee.

Show that you care.

PubMed

Wesolowski, C E

1990-01-01

Are you an Ebenezer Scrooge when it comes to reward and recognition for your staff? How many times last week did you phone a member of your staff, or better yet, visit in person to say that you appreciated something they did? When was the last time you wrote a note of thanks? Do you routinely recognize special efforts during staff meetings? When was the last time you awarded a certificate of appreciation to an employee for a job well done? Are employees working "behind the scenes" recognized? Do you have a system in place to recognize groups who work well as a team? If you answered "no" to most of these questions, don't fret. Establishing a reward and recognition program is relatively easy to do. And, it won't break the budget either.

Communicating with School Nurses about Sexual Orientation and Sexual Health: Perspectives of Teen Young Men who have Sex with Men

PubMed Central

Rasberry, Catherine N.; Morris, Elana; Lesesne, Catherine A.; Kroupa, Elizabeth; Topete, Pablo; Carver, Lisa H.; Robin, Leah

2015-01-01

Black and Latino young men who have sex with men (YMSM) are at disproportionate risk for sexually transmitted diseases (STDs), including HIV. This study informs school-centered strategies for connecting YMSM to health services by describing their willingness, perceived safety, and experiences in talking to school staff about sexual health. Cross-sectional data were collected from black and Latino YMSM ages 13–19 through Web-based questionnaires (n=415) and interviews (n=32). School nurses were the staff members youth most often reported willingness to talk to about HIV testing (37.8%), STD testing (37.1%), or condoms (37.3%), but least often reported as safe to talk to about attraction to other guys (11.4%). Interviews revealed youth reluctance to talk with school staff including nurses when uncertain of staff members’ perceptions of LGBTQ people or perceiving staff to lack knowledge of LGBTQ issues, communities, or resources. Nurses may need additional training to effectively reach black and Latino YMSM. PMID:25519713

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

PubMed

Alamgir, Hasanat; Li, Olivia Wei; Yu, Shicheng; Gorman, Erin; Fast, Catherine; Kidd, Catherine

2009-09-01

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

Agent of opportunity risk mitigation: people, engineering, and security efficacy.

PubMed

Graham, Margaret E; Tunik, Michael G; Farmer, Brenna M; Bendzans, Carly; McCrillis, Aileen M; Nelson, Lewis S; Portelli, Ian; Smith, Silas; Goldberg, Judith D; Zhang, Meng; Rosenberg, Sheldon D; Goldfrank, Lewis R

2010-12-01

Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk. Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes. We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to "defeat" inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about "open" front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls. We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered.

Emotional and informational support for families during their child's illness.

PubMed

Sarajärvi, A; Haapamäki, M L; Paavilainen, E

2006-09-01

To describe and compare the support provided by nursing staff to families during their child's illness from the viewpoint of families and nurses. A survey method was used. Data were collected by questionnaires planned for families and staff separately. The study population consisted of families who visited paediatric outpatient clinics, families with hospitalized children (n = 344) and the paediatric nursing staff (n = 60). Almost half of the families had received adequate emotional and informational support from the nursing staff for their physical and psychological reactions. One-fifth of the families reported that they had not been supported at all during the child's hospitalization. According to families and nurses, the support was provided in the forms of discussion, listening and giving time. Families' and nurses' suggestions for development of support were related to the time resources of the staff, to the flow of information, to more client-centred attitudes, to being appreciated and listened to and to home care guidance. However, the pervasiveness of this problem in the international literature suggests that deeper consideration of possible underlying reasons for this phenomenon is called for.

Developing an emotional coping skills workbook for inpatient psychiatric settings: a focus group investigation.

