Foster home placements and the probability of family reunification: Does licensing matter?

PubMed

Ryan, Joseph P; Perron, Brian E; Moore, Andrew; Victor, Bryan; Evangelist, Michael

2016-09-01

The concept of foster care has been widely studied in child welfare. The literature is well developed with regard to the risk of initial placement, length of stay in care, placement stability, exits to permanency, and emancipation. Yet, the literature is woefully underdeveloped when it comes to understanding if variations in the types and characteristics of foster homes impact important child welfare outcomes. The current study utilizes entry cohorts pulled from statewide administrative data (N=17,960) to investigate the association between types of foster care and the probability of reunification. We focus specifically on the licensing status of foster homes. Reflecting federal benchmarks, we examined the odds of reunification at one- and two-year intervals. Propensity score analysis was used to reduce selection bias. Adjusted logistic regression models revealed that youth placed in licensed relative care (LRC) homes were the least likely to achieve reunification compared with youth placed in licensed non-relative care (LNC) homes and unlicensed relative care (URC) homes. Conversely, youth placed in URC homes were more likely to achieve reunification as compared with youth placed in LRC and LNC homes. These findings will help states to efficiently target scarce resources to specific types of foster homes that may be impacting federal reunification benchmarks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

PubMed Central

Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

2013-01-01

Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behaviors may worsen nursing staff relationships. PMID:19182546

Summary of Selected State Licensing Requirements: Day Care Centers, Family Day Care Homes. Day Care Survey--1970. Preliminary Edition.

ERIC Educational Resources Information Center

Office of Economic Opportunity, Washington, DC. Evaluation Div.

This volume of abstracts of child day care facility licensing requirements is intended to serve as an introduction to selected aspects of the licensing process within the several states by reviewing (1) the various definitions of day care facilities in the jurisdictions covered, and (2) the prescribed regulations established by the states to…

We Can Do Better: Child Care Aware® of America's Ranking of State Child Care Center Regulations and Oversight. 2013 Update

ERIC Educational Resources Information Center

Child Care Aware of America, 2013

2013-01-01

Each week, nearly 11 million children under age 5 are in some type of child care setting for an average of 35 hours. Parents, as consumers of child care, equate a child care license with state approval--a gold seal for those businesses to which a state grants a license. Child Care Aware® of America reviews state licensing policies, which include…

38 CFR 47.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REGARDING REPORTING HEALTH CARE PROFESSIONALS TO STATE LICENSING BOARDS § 47.1 Definitions. (a) Dentist... dentist who is licensed or otherwise authorized by a State to provide health care services (or any...) State Licensing Board means, with respect to a physician, dentist or other health care practitioner in a...

38 CFR 47.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REGARDING REPORTING HEALTH CARE PROFESSIONALS TO STATE LICENSING BOARDS § 47.1 Definitions. (a) Dentist... dentist who is licensed or otherwise authorized by a State to provide health care services (or any...) State Licensing Board means, with respect to a physician, dentist or other health care practitioner in a...

38 CFR 47.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGARDING REPORTING HEALTH CARE PROFESSIONALS TO STATE LICENSING BOARDS § 47.1 Definitions. (a) Dentist... dentist who is licensed or otherwise authorized by a State to provide health care services (or any...) State Licensing Board means, with respect to a physician, dentist or other health care practitioner in a...

38 CFR 47.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REGARDING REPORTING HEALTH CARE PROFESSIONALS TO STATE LICENSING BOARDS § 47.1 Definitions. (a) Dentist... dentist who is licensed or otherwise authorized by a State to provide health care services (or any...) State Licensing Board means, with respect to a physician, dentist or other health care practitioner in a...

38 CFR 47.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGARDING REPORTING HEALTH CARE PROFESSIONALS TO STATE LICENSING BOARDS § 47.1 Definitions. (a) Dentist... dentist who is licensed or otherwise authorized by a State to provide health care services (or any...) State Licensing Board means, with respect to a physician, dentist or other health care practitioner in a...

North Carolina Star Rated License System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of North Carolina's Star Rated License System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false General license for custody and long-term care of uranium or thorium byproduct materials disposal sites. 40.28 Section 40.28 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF SOURCE MATERIAL General Licenses § 40.28 General license for custody and...

Open Source, Open Standards, and Health Care Information Systems

PubMed Central

2011-01-01

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

Open source, open standards, and health care information systems.

PubMed

Reynolds, Carl J; Wyatt, Jeremy C

2011-02-17

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.

Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: perspectives of licensed nursing staff.

PubMed

McGilton, Katherine S; Boscart, Veronique M; Brown, Maryanne; Bowers, Barbara

2014-06-01

Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses). The main objective of this study was to understand factors that influence nurses' intentions to remain employed at their current job. Qualitative descriptive study. Seven nursing homes in Ontario, Canada. A convenience sample of forty-one licensed LTC nurses. Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes. Work conditions were a salient element affecting nurses' intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses' willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay. Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector. Copyright © 2013 Elsevier Ltd. All rights reserved.

National Accreditation and Its Role in Early Education: An Analysis of Florida's Gold Seal Quality Child-Care Program and Licensing Standards

ERIC Educational Resources Information Center

Winterbottom, Christian; Jones, Ithel

2014-01-01

This article reports on the first Florida statewide assessment of the Gold Seal Quality Care program, accreditation, and the relationship with licensing violations. This study analyzed the differences between the Department of Children and Families Gold Seal-Accredited facilities and nonaccredited facilities by comparing the facilities and the…

The Relationships Among Licensed Nurse Turnover, Retention, and Rehospitalization of Nursing Home Residents

PubMed Central

Thomas, Kali S.

2013-01-01

Purpose: Individuals receiving postacute care in skilled nursing facilities often require complex, skilled care provided by licensed nurses. It is believed that a stable set of nursing personnel is more likely to deliver better care. The purpose of this study was to determine the relationships among licensed nurse retention, turnover, and a 30-day rehospitalization rate in nursing homes (NHs). Design and Methods: We combined two data sources: NH facility-level data (including characteristics of the facility, the market, and residents) and the Florida Nursing Home Staffing Reports (which provide staffing information for each NH) for 681 Florida NHs from 2002 to 2009. Using a two-way fixed effects model, we examined the relationships among licensed nurse turnover rates, retention rates, and 30-day rehospitalization rates. Results: Results indicate that an NH’s licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = −.02, p = .04) controlling for demographic characteristics of the patient population, residents’ preferences for hospitalization, and the ownership characteristics of the NH. The NHs experiencing a 10% increase in their licensed nurse retention had a 0.2% lower rehospitalization rate, which equates to 2 fewer hospitalizations per NH annually. Licensed nurse turnover is not significantly related to the 30-day rehospitalization rate. Implications: These findings highlight the need for NH administrators and policy makers to focus on licensed nurse retention, and future research should focus on the measures of staff retention for understanding the staffing/quality relationship. PMID:22936529

Structural Predictors of Child Care Quality in Child Care Homes.

ERIC Educational Resources Information Center

Burchinal, Margaret; Howes, Carollee; Kontos, Susan

2002-01-01

Used data from a family child care study and a licensing study to identify dimensions best predicting global day care quality in over 300 child care homes. Found that caregiver training most consistently predicted global quality. Found no reliable association between care quality and child-caregiver ratio or age-weighted group size recommendations…

Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

PubMed

Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum

2017-01-01

Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight and monitoring of care quality. © 2016 Sigma Theta Tau International.

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false General license for custody and long-term care of uranium... long-term care of uranium or thorium byproduct materials disposal sites. (a) A general license is... in this part for uranium or thorium mill tailings sites closed under title II of the Uranium Mill...

10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false General license for custody and long-term care of uranium... long-term care of uranium or thorium byproduct materials disposal sites. (a) A general license is... in this part for uranium or thorium mill tailings sites closed under title II of the Uranium Mill...

10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false General license for custody and long-term care of uranium... long-term care of uranium or thorium byproduct materials disposal sites. (a) A general license is... in this part for uranium or thorium mill tailings sites closed under title II of the Uranium Mill...

10 CFR 40.28 - General license for custody and long-term care of uranium or thorium byproduct materials disposal...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false General license for custody and long-term care of uranium... long-term care of uranium or thorium byproduct materials disposal sites. (a) A general license is... in this part for uranium or thorium mill tailings sites closed under title II of the Uranium Mill...

Illinois Department of Children and Family Services Text of Adopted Rules. Subchapter e: Requirements for Licensure. Part 407: Licensing Standards for Day Care Centers.

ERIC Educational Resources Information Center

Illinois State Dept. of Children and Family Services, Springfield.

Reprinted in this document are day care center licensing standards adopted and codified, effective August 1983, by the Illinois Department of Children and Family Services and amended June 1984 and January 1985. Sections of the report concern purpose, definitions, effective date of standards, application for license and license renewal, provisions…

A pressure ulcer prevention programme specially designed for nursing homes: does it work?

PubMed

Kwong, Enid W-Y; Lau, Ada T-Y; Lee, Rainbow L-P; Kwan, Rick Y-C

2011-10-01

The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. No pressure ulcer prevention protocol for long-term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. A quasi-experimental pretest and post-test design was adopted. Forty-one non-licensed care providers and eleven nurses from a government-subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non-licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. A statistically significant improvement in knowledge and skills scores amongst non-licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9-2·5% and 2·5-0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non-licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial. © 2011 Blackwell Publishing Ltd.

Family Child Care Licensing Study, 2002.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report presents the findings of the 2002 national survey of state child care regulatory agencies to update and expand family child care regulatory information published in the 2001 study. Data on small family child care homes and group or large family child care homes are organized into the following 23 categories: (1) number of regulated…

Family Child Care Licensing Study, 2001.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report presents the findings of the 2001 national survey of state child care regulatory agencies to update and expand family child care regulatory information published in the 2000 study. Data on small family child care homes and group or large family child care homes are organized into the following 23 categories: (1) number of regulated…

Family Child Care Licensing Study, 2000.

ERIC Educational Resources Information Center

Kelly, Nia, Comp.

This report presents the findings of the 2000 national survey of state child care regulatory agencies to update and expand family child care regulatory information published in the 1999 study. Data on small family child care homes and group or large family child care homes are organized in 23 categories: (1) number of regulated homes; (2)…

Family Child Care Licensing Study, 2003.

ERIC Educational Resources Information Center

Hollestelle, Kay; Koch, Pauline D.

This report presents the findings of the 2003 national survey of state child care regulatory agencies to update and expand family child care regulatory information published in the 2002 study. Data on small family child care homes and group or large family child care homes are organized into the following 23 categories: (1) number of regulated…

Universities That Litigate Patents

ERIC Educational Resources Information Center

Rooksby, Jacob H.

2012-01-01

American research universities frequently obtain and license patents to their faculty members' inventions. While university licensing is carefully tracked and thoroughly studied, little is known about university decisions to assertively litigate their patents through filing patent infringement lawsuits in federal court. Which universities…

Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder.

PubMed

Curry, Allison E; Metzger, Kristina B; Pfeiffer, Melissa R; Elliott, Michael R; Winston, Flaura K; Power, Thomas J

2017-08-01

Attention-deficit/hyperactivity disorder (ADHD) often persists into adolescence, when motor vehicle crash risk peaks. We know little about when adolescents with ADHD get licensed and, once they do, the extent to which they have increased crash risk compared with adolescents without ADHD. To examine the association between ADHD and both driver licensing and crash involvement and whether it varies by sex, licensing age, and/or being prescribed ADHD medication at licensure. This retrospective cohort study was conducted at 6 primary care practices of the Children's Hospital of Philadelphia, a large pediatric health care network in southeastern Pennsylvania and southern New Jersey. Using electronic health records, we defined a cohort of 2479 adolescents and young adults with ADHD and 15 865 without ADHD who were (1) born from 1987 to 1997; (2) residents of New Jersey and patients at 1 of 6 New Jersey primary care practices at age 12 years or older; and (3) age-eligible to obtain a driver's license from 2004 through 2014. Electronic health records data were then linked with New Jersey's statewide driver licensing and crash databases for 2004 through 2014. Acquisition of a driver's license and first involvement as a driver in a police-reported crash. Survival analysis was used to estimate adjusted hazard ratios for licensing and crash outcomes through age 25 years. The median age of individuals at the end of the study was 22.2 years (interquartile range, 19.7-24.8). Compared with individuals without ADHD, the licensing probability of individuals with ADHD 6 months after eligibility was 35% lower (for males: adjusted hazard ratio, 0.65; 95% CI, 0.61-0.70; females: adjusted hazard ratio, 0.64; 95% CI, 0.58-0.70). Among individuals with a driver's license, 764 of 1785 with ADHD (42.8%) and 4715 of 13 221 without ADHD (35.7%) crashed during the study period. The adjusted risk for first crash among licensed drivers with ADHD was 1.36 times higher than for those without ADHD (95% CI, 1.25-1.48) and did not vary by sex, licensing age, or over time. Only 129 individuals with ADHD (12.1%) were prescribed medication in the 30 days before licensure. Adolescents with ADHD get licensed less often and at an older age. Once licensed, this cohort has a greater risk of crashing. Additional research is needed to understand the specific mechanisms by which ADHD influences crash risk.

Are nursing home survey deficiencies higher in facilities with greater staff turnover.

PubMed

Lerner, Nancy B; Johantgen, Meg; Trinkoff, Alison M; Storr, Carla L; Han, Kihye

2014-02-01

To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. This study focused on the 1151 NNHS facilities with complete deficiency data. Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were included in the same model, high licensed nurse turnover was significantly associated with Quality of Care and total deficiencies, whereas CNA turnover was not associated with that category of deficiencies. Turnover in nursing homes for both licensed nurses and CNAs is associated with quality problems as measured by deficiencies. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.

PubMed

McCloskey, Rose; Donovan, Cindy; Stewart, Connie; Donovan, Alicia

2015-09-01

Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Family Child Care Licensing Study, 1999.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report presents the findings of the 1999 national survey of state child care regulatory agencies to update and expand family child care regulatory information published in the 1998 study. Data on small family child care homes and group or large family child care homes are organized in 22 categories: (1) number of regulated homes; (2)…

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2010 CFR

2010-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2013 CFR

2013-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2014 CFR

2014-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2011 CFR

2011-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

Effect of an Education Presentation On the Knowledge and Awareness of Urinary Tract Infection among Non-Licensed and Licensed Health Care Workers in Long-Term Care Facilities.

PubMed

Freeman-Jobson, Jennifer H; Rogers, Jamie L; Ward-Smith, Peggy

2016-01-01

This article presents the findings of a pre-test, post-test quality improvement project that describes the change in knowledge from prior to and following an evidence-based education presentation. The presentation addressed the clinical symptoms, diagnostic processes, interventions, and responsibilities of licensed and unlicensed health care workers employed in long-term care facilities related to prevention and detection of non-catheter-related urinary tract infections. Results indicate that the education presentation improved knowledge in specific.

Child Care Rates in Washington State: 1992.

ERIC Educational Resources Information Center

Miller, Marna Geyer; Mayfield, Jim

The Washington State Department of Social and Health Services (DSHS) subsidizes child care for about 30,000 children each month. In 1992, telephone interviews were conducted with 1,179 child care centers and 1,277 licensed family child care homes throughout the state. An estimated 140,000 children were in licensed care at that time. Three major…

42 CFR 409.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... nursing care and related services for inpatients who require medical or nursing care; (c) Provides 24-hour nursing service in accordance with Sec. 1861(e)(5) of the Act; (d) If it is a U.S. hospital, is licensed, or approved as meeting the standards for licensing, by the State or local licensing agency; and (e...

42 CFR 409.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... nursing care and related services for inpatients who require medical or nursing care; (c) Provides 24-hour nursing service in accordance with Sec. 1861(e)(5) of the Act; (d) If it is a U.S. hospital, is licensed, or approved as meeting the standards for licensing, by the State or local licensing agency; and (e...

42 CFR 409.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... nursing care and related services for inpatients who require medical or nursing care; (c) Provides 24-hour nursing service in accordance with Sec. 1861(e)(5) of the Act; (d) If it is a U.S. hospital, is licensed, or approved as meeting the standards for licensing, by the State or local licensing agency; and (e...

42 CFR 409.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... nursing care and related services for inpatients who require medical or nursing care; (c) Provides 24-hour nursing service in accordance with Sec. 1861(e)(5) of the Act; (d) If it is a U.S. hospital, is licensed, or approved as meeting the standards for licensing, by the State or local licensing agency; and (e...

The Florida Child Care Quality Improvement Study. Interim Report.

ERIC Educational Resources Information Center

Howes, Carollee; And Others

An ongoing child care improvement study is being conducted of approximately 150 licensed child care providers in 4 Florida counties. The study is assessing the impact of state legislation, which mandated lower caregiver-to-child ratios and increased credentialing. Thus far, the study has found the following effects: (1) children's emotional and…

Competence for older people nursing in care and nursing homes: An integrative review.

PubMed

Kiljunen, Outi; Välimäki, Tarja; Kankkunen, Päivi; Partanen, Pirjo

2017-09-01

People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. Integrative literature review. We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people. © 2016 John Wiley & Sons Ltd.

Family Child Care Providers' Perspectives regarding Effective Professional Development and Their Role in the Child Care System: A Qualitative Study

ERIC Educational Resources Information Center

Lanigan, Jane D.

2011-01-01

This study examines family child care providers' perspectives regarding effective professional development and their role in the early learning and care system. Four focus groups were conducted annually for 3 years involving a total of 54 licensed family child care providers. Supportive social relationships emerged as an important dimension of…

10 CFR 40.27 - General license for custody and long-term care of residual radioactive material disposal sites.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false General license for custody and long-term care of residual... residual radioactive material disposal sites. (a) A general license is issued for the custody of and long... water characterization and any necessary ground water protection activities or strategies. This...

Caring for a Living: A Study on Wages and Working Conditions in Canadian Child Care. Final Report.

ERIC Educational Resources Information Center

Canadian Child Care Federation, Ottawa (Ontario).

Between November 1990 and August 1992, a study examined wages and working conditions of child care staff in both licensed group centers and family day care homes in Canada. Three instruments were developed for the study, a short telephone interview for center directors, a follow-up director's questionnaire, and a staff questionnaire. The study…

Safety Hazards in Child Care Settings. CPSC Staff Study.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

Each year, thousands of children in child care settings are injured seriously enough to need emergency medical treatment. This national study identified potential safety hazards in 220 licensed child care settings in October and November 1998. Eight product areas were examined: cribs, soft bedding, playground surfacing, playground surface…

The Challenge of Caring for Mildly Ill Children: A Canadian National Childcare Study

ERIC Educational Resources Information Center

Polyzoi, E.; Babb, J.C.

2004-01-01

This Canadian study of the care of mildly ill children in licensed childcare facilities compares director and parent preferences for eight models of care, exclusionary practices for ill children by directors, and preferred backup care options of parents. It also investigates anticipated usage and willingness of parents to pay for emergency…

A Measure of the Child Care Ecology: Day Care Program Compliance with State Regulations.

ERIC Educational Resources Information Center

Fiene, Richard

Between July 1978 and June 1980 a program evaluation was undertaken in Pennsylvania in order to measure compliance with state day care licensing regulations. The evaluation involved approximately 1000 licensed/approved child care centers and 50,000 children. Statistical data indicate that by the period April to June 1980 the statewide compliance…

Who Cares for Kids? A Report on Child Care Providers.

ERIC Educational Resources Information Center

Benson, Carolyn

This study offers a profile of child care workers in family day care homes and child care centers, reporting general statistics and examining their wages, benefits, training, working conditions, and turnover rates. In addition, it looks at government regulation and licensing, employer-sponsored programs, child abuse, insurance rates, and federal…

Pediatric Palliative Care: A Personal Story

MedlinePlus

... a pediatric neuroblastoma patient—and her family. The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category Science & Technology License Standard YouTube License Show more Show less ...

Lead, Allergen, and Pesticide Levels in Licensed Child Care Centers in the United States

EPA Science Inventory

The First National Environmental Health Survey of Child Care Centers was conducted to provide information about lead, allergens, and pesticide levels in licensed U.S. child care centers. Lead levels were measured in settled dust, paint, and play area soil; indoor allergen levels ...

Driving behaviors and accident risk under lifetime license revocation.

PubMed

Chang, Hsin-Li; Woo, T Hugh; Tseng, Chien-Ming; Tseng, I-Yen

2011-07-01

This study explored the driving behaviors and crash risk of 768 drivers who were under administrative lifetime driver's license revocation (ALLR). It was found that most of the ALLR offenders (83.2%) were still driving and only a few (16.8%) of them gave up driving completely. Of the offenders still driving, 67.6% experienced encountering a police roadside check, but were not detained or ticketed by the police. Within this group, 50.6% continued driving while encountering a police check, 18.0% of them made an immediate U-turn and 9.5% of them parked and exited their car. As to crash risk, 15.2% of the ALLR offenders had at least one crash experience after the ALLR had been imposed. The results of the logistic regression models showed that the offenders' crash risk while under the ALLR was significantly correlated with their personal characteristics (personal income), penalty status (incarceration, civil compensation and the time elapsed since license revocation), annual distance driven, and needs for driving (working, commuting and driving kids). Low-income offenders were more inclined to have a crash while driving under the ALLR. Offenders penalized by being incarcerated or by paying a high civil compensation drove more carefully and were less of a crash risk under the ALLR. The results also showed there were no differences in crash risk under the ALLR between hit-and-run offences and drunk driving offences or for offenders with a professional license or an ordinary license. Generally, ALLR offenders drove somewhat more carefully and were less of a crash risk (4.3 crashes per million km driven) than legal licensed drivers (23.1 crashes per million km driven). Moreover, they seemed to drive more carefully than drivers who were under short-term license suspension/revocation which previous studies have found. Copyright © 2011 Elsevier Ltd. All rights reserved.

Protecting Our Children: State and Federal Policies for Exempt Child Care Settings.

ERIC Educational Resources Information Center

Blank, Helen

This study examined the extent to which states are adequately ensuring the health and safety of children who are cared for in informal care settings receiving public funds. Protections were analyzed for children receiving in-home care or family child care in settings that are legally exempt from state licensing or registration requirements. The…

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2012 CFR

2012-10-01

...; (iii) Licensed/regulated group home child care; (iv) Licensed/regulated center-based child care; (v... in State or locality) center-based child care; (5) If the State has adopted the Family Violence... 45 Public Welfare 2 2012-10-01 2012-10-01 false What information must the State file annually? 265...

Family Child Care Licensing Study, 1998.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report details a survey of state child care regulatory agencies. Data on both small family child care homes (FCCH) and group or large family child care homes (LCCH or GCCH) are included and organized into 22 categories: (1) number of regulated homes; (2) definitions and regulatory requirements; (3) unannounced inspection procedure; (4)…

Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

ERIC Educational Resources Information Center

Fortinsky, Richard H.; Zlateva, Ianita; Delaney, Colleen; Kleppinger, Alison

2010-01-01

Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in…

The Day Care Challenge: The Unmet Needs of Mothers and Children.

ERIC Educational Resources Information Center

Keyserling, Mary Dublin

An overview of the present shortage of day care facilities in the United States is presented in this speech. Statistics cited on the number of working mothers with children under the age of 6 and the number of day care licensed homes and centers show that the shortage of licensed day care facilities is much more acute than it was five years ago.…

A Two-State Study of Family Child Care Engagement in Quality Rating and Improvement Systems: A Mixed-Methods Analysis

ERIC Educational Resources Information Center

Hallam, Rena; Hooper, Alison; Bargreen, Kaitlin; Buell, Martha; Han, Myae

2017-01-01

Research Findings: The current study is a mixed-methods investigation of family child care provider participation in voluntary Quality Rating and Improvement Systems (QRIS) in 2 states. Study 1 is an analysis of matched QRIS and child care licensing administrative data extracted from both states in May, 2014. Poverty and population density…

78 FR 34386 - Agency Forms Undergoing Paperwork Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

...-to-date sampling frames of residential care facilities. Three year clearance is requested. Section... care facilities within each state that meet the NSLTCP definition and (2) for each relevant licensure... study definition of a residential care facility is one that is licensed, registered, listed, certified...

Family Day Care Licensing Study: Family Day Care Advocacy Project, 1986.

ERIC Educational Resources Information Center

Ainslie, Julie; And Others

Fifth of a series, this report presents the results of a nationwide 1986 survey of state regulatory systems for family day care services. Findings indicate that in most states the number of regulated providers has increased dramatically since the 1984 study, while federal and state funding has decreased, making regulatory efforts more difficult.…

Family Child Care Licensing Study, 1997.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report details the findings of an annual survey of state child care regulatory agencies. The survey gathered data on both small family child care homes and group or large family child care homes in each of the 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. The report's introduction lists the survey categories and…

The New York City Infant Day Care Study: A Comparative Study of Licensed Group and Family Infant Day Care Programs and the Effects of These Programs on Children and Their Families. Final Report.

ERIC Educational Resources Information Center

New York City Dept. of Health, NY.

This paper describes a longitudinal comparative study of group and family day care for infants in New York City. Approximately 400 infants from low income, predominantly Black or Hispanic families enrolled in publicly or privately funded, community-sponsored day care programs participated in the study from the time they entered the programs…

Licensing of Children's Services.

ERIC Educational Resources Information Center

Terpstra, Jake

The purpose of licensing is to provide protection in circumstances in which people are vulnerable and to mandate that positive services will be provided. The common denominator of human vulnerability in licensed children's services is the fact that the children are in the care of someone other than their families. Licensed services include family…

Broadening the Knowledge of the LPN Long-Term Care Provider: A Pilot Study

ERIC Educational Resources Information Center

Faulk, Debbie; Parker, Francine; Lazenby, Ramona; Morris, Arlene

2008-01-01

There are little data regarding Licensed Practical Nurse (LPN) roles in long-term care settings and how the roles might be expanded or changed to meet the unique needs of the elderly. The purpose of this quantitative descriptive study was to determine if an increase in knowledge occurred in LPN care providers after implementation of a 32-hour…

Evaluation design of New York City's regulations on nutrition, physical activity, and screen time in early child care centers.

PubMed

Breck, Andrew; Goodman, Ken; Dunn, Lillian; Stephens, Robert L; Dawkins, Nicola; Dixon, Beth; Jernigan, Jan; Kakietek, Jakub; Lesesne, Catherine; Lessard, Laura; Nonas, Cathy; O'Dell, Sarah Abood; Osuji, Thearis A; Bronson, Bernice; Xu, Ye; Kettel Khan, Laura

2014-10-16

This article describes the multi-method cross-sectional design used to evaluate New York City Department of Health and Mental Hygiene's regulations of nutrition, physical activity, and screen time for children aged 3 years or older in licensed group child care centers. The Center Evaluation Component collected data from a stratified random sample of 176 licensed group child care centers in New York City. Compliance with the regulations was measured through a review of center records, a facility inventory, and interviews of center directors, lead teachers, and food service staff. The Classroom Evaluation Component included an observational and biometric study of a sample of approximately 1,400 children aged 3 or 4 years attending 110 child care centers and was designed to complement the center component at the classroom and child level. The study methodology detailed in this paper may aid researchers in designing policy evaluation studies that can inform other jurisdictions considering similar policies.

QuickStats: Distribution of Long-Term Care Staffing* Hours,(†) by Staff Member Type and Sector - United States, 2014.

PubMed

2016-04-29

In 2014, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 60% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%). Aides accounted for 75% of all staffing hours in residential care communities, in contrast to activities staff members (11%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%). In adult day services centers, aides provided 41% of all staffing hours, followed by activities staff members (32%), registered nurses (12%), licensed practical or vocational nurses (9%), and social workers (6%).

California Child Care Workforce Study: Family Child Care Providers and Assistants in Alameda County, Kern County, Monterey County, San Benito County, San Francisco County, San Mateo County, Santa Cruz County, and Santa Clara County.

ERIC Educational Resources Information Center

Whitebook, Marcy; Almaraz, Mirella; Jo-Yung, Joon; Sakai, Laura; Boots, Shelley Waters; Voisin, Irene; Young, Marci; Burton, Alice; Duff, Brian; Laverty, Kassin; Bellm, Dan; Jay, E. Deborah; Krishnaswamy, Nandini; Kipnis, Fran

An important first step toward more effectively addressing the complexities of child care as a service for families and as an employment setting for workers in California is to develop a detailed picture of the child care workforce. On this premise, a study examined licensed family child care provider demographics, professional preparation, length…

Assessment of Detainee Medical Operations for OEF, GTMO, and OIF (REDACTED)

DTIC Science & Technology

2005-04-13

Administration Specialist), 74 91 W (Health Care Specialist), 17 91 WM6 (Health Care SpecialistlLicensed Practical Nurse ), 15 91X (Mental Health Specialist), and...91 W (Health Care Specialist), 17 91 WM6 (Licensed Practical Nurse ), 15 91X (Mental Health Specialist), and 40 OBC students. The findings, discussion...and principles of detainee care ." This policy does not identify when the required training should occur, nor who is responsible to provide the

Making Child Care Centers SAFER: A Non-Regulatory Approach to Improving Child Care Center Siting

PubMed Central

Somers, Tarah S; Harvey, Margaret L.; Rusnak, Sharee Major

2011-01-01

Licensed child care centers are generally considered to be safe because they are required to meet state licensing regulations. As part of their licensing requirements, many states inspect child care centers and include an assessment of the health and safety of the facility to look for hazardous conditions or practices that may harm children. However, most states do not require an environmental assessment of the child care center building or land to prevent a center from being placed on, next to, or inside contaminated buildings. Having worked on several sites where child care centers were affected by environmental contaminants, the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry (ATSDR) endeavor to raise awareness of this issue. One of ATSDR's partner states, Connecticut, took a proactive, non-regulatory approach to the issue with the development its Child Day Care Screening Assessment for Environmental Risk Program. PMID:21563710

7 CFR 110.5 - Availability of records to facilitate medical treatment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... agencies that deal with pesticide use or any health issue related to the use of pesticides when necessary... attending licensed health care professional, or an individual acting under the direction of the attending licensed health care professional, determines that any record of the application of any restricted use...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

Long-Term Care Planning Study: Strengths and Learning Needs of Nursing Staff

ERIC Educational Resources Information Center

Cruttenden, Kathleen E.

2006-01-01

This planning study was designed and conducted in a predominantly rural Canadian province to examine the strengths and learning needs of four categories of nursing staff practising in New Brunswick nursing homes. Participants included directors of care, registered nurses, licensed practical nurses, and resident attendants. The nursing homes ranged…

Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

ERIC Educational Resources Information Center

Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

2013-01-01

This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…

The influence of care provider access to structural empowerment on individualized care in long-term-care facilities.

PubMed

Caspar, Sienna; O'Rourke, Norm

2008-07-01

Implementing management initiatives that enable formal caregivers to provide quality, individualized care to older adults in long-term-care (LTC) facilities is increasingly important given that the number of LTC residents is projected to triple by 2031. The objective of this study was to explore the relationship between care provider access to structural empowerment and the provision of individualized care in LTC. We computed structural equation models separately for registered nurses and licensed practical nurses (n = 242) and care aides (n = 326) to examine the relationship between access to empowerment structures (i.e., informal power, formal power, information, support, resources, opportunity) and the provision of individualized care. We subsequently undertook invariance analyses to determine if the association between empowerment structures and reported provision of individualized care differed between caregiver groups. Access to structural empowerment had a statistically significant, positive association with provision of individualized care for both groups. For registered nurses/licensed practical nurses and care aides, empowerment explained 50% and 45% of observed variance in individualized care, respectively. These notable percentages did not differ significantly between caregiver groups. Of the empowerment structures, support, especially in the form of access to educational opportunities and recognition for a job well done, seems to be particularly significant to care providers. Findings from this study suggest that provision of individualized care in LTC may be enhanced when formal caregivers have appreciable access to empowerment structures.

Public School Center vs. Family Home Day Care: Single Parents' Reasons for Selection.

ERIC Educational Resources Information Center

Rothschild, Maria Stupp

This study investigates the reasons single parents in San Diego had for choosing either a public day care center or a licensed day care home for their children. A sample of 30 single parents with children in school district administered children's centers was drawn and matched by a similarly geographically distributed sample of 23 parents with…

A Conceptual Statement on the Enforcement of Child Day Care Licensing Standards: With Special Reference to Revocation.

ERIC Educational Resources Information Center

Class, Norris E.; And Others

This statement of the enforcement of child day care licensing standards identifies basic concepts of the enforcement process and operational procedures necessary to bring about this process. Two types of enforcement operations, negative and positive enforcement of standards, are identified and examined in detail. Positive enforcement is defined as…

Nurses' Perceptions of the Electronic Health Record

ERIC Educational Resources Information Center

Crawley, Rocquel Devonne

2013-01-01

The implementation of electronic health records (EHR) by health care organizations has been limited. Despite the broad consensus on the potential benefits of EHRs, health care organizations have been slow to adopt the technology. The purpose of this qualitative phenomenological study was to explore licensed practical and registered nurses'…

Garde a l'enfance: Etude sur la remuneration et les conditions de travail dans le domaine de la garde a l'enfance au Canada. Rapport final (Caring for a Living: A Study on Wages and Working Conditions in Canadian Child Care. Final Report).

ERIC Educational Resources Information Center

Canadian Child Care Federation, Ottawa (Ontario).

Between November 1990 and August 1992, a study examined wages and working conditions of child care staff in both licensed group centers and family day care homes in Canada. Three instruments were developed for the study, a short telephone interview for center directors, a follow-up director's questionnaire, and a staff questionnaire. The study…

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

PubMed

Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

2016-01-01

Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for encouraging voluntary reductions in prescribing and/or dispensing controlled substances.

Measuring Critical Thinking in Newly Licensed Registered Nurses

ERIC Educational Resources Information Center

Rush, Carreen W.

2017-01-01

A national conversation is stirring in the United States about mandating residency programs of newly-licensed nurses as findings indicate that newly-licensed registered nurses are not prepared to make appropriate patient care decisions. Even with many commercial instruments available on the market for outcome measurements, accurately assessing the…

A Study of the Salaries and Compensations of Child Care Workers in Hawaii County, State of Hawaii.

ERIC Educational Resources Information Center

Lau, Anne

The purpose of this study was to gather information regarding salaries and fringe benefits received by child care center personnel in Hawaii County, Hawaii. All 42 centers licensed by the Department of Social Services and Housing were surveyed. Directors from 38 centers responded to a two-page questionnaire. The information collected revealed a…

To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy.

PubMed

Brenna, Elenka; Gitto, Lara

2017-02-25

The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

LPN Analysis in the Health Industry.

ERIC Educational Resources Information Center

Omvig, Clayton P.; And Others

The health care industry has undergone a great many changes in the past several years: changes in technology, regulations, payment procedures, type of client, and personnel needs. A study attempted to answer the question, "What part will the licensed practical nurse (LPN) have in the health care industry of the future?" In Phase One of…

Awareness of the 2010 guidelines implemented by the New York State Education Department for respiratory therapists in their role as clinical preceptors.

PubMed

Smith, Stephen G; Brittelli, John; Scott, Lisa Benz

2014-12-01

In 1993, the New York State (NYS) legislature and governor signed into law the Respiratory Therapy Guide to Practice Education Law to guide and regulate the profession of respiratory care under the auspices of the New York State Education Department. New guidelines were implemented by the New York State Education Department for respiratory therapists (RTs) in 2010 to provide the opportunity for RTs to receive continuing education units (CEUs) when participating as clinical preceptors. This study was conducted in June 2012 to determine the extent to which the NYS RTs are aware of the new licensing guidelines and amendments. In June 2012, a web-based survey was e-mailed to 2,503 NYS members of the New York State Society for Respiratory Care, 14% of which (n= 360) completed the survey. The survey included 21 items to assess RTs' awareness of the licensing guidelines that were implemented in 2010, and these respondents were analyzed using basic descriptive statistics. The study showed that 50% of the respondents were not aware of eligibility to earn CEUs as a clinical preceptor in NYS. Twenty-eight percent responded correctly that licensed RTs were eligible to earn CEUs as a clinical preceptor in NYS. In addition, 67% of those who responded were unaware of how many CEUs could be earned for each renewal period for clinical precepting. Finally, 70% of the respondents indicated that they would be inclined to seek employment at a facility that has a clinical affiliation with a university or college respiratory care program. The findings indicate that more education is needed in NYS to make licensed RTs aware of the 2010 guidelines. Practitioners may require incentives to become actively involved in the clinical education of respiratory care students as their clinical preceptors. Copyright © 2014 by Daedalus Enterprises.

Health Care Providers' Spirit at Work Within a Restructured Workplace.

PubMed

Wagner, Joan I J; Brooks, Denise; Urban, Ann-Marie

2018-01-01

Spirit at work (SAW) research emerged as a response to care provider determination to maintain a healthy and productive health care work environment, despite restructuring. The aim of this descriptive mixed-methods research is to present the care provider's perceptions of SAW. SAW is a holistic measure of care provider workplace outcomes, defined as the unique experience of individuals who are passionate about and energized by their work. A mixed group of licensed and unlicensed care providers in a continuing care workplace were surveyed. Eighteen Likert-type scale survey questions were further informed by two open-ended questions. Results indicated that unlicensed continuing care providers' perceptions of SAW are lower than licensed care providers. Responses suggest that open discussion between managers and team members, combined with structured workplace interventions, will lead to enhanced SAW and improved patient care. Further research on SAW within the continuing care workplace is required.

Diabetes management in Commercial Driver License holders.

PubMed

Kerr, Jessica L; Frichtl, Kelsey D; Behnen, Erin M

2015-04-01

The purpose of this study is to evaluate diabetes management in Commercial Driver License (CDL) holders, how prescribing habits change when treating this patient population, and health care providers' knowledge of regulations concerning insulin use in CDL holders. A survey was posted on the American Association of Diabetes Educators (AADE) Communities of Interest websites and was open for 2 weeks. The anonymous survey collected demographic data and evaluated the perspectives of health care providers on diabetes management in CDL holders. Descriptive statistics were used to analyze the survey results. A total of 139 AADE members responded to the survey, and 22.2% were prescribing providers. Findings from the survey indicated an overall lack of knowledge by health care professionals regarding the current laws affecting diabetes management in CDL holders. Most participants emphasized the need for making decisions on CDL suspension on a case-by-case basis, and some expressed concern that current laws may not be appropriate. Additional diabetes education for health care providers who treat CDL holders is warranted as many health care providers were not familiar with current regulations and management strategies. © 2015 The Author(s).

Child Care Center Licensing Study, 2001.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report is an update of information initially compiled in 1991 through a survey of the child care regulatory offices of the 50 U.S. states, the District of Columbia, Puerto Rico, and the Virgin Islands. The report begins with an introduction, definition of terms, and a question and answer summary. The bulk of the report is organized in…

Child Care Center Licensing Study, 2003.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report is a yearly update of information initially compiled in 1991 through a survey of the child care regulatory offices of the 50 U.S. states, the District of Columbia, Puerto Rico, and the Virgin Islands. The report begins with an introduction, definition of terms, and a question and answer summary. The bulk of the report is organized in…

Child Care Center Licensing Study, 2002.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report is an update of information initially compiled in 1991 through a survey of the child care regulatory offices of the 50 U.S. states, the District of Columbia, Puerto Rico, and the Virgin Islands. The report begins with an introduction, definition of terms, and a question and answer summary. The bulk of the report is organized in…

Child Care Center Licensing Study, 2000.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report is an update of information initially compiled in 1991 through a survey of the child care regulatory offices of the 50 United States, the District of Columbia, Puerto Rico, and the Virgin Islands. The report begins with an introduction, definition of terms, and a question and answer summary. The bulk of the report is organized in…

The Child Care Center Licensing Study, 1999.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

This report compiles findings of a survey of the child care regulatory offices of the 50 United States, the District of Columbia, Puerto Rico, and the Virgin Islands. The report begins with an introduction, definition of terms, and a question and answer summary. The bulk of the report is organized in alphabetical order by state or territory, and…

42 CFR 1001.501 - License revocation or suspension.

Code of Federal Regulations, 2010 CFR

2010-10-01

... during which an individual's or entity's license is revoked, suspended or otherwise not in effect as a... care had or could have had a significant adverse physical, emotional or financial impact on one or more...

A Review of State Licensing Regulations to Determine Alignment with Best Practices to Prevent Human Norovirus Infections in Child-Care Centers

PubMed Central

Leone, Cortney M.; Jaykus, Lee-Ann; Cates, Sheryl M.

2016-01-01

Objectives Close, frequent contact between children and care providers in child-care centers presents many opportunities to spread human noroviruses. We compared state licensing regulations for child-care centers with national guidelines written to prevent human noroviruses. Methods We reviewed child-care licensing regulations for all 50 U.S. states and the District of Columbia in effect in June 2015 to determine if these regulations fully, partially, or did not address 14 prevention practices in four topic areas: (1) hand hygiene, (2) exclusion of ill people, (3) environmental sanitation, and (4) diapering. Results Approximately two-thirds (8.9) of the 14 practices across all state regulations were partially or fully addressed, with few (2.6) fully addressed. Practices related to exclusion of ill people and diapering were fully addressed most often, while practices related to hand hygiene and environmental sanitation were fully addressed least often. Conclusion Regulations based on guidelines for best practices are one way to prevent the spread of human noroviruses in child-care facilities, if the regulations are enforced. Our findings show that, in mid-2015, many state child-care regulations did not fully address these guidelines, suggesting the need to review these regulations to be sure they are based on best practices PMID:27252565

A Review of State Licensing Regulations to Determine Alignment with Best Practices to Prevent Human Norovirus Infections in Child-Care Centers.

PubMed

Leone, Cortney M; Jaykus, Lee-Ann; Cates, Sheryl M; Fraser, Angela M

2016-01-01

Close, frequent contact between children and care providers in child-care centers presents many opportunities to spread human noroviruses. We compared state licensing regulations for child-care centers with national guidelines written to prevent human noroviruses. We reviewed child-care licensing regulations for all 50 U.S. states and the District of Columbia in effect in June 2015 to determine if these regulations fully, partially, or did not address 14 prevention practices in four topic areas: (1) hand hygiene, (2) exclusion of ill people, (3) environmental sanitation, and (4) diapering. Approximately two-thirds (8.9) of the 14 practices across all state regulations were partially or fully addressed, with few (2.6) fully addressed. Practices related to exclusion of ill people and diapering were fully addressed most often, while practices related to hand hygiene and environmental sanitation were fully addressed least often. Regulations based on guidelines for best practices are one way to prevent the spread of human noroviruses in child-care facilities, if the regulations are enforced. Our findings show that, in mid-2015, many state child-care regulations did not fully address these guidelines, suggesting the need to review these regulations to be sure they are based on best practices.

Making sense of children's sexual behavior in child care: An analysis of adult responses in special investigation reports.

PubMed

Martin, Karin A

2014-10-01

This paper investigates how adults respond to sexual behavior among children in child care. Culturally, childhood sexuality is variously understood as natural curiosity, a sign of sexual abuse, or a symptom of a sex-offender in the making. Given these competing cultural meanings, how are sexual-like behaviors by children managed by the adults who care for them? An analysis of qualitative data from Special Investigation Reports by childcare licensing consultants in the state of Michigan is used to examine how parents, child care providers, and child care licensing consultants manage and respond to sexual behavior between children in the context of child care. How sexual behavior is responded to depends primarily on who is doing the responding - parent, childcare provider, or state licensing consultant - rather than what type of behavior is being responded to. Parents respond to a wide range of behaviors between children as if they are incidents of sexual abuse. Childcare providers respond to many of those same incidents as misbehavior. Licensing consultants understand these incidents as violation of rules of supervision, but they were also the only group to ever ask if children's sexual behavior was potentially a sign of a child having been sexually abused in another setting. Providers and parents need more education about what kinds of sexual behavior to be concerned about and what kind to understand as common. More education that sexuality that is "rare" and persistent could be a sign of sexual abuse is needed by all parties. Copyright © 2014 Elsevier Ltd. All rights reserved.

42 CFR 483.75 - Administration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... impairments, also address the care of the cognitively impaired. (f) Proficiency of Nurse aides. The facility...; physician assistant; nurse practitioner; physical, speech, or occupational therapist; physical or occupational therapy assistant; registered professional nurse; licensed practical nurse; or licensed or...

42 CFR 483.75 - Administration.

Code of Federal Regulations, 2012 CFR

2012-10-01

... impairments, also address the care of the cognitively impaired. (f) Proficiency of Nurse aides. The facility...; physician assistant; nurse practitioner; physical, speech, or occupational therapist; physical or occupational therapy assistant; registered professional nurse; licensed practical nurse; or licensed or...

The professional nurse and regulation.

PubMed

Flook, Denise M

2003-06-01

The regulation of nursing began as a simple registry process to protect the nursing title and the public. Today, the primary purpose is still the protection of the public through defining nursing practice, approving nursing education, and overseeing the competence of nurses through licensing and disciplinary rules and regulations. State Boards of Nursing are legislatively given the authority to license and discipline the nursing profession. The RN is responsible for the care given to assigned patients. Issues of staffing, delegation, and reporting of incompetent or impaired nurses are a concern of nurses today with regard to their license. Each nurse must understand the regulations, which vary from state to state, that directly and indirectly affect his/her daily practice. As the health care environment is met with several challenges, pressures are increasing to modernize the licensing and competency assessment of nurses. Ultimately, the safety of patients must remain at the center of the regulatory debate.

How Would Programs Rate under California's Proposed Quality Rating and Improvement System? Evidence from Statewide and County Data on Early Care and Education Program Quality. Documented Briefing

ERIC Educational Resources Information Center

Karoly, Lynn A.; Zellman, Gail L.