PubMed

Sharp, Molly; Gulati, Anu; Barker, Chris; Barnicot, Kirsten

2018-06-22

Evidence suggests an unmet need for provision of psychological interventions in inpatient psychiatric settings. However, inpatient wards can present a challenging environment in which to implement interventions. The authors developed the Emotional Coping Skills workbook, a psychosocial intervention designed to overcome these challenges and provide inpatients with an opportunity for psychologically-informed therapeutic engagement. The workbook includes information and exercises to empower inpatients to understand their emotions and learn to cope with their distress. A qualitative study using thematic analysis was undertaken in two UK inpatient psychiatric hospitals to explore staff's views about whether and how the workbook could be implemented, and on barriers to its use. Thirty-five nursing and occupational therapy staff members participated in four focus groups, and a further two psychologists in semi-structured interviews. Staff identified key barriers to successful implementation of the workbook. These were firstly, the difficulty in finding time and space for therapeutic work in the stressful ward environment. Secondly, staff identified a culture of emotional neglect whereby neither staff nor inpatients felt able to talk about emotions, and patients' physical needs and medication were prioritised. Thirdly, staff discussed how psychotic symptoms and emotional distress could limit patients' ability to engage with the workbook material. Staff suggested ways in which the feasibility of using the workbook could be enhanced. Firstly, they discussed the importance of encouraging staff to value psychological approaches and to view the workbook as a resource to help them manage their existing tasks. Secondly, they emphasised the value of staff drawing on their expertise to deliver the workbook flexibly in different formats and settings, depending on each patient's particular presentation. Thirdly, they advocated empowering staff to decide the timing of intervention delivery in the context of each inpatient's fluctuations in distress and progress towards recovery. The study has highlighted key principles for flexible and well-integrated intervention delivery; these principles will be helpful for enhancing the feasibility of any nurse-delivered psychological intervention in inpatient settings.

"This is not a drill": Activation of a student-led influenza vaccination point of dispensing.

PubMed

Adams, Lavonne M; Canclini, Sharon; Tillman, Kelle

2018-04-13

To describe activation of a Point of dispensing (POD) in response to an influenza outbreak, highlighting the use of a student-led model. Faculty, staff, and students of Harris College of Nursing and Health Sciences, Texas Christian University (TCU), as well as those located in its primary building. In response to an August 2017 influenza outbreak, a vaccination clinic was conducted for a target population through POD activation. The larger campus community was served through provision of additional doses by the Texas Christian University Health Center and the annual October student-led vaccination clinic. Eleven additional cases were diagnosed after vaccinations began. One hundred percent of the targeted population was vaccinated (n = 824), with an additional 127 participants vaccinated (others working in the building where POD held also vaccinated). This was the first time POD activation had occurred on campus in response to an outbreak.

Using distance technologies to facilitate a learning collaborative to implement stagewise treatment.

PubMed

Covell, Nancy H; Foster, Forrest P; Margolies, Paul J; Lopez, Luis O; Dixon, Lisa B

2015-06-01

This report describes experiences and outcomes of an online learning collaborative focused on implementation of stagewise treatment. Eleven participating programs convened online monthly for a year. Between meetings, program staff created an implementation plan and programs collected performance indicator data, including assessment of staff knowledge of integrated treatment for people with co-occurring disorders, whether a person's current stage of treatment was documented in his or her chart, and whether the treatments were appropriate for the stage of treatment. Descriptive statistics were used to characterize performance indicators and feedback. Wilcoxon matched-pairs signed-rank tests examined changes in performance indicators over time. Program staff generally demonstrated significant improvements in performance indicators over time and rated the distance learning collaborative favorably. Distance learning collaboratives can be structured to provide opportunities for program staff to interact and learn from one another and to implement and sustain changes.

Ergonomics and patient handling.

PubMed

McCoskey, Kelsey L

2007-11-01

This study aimed to describe patient-handling demands in inpatient units during a 24-hour period at a military health care facility. A 1-day total population survey described the diverse nature and impact of patient-handling tasks relative to a variety of nursing care units, patient characteristics, and transfer equipment. Productivity baselines were established based on patient dependency, physical exertion, type of transfer, and time spent performing the transfer. Descriptions of the physiological effect of transfers on staff based on patient, transfer, and staff characteristics were developed. Nursing staff response to surveys demonstrated how patient-handling demands are impacted by the staff's physical exertion and level of patient dependency. The findings of this study describe the types of transfers occurring in these inpatient units and the physical exertion and time requirements for these transfers. This description may guide selection of the most appropriate and cost-effective patient-handling equipment required for specific units and patients.

Impact on staff of improving access to the school breakfast program: a qualitative study.

PubMed

Haesly, Blair; Nanney, Marilyn S; Coulter, Sara; Fong, Sherri; Pratt, Rebekah J

2014-04-01

Project BREAK! was designed to test the efficacy of an intervention to increase student participation in the reimbursable School Breakfast Program (SBP). Two schools developed grab-n-go menus, added convenient serving locations, and allowed eating in the hallway. This follow-up study investigated faculty and staff perspectives of how the SBP changes influenced schools. Project BREAK! high schools were located near Minneapolis, Minnesota, enrolled over 1200 students each and were 70% to 90% white. Interviews with school personnel (N = 11) and focus groups with teachers (N = 16) from the 2 intervention schools were conducted. The Diffusion of Innovation (DOI) framework guided the question development. Analysis of the interviews identified the following DOI constructs as most prominently mentioned by school personnel and teachers: advantages for students and faculty/staff, minimal staff time required, communication of the changes, support of social relations between students and faculty/staff and trialability of the program. There appears to be numerous advantages for both students and school personnel to improving SBP access. The relative advantages of Project BREAK! appear to outweigh the negatives associated with extra time and effort required by staff. Communication about the changes is an area that needs strengthening. © 2014, American School Health Association.

Hospital accreditation: staff experiences and perceptions.

PubMed

Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

2018-06-11

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

Impact on staff of improving access to the school breakfast program: a qualitative study

PubMed Central

Haesly, Blair; Nanney, Marilyn S.; Coulter, Sara; Fong, Sherri; Pratt, Rebekah J.

2014-01-01

BACKGROUND Project BREAK! was designed to test the efficacy of an intervention to increase student participation in the reimbursable School Breakfast Program (SBP). Two schools developed grab-n-go menus, added convenient serving locations, and allowed eating in the hallway. This follow-up study investigated faculty and staff perspectives of how the SBP changes influenced schools. METHODS Project BREAK! high schools were located near Minneapolis, Minnesota, enrolled over 1200 students each and were 70%–90% white. Interviews with school personnel (N=11) and focus groups with teachers (N=16) from the 2 intervention schools were conducted. The Diffusion of Innovation (DOI) framework guided the question development. RESULTS Analysis of the interviews identified the following DOI constructs as most prominently mentioned by school personnel and teachers: advantages for students and faculty/staff, minimal staff time required, communication of the changes, support of social relations between students and faculty/staff and trialability of the program. CONCLUSION There appears to be numerous advantages for both students and school personnel to improving SBP access. The relative advantages of Project BREAK! appear to outweigh the negatives associated with extra time and effort required by staff. Communication about the changes is an area that needs strengthening. PMID:24617910

The health-care environment on a locked psychiatric ward: an ethnographic study.

PubMed

Johansson, Inger M; Skärsäter, Ingela; Danielson, Ella

2006-12-01

Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.

Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency.

PubMed

Lin, Sandra Y; Gavney, Dean; Ishman, Stacey L; Cady-Reh, Julie

2013-11-01

To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion. Prospective observational study. Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non-value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later. Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P = .042). On-time starts for patient exams improved by 34% (χ(2) = 16.091, P < .001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit. Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non-value added steps or processes were key to improvement. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Factors that affect the flow of patients through triage.

PubMed

Lyons, Melinda; Brown, Ruth; Wears, Robert

2007-02-01

To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. A two-phase study comprising observation of 16 h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870 min including 257 patients and for 16 different members of the triage staff. No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13 min 34 s; the average length of time to triage for a patient was 4 min 17 s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively "seen and treated" in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non-qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.

Using Video Modeling with Voiceover Instruction Plus Feedback to Train Staff to Implement Direct Teaching Procedures.