2012-01-01

In 2010, the California Early Learning Quality Improvement System (CAEL QIS) Advisory Committee recommended a structure for a voluntary quality rating and improvement system (QRIS) that could apply to the state's 11,000 licensed centers and 36,600 licensed family child care homes (FCCHs). The proposed design consisted of an unweighted block system…

Licensed Vocational Nurse Residency Program in Primary Care.

PubMed

Dannemeyer, Deborah; Jalandoni, Cecile; Vonderheide, Dawn

This article will explain one organization's experience in developing a licensed vocational nurse residency program in an ambulatory setting, the barriers and challenges, and program outcomes. It outlines results of the program in building competence and confidence for vocational nurses to perform as effective team members in the primary care office setting. Learnings from this experience may be applied to enhance new and transitioning employee orientation and education programs in ambulatory and inpatient settings.

The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural Region

PubMed Central

Arcury, Thomas A; Gesler, Wilbert M; Preisser, John S; Sherman, Jill; Spencer, John; Perin, Jamie

2005-01-01

Objective This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. Principal Findings Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. Conclusions These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy. PMID:15663706

Obesity Prevention in Early Child Care Settings: A Bistate (Minnesota and Wisconsin) Assessment of Best Practices, Implementation Difficulty, and Barriers

ERIC Educational Resources Information Center

Nanney, Marilyn S.; LaRowe, Tara L.; Davey, Cynthia; Frost, Natasha; Arcan, Chrisa; O'Meara, Joyce

2017-01-01

Background: Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center-…

A Correlational Study of the Relationship between TEAS V and Success in Licensed Practical Nursing Students

ERIC Educational Resources Information Center

Grace, Jamila

2017-01-01

Practical nurses can provide quality, cost-effective care in an ever-changing health care setting which is faced with a shortage of nurses. A community college system in the southeastern area of the United States began using the Test of Essential Academic Skills (TEAS) V as part of admission criteria for nursing programs. While Assessment…

Child Care in Mexico.

ERIC Educational Resources Information Center

Hernandez, Clotilde Juarez

2003-01-01

Discusses the following issues pertaining to Mexican child care: history of child care in Mexico; prevalence of child care in the national system; other agencies providing child care and the nature of their services; extent to which working families use child care; circumstances requiring day care; licensing, accreditation, and quality standards;…

10 CFR 40.27 - General license for custody and long-term care of residual radioactive material disposal sites.

Code of Federal Regulations, 2010 CFR

2010-01-01

... disposed. In such cases, the Commission shall grant a license permitting use of the land if it finds that... the disposal site to be licensed, including documentation on whether land and interests are owned by the United States or an Indian tribe. If the site is on Indian land, then, as specified in the Uranium...

Newly licensed RNs' characteristics, work attitudes, and intentions to work.

PubMed

Kovner, Christine T; Brewer, Carol S; Fairchild, Susan; Poornima, Shakthi; Kim, Hongsoo; Djukic, Maja

2007-09-01

In an effort to better understand turnover rates in hospitals and the effect of new nurses on them, this study sought to describe the characteristics and attitudes toward work of newly licensed RNs, a population important to both the nursing profession and the health care system. A survey was mailed to a random sample of new RNs in 35 states and the District of Columbia. A total of 3,266 returned surveys met the inclusion criteria, for a response rate of 56%. RNs who qualified had completed the licensing examination and obtained a first license between August 1, 2004, and July 31, 2005. Data pertaining to four areas were collected: respondent characteristics, work-setting characteristics, respondents' attitudes toward work, and job opportunities. Respondents who were not working were asked to specify why. Of the eligible newly licensed RNs, 58.1% had an associate's degree, 37.6% had a bachelor's degree, and 4.3% had a diploma or a master's or higher degree as their first professional degree. They were generally pleased with their work groups but felt they had only moderate support from supervisors. About 13% had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. More than half of the respondents (51%) worked voluntary overtime, and almost 13% worked mandatory overtime. Also, 25% reported at least one on-the-job needlestick in a year; 39%, at least one strain or sprain; 21%, a cut or laceration; and 46%, a bruise or contusion; 62% reported experiencing verbal abuse. A quarter of them found it "difficult or impossible" to do their jobs at least once per week because of inadequate supplies. This study provides descriptive evidence that a majority of newly licensed RNs are reasonably satisfied and have no plans to change jobs, but the group is not homogeneous. The negative attitudes expressed in response to some survey questions suggest that newly licensed RNs may not remain in the acute care settings where they start out. Investing in better orientation and management may be the key to retaining them in hospitals. The authors will be following these RNs for two years and will develop predictive models of turnover rates.

Evaluating a Human Rights-Based Advocacy Approach to Expanding Access to Pain Medicines and Palliative Care: Global Advocacy and Case Studies from India, Kenya, and Ukraine.

PubMed

Lohman, Diederik; Amon, Joseph J

2015-12-10

Palliative care has been defined as care that is person-centered and attentive to physical symptoms and psychological, social, and existential distress in patients with severe or life-threatening illness. The identification of access to palliative care and pain treatment as a human rights issue first emerged among palliative care advocates, physicians, and lawyers in the 1990s, with a basis in the right to health and the right to be free from cruel, inhuman, and degrading treatment. Using a case study approach, we evaluate the results of a human rights-based advocacy approach on access to pain medicine and palliative care in India, Kenya, and Ukraine. In each country, human rights advocacy helped raise awareness of the issue, identify structural barriers to care, define government obligations, and contribute to the reform of laws, policies, and practices impeding the availability of palliative care services. In addition, advocacy efforts stimulated civil society engagement and high-level political leadership that fostered the implementation of human rights-based palliative care programs. Globally, access to palliative care was increasingly recognized by human rights bodies and within global health and drug policy organizations as a government obligation central to the right to health. Copyright © 2015 Lohman, Amon. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Mental Illness Training for Licensed Staff in Long-Term Care

PubMed Central

Irvine, A. Blair; Billow, Molly B.; Eberhage, Mark G.; Seeley, John R.; McMahon, Edward; Bourgeois, Michelle

2013-01-01

Licensed care staff working in long-term care facilities may be poorly prepared to work with residents with mental illness. This research reports on the program evaluation of Caring Skills: Working with Mental Illness, a training program delivered on the Internet. It was tested with a randomized treatment-control design, with an eight-week follow-up. The training provided video-based behavioral skills and knowledge training. Measures included video situations testing and assessment of psycho-social constructs including empathy and stigmatization. ANCOVA analysis at 4-weeks posttest showed significant positive effects with medium-large effect sizes, which were largely maintained at the 8-week follow-up. The training was well-received by the users. PMID:22364430

The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care.

PubMed

Timmons, Edward Joseph

2017-02-01

The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician assistants have affected cost and intensity of health care for Medicaid patients. The results suggest that allowing physician assistants to prescribe controlled substances is associated with a substantial (more than 11%) reduction in the dollar amount of outpatient claims per Medicaid recipient. I find little evidence that expanded scope of practice has affected proxies for care intensity such as total claims and total care days. Relaxing occupational licensing requirements by broadening the scope of practice for healthcare providers may represent a low-cost alternative to providing quality care to America's poor. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intravenous Therapy.

ERIC Educational Resources Information Center

Galliart, Barbara

Intended for teaching licensed practical nurses, this curriculum guide provides information related to the equipment and skills required for nursing care of patients needing intravenous (IV) therapy. It also explains the roles and responsibilities of the licensed practical nurse with regard to intravenous therapy. Each of the 15 instructional…

47 CFR 5.54 - Types of authorizations available.

Code of Federal Regulations, 2013 CFR

2013-10-01

... experimentation for the development and advancement of new broadcast technology, equipment, systems or services... testing experimental radio license. This type of license is issued to hospitals and health care institutions that demonstrate expertise in testing and operation of experimental medical devices that use...

47 CFR 5.54 - Types of authorizations available.

Code of Federal Regulations, 2014 CFR

2014-10-01

... experimentation for the development and advancement of new broadcast technology, equipment, systems or services... testing experimental radio license. This type of license is issued to hospitals and health care institutions that demonstrate expertise in testing and operation of experimental medical devices that use...

Using a Handheld Device for Patient Data Collection: A Pilot for Medical Countermeasures Surveillance.

PubMed

Daley, Matthew F; Goddard, Kristin; McClung, Melissa; Davidson, Arthur; Weiss, Gretchen; Palen, Ted; Nyirenda, Carsie; Platt, Richard; Courtney, Brooke; Reichman, Marsha E

2016-01-01

Medical countermeasures (MCMs) are medical products used during public health emergencies. This study, conducted within the Mini-Sentinel Initiative, sought to develop the patient identification and matching processes necessary to assess safety outcomes for MCMs. A handheld device was used to collect identifying information (e.g., name, birthdate, and sex) from the driver's licenses of 421 individuals presenting for routine care at their primary care medical office. Overall, 374 individuals (88.8%) could be linked to their electronic health data using driver's license information. The device was also pilot-tested at a seasonal influenza immunization clinic: detailed vaccine information (e.g., lot number and manufacturer) was captured with a high degree of accuracy. This investigation demonstrated that a handheld device is a feasible means of collecting patient identity and medical product receipt data. This capacity should be useful for safety surveillance of MCMs, particularly when dispensed in settings outside the traditional health-care delivery system.

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... approval to provide day care services to children. Day care homes which cannot obtain their license because... access to its meal service and records during its normal hours of child care operations. For day care...

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... approval to provide day care services to children. Day care homes which cannot obtain their license because... access to its meal service and records during its normal hours of child care operations. For day care...

Policies and Practices in Canadian Family Child Care Agencies. You Bet I Care!

ERIC Educational Resources Information Center

Doherty, Gillian; Lero, Donna S.; Tougas, Jocelyne; LaGrange, Annette; Goelman, Hillel

Four Canadian provinces license or contract with family child care agencies, which in turn recruit and monitor child care providers. These family child care agencies have two primary roles: monitoring and supervising providers, and supplying their affiliated family child care providers with professional development opportunities and other types of…

Immunizations challenge healthcare personnel and affects immunization rates.

PubMed

Strohfus, Pamela K; Kim, Susan C; Palma, Sara; Duke, Russell A; Remington, Richard; Roberts, Caleb

2017-02-01

This study measured 1. medical office immunization rates and 2. health care personnel competency in managing vaccine practices before and after evidence-based immunization education was provided. This descriptive study compared 32 family medicine and pediatric offices and 178 medical assistants, licensed practical nurses, registered nurses, nurse practitioners, and physicians in knowledge-based testing pre-education, post-education, and 12-months post-education. Immunization rates were assessed before and 18-months post-education. Immunization rates increased 10.3% - 18months post-education; knowledge increased 7.8% - 12months post-education. Family medicine offices, licensed practical nurses, and medical assistants showed significant knowledge deficits before and 12-months post-education. All demographic groups scored less in storage/handling 12-months post-education. This study is one of the first studies to identify competency challenges in effective immunization delivery among medical assistants, licensed practical nurses, and family medicine offices. Formal and continuous education in immunization administration and storage/handling is recommended among these select groups. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges for Nurses Caring for Patients With Peripherally Inserted Central Catheters in Skilled Nursing Facilities

PubMed Central

Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet

2016-01-01

Objectives To understand frontline nurses’ (registered nurses and licensed practical nurses), unit nurse managers’ and skilled nursing facility (SNF) administrators’ perceived preparedness in providing care for patients with peripherally inserted central catheters (PICCs) in SNFs. Design An exploratory, qualitative pilot study. Setting Two community based SNFs. Participants Patients, frontline nurses (registered nurses and licensed practical nurses), unit nurse managers and SNF administrators. Methods Over 36-weeks, we observed and conducted informal interviews with 56 patients with PICCs and their nurses focusing on PICC care practices and documentation. In addition, we collected baseline PICC data including placement indication (e.g., antimicrobial administration), placement setting (hospital vs. SNF), and dwell time. We then conducted focus groups with frontline nurses and unit nurse managers and semi-structured interviews with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Results During weekly informal interviews and observations variations in documentation were observed. Differences between patient-reported PICC concerns (quality-of-life) and those described by frontline nurses were noted. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs and gaps in training and education were highlighted as barriers in improving practice and safety. Conclusion Our study suggests that practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions and increase resource availability in SNFs appear necessary to enhance PICC care and patient safety. PMID:27603747

Preparing a Health Care White Paper: Providing Structure to the Writing Process.

PubMed

Rotarius, Timothy; Rotarius, Velmarie

2016-01-01

Health care leaders operate in a very complex and turbulent business environment. Both government regulations and market forces are very active in the industry. Thus, health care managers have many multifaceted and, sometimes, contradictory expectations placed upon them and their organizations. To ensure professional accountability, health care executives often join professional associations and strive for licenses and certifications that are intended to place the professional above the rest. One important avenue to achieve various licensing and certification accomplishments involves writing a white paper about a specific topic of interest to the industry and organization. Presented herein are structural processes that facilitate the creation and preparation of a health care white paper. Both conceptual and empirical structures of white papers are presented, with the similarities and the differences between conceptual and empirical papers highlighted.

Access to inpatient dermatology care in Pennsylvania hospitals.

PubMed

Messenger, Elizabeth; Kovarik, Carrie L; Lipoff, Jules B

2016-01-01

Access to care is a known issue in dermatology, and many patients may experience long waiting periods to see a physician. In this study, an anonymous online survey was sent to all 274 Pennsylvania hospitals licensed by the US Department of Health in order to evaluate current levels of access to inpatient dermatology services. Although the response rate to this survey was limited, the data suggest that access to inpatient dermatology services is limited and may be problematic in hospitals across the United States. Innovation efforts and further studies are needed to address this gap in access to care.

The quality of feeding assistance care practices for long-term care veterans: implications for quality improvement efforts.

PubMed

Simmons, Sandra F; Sims, Nichole; Durkin, Daniel W; Shotwell, Matthew S; Erwin, Scott; Schnelle, John F

2013-09-01

The primary purpose of this study was to determine the quality of feeding assistance care and identify areas in need of improvement for a sample of long-term care veterans. A secondary purpose was to compare these findings with the results of previous studies in community facilities to determine ways in which the VA sample might differ. A repeated measures observational study was conducted in two VA facilities with 200 long-stay residents. Research staff conducted standardized observations during and between meals for 3 months. There was a trend for better feeding assistance care quality during meals in the VA sample, but there were still multiple aspects of care in need of improvement both during and between meals. Higher licensed nurse staffing levels in the VA should enable effective supervision and management, but observation-based measures of care quality are necessary for accurate information about daily feeding assistance care provision.

42 CFR 433.55 - Health care-related taxes defined.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Health care-related taxes defined. 433.55 Section... Financial Participation § 433.55 Health care-related taxes defined. (a) A health care-related tax is a licensing fee, assessment, or other mandatory payment that is related to— (1) Health care items or services...

Organizational factors impacting job strain and mental quality of life in emergency and critical care units.

PubMed

Bellagamba, Gauthier; Gionta, Guillaume; Senergue, Julie; Bèque, Christine; Lehucher-Michel, Marie-Pascale

2015-01-01

This study measures the association between hospital staff's job strain (JS), mental quality of life (MQL) and how they are influenced by the organization models within emergency and critical care units. This study describes workers employed in emergency departments and intensive care units of a French public hospital. A selfadministered questionnaire was used to survey the demographic and organizational characteristics of their work, as well as work-related mental stress, psychosocial and organizational constraints, and their MQL. Among 145 workers participating in the study, 59.3% of them report job strain and 54.5% of them have low MQL scores. The majority of staff with job strain has reported working more than 2 weekends per month, were regularly on-call, worked in dysfunctional environments and did not participate in regular meetings. The staff with low MQL worked more frequently in dysfunctional environments, had significant complaints regarding employer's efforts to promote communications or provide adequate staffing levels than the workers with a high MQL score. If stress reduction and improved MQL in emergency and intensive care units is to be achieved, hospital management needs to design work schedules that provide a better balance between working and non-working hours. Additionally, ergonomic design, functional environments and improved communications needs to be implemented. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

20 CFR 416.640a - Compensation for qualified organizations serving as representative payees.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... An example of an appropriately licensed organization is a community mental health center holding a State license to provide community mental health services. (b) Requirements qualified organizations must... responsibilities or whose mission is to carry out income maintenance, social service, or health care-related...

45 CFR Appendix A to Part 96 - Uniform Definitions of Services

Code of Federal Regulations, 2011 CFR

2011-10-01

... transportation. 6. Day Care Services—Children Day care services for children (including infants, pre-schoolers... service counseling for parents, plan development, and licensing and monitoring of child care homes and...; obtaining legal services; and providing counseling, child care education, and training in and development of...

45 CFR Appendix A to Part 96 - Uniform Definitions of Services

Code of Federal Regulations, 2012 CFR

2012-10-01

... transportation. 6. Day Care Services—Children Day care services for children (including infants, pre-schoolers... service counseling for parents, plan development, and licensing and monitoring of child care homes and...; obtaining legal services; and providing counseling, child care education, and training in and development of...

45 CFR Appendix A to Part 96 - Uniform Definitions of Services

Code of Federal Regulations, 2014 CFR

2014-10-01

... transportation. 6. Day Care Services—Children Day care services for children (including infants, pre-schoolers... service counseling for parents, plan development, and licensing and monitoring of child care homes and...; obtaining legal services; and providing counseling, child care education, and training in and development of...

45 CFR Appendix A to Part 96 - Uniform Definitions of Services

Code of Federal Regulations, 2013 CFR

2013-10-01

... transportation. 6. Day Care Services—Children Day care services for children (including infants, pre-schoolers... service counseling for parents, plan development, and licensing and monitoring of child care homes and...; obtaining legal services; and providing counseling, child care education, and training in and development of...

Family Day Care Handbook. Fifth Edition.

ERIC Educational Resources Information Center

Bellm, Dan

The California Child Care Initiative is a collaborative program with the objective of increasing the supply of licensed quality child care in the state to better meet demand. This handbook provides family child care providers with guidance in implementing and maintaining a family daycare operation. The handbook provides articles, sample forms and…

45 CFR 98.40 - Compliance with applicable State and local regulatory requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider... shall: (1) Certify that they have in effect licensing requirements applicable to child care services... requirements on child care providers of services for which assistance is provided under the CCDF than the...

45 CFR 98.40 - Compliance with applicable State and local regulatory requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider... shall: (1) Certify that they have in effect licensing requirements applicable to child care services... requirements on child care providers of services for which assistance is provided under the CCDF than the...

45 CFR 98.40 - Compliance with applicable State and local regulatory requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider... shall: (1) Certify that they have in effect licensing requirements applicable to child care services... requirements on child care providers of services for which assistance is provided under the CCDF than the...

45 CFR 98.40 - Compliance with applicable State and local regulatory requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider... shall: (1) Certify that they have in effect licensing requirements applicable to child care services... requirements on child care providers of services for which assistance is provided under the CCDF than the...

45 CFR 98.40 - Compliance with applicable State and local regulatory requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider... shall: (1) Certify that they have in effect licensing requirements applicable to child care services... requirements on child care providers of services for which assistance is provided under the CCDF than the...

Top-of-License Nursing Practice: Describing Common Nursing Activities and Nurses' Experiences That Hinder Top-of-License Practice, Part 1.

PubMed

Buck, Jacalyn; Loversidge, Jacqueline; Chipps, Esther; Gallagher-Ford, Lynn; Genter, Lynne; Yen, Po-Yin

2018-05-01

The aims of this study were to describe nurses' perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice. The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses' points of view. This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses' work during typical shifts. Nurses' full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses' total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified. Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study

PubMed Central

2014-01-01

Background In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Methods Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. Results The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Conclusions Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care. PMID:25103861

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study.

PubMed

Kuusio, Hannamaria; Lämsä, Riikka; Aalto, Anna-Mari; Manderbacka, Kristiina; Keskimäki, Ilmo; Elovainio, Marko

2014-08-07

In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs' experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an 'active' job profile (high job demands and high levels of job control combined) according to Karasek's demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland's GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.

Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking: A Narrative Review

ERIC Educational Resources Information Center

Gwon, Seok Hyun; DeGuzman, Pamela B.; Kulbok, Pamela A.; Jeong, Suyong

2017-01-01

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on…

Child Day Care Center Licensing Study, 1996.

ERIC Educational Resources Information Center

Children's Foundation, Washington, DC.

The information contained in this report was compiled by The Children's Foundation in fall 1995 and reflects data provided by the regulatory offices in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. The study is organized in alphabetical order of the states and territories. The requirements, regulations, and policies…

45 CFR 400.117 - Provision of care and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Provision of care and services. 400.117 Section... Child Welfare Services § 400.117 Provision of care and services. (a) A State may provide care and... agency approved or licensed under State law. (b) If a State arranges for the care and services through a...

Day Care: Old Think and New Think.

ERIC Educational Resources Information Center

Morgan, Gwen G.

In this paper, old and new ways of thinking about day care are described as "oldthink" and "newthink." Major points of oldthink are that: (1) day care is a social service; (2) day care users are recipients, or at best, clients; (3) day care must be limited to low-income families; (4) licensing should protect children in day…

A macroeconomic review of dentistry in Canada in the 2000s.

PubMed

Ramraj, Chantel; Weitzner, Eleanor; Figueiredo, Rafael; Quiñonez, Carlos

2014-01-01

To describe trends in expenditures on dental health care services, the number of dental health care professionals and self-reported dental visits and cost barriers to dental care in Canada from 2000 to 2010. Data on licensed dental professionals; total expenditures on dental care, both public and private; and mean per capita amount spent on dental care were obtained from the Canadian Institute for Health Information. Information on self-reported dental visits and cost barriers to dental care were collected from the Canadian Community Health Surveys and the Canadian Health Measures Survey. To compare Canada with other countries, data from the Organisation for Economic Co-operation and Development (OECD) were used. From 2000 to 2010, the number of licensed dental professionals increased by 35%, with a particularly large rise in the number of dental hygienists (61%). Total real expenditures on dental care, after adjusting for inflation, increased by 56%, while the percentage of dental care expenditures paid by private insurance and through public funds decreased. Mean per capita expenditures increased from $233.94 in 2000 to $327.84 in 2010. Compared with other OECD countries, Canada ranked among the highest in mean per capita spending on dental care, but among the lowest in terms of public share. The proportion of people reporting a dental visit in the past year increased from 60.3% in 2001 to 75.5% in 2009, and those reporting cost barriers increased from 15% in 2001 to 17% in 2009. The dental care market appears to be growing, with increases in licensed dental professionals, total and mean per capita dental care expenditures and self-reported dental visits. However, these increases are not necessarily associated with greater effectiveness in meeting population needs and outcomes, such as equity in financing, delivery and improvements in oral health. Concerns with the financing of dental care and related issues of access may have implications for the future of dental care in Canada.