PubMed

Giannakakos, Antonia R; Vladescu, Jason C; Kisamore, April N; Reeve, Sharon A

2016-06-01

Direct teaching procedures are often an important part of early intensive behavioral intervention for consumers with autism spectrum disorder. In the present study, a video model with voiceover (VMVO) instruction plus feedback was evaluated to train three staff trainees to implement a most-to-least direct (MTL) teaching procedure. Probes for generalization were conducted with untrained direct teaching procedures (i.e., least-to-most, prompt delay) and with an actual consumer. The results indicated that VMVO plus feedback was effective in training the staff trainees to implement the MTL procedure. Although additional feedback was required for the staff trainees to show mastery of the untrained direct teaching procedures (i.e., least-to-most and prompt delay) and with an actual consumer, moderate to high levels of generalization were observed.

The oppressive nature of work in healthcare: predictors of aggression against nurses and administrative staff.

PubMed

Rodwell, John; Demir, Defne; Flower, Rebecca L

2013-09-01

To assess the antecedents of workplace aggression (bullying and violence) among nurses and administration staff. As a result of power structures within the healthcare industry, nurses and administration staff may be more vulnerable to workplace aggression. Environmental and individual characteristics have been linked to the occurrence of such aggression among other groups. However, most research focuses on bullying, rarely extending these ideas to violence or nurses and administration staff specifically. Surveys were distributed to nurses and administration staff employed by an Australian healthcare organisation. Aggression types (bullying and violence), as well as environmental (demands, control and support) and individual (negative affectivity, NA) characteristics were measured. External emotional abuse was most frequently reported for nurses (29%) and bullying for administration staff (27%). Demands, support and NA were associated with different aggression types in nurses, whereas for administration staff, control, support and NA were linked. Low support and high NA are particularly important to nurses and administration staff and their experiences of aggression. Appropriate training for managers in providing support and acknowledging individual factors associated with aggression is essential. Further, managers should monitor aggression risk from patients and their associations towards staff in busy times. © 2013 John Wiley & Sons Ltd.

Birth Outcomes, Intervention Frequency, and the Disappearing Midwife-Potential Hazards of Central Fetal Monitoring: A Single Center Review.

PubMed

Brown, James; McIntyre, Andrew; Gasparotto, Robyn; McGee, Therese M

2016-06-01

Many birth units use central fetal monitoring (CFM) under the assumption that greater surveillance improves perinatal outcomes. The unexpected loss of the CFM system at a tertiary unit provided a unique opportunity to evaluate outcomes and staff attitudes toward CFM. This retrospective cohort study compared patient data from 2,855 electronically monitored women delivering over a 12-month period, where CFM was available for the first 6 months but unavailable for the following 6 months. Primary outcomes relating to neonatal morbidity and secondary outcomes relating to intrapartum interventions were examined. Additionally, birth unit staff members were surveyed about aspects of care related to CFM. There were no significant differences in perinatal outcomes between the cohorts. While unadjusted analysis suggested a lower spontaneous vaginal birth rate (55.4% vs 60.3%) and a higher cesarean delivery rate (25.1% vs 22.0%, p = 0.026), together with higher epidural (53.0% vs 49.2%, p = 0.04) and fetal blood sampling (11.8% vs 9.4%, p = 0.03) rates in the presence of CFM, these differences were lost when adjusted for prostaglandin ripening. Over half of the staff (56.0% of midwives, 54.0% of obstetricians) reported spending more time with the laboring woman in the period without CFM. This single institution's experience indicates that in birth units staffed for one-to-one care in labor, central fetal monitoring does not appear to be associated with either a benefit on perinatal outcomes or an increase in cesarean delivery and other interventions. However, it is associated with a reduction in the time a midwife spends with the laboring woman. © 2016 Wiley Periodicals, Inc.

Automation in an Addiction Treatment Research Clinic: Computerized Contingency Management, Ecological Momentary Assessment, and a Protocol Workflow System

PubMed Central

Vahabzadeh, Massoud; Lin, Jia-Ling; Mezghanni, Mustapha; Epstein, David H.; Preston, Kenzie L.