77 FR 8880 - Agency Information Collection Activities; Proposed Collection; Comment Request; General Licensing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... Provisions; Section 351(k) Biosimilar Applications AGENCY: Food and Drug Administration, HHS. ACTION: Notice... of information technology. General Licensing Provisions; Section 351(K) Biosimilar Applications On... Affordable Care Act.) Section 351(k) of the PHS Act (42 U.S.C. 262(k)), added by the BPCI Act, sets forth the...

42 CFR 1001.501 - License revocation or suspension.

Code of Federal Regulations, 2011 CFR

2011-10-01

... result of, or in connection with, a State licensing agency action. (2) Any of the following factors may... care had or could have had a significant adverse physical, emotional or financial impact on one or more... had a significant adverse impact on the financial integrity of the programs; or (iv) The individual or...

42 CFR 1001.501 - License revocation or suspension.

Code of Federal Regulations, 2014 CFR

2014-10-01

... result of, or in connection with, a State licensing agency action. (2) Any of the following factors may... care had or could have had a significant adverse physical, emotional or financial impact on one or more... had a significant adverse impact on the financial integrity of the programs; or (iv) The individual or...

[Legal Framework of Autologous Fat Usage in Point-of-Care Treatments in Plastic and Aesthetic Surgery - Risks of Criminal Prosecution and Infringement of Medical Law Due to Pharmaceutical Regulations].

PubMed

Faltus, T

2016-08-01

The use of autologous fat, especially for (stem) cell-assisted lipotransfer in plastic and aesthetic surgery, has regularly been regarded as the manufacture and application of so called Advanced Therapy Medicinal Products (ATMP). However, the in-house production of such pharmaceuticals at the point-of-care (PoC) in the surgeon's practice is not permitted without an official manufacturing license. Therefore, before beginning such treatments, a pharmaceutical manufacturing license has to be granted to the surgeon to avoid criminal prosecution and negative consequences due to infringement of professional regulations. Because such a license is linked to compliance with GMP standard, in-house manufacturing of such pharmaceuticals also implies extra technical and personnel expenses. The surgeon is obliged to check that the available autologous fat based applications are in compliance with pharmaceutical legislation. Repeated infringements of pharmaceutical regulations are incompatible with medical reliability - a prerequisite for the license to practice medicine. © Georg Thieme Verlag KG Stuttgart · New York.

7 CFR 735.105 - Care of agricultural products.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Care of agricultural products. 735.105 Section 735.105... § 735.105 Care of agricultural products. Each warehouse operator must at all times, including during any period of suspension of their license, exercise such care in regard to stored and non-storage...

Nutrition and Meal Planning in Child-Care Programs: A Practical Guide.

ERIC Educational Resources Information Center

Edelstein, Sari

Designed to assist child care center managers in planning nutritious meals for children in centers or licensed home day care programs, this guide presents information on the nutritional requirements of infants and children, sample menus for child care centers, and resources for further information. The first part of the guide details the…

7 CFR 3565.206 - Ineligible uses of loan proceeds.

Code of Federal Regulations, 2010 CFR

2010-01-01

... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

7 CFR 3565.206 - Ineligible uses of loan proceeds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

7 CFR 3565.206 - Ineligible uses of loan proceeds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

7 CFR 3565.206 - Ineligible uses of loan proceeds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

7 CFR 3565.206 - Ineligible uses of loan proceeds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

Patient Safety Culture: A Review of the Nursing Home Literature and Recommendations for Practice

PubMed Central

Bonner, Alice F.; Castle, Nicholas G.; Perera, Subashan; Handler, Steven M.

2010-01-01

Patient safety culture (PSC) is a critical factor in creating high-reliability health-care organizations. Most PSC research studies to date have been conducted in acute care settings; however, nursing home studies have recently begun to appear in the literature. Nursing homes differ from hospitals in a number of ways, including the population they serve, the medical model of care, and having the vast majority of direct care provided by non-licensed certified nursing assistants. Research has shown that nursing home PSC differs in important ways from PSC in acute care institutions. Recent PSC studies conducted in nursing homes and related quality and safety research can guide recommendations for nursing homes wishing to evaluate their own PSC. Relationships between PSC measurement, quality improvement, and workforce issues are potentially important and may influence clinical outcomes. PMID:21701601

A Self-Help Organization of Family Day Care Mothers as a Means of Quality Control.

ERIC Educational Resources Information Center

Sale, June Solnit

Recognizing that licensing or certification have not been an effective method of supervising or insuring quality of family day care, the largest form of out-of-home, non-relative care of children, this paper describes an alternative way of building more developmental care into family day care homes. The growth and progress of WATCH (Women…

Enhancing the quality of supportive supervisory behavior in long-term care facilities.

PubMed

McGillis Hall, Linda; McGilton, Katherine S; Krejci, Janet; Pringle, Dorothy; Johnston, Erin; Fairley, Laura; Brown, Maryanne

2005-04-01

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

Unlicensed care homes in the United States: a clandestine sector of long-term care.

PubMed

Lepore, Michael; Greene, Angela M; Porter, Kristie; Lux, Linda; Vreeland, Emily; Hawes, Catherine

2018-06-11

Residential care facilities operating without a state license are known to house vulnerable adults. Such unlicensed care homes (UCHs) commonly operate illegally, making them difficult to investigate. We conducted an exploratory, multimethod qualitative study of UCHs, including 18 subject matter expert interviews and site visits to three states, including a total of 30 stakeholder interviews, to understand UCH operations, services provided, and residents served. Findings indicate that various vulnerable groups reside in UCHs; some UCHs offer unsafe living environments; and some residents are reportedly abused, neglected, and financially exploited. Regulations, policies and practices that might influence UCH prevalence are discussed.

25 CFR 20.334 - What happens after I apply?

Code of Federal Regulations, 2014 CFR

2014-04-01

... SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.334 What happens after I apply? (a) The... purchase of service agreements for adult care provided in state or tribally licensed or certified group...

25 CFR 20.334 - What happens after I apply?

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.334 What happens after I apply? (a) The... purchase of service agreements for adult care provided in state or tribally licensed or certified group...

Family Day Care Services: Our Great-Grandmothers' Quilt

ERIC Educational Resources Information Center

Arruda, Joan

2009-01-01

This article features Family Day Care Services, one of the largest nonprofit providers of licensed home and centre-based child care programs in the Greater Toronto Area with 400 staff serving more than 4,000 children and their families. Family Day Care Services is also the lead agency for five Ontario Early Years Centres which are family…

Child Day Care Health Handbook.

ERIC Educational Resources Information Center

Fookson, Maxine; And Others

Developed to meet Washington State Day Care Minimum Licensing Requirements, guidelines in this handbook concern 10 health topics. Discussion focuses on (1) preventing illness in day care settings; (2) illnesses, their treatment, ways to limit their spread, and what caregivers can do when they have a sick child at their center; (3) caregivers'…

76 FR 17673 - Bienvenido Tan, M.D.; Denial of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

...]'' and that his ``prescribing was `an extreme departure from the standard of care expected of a licensed... reprimanded the Respondent `for his departures from the standard of care regarding his medical record keeping... each party's experts (who had examined various patient records) regarding the standard of care for...

A Military Hospice Model

DTIC Science & Technology

1983-05-06

that apply) A. A hospice inpatient facility; B. An inpatient unit in a a. Hospital; b. Intermediate Care Facility ; c. Skilled Nursing facility; C. A...Care Hospital Intermediate Care Facility SNF Hospice Other No License Page 3 V. "WEIGHTED" STANDARDS Please feel free to indicate with a "W" in the

75 FR 26759 - Health Care Integrity and Protection Data Bank (HIPDB) and National Practitioner Data Bank (NPDB...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Care... that license or certify health care practitioners, providers or suppliers, must report final adverse...-Compliant Government Agencies AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of...

38 CFR 46.5 - National Practitioner Data Bank inquiries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 60, subpart C, as applicable, concerning a physician, dentist, or other licensed health care practitioner as follows: (a) At the time a physician, dentist, or other health care practitioner applies for a... than every 2 years concerning any physician, dentist, or other health care practitioner who is on the...

38 CFR 46.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., dentist, or other health care practitioner in furnishing (or failing to furnish) health care services, and... individuals to furnish health care. (d) Dentist means a doctor of dental surgery or dental medicine legally... means an individual other than a physician or dentist who is licensed or otherwise authorized by a State...

38 CFR 46.5 - National Practitioner Data Bank inquiries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 60, subpart C, as applicable, concerning a physician, dentist, or other licensed health care practitioner as follows: (a) At the time a physician, dentist, or other health care practitioner applies for a... than every 2 years concerning any physician, dentist, or other health care practitioner who is on the...

38 CFR 46.5 - National Practitioner Data Bank inquiries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 60, subpart C, as applicable, concerning a physician, dentist, or other licensed health care practitioner as follows: (a) At the time a physician, dentist, or other health care practitioner applies for a... than every 2 years concerning any physician, dentist, or other health care practitioner who is on the...

38 CFR 46.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., dentist, or other health care practitioner in furnishing (or failing to furnish) health care services, and... individuals to furnish health care. (d) Dentist means a doctor of dental surgery or dental medicine legally... means an individual other than a physician or dentist who is licensed or otherwise authorized by a State...

38 CFR 46.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., dentist, or other health care practitioner in furnishing (or failing to furnish) health care services, and... individuals to furnish health care. (d) Dentist means a doctor of dental surgery or dental medicine legally... means an individual other than a physician or dentist who is licensed or otherwise authorized by a State...

38 CFR 46.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., dentist, or other health care practitioner in furnishing (or failing to furnish) health care services, and... individuals to furnish health care. (d) Dentist means a doctor of dental surgery or dental medicine legally... means an individual other than a physician or dentist who is licensed or otherwise authorized by a State...

38 CFR 46.5 - National Practitioner Data Bank inquiries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 60, subpart C, as applicable, concerning a physician, dentist, or other licensed health care practitioner as follows: (a) At the time a physician, dentist, or other health care practitioner applies for a... than every 2 years concerning any physician, dentist, or other health care practitioner who is on the...

38 CFR 46.5 - National Practitioner Data Bank inquiries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 60, subpart C, as applicable, concerning a physician, dentist, or other licensed health care practitioner as follows: (a) At the time a physician, dentist, or other health care practitioner applies for a... than every 2 years concerning any physician, dentist, or other health care practitioner who is on the...

38 CFR 46.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., dentist, or other health care practitioner in furnishing (or failing to furnish) health care services, and... individuals to furnish health care. (d) Dentist means a doctor of dental surgery or dental medicine legally... means an individual other than a physician or dentist who is licensed or otherwise authorized by a State...

The job analysis of Korean nurses as a strategy to improve the Korean Nursing Licensing Examination.

PubMed

Park, In Sook; Suh, Yeon Ok; Park, Hae Sook; Ahn, Soo Yeon; Kang, So Young; Ko, Il Sun

2016-01-01

This study aimed at characterizing Korean nurses' occupational responsibilities to apply the results for improvement of the Korean Nursing Licensing Examination. First, the contents of nursing job were defined based on a focus group interview of 15 nurses. Developing a Curriculum (DACOM) method was used to examine those results and produce the questionnaire by 13 experts. After that, the questionnaire survey to 5,065 hospital nurses was done. The occupational responsibilities of nurses were characterized as involving 8 duties, 49 tasks, and 303 task elements. Those 8 duties are nursing management and professional development, safety and infection control, the management of potential risk factors, basic nursing and caring, the maintenance of physiological integrity, medication and parenteral treatments, socio-psychological integrity, and the maintenance and improvement of health. The content of Korean Nursing Licensing Examination should be improved based on 8 duties and 49 tasks of the occupational responsibilities of Korean nurses.

Report of survey results for newly licensed registered nurses in Washington state.

PubMed

Hirsch, Anne M

2011-10-01

Current projections for the need for nurses in Washington state are based on an increase in the need for health care, the aging of the population, and the inability of the nursing educational institutions to supply adequate numbers of graduates. Yet many new graduates are providing anecdotal evidence that they cannot find a job in nursing. This study gathered information regarding the employment of newly licensed registered nurses in Washington between May 2009 and August 2010. Questionnaires were administered to a randomly selected sample of 2,200 newly licensed nurses; 532 responses were returned. Nearly 81% reported current employment as a registered nurse and 69.5% reported that they were very or somewhat satisfied with their employment situation. The job search strategies, type of job sought, and factors contributing to their success are reported. Factors contributing to the success of their job search and to job dissatisfaction are explored. Copyright 2011, SLACK Incorporated.

Nurses' scope of practice and the implication for quality nursing care.

PubMed

Lubbe, J C Irene; Roets, Lizeth

2014-01-01

This article provides an overview of the implications for patients' health status and care needs when assessments are performed by nurses not licensed or competent to perform this task. The Waterlow scale (Judy Waterlow, The Nook, Stroke Road, Henlade, TAUNTON, TA3 5LX) scenario is used as a practice example to illustrate this case. The international nursing regulatory bodies, in South Africa called the South African Nursing Council, set the scope of practice wherein nurses are allowed to practice. Different categories of nurses are allowed to practice according to specified competencies, in alignment with their scope of practice. A retrospective quantitative study was utilized. A checklist was used to perform an audit on a random sample of 157 out of an accessible population of 849 patient files. Data were gathered in May 2012, and the analysis was done using frequencies and percentages for categorical data. Reliability and validity were ensured, and all ethical principles were adhered to. Eighty percent of risk assessments were performed by nurses not licensed or enrolled to perform this task unsupervised. Areas such as tissue malnutrition, neurological deficits, and medication were inaccurately scored, resulting in 50% of the Waterlow risk-assessment scales, as an example, being incorrectly interpreted. This has implications for quality nursing care and might put the patient and the institution at risk. Lower-category nurses and student nurses should be allowed to perform only tasks within their scope of practice for which they are licensed or enrolled. Nurses with limited formal theoretical training are not adequately prepared to perform tasks unsupervised, even in the current global nursing shortage scenario. To optimize and ensure safe and quality patient care, risk assessments should be done by a registered professional nurse, who will then coordinate the nursing care of the patient with the assistance of the lower category of nurses. © 2013 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.

Overview of the gaps in the health care legislation in Georgia: short-, medium-, and long-term priorities.

PubMed

Kiknadze, Nino; Beletsky, Leo

2013-12-12

After gaining independence following the dissolution of the Soviet Union, Georgia has aspired to become the region's leader in progressive legal reform. Particularly in the realm of health care regulation, Georgia has proceeded with extensive legislative reforms intended to modernize its health care system, and bring it in line with international standards. As part of a larger project to improve human rights in patient care, we conducted a study designed to identify gaps in the current Georgian health care legislation. Using a cross-site research framework based on the European Charter of Patients’ Rights, an interdisciplinary working group oversaw a comprehensive review of human rights legislation pertinent to health care settings using various sources, such as black letter law, expert opinions, court cases, research papers, reports, and complaints. The study identified a number of serious inconsistencies, gaps, and conflicts in the definition and coverage of terms used in the national legislative canon pertinent to human rights in patient care. These include inconsistent definitions of key terms "informed consent" and "medical malpractice" across the legislative landscape. Imprecise and overly broad drafting of legislation has left concepts like patient confidentiality and implied consent wide open to abuse. The field of health care provider rights was entirely missing from existing Georgian legislation. To our knowledge, this is the first study of its kind in Georgia. Gaps and inconsistencies uncovered were categorized based on a short-, medium-, and long-term action framework. Results were presented to key decision makers in Georgian ministerial and legislative institutions. Several of the major recommendations are currently being considered for inclusion into future legal reform. Copyright © 2013 Kiknadze and Beletsky. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Creating New Child Care Slots in Mini Child Care Centers: Big Bang for the Buck in New Jersey.

ERIC Educational Resources Information Center

Frankel, Arthur J.; And Others

1992-01-01

Small grants of $7,500 with technical assistance were offered to the child care community of New Jersey to either start or increase licensed capacity in mini-child care centers. Results of a subsequent analysis showed that 26 grantees created 481 new child care slots at an average cost of $561 per slot. (Author/SM)

Beyond Academic and Social Integration: Understanding the Impact of a STEM Enrichment Program on the Retention and Degree Attainment of Underrepresented Students.

PubMed

Lane, Tonisha B

2016-01-01

The current study used a case study methodological approach, including document analysis, semistructured interviews, and participant observations, to investigate how a science, technology, engineering, and mathematics (STEM) enrichment program supported retention and degree attainment of underrepresented students at a large, public, predominantly white institution. From this study, a model emerged that encompassed four components: proactive care, holistic support, community building, and catalysts for STEM identity development. These components encompassed a number of strategies and practices that were instrumental in the outcomes of program participants. This paper concludes with implications for practice, such as using models to inform program planning, assessment, and evaluation. © 2016 T. B. Lane. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City

PubMed Central

Sanchez, John P.; Danoff, Ann

2009-01-01

Objectives. We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. Methods. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. Results. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). Conclusions. Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals. PMID:19150911

Sex trafficking and health care in Metro Manila: identifying social determinants to inform an effective health system response.

PubMed

Williams, Timothy P; Alpert, Elaine J; Ahn, Roy; Cafferty, Elizabeth; Konstantopoulos, Wendy Macias; Wolferstan, Nadya; Castor, Judith Palmer; McGahan, Anita M; Burke, Thomas F

2010-12-15

This social science case study examines the sex trafficking of women and girls in Metro Manila through a public health lens. Through key informant interviews with 51 health care and anti-trafficking stakeholders in Metro Manila, this study reports on observations about sex trafficking in Metro Manila that provide insight into understanding of risk factors for sex trafficking at multiple levels of the social environment: individual (for example, childhood abuse), socio-cultural (for example, gender inequality and a "culture of migration"), and macro (for example, profound poverty caused, inter alia, by environmental degradation disrupting traditional forms of labor). It describes how local health systems currently assist sex-trafficking victims, and provides a series of recommendations, ranging from prevention to policy, for how health care might play a larger role in promoting the health and human rights of this vulnerable population. Copyright © 2010 Williams, Alpert, Ahn, Cafferty, Konstantopoulos, Wolferstan, Castor, McGahan, and Burke. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Mental Health Care: Licensing and Certification Requirements for Staff in State Hospitals. Fact Sheet for the Honorable Daniel K. Inouye, United States Senate.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of Human Resources.

The Office of United States Senator Daniel Inouye requested information on state minimum licensing and certification requirements for physicians, psychiatrists, psychologists, social workers, and nurses who work directly with patients in state mental hospitals. To obtain this information, the General Accounting Office called the offices of the…

Podiatrists Licensed in Washington.

ERIC Educational Resources Information Center

Washington State Dept. of Social and Health Services, Olympia. Health Manpower Project.

This survey, based on a 95 0/0 response rate, determined that of all the podiatrists licensed in the state of Washington, 69 0/0 live within the state, 95 0/0 were actively employed in that profession, and almost all were in private practice. The primary work function of 83 0/0 was direct patient care, and over half of the respondents worked 40 to…

How Safe? The Status of State Efforts To Protect Children in Child Care.

ERIC Educational Resources Information Center

Adams, Gina

Based on the view that strong state child care licensing policies can influence the quality of child care and thereby enhance children's health and development, this report examines the status of state efforts to improve the quality of child care programs. Almost all data were collected for a 1993 Parenting Magazine survey, and were verified by…

Disinfection of reusable elastomeric respirators by health care workers: a feasibility study and development of standard operating procedures.

PubMed

Bessesen, Mary T; Adams, Jill C; Radonovich, Lewis; Anderson, Judith

2015-06-01

This was a feasibility study in a Department of Veterans Affairs Medical Center to develop a standard operating procedure (SOP) to be used by health care workers to disinfect reusable elastomeric respirators under pandemic conditions. Registered and licensed practical nurses, nurse practitioners, aides, clinical technicians, and physicians took part in the study. Health care worker volunteers were provided with manufacturers' cleaning and disinfection instructions and all necessary supplies. They were observed and filmed. SOPs were developed, based on these observations, and tested on naïve volunteer health care workers. Error rates using manufacturers' instructions and SOPs were compared. When using respirator manufacturers' cleaning and disinfection instructions, without specific training or supervision, all subjects made multiple errors. When using the SOPs developed in the study, without specific training or guidance, naïve health care workers disinfected respirators with zero errors. Reusable facial protective equipment may be disinfected by health care workers with minimal training using SOPs. Published by Elsevier Inc.

Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

ERIC Educational Resources Information Center

Hulburd, Kimberly

A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first…

Nurse Assistant Instructor Guide.

ERIC Educational Resources Information Center

Connecticut State Dept. of Education, Hartford. Div. of Vocational, Technical, and Adult Education.

This document is designed to assist the teacher in a nurse assistant certification program. The program is intended to prepare students for entry-level employment in a long-term care facility or with a licensed home health care agency. The 135-hour course teaches basic skills in patient care that will qualify the student to assist the licensed…

Geriatric Training Needs of Nursing-Home Physicians

ERIC Educational Resources Information Center

Lubart, Emily; Segal, Refael; Rosenfeld, Vera; Madjar, Jack; Kakuriev, Michael; Leibovitz, Arthur

2009-01-01

Medical care in nursing homes is not provided by board-licensed geriatricians; it mainly comes from physicians in need of educational programs in the field of geriatrics. Such programs, based on curriculum guidelines, should be developed. The purpose of this study was to seek input from nursing home physicians on their perceived needs for training…

Differences between Adolescent Mothers and Nonmothers: An Interview Study.

ERIC Educational Resources Information Center

Garrett, Susan Corona; Tidwell, Romeria

1999-01-01

Reports on in-depth interviews conducted with nine adolescent females, all residing in a licensed care institution. Four of them were already mothers, four were not mothers, and one was pregnant. Abuse, neglect, and family dysfunction were found to be more pronounced among the mothers and the pregnant adolescent. (Author/GCP)

From Standards to Compliance, to Good Services, to Quality Lives: Is This How It Works?

ERIC Educational Resources Information Center

Shea, John R.