2009-01-01

Issues A challenge in treatment research is the necessity of adhering to protocol and regulatory strictures while maintaining flexibility to meet patients’ treatment needs and accommodate variations among protocols. Another challenge is the acquisition of large amounts of data in an occasionally hectic environment, along with provision of seamless methods for exporting, mining, and querying the data. Approach We have automated several major functions of our outpatient treatment research clinic for studies in drug abuse and dependence. Here we describe three such specialized applications: the Automated Contingency Management (ACM) system for delivery of behavioral interventions, the Transactional Electronic Diary (TED) system for management of behavioral assessments, and the Protocol Workflow System (PWS) for computerized workflow automation and guidance of each participant’s daily clinic activities. These modules are integrated into our larger information system to enable data sharing in real time among authorized staff. Key Findings ACM and TED have each permitted us to conduct research that was not previously possible. In addition, the time to data analysis at the end of each study is substantially shorter. With the implementation of the PWS, we have been able to manage a research clinic with an 80-patient capacity having an annual average of 18,000 patient-visits and 7,300 urine collections with a research staff of five. Finally, automated data management has considerably enhanced our ability to monitor and summarize participant-safety data for research oversight. Implications and conclusion When developed in consultation with end users, automation in treatment-research clinics can enable more efficient operations, better communication among staff, and expansions in research methods. PMID:19320669

Costs of Recruiting Couples to a Clinical Trial

PubMed Central

Sadler, Georgia Robins; Ko, Celine M.; Malcarne, Vanessa L.; Banthia, Rajni; Gutierrez, Ivan; Varni, James W.

2009-01-01

Multiple barriers contribute to the slow recruitment of participants to research studies, which in turn extends the time required to translate promising scientific discoveries into proven therapeutic interventions. A small but growing literature is developing on the extraordinary costs of recruiting participants to studies, and thereby demonstrating that underestimating the cost of participant recruitment can contribute to these recruitment problems. These recruitment challenges and costs are exacerbated when the participants’ study eligibility is determined by relatively narrowly defined illness parameters. Recruitment challenges are further compounded when dyads (two individuals engaged in a sociologically significant relationship, such as husbands and wives, siblings or extended families) must be recruited to an illness-focused study. For these latter groups, there are no data to guide researchers in how to anticipate those participant recruitment costs. This paper describes the staff costs for a variety of strategies used to recruit participants to a randomized supportive care study for couples who were within 18 months of a prostate cancer diagnosis. Pegged to the value of the U.S. dollar for the period, the average cost of staff time was $288 per recruited and enrolled dyad, plus a promised additional $100 incentive for study retention. Within the strategies used, the staff costs per recruited dyad ranged from $ 152 to $1,688. Accrual per strategy ranged from zero to 107 enrolled couples. When asked for secondary sources of information about the study, many participants reported more than one source of study referral, reflective of the multifaceted recruitment strategies deployed. In spite of innovative, culturally competent, and broad based recruitment methods, attainment of a diverse sample was difficult to accomplish in this study. Having estimates of the actual cost of recruiting dyads to research studies can help investigators prepare realistic study budgets. PMID:17218166

Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety.

PubMed

Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Llewellyn, Dawn; Williamson, Robert G; Carson, Chris A

2017-06-01

Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal. Phase I was implemented within three months of assuming management of the facility and involved a redesign of flow, space utilization, and clinical protocols. Phase II was implemented three months later and improved the provider staffing model. Organizational changes such as the development of shift leads and daily huddles were implemented to sustain change and create an environment supportive of future improvements. Post-Phase I, there were significant decreases (pre vs. post and one-year post) in median door-to-door dwell time (343 min vs. 118 and 99), calls to security for behavioral emergencies (13.5 per month vs. 4.3 and 4.8), and staff injuries (3.3 per month vs. 1.2 and 1.2). Post-Phase II, there were decreases in median door-to-doctor time (8.2 hours vs. 1.6 and 1.4) and hours on diversion (90% vs. 17% and 34%). Lean methods can positively affect safety and throughput and are complementary to patient-centered clinical goals in a behavioral health setting. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.