1992-01-01

Licensing and certification regulations for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) can adversely affect individuals, distort the allocation of scarce resources, and encourage community residences to become small institutions. A case study of one home in northern California illustrates poor program evaluation and the need…

The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes

ERIC Educational Resources Information Center

Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert

2011-01-01

Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…

Critical Thinking Skill Acquisition in Accelerated LVN to RN Nursing Programs: An Evaluative Case Study

ERIC Educational Resources Information Center

Hutchison, Billy Eugene

2013-01-01

Accelerated transitional nursing programs (ATNPs) designed specifically for licensed vocational nurses (LVNs) to transition to become registered nurses (RNs) are graduating novice nurses who need critical thinking skills to solve patient problems. The health care industry and patient outcomes depend on graduate nurses to be proficient with quality…

The Effect of Licensure Type on the Policies, Practices, and Resident Composition of Florida Assisted Living Facilities

PubMed Central

Street, Debra; Burge, Stephanie; Quadagno, Jill

2009-01-01

Purpose: Most assisted living facility (ALF) residents are White widows in their mid- to late 80s who need assistance with activities of daily living (ADLs) because of frailty or cognitive decline. Yet, ALFs also serve younger individuals with physical disabilities, traumatic brain injury, or serious mental illness. We compare Florida ALFs with different licensure profiles by admission–discharge policies and resident population characteristics. Design and Methods: We use state administrative data and facility survey data from the Florida Study of Assisted Living (FSAL) to classify ALFs by licensure type and to determine how licensure influences ALF policies, practices, and resident population profiles. Results: Standard-licensed traditional ALFs primarily serve elderly White women with physical care needs and typically retain residents when their physical health deteriorates. Some ALFs that hold specialty licenses (extended congregate care and limited nursing services) offer extra physical care services and serve an older, more physically frail population with greater physical and cognitive challenges. ALFs with limited mental health (LMH) licenses serve clientele who are more racially and ethnically diverse, younger, and more likely to be men and single. LMH facilities also have a significant proportion of frail elder residents who live alongside these younger residents, including some who exhibit behavioral problems. LMH facilities also employ discharge policies that make it more difficult for frail elderly residents to age in place. Implications: These differences by facility type raise important quality of life issues for both the frail elderly individuals and assisted living residents who do not fit the conventional demographic profile. PMID:19363016

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

PubMed

Blöndal, Katrin; Zoëga, Sigridur; Hafsteinsdottir, Jorunn E; Olafsdottir, Olof Asdis; Thorvardardottir, Audur B; Hafsteinsdottir, Sigrun A; Sveinsdóttir, Herdis

2014-08-01

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration. © The Author(s) 2014.

Is there a doctor in the house? Availability of Israeli physicians to the workforce.

PubMed

Horowitz, Pamela Kuflik; Shemesh, Annarosa Anat; Horev, Tuvia

2017-01-01

Israeli policymakers have expressed serious concerns about being able to meet the growing demand for physician services. For this reason, the Israel Ministry of Health (MoH) undertook studies based on 2008 and then 2012 data to obtain an accurate assessment of the size, specialty mix, demographic and geographic composition of the physician workforce. This paper highlights the findings from these studies about the number and percentage of licensed physicians in Israel who were not available, were only partially available, or were about to leave the Israeli healthcare workforce. The two studies cross-linked administrative files of the entire physician population in Israel. The two sources were the MoH registry of licensed physicians, which contains demographic, medical education and specialty information, and the Israel Tax Authority income file on employment data. A third source, used only for the study of 2008 data, was the CBS Population Census Data 2008 which was based on a large representative sample of the population (14%), along with the updated Population Registry, which provided data on physicians whose occupation was in medical care as well as the number of work-hours. By linking the files we could also assess the population of licensed Israeli physicians living abroad. Only 74% of licensed physicians of all ages in 2012 were active in the Israeli workforce. Of physicians under the age of 70, 87% were living and working in Israel. Female physicians tended to retire from the workforce earlier than males and were more likely to work fewer hours during their working years. The rate of physicians who worked longer hours declined in both genders as age rose. About 10% of licensees had been living abroad for at least a year and the majority of these were older. Approximately 7% of licensed physicians, ages 30-44, were abroad and most are presumed to be doing additional clinical training or gaining research experience. In some specialty fields young physicians were not replacing retirees at a compensatory rate; anesthesiologists, a specialty in short supply in Israel were more likely to be living abroad than other specialists. Assessment of the medical workforce pool and personnel planning require not just the number of licensed physicians but also information about the employment mix of license holders and their level of professional activity in Israel. For planning future workforce needs, it is important to keep in mind that the average female vs. male physician has lower clinical productivity due to shorter hours and earlier retirement and that a group of young physicians will predictably be abroad at any point in time; however major "brain drain" is not evident. Furthermore, extrapolating from the findings in the current studies, we believe that a potential shortage of physicians within Israel can be mitigated by better administrative support of physicians, use of physician extenders, and careful attention to improving physician satisfaction in certain specialties.

42 CFR 51c.102 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of primary care physicians in general or family practice, internal medicine, pediatrics, or... individual. (g) Physician means a licensed doctor of medicine or doctor of osteopathy. (h) Primary health..., preventive health education, children's eye and ear examinations, prenatal and post-partum care, prenatal...

Getting Started in the Child Care Business.

ERIC Educational Resources Information Center

Kimery, Sharon

This pamphlet discusses questions to consider when planning a child care facility. Topics discussed include licensing, financial management, written policies on facility operation, recordkeeping, insurance, the physical nature of the facility, program planning, scheduling of daily activities, personnel selection, staff development, parent…

The overall impact of emotional intelligence on nursing students and nursing

PubMed Central

Michelangelo, Lori

2015-01-01

Healthcare employers often criticize the lack of emotional competency and critical thinking skills demonstrated by newly licensed nurses. The purpose of this study was to evaluate whether emotional intelligence (EI) training for nurses improves critical thinking and emotional competence enough to justify including EI in nursing curricula. A meta-analysis was conducted inclusive of EI related nursing abilities and traits such as leadership, health, reflection, ethical behavior, nursing student performance, and job retention/satisfaction. Studies of EI constructs, test instruments, and contrary viewpoints were also examined. The analysis included 395 EI studies of approximately 65,300 participants. All the studies reported a positive correlation with EI ranging from weak to strong with a moderate cumulative effect size of r = 0.3022 across all studies. This study may contribute to positive social change by reducing employers time and cost for training newly licensed nurses, thereby decreasing the overall cost of health care to the public. PMID:27981103

The overall impact of emotional intelligence on nursing students and nursing.

PubMed

Michelangelo, Lori

2015-01-01

Healthcare employers often criticize the lack of emotional competency and critical thinking skills demonstrated by newly licensed nurses. The purpose of this study was to evaluate whether emotional intelligence (EI) training for nurses improves critical thinking and emotional competence enough to justify including EI in nursing curricula. A meta-analysis was conducted inclusive of EI related nursing abilities and traits such as leadership, health, reflection, ethical behavior, nursing student performance, and job retention/satisfaction. Studies of EI constructs, test instruments, and contrary viewpoints were also examined. The analysis included 395 EI studies of approximately 65,300 participants. All the studies reported a positive correlation with EI ranging from weak to strong with a moderate cumulative effect size of r = 0.3022 across all studies. This study may contribute to positive social change by reducing employers time and cost for training newly licensed nurses, thereby decreasing the overall cost of health care to the public.

Summary of ACOP (American College of Osteopathic Pediatricians) Program Directors' Annual Reports for First-Year Residents and Relationships between Resident Competency Performance Ratings and COMLEX-USA Test Scores

ERIC Educational Resources Information Center

Langenau, Erik E.; Pugliano, Gina; Roberts, William L.; Hostoffer, Robert

2010-01-01

Context: The Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) endorsed the use of competency-based assessment, with the intention to improve health care administration [1, 2]. High-stakes licensing exams, such as the Comprehensive Osteopathic Medical Licensing Examination -- USA (COMLEX-USA),…

A Phenomenological Study of the Office Environments of Clinical Social Workers.

PubMed

Jones, Jamie K

2018-01-01

The purpose of this study was to explore the meaning and uses of the office space among licensed clinical social workers in private practice. Previous research suggests the importance of the office space in clinical practice in regard to therapeutic alliance, client behavior, and the well-being of the therapist. However, therapist offices contain much variation in design. This study looked further into specifically how the therapy room is important through the perspective of the licensed clinical social workers in order to identify common themes. Seven licensed clinical social workers in private psychotherapy practice were interviewed in their offices. Phenomenological research methods were used to explore and analyze their experiences. While the offices contained many physical differences, the intentions behind the designs were similar. Three themes emerged regarding how participants used and designed their spaces. First, participants used their offices to provide care for clients and themselves. Second, participants used their spaces to communicate therapeutic messages and to reveal and/or conceal aspects of themselves. Third, participants also used their space in direct practice. This phenomenological study provided insight into the importance and use of the psychotherapy office space. These findings may be helpful for therapists designing or redesigning their own practice spaces.

Day Care: Serving Preschool Children-3.

ERIC Educational Resources Information Center

Cohen, Donald J.; Brandegee, Ada S.

The handbook offers information and guidelines for establishing model daycare services for preschool children. Topics examined include: the nature of day care for preschoolers, the developmental patterns of preschool children, administration, budgeting and funding, licensing and other forms of regulation, facilities, parent involvement, curriculum…

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2013 CFR

2013-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2012 CFR

2012-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2010 CFR

2010-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2011 CFR

2011-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

24 CFR 266.205 - Ineligible projects.

Code of Federal Regulations, 2014 CFR

2014-04-01

... designed for the elderly with extensive services and luxury accommodations that provide for central kitchens and dining rooms with food service or mandatory services. (d) Nursing homes or intermediate care facilities. Nursing homes and intermediate care facilities licensed and regulated by State or local...

A Short Term Evaluation of the Direct Operating Grants. Final Report.

ERIC Educational Resources Information Center

Levy-Coughlin Partnership.

Findings of a survey of a sample of center-based child care (CBCC) programs and private home day care (PHDC) agencies listed in Ontario's Direct Operating Grant Calculation Data Base are reported. During 1988, licensed child care programs in Ontario received approximately 46.5 million dollars in Direct Operating Grants (DOGs). Grants were…

State CCDBG Plans to Promote Opportunities for Babies and Toddlers in Child Care. Policy Brief

ERIC Educational Resources Information Center

Lim, Teresa; Schumacher, Rachel

2009-01-01

State child care policies--including licensing, subsidy, and quality enhancement strategies--can promote the quality and continuity of early childhood experiences and foster the healthy growth and development of babies and toddlers in child care settings, especially if they are informed by research. One of the policy levers states may use to…

Recognising Health Care Assistants' Prior Learning through a Caring Ideology

ERIC Educational Resources Information Center

Sandberg, Fredrik

2010-01-01

This article critically appraises a process of recognising prior learning (RPL) using analytical tools from Habermas' theory of communicative action. The RPL process is part of an in-service training program for health care assistants where the goal is to become a licensed practical nurse. Data about the RPL process were collected using interviews…

Facilitating Employee Recruitment and Retention through On-Site Child Day Care.

ERIC Educational Resources Information Center

Lombardo, Kathy A.

An early childhood educator at a 360-bed community general hospital implemented a licensed on-site child care program for children between 6 weeks and 10 years of age in order to improve employee recruitment and retention by assisting employees with appropriate child care arrangements. A parent questionnaire was used to assess the degree to which…

Service-Learning Linking Family Child Care Providers, Community Partners, and Preservice Professionals

ERIC Educational Resources Information Center

Garner, Pamela W.; Parker, Tameka S.

2016-01-01

This article describes the implementation of a service-learning project, which was infused into a child development course. The project linked family child care providers, their licensing agency, and 39 preservice teachers in a joint effort to develop a parent handbook to be used by the providers in their child care businesses and to support…

20 CFR 30.403 - Will OWCP pay for the services of an attendant?

Code of Federal Regulations, 2010 CFR

2010-04-01

... attendant? OWCP will authorize payment for personal care services under section 7384t of the Act, whether or not such care includes medical services, so long as the personal care services have been determined to be medically necessary and are provided by a home health aide, licensed practical nurse, or similarly...

The Work-Family Support Roles of Child Care Providers across Settings

ERIC Educational Resources Information Center

Bromer, Juliet; Henly, Julia R.

2009-01-01

This paper presents a qualitative investigation of the work-family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents…

Home-SAFE: A New Approach in Day Care for the Young Child.

ERIC Educational Resources Information Center

Kornfeld, Maurine

The Los Angeles Section, National Council of Jewish Women, has developed an innovative pilot program in day care geared to the changing life style of child rearing by single parents. Home-SAFE provides children a warm, secure environment in supervised, subsidized, licensed day care homes, and includes enrichment activities by trained volunteers;…

Do recreational cannabis users, unlicensed and licensed medical cannabis users form distinct groups?

PubMed

Sznitman, Sharon R

2017-04-01

This study aims to gain a more nuanced perspective on the differences between recreationally and medically motivated cannabis use by distinguishing between people who use cannabis for recreational purposes, unlicensed and licensed medical users. Data collection was conducted online from a convenience sample of 1479 Israeli cannabis users. Multinomial regression analysis compared unlicensed medical users (38%) with recreational (42%) and licensed medical (5.6%) users in terms of sociodemographics, mode, frequency and problematic cannabis use. There were more variables distinguishing unlicensed from licensed users than there were distinguishing features between unlicensed and recreational users. Recreational users were more likely to be male, less likely to eat cannabis, to use cannabis frequently and to use alone and before midday than unlicensed users. Licensed users were older than unlicensed users, they reported less hours feeling stoned, less cannabis use problems and they were more likely to report cannabis use patterns analogous of medication administration for chronic problems (frequent use, vaping, use alone and use before midday). This study suggests that a sizable proportion of cannabis users in Israel self-prescribe cannabis and that licensed medical cannabis users differ from unlicensed users. This is, in turn, suggestive of a rigorous medicalized cannabis program that does not function as a backdoor for legal access to recreational use. However, due to methodological limitations this conclusion is only suggestive. The most meaningful differences across recreational, unlicensed and licensed users were mode and patterns of use rather than cannabis use problems. Current screening tools for cannabis use problems may, however, not be well suited to assess such problems in medically motivated users. Indeed, when screening for problematic cannabis use there is a need for a more careful consideration of whether or not cannabis use is medically motivated. Copyright © 2016 Elsevier B.V. All rights reserved.

A Comparison of the Mandatory Continuing Education (MCE) Requirements of the Regulated Health Occupations in Minnesota.

ERIC Educational Resources Information Center

Green-Eide, Beth

A study reviewed and compared initial and renewal practices for licensure/registration of 13 health care occupations regulated in the state of Minnesota. It examined mandatory continuing education (MCE) documentation and the practices of licensing boards in their enforcement of the MCE legislation. The Minnesota Statutes and Rules for the…

Herbal remedies: issues in licensing and economic evaluation.

PubMed

Ashcroft, D M; Po, A L

1999-10-01

In recent years, the use of alternative therapies has become widespread. In particular, there has been a resurgence in the public's demand for herbal remedies, despite a lack of high-quality evidence to support the use of many of them. Given the increasing pressures to control healthcare spending in most countries, it is not surprising that attention is being focused on the cost effectiveness of herbal remedies. We address the question of whether there is sufficient information to enable the assessment of the cost effectiveness of herbal remedies. In so doing, we discuss the current state of play with several of the more high-profile alternative herbal remedies [Chinese medicinal herbs for atopic eczema, evening primrose oil, ginkgo biloba, hypericum (St John's wort)] and some which have made the transition from being alternative to being orthodox remedies. We use historical context to discuss, on the one hand, the increasing commodification of herbal remedies and on the other, the trend towards greater regulatory control and licensing of alternative herbal remedies. We argue that unless great care is exercised, these changes are not necessarily in the best interests of patients. In order to identify cost-effective care, we need reliable information about the costs as well as the efficacy and safety of the treatments being assessed. For most alternative therapies, such data are not available. We believe that studies to gather such data are long overdue. Whilst we argue strongly in favour of control of some herbal remedies, we urge caution with the trend towards licensing of all herbal remedies. We argue that the licensing of those herbal remedies with equivocal benefits and few risks, as evidenced by a long history of safe use, increases barriers to entry and increases societal healthcare costs.

Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter.

PubMed

Kemeny, M Elizabeth; Mabry, J Beth

2017-01-01

Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

Community Pharmacists' Perceptions about Pharmaceutical Care of Traditional Medicine Products: A Questionnaire-Based Cross-Sectional Study in Guangzhou, China

PubMed Central

Chen, Xi; Ung, Carolina Oi Lam; Hu, Hao; Liu, Xiaodan; Zhao, Jing; Hu, Yuanjia; Li, Peng; Yang, Qing

2016-01-01

This study aimed to investigate community pharmacists' perceived responsibility, practice behaviors, knowledge, perceived barriers, and improvement measures towards provision of pharmaceutical care in relation to traditional medicine (TM) products in Guangzhou, China. A self-completion questionnaire was used to survey licensed pharmacists working at community pharmacies. This study found that the community pharmacists in Guangzhou, China, were involved in the provision of TM products during their daily practice but only provided pharmaceutical care in this area with a passive attitude. Extrinsic barriers such as lack of scientific evidence for the safety and efficacy of TM products and unclear definition of their roles and responsibilities were highlighted while intrinsic factors such as insufficient TM knowledge were identified. PMID:27066101

Measurement of workplace empowerment across caregivers.

PubMed

Caspar, Sienna; O'Rourke, Norm

2011-01-01

Culture change models (CCM) developed to improve the provision of individualized care in long-term care (LTC) facilities often include initiatives that are thought to empower care staff. Therefore, the ability to measure empowerment accurately across all levels of care staff is necessary. The objective of this study was to examine the structure of responses by registered nurses (RNs), licensed practical nurses (LPNs), and care aides to 3 instruments measuring workplace empowerment: the Conditions of Work Effectiveness Questionnaire, Job Activities Scale, and Organizational Relationships Scale. Despite considerable differences in education and job function, both caregiver groups appear to interpret and respond to 38 of 40 empowerment items in a similar manner. Therefore, our findings support the inclusion of all care staff when using these instruments to measure work place empowerment in LTC settings. Copyright © 2011 Mosby, Inc. All rights reserved.

78 FR 73553 - Prospective Grant of Exclusive License: Development of Cripto-1 Point of Care (POC) Tests and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

...This is notice, in accordance with 35 U.S.C. 209 and 37 CFR Part 404, that the National Institutes of Health, Department of Health and Human Services, is contemplating the grant of an exclusive patent license to practice the inventions embodied in the following U.S. Patents and Patent Applications to Beacon Biomedical LLC (``Beacon'') located in Scottsdale, AZ, USA.

Assistant practitioners: lessons learned from licensed practical nurses.

PubMed

Whittingham, Katrina

The role of the assistant practitioner (AP) needs to be defined so they have clear career pathways and opportunities for professional development. The author sought to learn from other countries where a sustained effort had been made to support practitioners fulfilling this intermediate role. The equivalent of an AP in Canada is the licensed practical nurse (LPN); LPNs are subject to clear regulation and practice within their remit of their license. The author travelled to Alberta, Canada, and performed a qualitative study to investigate the role of the LPN. LPNs undertake a 2-year diploma-level course and have the opportunity to enhance their careers through specialist courses or to train as a RN. LPNs benefit from careful regulation, enabling them to have a clear scope of practice, a career structure with opportunities for development and consistent ethical standards. Lessons can be learned from the LPN model and put in practice in the UK; APs need a consistent education programme, a career pathway that promotes development and effective regulation.

Music therapy in an integrated pediatric palliative care program.

PubMed

Knapp, Caprice; Madden, Vanessa; Wang, Hua; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth

National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida's Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents' experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.

A qualitative assessment of factors influencing acceptance of a new rotavirus vaccine among health care providers and consumers

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

Manish M Patel, Alan P Janssen, Richard Tardif, Mark Herring, Umesh Parashar

2007-10-18

In 2006, a new rotavirus vaccine (RotaTeq) was licensed in the US and recommended for routine immunization of all US infants. Because a previously licensed vaccine (Rotashield) was withdrawn from the US for safety concerns, identifying barriers to uptake of RotaTeq will help develop strategies to broaden vaccine coverage. Our qualitative assessment provides complementary data to recent quantitative surveys and suggests that physicians and parents are likely to adopt the newly licensed rotavirus vaccine. Increasing parental awareness of the rotavirus disease burden and providing physicians with timely post-marketing surveillance data will be integral to a successful vaccination program.

The characteristics and distribution of dentist workforce in Saudi Arabia: A descriptive cross-sectional study.

PubMed

AlBaker, Abdulaziz A; Al-Ruthia, Yazed Sulaiman H; AlShehri, Mohammed; Alshuwairikh, Samar

2017-12-01

The Kingdom of Saudi Arabia has shown steady growth in the dental workforce over the last 20 years. Although the number of dental colleges has significantly increased in the last decade, there is not any study so far that described the status of the licensed dentist workforce in the kingdom. The present study aimed to explore the demographic distribution and professional characteristics of licensed dentist workforce in Saudi Arabia. This was a descriptive cross-sectional study using the Saudi Commission for Health Specialties (SCFHS) database to identify the number of licensed dentists in Saudi Arabia as well as their professional and demographic characteristics as of December 2016. The data was categorized based on gender, nationality, dental specialty, health sector, geographic location, and professional rank. The number of licensed dentists working in the kingdom as of December 2016 was 16887 dentists, and the vast majority of them are professionally registered as general dentists (70.27%). The percentage of general dentists among the professionally registered female dentists is significantly higher than their male counterparts (79.71% vs. 64.80%; P  < 0.001). Only 22.08% of the dentists working in the kingdom are Saudi. Most of the dentist workforce in the kingdom are male (61.06%). The mean age of the Saudi dentists is slightly but significantly younger than non-Saudi dentists (37.7 vs. 40.7 years; P  < 0.001). Over 80% of the Saudi dentists are working in the regions of Riyadh, Makkah, and Eastern province. About 66% of the Saudi dentists are working in the public health sector in comparison to only 20.46% of the non-Saudi dentists ( P  < 0.001). Most of the dental care in Saudi Arabia is provided by non-Saudi dentists in both private and public health sectors. With the rising unemployment rate among Saudi dentists, the governmental bodies that are responsible of dental labor market regulations such as the ministries of health, economy and planning, and labor should come up with a policy to gradually but carefully replace the non-Saudi dentists in both public and private sectors with Saudi dentists.

"Are You Done?" Child Care Providers' Verbal Communication at Mealtimes that Reinforce or Hinder Children's Internal Cues of Hunger and Satiation

ERIC Educational Resources Information Center

Ramsay, Samantha A.; Branen, Laurel J.; Fletcher, Janice; Price, Elizabeth; Johnson, Susan L.; Sigman-Grant, Madeleine

2010-01-01

Objective: To explore the verbal communication of child care providers regarding preschool children's internal and non-internal hunger and satiation cues. Methods: Video observation transcripts of Head Start staff (n=29) at licensed child care centers in Colorado, Idaho, and Nevada were analyzed for common themes. Results: Adults' verbal…

41 CFR Appendix C to Part 102 - 37-Glossary of Terms for Determining Eligibility of Public Agencies and Nonprofit Organizations

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Child care center means a public or nonprofit facility where educational, social, health, and nutritional services are provided to children through age 14 (or as prescribed by State law) and that is approved or licensed by the State or other appropriate authority as a child day care center or child care...

Common Day Care Safety Renovations: Descriptions, Explanations and Cost Estimates.

ERIC Educational Resources Information Center

Spack, Stan

This booklet explains some of the day care safety features specified by the new Massachusetts State Building Code (January 1, 1975) which must be met before a new day care center can be licensed. The safety features described are those which most often require renovation to meet the building code standards. Best estimates of the costs involved in…

Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers

PubMed Central

Angus, Kathryn; Elders, Andrew; de Andrade, Marisa; Raistrick, Duncan; Heather, Nick; McCambridge, Jim

2016-01-01

Abstract Background and aims Nalmefene has been approved in Europe for the treatment of alcohol dependence and subsequently recommended by the UK National Institute for Health and Care Excellence (NICE). This study examines critically the evidence base underpinning both decisions and the issues arising. Methods Published studies of nalmefene were identified through a systematic search, with documents from the European Medicines Agency, the NICE appraisal and public clinical trial registries also examined to identify methodological issues. Results Efficacy data used to support the licensing of nalmefene suffer from risk of bias due to lack of specification of a priori outcome measures and sensitivity analyses, use of post‐hoc sample refinement and the use of inappropriate comparators. Despite this, evidence for the efficacy of nalmefene in reducing alcohol consumption in those with alcohol dependence is, at best, modest, and of uncertain significance to individual patients. The relevance of existing trial data to routine primary care practice is doubtful. Conclusions Problems with the registration, design, analysis and reporting of clinical trials of nalmefene did not prevent it being licensed and recommended for treating alcohol dependence. This creates dilemmas for primary care clinicians and commissioning organisations where nalmefene has been heavily promoted, and poses wider questions about the effectiveness of the medicines regulation system and how to develop the alcohol treatment evidence base. PMID:27262594

26 CFR 1.162-29 - Influencing legislation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... proposed regulation increasing the threshold value of commercial and residential real estate transactions... all day-care providers. Agency B in State X is charged with writing rules to implement the statute... rules that S recommends Agency B adopt to implement the statute on licensing of day-care providers...

26 CFR 1.162-29 - Influencing legislation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... proposed regulation increasing the threshold value of commercial and residential real estate transactions... all day-care providers. Agency B in State X is charged with writing rules to implement the statute... rules that S recommends Agency B adopt to implement the statute on licensing of day-care providers...

26 CFR 1.162-29 - Influencing legislation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... proposed regulation increasing the threshold value of commercial and residential real estate transactions... all day-care providers. Agency B in State X is charged with writing rules to implement the statute... rules that S recommends Agency B adopt to implement the statute on licensing of day-care providers...

26 CFR 1.162-29 - Influencing legislation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... proposed regulation increasing the threshold value of commercial and residential real estate transactions... all day-care providers. Agency B in State X is charged with writing rules to implement the statute... rules that S recommends Agency B adopt to implement the statute on licensing of day-care providers...

Underserved parents, underserved youth: Considering foster parent willingness to foster substance-using adolescents

PubMed Central

Meyers, Kathleen; Kaynak, Övgü; Clements, Irene; Bresani, Elena; White, Tammy

2014-01-01

Adolescents involved with foster care are five times more likely to receive a drug dependence diagnosis when compared to adolescents in the general population. Prior research has shown that substance use is often hidden from providers, negating any chance for treatment and almost guaranteeing poor post-foster care outcomes. There are virtually no studies that examine the willingness (and its determinants) to foster youth with substance abuse problems. The current study conducted a nationally-distributed survey of 752 currently licensed foster care parents that assessed willingness to foster youth overall and by type of drug used, and possible correlates of this decision (e.g., home factors, system factors, and individual foster parent factors such as ratings of perceived difficulty in fostering this population). Overall, willingness to foster a youth involved with alcohol and other drugs (AOD) was contingent upon the types of drugs used. The odds that a parent would foster an AOD-involved youth were significantly increased by being licensed as a treatment foster home, having fostered an AOD-involved youth in the past, having AOD-specific training and past agency-support when needed, and self-efficacy with respect to positive impact. Surprisingly, when religion played a large part in the decision to foster any child, the odds of willingness to foster an AOD-involved youth dropped significantly. These results suggest that a large proportion of AOD-involved youth who find themselves in the foster care system will not have foster families willing to parent them, thereby forcing placement into a variety of congregate care facilities (e.g., residential treatment facilities, group homes). Specific ways in which the system can address these issues to improve placement and permanency efforts is provided. PMID:25878368

Integrated networks and health care provider cooperatives: new models for rural health care delivery and financing.

PubMed

Casey, M M

1997-01-01

Minnesota's 1994 health care reform legislation authorized the establishment of community integrated service networks (CISNs) and health care provider cooperatives, which were envisioned as new health care delivery models that could be successfully implemented in rural areas of the state. Four CISNs are licensed, and three organizations are incorporated as health care provider cooperatives. Many of the policy issues Minnesota has faced regarding the development of CISNs and health care provider cooperatives in rural areas are similar to those raised by current Medicare reform proposals.

Original research: New nurses: has the recession increased their commitment to their jobs?

PubMed

Brewer, Carol S; Kovner, Christine T; Yingrengreung, Siritorn; Djukic, Maja

2012-03-01

Current evidence suggests that the economic recession has induced retired RNs to reenter nursing and working nurses to work more hours and delay retirement, thus easing the projected RN shortage. We wondered whether the economic downturn had affected new nurses' work attitudes and behaviors, including those related to turnover. The purpose of this study was to compare perceptions about job opportunities, as well as key attitudinal variables (such as job satisfaction and intent to stay), in two cohorts of newly licensed RNs. Our data came from two sources: a subset of new RNs licensed between August 1, 2004, and July 31, 2005, who were part of a larger 2006 study on turnover, and a later cohort of new RNs licensed between August 1, 2007, and July 31, 2008. We mailed survey questionnaires to one cohort before the recession in 2006 and to a second cohort during the recession in 2009. We found that RNs' commitment to their current employers was higher in the later cohort than in the earlier one, although neither nurses' incomes nor their reported job satisfaction levels had changed. Our findings suggest that, despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations' efforts to improve RNs' working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.

Scheduling and shift work characteristics associated with risk for occupational injury in newly licensed registered nurses: An observational study.

PubMed

Stimpfel, Amy Witkoski; Brewer, Carol S; Kovner, Christine T

2015-11-01

Registered nurses across the globe bear a heavy injury burden. Every shift, nurses are exposed to a variety of hazards that can jeopardize their health, which negatively impacts their ability to provide high-quality patient care. Previous research suggests that inexperienced, or newly licensed nurses, may have an increased risk for certain occupational injuries. However, the current knowledge base is insufficient to fully understand how work hours influence newly licensed nurses' occupational injury, given the significant variation in hospital organization and work characteristics. To describe newly licensed nurses' shift work characteristics and determine the association between shift type and scheduling characteristics and nurse injury, before and after adjusting for individual and combined effects of demographics, external context, organizational context, and work context, following the Organization of Work model. This study is a secondary analysis of a nationally representative survey of newly licensed registered nurses using a cross-sectional design. The analytic sample includes 1744 newly licensed registered nurses from 34 states and the District of Columbia who reported working in a hospital and were within 6-18 months of passing their state licensure exam at the time of survey administration. Descriptive statistics were calculated, followed by bivariate and multivariate Poisson regression models to assess the relationship between shift type and scheduling characteristics and nurse injury. Lastly, full models with the addition of demographics, external context, organizational context, and work context variables were calculated. The majority (79%) of newly licensed nurses worked 12-h shifts, a near majority worked night shift (44%), and over half (61%) worked overtime (mandatory or voluntary) weekly. Nurses working weekly overtime were associated with a 32% [incidence rate ratio (IRR) 1.32, CI 1.07-1.62] increase in the risk of a needle stick and nurses working night shift were associated with a 16% [IRR 1.16, CI 1.02-1.33] increase in the risk of a sprain or strain injury. Overtime and night shift work were significantly associated with increased injury risk in newly licensed nurses independent of other work factors and demographic characteristics. The findings warrant further study given the long-term consequences of these injuries, costs associated with treatment, and loss of worker productivity. Copyright © 2015 Elsevier Ltd. All rights reserved.

45 CFR 158.160 - Other non-claims costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., expenditures for activities that improve health care quality, and Federal and State taxes and licensing or... Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER..., reimbursement for clinical services to enrollees as defined in § 158.140 of this subpart, or expenditures on...

45 CFR 158.160 - Other non-claims costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., expenditures for activities that improve health care quality, and Federal and State taxes and licensing or... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER..., reimbursement for clinical services to enrollees as defined in § 158.140 of this subpart, or expenditures on...

45 CFR 158.160 - Other non-claims costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., expenditures for activities that improve health care quality, and Federal and State taxes and licensing or... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER..., reimbursement for clinical services to enrollees as defined in § 158.140 of this subpart, or expenditures on...

45 CFR 158.160 - Other non-claims costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., expenditures for activities that improve health care quality, and Federal and State taxes and licensing or... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS ISSUER..., reimbursement for clinical services to enrollees as defined in § 158.140 of this subpart, or expenditures on...

20 CFR 404.1538 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b) An... persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care providers; (d... addiction or alcoholism; (e) Medicare or Medicaid certified care providers; or (f) Nationally recognized...

20 CFR 404.1538 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b) An... persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care providers; (d... addiction or alcoholism; (e) Medicare or Medicaid certified care providers; or (f) Nationally recognized...

20 CFR 404.1538 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b) An... persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care providers; (d... addiction or alcoholism; (e) Medicare or Medicaid certified care providers; or (f) Nationally recognized...

20 CFR 404.1538 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b) An... persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care providers; (d... addiction or alcoholism; (e) Medicare or Medicaid certified care providers; or (f) Nationally recognized...

We Care for Kids: A Handbook for Foster Parents.

ERIC Educational Resources Information Center

Illinois State Dept. of Children and Family Services, Springfield.

This handbook outlines essential information for foster parents under these basic headings: (1) legal rights and responsibilities of children, parents and foster parents; (2) recruitment, licensing, training, and evaluation of foster homes; (3) placement and removal of foster children; (4) payments and expenses; (5) medical care; (6)…

Napa County Entrepreneurial Child Care Training.

ERIC Educational Resources Information Center

Napa County Employment Training Office, CA.

A multiagency project designed a program to train participants to become licensed family day care home operators. Participant recruitment was conducted by means of a flyer, advertisements in the help wanted section, community service announcements, press releases, and notices to the high schools. The program recruited 43 potential family day care…

Emergency Care Skills for Occupational Health Nurses.

ERIC Educational Resources Information Center

North Carolina State Dept. of Community Colleges, Raleigh. Occupational Information Center.

Designed for use in community colleges, technical colleges, and technical institutes, this manual contains a course for teaching emergency care skills to both licensed practical and registered nurses employed in occupational health. The manual consists of three sections. In section 1 the need for the course, its content, objectives, length,…

45 CFR 60.9 - Reporting licensure actions taken by States.

Code of Federal Regulations, 2012 CFR

2012-10-01

... against a health care practitioner, physician, dentist, or entity (as defined in § 60.3). The actions... health care practitioner, physician, dentist, or entity surrendering the license, or the practitioner..., physician, dentist, or entity, whether by operation of law, voluntary surrender (excluding those due to non...

45 CFR 60.9 - Reporting licensure actions taken by States.

Code of Federal Regulations, 2010 CFR

2010-10-01

... against a health care practitioner, physician, dentist, or entity (as defined in § 60.3). The actions... health care practitioner, physician, dentist, or entity surrendering the license, or the practitioner..., physician, dentist, or entity, whether by operation of law, voluntary surrender (excluding those due to non...

45 CFR 60.9 - Reporting licensure actions taken by States.

Code of Federal Regulations, 2011 CFR

2011-10-01

... against a health care practitioner, physician, dentist, or entity (as defined in § 60.3). The actions... health care practitioner, physician, dentist, or entity surrendering the license, or the practitioner..., physician, dentist, or entity, whether by operation of law, voluntary surrender (excluding those due to non...

Nursing/LVN Course. Bilingual Vocational Instructional Materials.

ERIC Educational Resources Information Center

Lopez-Cox, Guadalupe

This course in licensed vocational nursing, one of a series of bilingual English-Spanish vocational education courses, is designed to teach basic nursing principles needed by nurses' aides to do nursing procedures and skills in the different health care institutions. It covers many areas, including the following: the health care system, personal…

Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems

PubMed

Khanali Mojen, Leila; Rassouli, Maryam; Eshghi, Peyman; Zendedel, Kazem; Akbari Sari, Ali; Heravi Karimooi, Majideh; Tahmasebi, Mamak; Shirin Abadi Farahani, Azam

2018-05-26

Background: Establishing palliative care services is a priority in the health system of Iran. Considering the necessity of integrating these services into the health system, this study aimed to explore the stakeholders’ perceptions about the provision of a conceptual framework for palliative care services for children with cancer according to the health system in of Iran. Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 29 participants including palliative care specialists, policy-makers, health care providers, the parents of children with cancer selected through purposive sampling, between August 2016 and February 2017. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed using MAXQDA10 software. Results: The codes extracted from interviews produced the main theme “ classes of palliative care services” with the two main categories “comprehensive care” including, strengthening family shelter, maintaining the child in a familiar environment, achieving stability and “establishing social justice” including, easy access to services, financial relief and quality care. Conclusion: Presenting a framework based on level of palliative care services, the findings of this study paves the way for integrating these services into Iranian health system. Creative Commons Attribution License

Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking.

PubMed

Gwon, Seok Hyun; DeGuzman, Pamela B; Kulbok, Pamela A; Jeong, Suyong

2017-02-01

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention.

Are low income patients receiving the benefits of electronic health records? A statewide survey.

PubMed

Butler, Matthew J; Harootunian, Gevork; Johnson, William G

2013-06-01

There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study.

Needlestick and other potential blood and body fluid exposures among health care workers in British Columbia, Canada.

PubMed

Alamgir, Hasanat; Cvitkovich, Yuri; Astrakianakis, George; Yu, Shicheng; Yassi, Annalee

2008-02-01

Health care workers have high risk of exposure to human blood and body fluids (BBF) from patients in acute care and residents in nursing homes or personal homes. This analysis examined the epidemiology for BBF exposure across health care settings (acute care, nursing homes, and community care). Detailed analysis of BBF exposure among the health care workforce in 3 British Columbian health regions was conducted by Poisson regression modeling, with generalized estimating equations to determine the relative risk associated with various occupations. Acute care had the majority of needlestick, sharps, and splash events with the BBF exposure rate in acute care 2 to 3 times higher compared with nursing home and community care settings. Registered nurses had the highest frequency of needlestick, sharps, and splash events. Laboratory assistants had the highest exposure rates from needlestick injuries and splashes, whereas licensed practical nurses had the highest exposure rate from sharps. Most needlestick injuries (51.3%) occurred at the patient's bedside. Sharps incidents occurred primarily in operating rooms (26.9%) and at the patient's bedside (20.9%). Splashes occurred most frequently at the patient's bedside (46.1%) and predominantly affected the eyes or face/mouth. The majority of needlestick/sharps injuries occurred during use for registered nurses, during disposal for licensed practical nurses, and after disposal for care aides. The high risk of BBF exposure for some occupations indicates there is room for improvement to reduce BBF exposure by targeting high-risk groups for prevention strategies.

A Review of Federal and State Regulations for Day Care Programs and Facilities. Center for Human Services Development Report No. 10.

ERIC Educational Resources Information Center

Hollick, Rosemary; And Others

This report provides a review of U.S. regulatory standards for day care programs and facilities and makes recommendations for the revision of day care regulations in Pennsylvania. Following a brief discussion of federal interagency requirements, a number of short descriptive analyses compare individual state standards in the areas of licensing,…

Implementing the Academy of Nutrition and Dietetics Benchmarks for Nutrition Education for Children: Child-Care Providers' Perspectives.

PubMed

Dev, Dipti A; Carraway-Stage, Virginia; Schober, Daniel J; McBride, Brent A; Kok, Car Mun; Ramsay, Samantha

2017-12-01

National childhood obesity prevention policies recommend that child-care providers educate young children about nutrition to improve their nutrition knowledge and eating habits. Yet, the provision of nutrition education (NE) to children in child-care settings is limited. Using the 2011 Academy of Nutrition and Dietetics benchmarks for NE in child care as a guiding framework, researchers assessed child-care providers' perspectives regarding delivery of NE through books, posters, mealtime conversations, hands-on learning, and sensory exploration of foods to young children (aged 2 to 5 years). Using a qualitative design (realist method), individual, semistructured interviews were conducted until saturation was reached. The study was conducted during 2012-2013 and used purposive sampling to select providers. Final sample included 18 providers employed full-time in Head Start or state-licensed center-based child-care programs in Central Illinois. Child-care providers' perspectives regarding implementation of NE. Thematic analysis to derive themes using NVivo software. Three overarching themes emerged, including providers' motivators, barriers, and facilitators for delivering NE to children. Motivators for delivering NE included that NE encourages children to try new foods, NE improves children's knowledge of healthy and unhealthy foods, and NE is consistent with children's tendency for exploration. Barriers for delivering NE included that limited funding and resources for hands-on experiences and restrictive policies. Facilitators for delivering NE included providers obtain access to feasible, low-cost resources and community partners, providers work around restrictive policies to accommodate NE, and mealtime conversations are a feasible avenue to deliver NE. Providers integrated mealtime conversations with NE concepts such as food-based sensory exploration and health benefits of foods. Present study findings offer insights regarding providers' perspectives on implementing NE in child care. Drawing from these perspectives, registered dietitian nutritionists can train providers about the importance of NE for encouraging healthy eating in children, integrating NE with mealtime conversations, and practicing low-cost, hands-on NE activities that meet the food safety standards for state licensing. Such strategies may improve providers' ability to deliver NE in child-care settings. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies.

PubMed

Backhaus, Ramona; Verbeek, Hilde; van Rossum, Erik; Capezuti, Elizabeth; Hamers, Jan P H

2014-06-01

The relationship between nurse staffing and quality of care (QoC) in nursing homes continues to receive major attention. The evidence supporting this relationship, however, is weak because most studies employ a cross-sectional design. This review summarizes the findings from recent longitudinal studies. In April 2013, the databases PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched. Studies were eligible if they (1) examined the relationship between nurse staffing and QoC outcomes, (2) included only nursing home data, (3) were original research articles describing quantitative, longitudinal studies, and (4) were written in English, Dutch, or German. The methodological quality of 20 studies was assessed using the Newcastle-Ottawa scale, excluding 2 low-quality articles for the analysis. No consistent relationship was found between nurse staffing and QoC. Higher staffing levels were associated with better as well as lower QoC indicators. For example, for restraint use both positive (ie, less restraint use) and negative outcomes (ie, more restraint use) were found. With regard to pressure ulcers, we found that more staff led to fewer pressure ulcers and, therefore, better results, no matter who (registered nurse, licensed practical nurse/ licensed vocational nurse, or nurse assistant) delivered care. No consistent evidence was found for a positive relationship between staffing and QoC. Although some positive indications were suggested, major methodological and theoretical weaknesses (eg, timing of data collection, assumed linear relationship between staffing and QoC) limit interpretation of results. Our findings demonstrate the necessity for well-designed longitudinal studies to gain a better insight into the relationship between nurse staffing and QoC in nursing homes. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Patient Care Staffing Levels and Facility Characteristics in U.S. Hemodialysis Facilities

PubMed Central

Yoder, Laura A. G.; Xin, Wenjun; Norris, Keith C.; Yan, Guofen

2013-01-01

Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. ESRD networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse-staffing levels in hemodialysis facilities. PMID:23810689

42 CFR 423.153 - Drug utilization management, quality assurance, and medication therapy management programs (MTMPs).

Code of Federal Regulations, 2011 CFR

2011-10-01

... pharmacist or other qualified provider; and (iv) May distinguish between services in ambulatory and... pharmacist or other qualified provider unless the beneficiary is in a long-term care setting and may result... with licensed and practicing pharmacists and physicians. (4) Coordination with care management plans...

Menu Variety in Mississippi Child Care Centers.

ERIC Educational Resources Information Center

Knight, Kathy B.; And Others

1995-01-01

Examined the variety of lunch menus in licensed child care centers in Mississippi. A total of 460 lunch menus were analyzed using nutrient analysis software, and a frequency analysis showed the most commonly used foods. Found that foods used most often included white bread, sliced ham, and sausage pizza. Results support the need for nutrition…

The Challenge of Experiential Learning.

ERIC Educational Resources Information Center

Blower, Deborah F.; Parsons, Nancy A.

The Child Care Services Course (CCSC) at Red River Community College in Manitoba offers an innovative experiential learning component for the first year of a two-year diploma program. To apply for the experiential learning program (ELP), applicants must have 2 years of full-time experience in a children's center or licensed day care home working…

42 CFR 424.101 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... disabled; (2) Is not primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care, as described in section 1861(j)(1)(A) of the Act; (3) Provides 24-hour nursing service in accordance with section 1861(e)(5) of the Act; and (4) Is licensed, or is...

42 CFR 424.101 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... disabled; (2) Is not primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care, as described in section 1861(j)(1)(A) of the Act; (3) Provides 24-hour nursing service in accordance with section 1861(e)(5) of the Act; and (4) Is licensed, or is...

42 CFR 424.101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... disabled; (2) Is not primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care, as described in section 1861(j)(1)(A) of the Act; (3) Provides 24-hour nursing service in accordance with section 1861(e)(5) of the Act; and (4) Is licensed, or is...

42 CFR 424.101 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... disabled; (2) Is not primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care, as described in section 1861(j)(1)(A) of the Act; (3) Provides 24-hour nursing service in accordance with section 1861(e)(5) of the Act; and (4) Is licensed, or is...

How's Business? Status Report #10 on For Profit Child Care.

ERIC Educational Resources Information Center

Neugebauer, Roger

1997-01-01

Examines trends in for-profit child care since the 1970s. Finds growth has been dramatic, but unsteady, with four companies dominating the industry. Executives' concerns have shifted from federal licensing standards, liability insurance, and the national economy to public school competition and the shortage of qualified teachers. Major service…

Educational Services for Home Day Caregivers. Final Report.

ERIC Educational Resources Information Center

Colbert, Janice C.; And Others

The research project described in this report (Educational Services for Home Day Care Sub-Professionals) examines the education/training needs of a group of women who are licensed home day caregivers and who provide day care services to preschool children for a fee. This project represents an attempt undertaken by an urban university working in…

How to Start and Operate a Day Care Home.

ERIC Educational Resources Information Center

Griffin, Al

This book includes information on licensing, regulations, zoning, equipment and toys, daily schedules, meals and nutrition, naps and rest periods, parental relationships, problem children, advertising and promotion, and financing and bookkeeping. A bibliography on aspects of child care is included, as well as a list of the addresses of all state…

Factors affecting Polish nurses' willingness to recommend the hospital as a place of care.

PubMed

Kózka, Maria; Brzostek, Tomasz; Cisek, Maria; Brzyski, Piotr; Przewoźniak, Lucyna; Gabryś, Teresa; Ogarek, Maria; Gajda, Krzysztof; Ksykiewicz-Dorota, Anna

Nurses constitute the major professional group offering constant hospital patients' care. Willingness to recommend their hospital reflects confidence in the offered care, satisfaction and identification with the work place. The aim of the present study has been to investigate which elements of hospital environment and nurse personal related factors predict recommendation of the hospital as a place of care by employed nurses. Cross-sectional, correlation study was, based on 1723 self-reported, anonymous questionnaires of nurses working in 30 acute hospitals. Data was analyzed using the logistic regression model, with general estimation equations. About 25% of nurses were unwilling to recommend their hospital as the place of care. The odds ratio (OR) of the lack of willingness to recommend the hospital was related to assessment of patients' safety (OR = 0.28, 95% confidence interval (CI): 0.18-0.46, p = 0.00), decrease in the quality of patient care during the preceding year (OR = 0.62, 95% CI: 0.41-0.93, p = 0.02), overall work conditions (OR = 0.35, 95% CI: 0.22-0.57, p = 0.00), weak cooperation between nurses and physicians (OR = 0.37, 95% CI: 0.25-0.54, p = 0.00), poor work schedule flexibility (OR = 0.74, 95% CI: 0.55- 0.99, p = 0.04) and educational opportunities (OR = 0.71, 95% CI: 0.54-0.95, p = 0.02) and the level of nurses depersonalization (OR = 1.78, 95% CI: 1.18-1.68, p = 0.00). The hospital manager should consider strategies which improve patients' safety and the staff working conditions. Thanks to that they will also achieve better and more competitive image of the hospital in the local community. Med Pr 2016;67(4):447-454. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Pilot Trial of a Licensed Practical Nurse Intervention for Hypertension and Depression

PubMed Central

Bogner, Hillary R.; de Vries, Heather F.; Kaye, Elise M.; Morales, Knashawn H.

2014-01-01

BACKGROUND AND OBJECTIVES Depression is a risk factor for hypertension, and risk of depression is increased substantially in patients with hypertension. Our objective was to examine whether an intervention carried out by Licensed Practical Nurses (LPNs) integrating depression treatment into care for hypertension improved blood pressure control and depressive symptoms. METHODS In all, 60 patients ages 41 to 92 years with hypertension and depressive symptoms at a large primary care practice in Philadelphia were randomly assigned to an integrated care intervention carried out by LPNs (n=30) or usual care (n=30). Intervention and control groups did not differ statistically on baseline measures. Outcomes assessed at baseline and 12 weeks included standard laboratory procedures to measure blood pressure control and the Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Patients in the integrated care intervention had lower diastolic blood pressure (intervention 74.2 mmHg versus usual care 82.0 mmHg) and fewer depressive symptoms (PHQ-9 mean scores, intervention 2.4 versus usual care 7.1) compared with patients in the usual care group at 12 weeks after adjustment for baseline values. Patients in the integrated care intervention also had lower systolic blood pressure (intervention 130.0 mmHg versus usual care 140.6 mmHg) compared with patients in the usual care group at 12 weeks although the results approached but did not reach conventional levels of statistical significance. CONCLUSION Training existing primary care practice office staff will facilitate implementation in real world practices with limited resources and competing demands. PMID:23681683

Day-Care Regulation: Serving Children or Bureaucrats? Cato Institute Policy Analysis No. 59.

ERIC Educational Resources Information Center

Lehrman, Karen; Pace, Jana

If the supply of day care is ever to keep pace with the rapidly rising demand, it is essential that there be a favorable climate for its growth. At present there is not, and the regulatory obstacle course laid out by state and local officials is in large part why. State barriers to the provision of day care involve licensing and registration and…

Stepping Stones To Using "Caring for Our Children": National Health and Safety Performance Standards for Out-of-Home Child Care Programs. Protecting Children from Harm.

ERIC Educational Resources Information Center

Colorado Univ. Health Sciences Center, Denver.

Developed in support of state licensing and regulatory agencies as well as state child care, health, and resource and referral agencies, and a variety of other public and private organizations, parents, and advocacy groups, this guide identifies those standards most needed for the prevention of injury, morbidity, and mortality in child care…

The professional role of massage therapists in patient care in Canadian urban hospitals--a mixed methods study.

PubMed

Kania-Richmond, Ania; Reece, Barb Findlay; Suter, Esther; Verhoef, Marja J

2015-02-07

Massage therapy (MT) is becoming established as a recognized health care profession in Canada. It has been integrated as a core service in settings such as health spas, private integrative health centers, and there is indication that MT is starting to be integrated into hospitals. Research in the area of hospital-based MT has primarily focused on the efficacy, effectiveness, and increasingly, the safety of MT. However, little is known about the professional role of massage therapists in the hospital setting. The purpose of this study was to conduct an in-depth exploration and description of massage therapists' professional role in patient care in the context of Canadian urban hospitals. A sequential mixed methods study design was used. For the quantitative phase, a survey was sent to urban hospitals where MT services were organized by hospitals and provided by licensed massage therapists to patients to a) provide a contextual description of the hospitals and b) identify a sampling frame for the qualitative phase. The subsequent qualitative phase entailed semi structured interviews with a purposively diverse sample of participants massage therapists from the surveyed sites to explore their role perceptions. The quantitative and qualitative approaches were integrated during data collection and analysis. Of the hospitals that responded, sixteen urban hospitals across Canada (5%) provided MT to patients by licensed therapists. The majority of hospitals were located in Ontario and ranged from specialized small community hospitals to large multi-site hospitals. Based on interviews with 25 participants, six components of the massage therapists' professional role emerged: health care provider, team member, program support, educator, promoter of the profession, and researcher. While hospital-based MT in Canada is not a new phenomenon, MT is not yet an established health care profession in such settings. However, there is significant potential for the inclusion of the massage therapists' role in Canadian hospitals that should be evidence based for effective implementation.

Public Health Support for Weight-Related Practices in Child Care Settings in Minnesota.

PubMed

Pelletier, Jennifer E; Hassan, Asha; Zukoski, Ann P; Loth, Katie

2018-06-01

Childhood obesity experts have identified licensed child care providers as a focus for prevention efforts. Since 2011, local public health agencies in Minnesota have provided training and support to child care providers to assist in implementation of weight-related policies and practices as part of Minnesota's Statewide Health Improvement Partnership (SHIP). A representative sample of licensed child care centers and family home providers in Minnesota participated in a 2016 survey of policies and practices on child nutrition, infant feeding, and physical activity ( n = 618, response rate = 38.5%). In adjusted analyses, SHIP-participating providers were significantly more likely to implement child nutrition (prevalence ratio = 1.46, 95% confidence interval [CI] 1.14, 1.88]) and physical activity (PR = 1.64, 95% CI [1.26, 2.14]) policies and implemented approximately one additional best practice in child nutrition and infant feeding, respectively. SHIP participation was associated with best practices and policies among home-based providers and policies among centers. Child care providers who participated in SHIP implemented more best practices and policies on weight-related topics than providers who did not participate. Findings suggest that efforts by local public health agencies to support child care providers can be effective at increasing adherence to practices and policies that are likely to influence child behavior and weight.

Oral health content of early education and child care regulations and standards.

PubMed

Kranz, Ashley M; Rozier, R Gary

2011-01-01

Almost two out of every three US children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers. State licensing regulations were obtained from the National Resource Center for Health and Safety in Child Care's online database. Professional standards were identified through a search of PubMed, early childhood organizations' websites, and early childhood literature. All EECC guidelines were reviewed for key terms related to oral health promotion in children and summarized by domains. Thirty-six states include oral health in their licensing regulations, but recommendations are limited and most often address the storage of toothbrushes. Eleven sets of standards were identified, four of which make recommendations about oral health. Standards from the American Academy of Pediatrics/American Public Health Association (AAP/APHA) and the Office of Head Start (OHS) provide the most comprehensive oral health recommendations regarding screening and referral, classroom activities, and education. Detailed guidelines for oral health practices exist but they exhibit large variation in number and content. States can use the comprehensive standards from the AAP/APHA and OHS to inform and strengthen the oral health content of their licensing regulations. Research is needed to determine compliance with regulations and standards, and their effect on oral health.

The characteristics of physicians disciplined by professional colleges in Canada.

PubMed

Alam, Asim; Klemensberg, Jason; Griesman, Joshua; Bell, Chaim M

2011-01-01

The identification of health care professionals who are incompetent, impaired, uncaring or have criminal intent has received increasing attention in recent years. These individuals are often subject to disciplinary action by professional licensing authorities. To date, no national data exist for Canadian physicians disciplined for professional misconduct. We sought to describe the characteristics of physicians disciplined by Canadian professional licensing authorities. We constructed a database of physicians disciplined by provincial licensing authorities during the years 2000 to 2009. Comparisons were made with the general population of physicians licensed in Canada. Data on demographic characteristics, type of misconduct and penalty imposed were collected for each disciplined physician. A total of 606 identifiable physicians were disciplined by their professional college during the years 2000 to 2009. The proportion of licensed physicians who were disciplined in a given year ranged from 0.06% to 0.11%. Fifty-one of the disciplined physicians committed 64 repeat offences, accounting for a total of 113 (19%) offences. Most of the disciplined physicians were independent practitioners (99%), male (92%) and trained in Canada (67%). The most common specialties of physicians subject to disciplinary action were family medicine (62%), psychiatry (14%) and surgery (9%). For disciplined physicians, the average number of years from medical school graduation to disciplinary action was 28.9 (standard deviation [SD] = 11.3). The 3 most frequent violations were sexual misconduct (20%), failure to meet a standard of care (19%) and unprofessional conduct (16%). The 3 most frequently imposed penalties were fines (27%), suspensions (19%) and formal reprimands (18%). A small proportion of registered physicians in Canada were disciplined by their medical licensing authorities. Sexual misconduct was the most common disciplined offence. The standardization of provincial reporting along with the creation of a national database of physician offenders would facilitate more comparable public reporting as well as further research and educational initiatives.

The characteristics of physicians disciplined by professional colleges in Canada

PubMed Central

Alam, Asim; Klemensberg, Jason; Griesman, Joshua; Bell, Chaim M

2011-01-01

Background The identification of health care professionals who are incompetent, impaired, uncaring or have criminal intent has received increasing attention in recent years. These individuals are often subject to disciplinary action by professional licensing authorities. To date, no national data exist for Canadian physicians disciplined for professional misconduct. We sought to describe the characteristics of physicians disciplined by Canadian professional licensing authorities. Methods We constructed a database of physicians disciplined by provincial licensing authorities during the years 2000 to 2009. Comparisons were made with the general population of physicians licensed in Canada. Data on demographic characteristics, type of misconduct and penalty imposed were collected for each disciplined physician. Results A total of 606 identifiable physicians were disciplined by their professional college during the years 2000 to 2009. The proportion of licensed physicians who were disciplined in a given year ranged from 0.06% to 0.11%. Fifty-one of the disciplined physicians committed 64 repeat offences, accounting for a total of 113 (19%) offences. Most of the disciplined physicians were independent practitioners (99%), male (92%) and trained in Canada (67%). The most common specialties of physicians subject to disciplinary action were family medicine (62%), psychiatry (14%) and surgery (9%). For disciplined physicians, the average number of years from medical school graduation to disciplinary action was 28.9 (standard deviation [SD] = 11.3). The 3 most frequent violations were sexual misconduct (20%), failure to meet a standard of care (19%) and unprofessional conduct (16%). The 3 most frequently imposed penalties were fines (27%), suspensions (19%) and formal reprimands (18%). Interpretation A small proportion of registered physicians in Canada were disciplined by their medical licensing authorities. Sexual misconduct was the most common disciplined offence. The standardization of provincial reporting along with the creation of a national database of physician offenders would facilitate more comparable public reporting as well as further research and educational initiatives. PMID:22567070

Influence of behavioral concerns and early childhood expulsions on the development of early childhood mental health consultation in Colorado.

PubMed

Hoover, Sarah D; Kubicek, Lorraine F; Rosenberg, Cordelia Robinson; Zundel, Claudia; Rosenberg, Steven A

2012-05-01

This article examines how the Colorado study Children With Social, Emotional and Behavioral Concerns and the Providers Who Support Them (S.D. Hoover, 2006) was used to advance a statewide agenda for early childhood mental health consultation in Colorado. The study involved a survey of licensed childcare providers throughout the state asking about the behavior of children in their care and their responses to that behavior. Exclusion of children from early care and education settings due to challenging behavior was found to be a significant problem taking a toll on families, children, and early care and education providers. Importantly, results from the survey indicated that the rate of exclusion of children from care due to challenging behavior was lower for family childcare providers who had access to mental health consultation. Recommendations are offered regarding the infrastructure needed to sustain mental health consultation capacity in early care and education settings, and related policies and practices. Copyright © 2012 Michigan Association for Infant Mental Health.

Glossary

MedlinePlus

... Loss Resources Resources Resources Content Licensing and Co-branding Glossary Advance directive - A general term that describes ... approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the person's ...

[Is the needs-based planning mechanism effectively needs-based? An analysis of the regional distribution of outpatient care providers].

PubMed

Ozegowski, S; Sundmacher, L

2012-10-01

Since the 1990s licenses for opening a medical practice in Germany are granted based on a needs-based planning system which regulates the regional allocation of physicians in primary care. This study aims at an analysis of the distribution of physicians (and hence the effects of the planning system) with regard to the overarching objective of primary care supply: the safeguarding of "needs-based and evenly distributed health care provision" (Section 70 para 1 German Social Code V). The need for health care provision of each German district (or region) and the actual number of physicians in the respective area are compared using a concentration analysis. For this purpose, the local health-care need was approximated in a model based on the morbidity predictors age and sex and by combining data on the local population structure with the age- and sex-specific frequency of physician consultations (according to data of the GEK sickness fund). The concentration index then measures the degree of regional inequity in the distribution of outpatient care. The results of the analysis demonstrate an inequitable regional distribution between medical needs of the local population and the existing outpatient health care provider capacities. These regional disparities in needs-adjusted supply densities are particularly large for -outpatient secondary care physicians and psychotherapists, even when taking into account the care provision of urban physicians for peri-urban areas as well as the adequacy of longer travel times to specialists. One major reason for these inequities is the design of today's physician planning mechanism which mainly conserves a suboptimal status quo of the past. The initiated reforms of the planning mechanism should progress and be further deepened. Especially today's quota-based allocation of practice licenses requires fundamental changes taking into account the relevant factors approximating local health care needs, re-assessing the adequate spatial planning level and expanding opportunities for introducing innovative and more flexible health care services models. © Georg Thieme Verlag KG Stuttgart · New York.

Hennepin County Grant Purchase of Child Day Care through a Voucher System: An Evaluation and Use of Technology (Transfer and Technical Assistance to Enhance Service Delivery (with Exeuctive Summary). Final Report.

ERIC Educational Resources Information Center

Scoll, Barbara; Engstrom, Roger

In January of 1982, the Hennepin County Community Services Department began implementing a day care voucher system which allowed day care clients to place their children in any licensed day care home or center that was willing to contract with Hennepin County. In October of the same year, Hennepin County was awarded a grant by the Department of…

Health care utilization and charges following the enactment of the 2007 Graduated Drivers Licensing Law in Massachusetts.

PubMed

Sangji, Naveen F; Ramly, Elie P; Kaafarani, Haytham M A; Seethala, Raghu; Raybould, Toby; Camargo, Carlos A; Velmahos, George; Masiakos, Peter T; Lee, Jarone

2015-10-01

Graduated Drivers Licensing (GDL) programs phase in driving privileges for teenagers. In 2007, Massachusetts implemented a stricter version of the 1998 GDL law, with increased fines and education. This study evaluated the impact of the law on motor vehicle crash (MVC)-related health care utilization and charges. Massachusetts government and US Census Bureau data were analyzed to compare the rates of MVC-related emergency department (ED) visits and hospital charges before (2002-2006) and after (2007-2011) the 2007 GDL law. Three driver age groups were studied: 16-17 (evaluating the law effect), 18-20 (evaluating the sustainability of the effect), and 25-29 years old (control group). MVC-related ED visits per population decreased after the law for all three age groups (16-17: 2326 to 713; 18-20: 2110 to 1304; 25-29: 1694 to 1228; per 100,000, p<0.001), but the decrease was greater amongst teenagers (16-17: -69%; 18-20: -38%) compared to the control group (-27%); p<0.001. MVC-related hospital charges per population also decreased for teenagers but increased for the control group (16-17: $2.70 m to $1.45 m; 18-20: $3.52 m to $2.26 m; 25-29: $1.86 m to $1.92 m; per 100,000, p<0.001). The 2007 GDL law in Massachusetts was associated with significant decreases in MVC-related health care utilization and hospital charges among teenage drivers. Copyright © 2015 Elsevier Inc. All rights reserved.

Modification of oral dosage forms for the older adult: An Irish prevalence study.

PubMed

Mc Gillicuddy, Aoife; Kelly, Maria; Sweeney, Catherine; Carmichael, Ann; Crean, Abina M; Sahm, Laura J

2016-08-20

Age-related pharmacological changes complicate oral dosage form (ODF) suitability for older adults. The aim of this study was to investigate the appropriateness of ODF for older adults by determining the prevalence of ODF modifications in an aged care facility in Ireland. Drug charts for eligible patients were obtained. Details of all medications administered were recorded. ODF modifications were examined to determine if they were evidence-based: defined as complying with the product license or best practice guidelines (BPG). In total, of 111 patients, 35.1% received at least one modified medicine. Medicines were most commonly modified to facilitate fractional dosing (82.0%). Of the 68 instances of medicine modification, 35.3% complied with the product license. Of the 44 unlicensed modifications, 14 complied with BPG. Therefore, 44.1% of modifications were not evidence-based. This study highlights that clinicians have to routinely tailor commercial ODF to meet older patients' needs despite the lack of an evidence-base for almost half of these modifications. The main factor contributing to these modifications is the lack of appropriate, licensed dosage forms. However, reimbursement policies also play a role. Research is needed to optimise medicine administration and to provide clinicians with much needed evidence to support their daily practice. Copyright © 2016 Elsevier B.V. All rights reserved.

Viral arthritis

MedlinePlus

... joint to determine the cause of the inflammation. Treatment Your health care provider may prescribe pain medicines ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...

The Impact of Human Rights on Universalizing Health Care in Vermont, USA.

PubMed

MacNaughton, Gillian; Haigh, Fiona; McGill, Mariah; Koutsioumpas, Konstantinos; Sprague, Courtney

2015-12-10

In 2010, Vermont adopted a new law embracing human rights principles as guidelines for health care reform, and in 2011, Vermont was the first state in the US to enact framework legislation to establish a universal health care system for all its residents. This article reports on the Vermont Workers' Center's human rights-based approach to universal health care and the extent to which this approach influenced decision makers. We found the following: (1) by learning about the human right to health care and sharing experiences, Vermonters were motivated to demand universal health care; (2) mobilizing Vermonters around a unified message on the right to health care made universal health care politically important; (3) using the human rights framework to assess new proposals enabled the Vermont Workers' Center to respond quickly to new policy proposals; (4) framing health care as a human right provided an alternative to the dominant economics-based discourse; and (5) while economics continues to dominate discussions among Vermont leaders, both legislative committees on health care use the human rights principles as guiding norms for health care reform. Importantly, the principles have empowered Vermonters by giving them more voice in policymaking and have been internalized by legislators as democratic principles of governance. Copyright © 2015 MacNaughton, Haigh, McGill, Koutsioumpas, Sprague. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

The characteristics of registered nurses whose licenses expire: why they leave nursing and implications for retention and re-entry.

PubMed

Skillman, Susan M; Palazzo, Lorella; Hart, L Gary; Keepnews, David

2010-01-01

Little is known about RNs who drop their licenses and their potential re-entry into the nursing workforce. The results of this study provide insight into reasons nurses leave their careers and the barriers to re-entry, all important indicators of the current professional climate for nursing. While representing only one state, these findings suggest that RNs who allow their licenses to expire do so because they have reached retirement age or, among those who do not cite age as a factor, because many are unable or unwilling to work in the field. Inactive nurses who might otherwise appear to be likely candidates for re-entry into the profession may not be easily encouraged to practice nursing again without significant changes in their personal circumstances or the health care work environment. Effective ways to address current and pending RN workforce shortages include expanding RN education capacity to produce more RNs who can contribute to the workforce across the coming decades, and promote work environments in which RNs want to, and are able to, practice across a long nursing career.

Public perceptions of health care professionals' participation in pharmaceutical marketing.

PubMed

Crigger, Nancy J; Courter, Laura; Hayes, Kristen; Shepherd, K

2009-09-01

Trust in the nurse-patient relationship is maintained not by how professionals perceive their actions but rather by how the public perceives them. However, little is known about the public's view of nurses and other health care professionals who participate in pharmaceutical marketing. Our study describes public perceptions of health care providers' role in pharmaceutical marketing and compares their responses with those of a random sample of licensed family nurse practitioners. The family nurse practitioners perceived their participation in marketing activities as significantly more ethically appropriate than did the public responders. Further research is warranted before conclusions can be drawn, but these early findings suggest that nurse practitioners should consider a conservative approach to participating in pharmaceutical marketing.

Which features of primary care affect unscheduled secondary care use? A systematic review.

PubMed

Huntley, Alyson; Lasserson, Daniel; Wye, Lesley; Morris, Richard; Checkland, Kath; England, Helen; Salisbury, Chris; Purdy, Sarah

2014-05-23

To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Observational studies at primary care practice level. Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions. 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.

Impact of Training and Education for Caregivers of Infants and Toddlers. Research-to-Policy Connections No. 3

ERIC Educational Resources Information Center

Kreader, J. Lee; Ferguson, Daniel; Lawrence, Sharmila

2005-01-01

Training and education of infant and toddler caregivers is one important factor associated with the quality of child care they provide. In response to research showing that high-quality care supports positive development in young children, policymakers have established training and education requirements for licensed providers and launched…

Defense Health Care: 2008 Access to Care Surveys Indicate Some Problems, but Beneficiary Satisfaction Is Similar to Other Health Plans

DTIC Science & Technology

2010-03-01

reported that servicemembers and their families are at risk for mental health problems given the stress of deployment and exposure to combat. A...office-based civilian medical doctors or licensed civilian doctors of osteopathy within the specified locations who were engaged in more than 20

California: The State of Our Children, 2002. Children's Critical Early Years.

ERIC Educational Resources Information Center

Grossman-Swenson, Sarah

This Kids Count data book examines trends in the well-being of California's children, focusing on factors influencing young children. The statistical portrait is based on trends in 54 indicators of well-being in 4 areas: (1) education, including preschool participation, licensed child care spaces, percentage of income spent on child care, reading…

Future care planning: a first step to palliative care for all patients with advanced heart disease.

PubMed

Denvir, M A; Murray, S A; Boyd, K J

2015-07-01

Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences. 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.

Health and Safety in the Child Care Setting: Prevention of Injuries--A Curriculum for the Training of Child Care Providers. Module 2. Second Edition

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Evinger, Sara, Ed.

2007-01-01

This curriculum was first published in June 1998 to be used by qualified health and safety trainers to fulfill part of the learning needs and licensing requirements of child care providers (Health and Safety Code, Section 1596.866) in California. This second and updated edition of Module 2, Prevention of Injuries, covers the content of the…

Have procompetitive changes altered hospital provision of indigent care?

PubMed

Campbell, E S; Ahern, M W

1993-10-01

In the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax-exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with a quid pro quo hypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON licenses.

Nurses and Aides

ERIC Educational Resources Information Center

Franklin, John

1976-01-01

Gerontological nursing (the care of the elderly) as a specialization for registered nurses, licensed practical nurses, and nursing aides is discussed with respect to training and qualifications, employment outlook, and earnings for each group. (JT)

Nurses' knowledge of foot care in the context of home care: a cross-sectional correlational survey study.

PubMed

Stolt, Minna; Suhonen, Riitta; Puukka, Pauli; Viitanen, Matti; Voutilainen, Päivi; Leino-Kilpi, Helena

2015-10-01

This study aimed to explore nurses' knowledge of foot care and related factors in home care nursing. Nurses caring for older people are increasingly confronted with clients who have multiple foot problems and need support with their foot health. The role of nurses in promoting foot health, caring for existing foot problems and supporting older people in foot self-care is especially important in the home care context. However, this entails up-to-date foot care knowledge and practices. A cross-sectional correlational survey study design. Nurses' knowledge of foot care was evaluated using the Nurses' Foot Care Knowledge Test developed for this study. The data were analysed with descriptive and inferential statistics. Nurses (registered nurses, public health nurses and licensed practical nurses) from public home care (n = 322, response rate 50%) participated the study. Nurses' knowledge in foot care varied. The knowledge scores were highest for skin and nail care and lowest for the identification and care of foot structural deformities. Longer working experience in the current work place and participation in continuing education explained higher Nurses' Foot Care Knowledge Test scores. Nurses need more knowledge, and hence continuing education, in the foot care of older people to effectively prevent, recognise and care for foot problems and promote independent living in the community. Nurses' have clinically relevant knowledge gaps. Therefore, foot care knowledge of nurses needs to be improved by continuing education in clinical settings. Adequate foot care knowledge among nurses is important to identify, prevent and care foot problems especially in older people. © 2015 John Wiley & Sons Ltd.

[Burnout syndrome in licensed nurses. Approaches for a debate].

PubMed

de los Ríos-Castillo, José Lauro; Barrios-Santiago, Pedro; Ocampo-Mancilla, Mariano; Avila-Rojas, Teresa Luzeldy

2007-01-01

The burnout syndrome (BS) is characterized by emotional fatigue, loss of personal identity and loss of personal realization feelings. BS is frequent among professionals that assist people (health care workers) and among those that have interpersonal contact; the occupational characteristics are among BS contributing factors. The objective was to ascertain BS prevalence among nurses affiliated to the San Luis Potosí General Hospital. A cross-sectional survey was carried out with a groups of nurses who gave their informed consent to participate. The Brief Questionnaire of Burnout version standardized for Mexico was used to collect the information. This version explores the following areas: emotional fatigue, loss of personal identity and personal realization. Also, participants answered three questionnaires about their socio-demographic characteristics, occupational satisfaction, family variables and emotional dysfunction. 70 licensed nurses participated. The BS was common among participants. Some variables related to BS were: age older than 30 years, being female, being married, housekeeping work, absenteeism due to illness, serious depression and occupational dissatisfaction. Nurses working at the emergency room and in critical care services had BS more often. The burnout syndrome has a high prevalence among licensed nurses. Interventions to decrease and to avert BS are needed.

Massage Therapy for Health Purposes

MedlinePlus

... Web site: www.nih.gov/health/clinicaltrials/ Cochrane Database of Systematic Reviews The Cochrane Database of Systematic ... Licensed Complementary and Alternative Healthcare Professions. Seattle, WA: Academic Consortium for Complementary and Alternative Health Care; 2009. ...

Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers.

PubMed

Al-Rousan, Tala; Schwabkey, Zaker; Jirmanus, Lara; Nelson, Brett D

2018-06-10

The United Nations has declared the Syrian refugee crisis to be the biggest humanitarian emergency of our era. Neighbouring countries, such as Jordan, strain to meet the health needs of Syrian refugees in addition to their own citizens given limited resources. This study aimed to determine the perspectives of Syrian refugees in Jordan, Jordanian health care providers and other stakeholders in addressing the public health issues of the refugee crisis. Qualitative and quantitative methodologies were used to explore Syrian refugee health needs and services in camp and urban settings in Jordan. Focus group discussions and key informant interviews were used to identify needs, challenges and potential solutions to providing quality health care to refugees. By-person factor analysis divided refugee participants into 4 unique respondent types and compared priorities for interventions. Focus group discussions and key informant interviews revealed a many different problems. Cost, limited resources, changing policies, livelihoods and poor health literacy impeded delivery of public and clinical health services. Respondent Type 1 emphasized the importance of policy changes to improve Syrian refugee health. Type 2 highlighted access to fresh foods and recreational activities for children. For Type 3, poor quality drinking-water was the primary concern, and Type 4 believed the lack of good, free education for Syrian children exacerbated their mental health problems. Syrian refugees identified cost as the main barrier to health care access. Both refugees and health care providers emphasized the importance of directing more resources to chronic diseases and mental health. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

"Click for Closer Care": A Content Analysis of Community Pharmacy Websites in Four Countries.

PubMed

Zwier, Sandra

2017-06-14

Combinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication. The aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies. A content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted. The top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies' homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001). A considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients' health. ©Sandra Zwier. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.06.2017.

[Nurses' professionalism as a component of evaluation of parents/caregivers satisfaction with nursing care].

PubMed

Smoleń, Ewa; Ksykiewicz-Dorota, Anna

2015-01-01

Professionalism in nursing means the provision of medical and nursing services based on the best knowledge and skills, as well as on great responsibility for the undertaken actions. The opinions of patients and their families concerning professionalism, reflected in the level of satisfaction, contribute to the improvement of the quality of services offered. The study covered 120 parents/caregivers of children hospitalized in a pediatric ward. Diagnostic survey method was applied in the research. The standardized questionnaire for evaluation of the level of parents/caregivers satisfaction with nursing care (Latour et al.) adjusted to the conditions of Polish pediatric hospital services and subjected to validation was adopted as a research tool. Statistical analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test. A value of p≤0.05 was considered to indicate statistical significance. The respondents were selected at random. The parents/caregivers received the questionnaire the day before the child's discharge. The parents/caregivers generally evaluated the professionalism of nursing care in positive terms (4.3). They expressed higher satisfaction with respect showed by nurses for patients (4.7), while lower satisfaction with nurses introducing themselves (3.2). A high level of satisfaction was obtained with respect to the parents/caregivers' opinions pertaining to cooperation within a therapeutic team (4.6), organization of nurses' work (4.6), and quality of nursing care (4.6). Parents/caregivers expressed their satisfaction with the professionalism of nursing care. Education of respondents, frequency and reasons for hospitalization among children proved to be the variables that significantly differed the opinions of parents/caregivers concerning the selected criteria for professionalism of nursing care. No correlation was found between the duration of hospitalization, children's age, place of parents/caregivers residence, and the level of satisfaction with professionalism of nursing care. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

The changing meaning of a health care workforce.

PubMed

Howell, Joel D

2013-12-01

In this commentary, the author describes how the meaning of the health care workforce has changed, focusing on the physician workforce. Some questions have been asked consistently over the years: How many should we have? What type? Where should they work? In 1830 there were no licensing laws, and every literate American could be a member of the health care workforce by following detailed instructions in a popular handbook. Subsequent years saw the initiation of state licensing laws and the reform of medical education. Medical specialties and specialty boards were created, although it was not until after World War II that the dominance of the general practitioner gave way to specialists. For over a century, estimates of physician supply have swung between "too many" and "too few." Rural and economically disadvantaged communities have long struggled with access to health care providers. The author also identifies some issues that have only been considered fairly recently, such as the ethnic and gender diversity of the workforce. Wars have played a major role in changing ideas about the workforce, often in ways that long outlast the actual dates of the conflict. The meaning of the health care workforce has always been deeply embedded in a specific social, political, and economic context.

Regulated provider perceptions of feedback reports.

PubMed

O'Rourke, Hannah M; Fraser, Kimberly D; Boström, Anne-Marie; Baylon, Melba Andrea B; Sales, Anne E

2013-11-01

This paper reports on regulated (or licensed) care providers' understanding and perceptions of feedback reports in a sample of Canadian long-term care settings using a cross-sectional survey design. Audit with feedback quality improvement studies have seldom targeted front-line providers in long-term care to receive feedback information. Feedback reports were delivered to front-line regulated care providers in four long-term care facilities for 13 months in 2009-10. Providers completed a postfeedback survey. Most (78%) regulated care providers (n = 126) understood the reports and felt they provided useful information for making changes to resident care (64%). Perceptions of the report differed, depending on the role of the regulated care provider. In multivariable logistic regression, the regulated nurses' understanding of more than half the report was negatively associated with 'usefulness of information for changing resident care', and perceiving the report as generally useful had a positive association. Front-line regulated providers are an appropriate target for feedback reports in long-term care. Long-term care administrators should share unit-level information on care quality with unit-level managers and other professional front-line direct care providers. © 2013 John Wiley & Sons Ltd.

A PROSPECTIVE STUDY ON LIFESTYLE GUIDANCE AND USE OF MANAGEMENT FORMS FOR FOOD ALLERGY IN LICENSED NURSERY SCHOOLS.

PubMed

Yanagida, Noriyuki; Sato, Sakura; Murata, Junko; Seto, Akiko; Nishisako, Shin; Ebisawa, Motohiro

2016-01-01

There have been no reports on the use of "foods allergy disease lifestyle guidance and management forms at day care centers" (life management guidance forms) for understanding details of pupils with food allergies. The contents of lifestyle management guidance forms obtained in Sagamihara city from licensed nurseries were investigated prospectively. We compared and analyzed for the use of life management guidance forms initially in 2013 and in the fiscal year of 2014 in Sagamihara city licensed nurseries. In all, in 2013 and 2014, 9,567 and 10,069 pupils were included in licensed nurseries, and 426 (4.5%) and 447 (4.4%) pupils had food allergies, 61 (0.6%) and 61 (0.6%) had anaphylaxis, respectively.The causative foods in 2013 and 2014, respectively, included unheated hen's egg in 71.6% and 69.6%; heated hen's egg in 54.2% and 54.8%; milk in 23.0% and 23.3%; peanuts in 17.8% and 17.0%; buckwheat in 7.3% and 8.5%; and wheat in 6.3% and 8.3%. There are no significant differences in the distribution of causative foods between 2013 and 2014.Immediate-type food allergy was significantly more frequent in 2014 than in 2013 (73.0% and 78.8%, respectively; p=0.040). Using a life management guidance form will make it easier to manage food allergies in children.

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

PubMed

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

Mental Health Care: Who's Who

MedlinePlus

... with a master’s degree or doctoral degree in psychology (Psy.D.), philosophy (Ph.D.) or education (Ed. ... work experience. Licensed Professional Counselor: Master’s degree in psychology, counseling or a related field. Mental Health Counselor: ...

Acute care nurse practitioners in trauma care: results of a role survey and implications for the future of health care delivery.

PubMed

Noffsinger, Dana L

2014-01-01

The role of acute care nurse practitioners (ACNPs) in trauma care has evolved over time. A survey was performed with the aim of describing the role across the United States. There were 68 respondents who depicted the typical trauma ACNP as being a 42-year-old woman who works full-time at a level I American College of Surgeons verified trauma center. Trauma ACNPs typically practice with 80% of their time for clinical care and are based on a trauma and acute care surgery service. They are acute care certified and hold several advanced certifications to supplement their nursing license.

Impact of universal health insurance coverage in Thailand on sales and market share of medicines for non-communicable diseases: an interrupted time series study.

PubMed

Garabedian, Laura Faden; Ross-Degnan, Dennis; Ratanawijitrasin, Sauwakon; Stephens, Peter; Wagner, Anita Katharina

2012-01-01

In 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes. Interrupted time-series design, with a non-equivalent comparison group. Thailand, 1998-2006. Quarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006. UCS implementation, April-October 2001. Total pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status. The UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors. Our results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed.

The cost effectiveness of ivabradine in the treatment of chronic heart failure from the U.K. National Health Service perspective.

PubMed

Griffiths, A; Paracha, N; Davies, A; Branscombe, N; Cowie, M R; Sculpher, M

2014-07-01

Ivabradine, a specific heart rate lowering therapy, has been shown in a randomised placebo-controlled study, Systolic HF Treatment with the If Inhibitor Ivabradine Trial (SHIfT), to significantly reduce the composite end point of cardiovascular death and hospitalisation for worsening heart failure (HF) in patients with systolic HF who are in sinus rhythm and with a heart rate ≥70 bpm, when added to optimised medical therapy (HR: 0.82, 95% CI 0.75 to 0.90, p<0.0001). We assessed the cost effectiveness of ivabradine, from a UK National Health Service perspective, based on the results of SHIfT. A Markov model estimated the cost effectiveness of ivabradine compared with standard care for two cohorts of patients with HF (heart rate ≥75 bpm in line with the EU labelled indication; and heart rate ≥70 bpm in line with the SHIfT study population). Modelled outcomes included death, hospitalisation, quality of life and New York Heart Association class. Total costs and quality adjusted life years (QALYs) for ivabradine and standard care were estimated over a lifetime horizon. The incremental cost per additional QALY for ivabradine plus standard care versus standard care has been estimated as £8498 for heart rate ≥75 bpm and £13 764 for heart rate ≥70 bpm. Ivabradine is expected to have a 95% chance of being cost-effective in the EU licensed population using the current National Institute for Health and Care Excellence cost effectiveness threshold of £20 000 per QALY. These results were robust in sensitivity analyses. This economic evaluation suggests that the use of ivabradine is likely to be cost-effective in eligible patients with HF from a UK National Health Service perspective. 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.

Impact of universal health insurance coverage in Thailand on sales and market share of medicines for non-communicable diseases: an interrupted time series study

PubMed Central

Garabedian, Laura Faden; Ross-Degnan, Dennis; Ratanawijitrasin, Sauwakon; Stephens, Peter; Wagner, Anita Katharina

2012-01-01

Objective In 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes. Design Interrupted time-series design, with a non-equivalent comparison group. Setting Thailand, 1998–2006. Data Quarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006. Intervention UCS implementation, April–October 2001. Outcome measures Total pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status. Results The UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors. Conclusions Our results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed. PMID:23192243

The impact of managed care on community mental health outpatient services in New York State.

PubMed

Cypres, A; Landsberg, G; Spellmann, M

1997-07-01

This article explores the impact of managed care on community mental health outpatient services in New York State. A survey was sent to directors of all the licensed mental health organizations to obtain information about staff composition, services provided, training, funding, managed care affiliations, and advertising. The survey focus was on changes that had taken place in the past 4 years and those anticipated in the future due to managed care. Results indicate that managed care has led to changes in the aforementioned areas and that these changes varied by agency size, region, and type.

Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

PubMed

Vogel, Wendy H

2016-01-01

Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.

Has income-related inequity in health care utilization and expenditures been improved? Evidence from the Korean National Health and Nutrition Examination Survey of 2005 and 2010.

PubMed

Kim, Eunkyoung; Kwon, Soonman; Xu, Ke

2013-09-01

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

In-Home Child Care Providers, Training, and Social-Emotional Development of Young Children

ERIC Educational Resources Information Center

Hudson, Kelly P.

2010-01-01

Approximately 214,000 licensed child care homes operate in the United States servicing over 3 million children, while 5,300 homes are in Washington State servicing 175,000 children. Research suggests that children who acquire social-emotional skills between birth and age 5 are equipped for greater success in school and later adulthood. However,…

Clinician Beliefs and Practices in Dementia Care: Implications for Health Educators

ERIC Educational Resources Information Center

Meuser, Thomas M.; Boise, Linda; Morris, John C.

2004-01-01

Research on assessment and treatment of Alzheimer's disease (AD) is moving at a rapid pace. Continuing education (CE) providers must translate new findings for clinicians so as to enhance patient care. A two-page survey was distributed by mail to a sample of 5,000 licensed Missouri clinicians to gather data in support of this translation process.…

Smart Start and Preschool Child Care Quality in North Carolina: Change Over Time and Relation to Children's Readiness.

ERIC Educational Resources Information Center

Bryant, Donna; Maxwell, Kelly; Taylor, Karen; Poe, Michele; Peisner-Feinberg, Ellen; Bernier, Kathleen

The primary goal of Smart Start is to ensure that all children enter school healthy and prepared to succeed. Smart Start has funded a variety of technical assistance (TA) activities to improve child care, including on-site technical assistance, quality improvement and facility grant, teacher education scholarships, license upgrades, teacher salary…

Michigan Day Care Provider Training Project, Year One: An Evaluation.

ERIC Educational Resources Information Center

Kaplan, Melissa G.; And Others

A Title XX funded statewide training program offering 20 hours of instruction for 1,662 licensed center and home child care providers who served Title XX eligible children in Michigan was evaluated at the end of its first year of operation. The first three chapters of this evaluation report discuss (1) the history, philosophy, and goals of the…

Predictors and economic burden of serious workplace falls in health care.

PubMed

Alamgir, H; Ngan, K; Drebit, S; Guiyun Li, H; Keen, D

2011-06-01

To examine the demographic and workplace risk factors of serious falls and associated economic burden in Canadian health care workers. Fall injury data during 2005-2008 from a workplace health and safety surveillance system were linked with workers' compensation claims and payroll records. The costs for treatment and wage loss and days lost for accepted time-loss claims were calculated. Demographic and work-related factors were identified to distinguish the risk for more serious falls from less serious falls. Nine hundred and thirty-eight fall injury claims were captured among 48 519 full-time equivalent workers. Workers >60 years, part time or employed in the long-term care sector sustained a higher proportion of serious falls (>70%). Over 75% of falls were serious for care aides, facility support service workers and community health workers. In the multivariate analysis, the risk of serious falls remained higher for workers in the long-term care sector [odds ratio (OR) 1.71; P < 0.05] compared with those in acute care and for care aides (OR 1.72; P < 0.05), facility support service workers (OR 2.58; P < 0.01) and community health workers (OR 3.61; P < 0.001) compared with registered nurses (RNs). The median number of days lost was higher for females, long-term care workers, licensed practical nurses and care aides. Females, long-term care workers, RNs, licensed practical nurses, care aides and maintenance workers had the most costly falls. Reducing work-related serious fall injuries would be expected to bring about significant benefits in terms of reduced pain and suffering, improved workplace productivity, reduced absenteeism and reduced compensation costs.

A survey of pharmacists' perceptions of the adequacy of their training for addressing mental health–related medication issues

PubMed Central

2017-01-01

Introduction: The purpose of this study was to conduct a survey of North Carolina pharmacists' perceptions of their pharmacy training in mental health–related medication issues and how this influenced their perceived ability to address these issues in the provision of pharmaceutical care to their patients. Methods: A survey consisting of 17 questions was developed and emailed to licensed pharmacists in North Carolina. Surveys that were returned were analyzed to see if conclusions could be made regarding the pharmacists' perceptions about their mental health–related medication training and its influence on their practice. Results: A total of 848 pharmacists completed the survey (response rate of 7.9%). Of the survey participants, 489 (58.2%) reported that pharmacy school training adequately prepared them to provide basic pharmaceutical care to patients taking mental health–related medications. However, 350 (41.4%) reported feeling less comfortable providing medication counseling for mental health–related medications compared to cardiac medications. Discussion: Despite the volume of prescriptions that mental health–related medications represent in day-to-day practice, a significant portion of licensed pharmacists responding to our survey indicate that the emphasis on mental health in their training may have been inadequate.

Designing a personal health application for older adults to manage medications: a comprehensive case study.

PubMed

Siek, Katie A; Khan, Danish U; Ross, Stephen E; Haverhals, Leah M; Meyers, Jane; Cali, Steven R

2011-10-01

Older adults with multiple chronic conditions often go through care transitions where they move between care facilities or providers during their treatment. These transitions are often uncoordinated and can imperil patients by omitted, duplicative, or contradictory care plans. Older adults sometimes feel overwhelmed with the new responsibility of coordinating the care plan with providers and changing their medication regimes. In response, we developed a Lesser General Public License (LGPL) open source, web-based Personal Health Application (PHA) using an iterative participatory design process that provided older adults and their caregivers the ability to manage their personal health information. In this paper, we document the PHA design process from low-fidelity prototypes to high-fidelity prototypes over the course of six user studies. Our findings establish the imperative need for interdisciplinary research and collaboration among all stakeholders to create effective PHAs. We conclude with design guidelines that encourage researchers to gradually increase functionality as users become more proficient.

A Scoping Review of Physical Rehabilitation in Long-Term Care: Interventions, Outcomes, Tools.

PubMed

McArthur, Caitlin; Gibbs, Jenna C; Patel, Ruchit; Papaioannou, Alexandra; Neves, Paula; Killingbeck, Jaimie; Hirdes, John; Milligan, James; Berg, Katherine; Giangregorio, Lora

2017-12-01

Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents' stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.

Identification of human trafficking victims in health care settings.

PubMed

Baldwin, Susie B; Eisenman, David P; Sayles, Jennifer N; Ryan, Gery; Chuang, Kenneth S

2011-07-14

An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers' control. Our project aimed to characterize trafficking victims' encounters in US health care settings. The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims' encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains. The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers' control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles. This exploration of survivors' experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter human trafficking victims. Increasing awareness of human trafficking, and modifying practice to facilitate disclosure, could improve victim identification. Copyright © 2011 Baldwin, Eisenman, Sayles, Ryan, and Chuang. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

21 CFR 522.1150 - Hydrochlorothiazide injection.

Code of Federal Regulations, 2011 CFR

2011-04-01

... information. (3) Limitations. Animals should be regularly and carefully observed for early signs of fluid and.... Federal law restricts this drug to use by or on the order of a licensed veterinarian.1 [43 FR 59058, Dec...

21 CFR 522.1150 - Hydrochlorothiazide injection.

Code of Federal Regulations, 2012 CFR

2012-04-01

... information. (3) Limitations. Animals should be regularly and carefully observed for early signs of fluid and.... Federal law restricts this drug to use by or on the order of a licensed veterinarian.1 [43 FR 59058, Dec...

21 CFR 522.1150 - Hydrochlorothiazide injection.

Code of Federal Regulations, 2013 CFR

2013-04-01

... information. (3) Limitations. Animals should be regularly and carefully observed for early signs of fluid and.... Federal law restricts this drug to use by or on the order of a licensed veterinarian.1 [43 FR 59058, Dec...

21 CFR 522.1150 - Hydrochlorothiazide injection.

Code of Federal Regulations, 2010 CFR

2010-04-01

... information. (3) Limitations. Animals should be regularly and carefully observed for early signs of fluid and.... Federal law restricts this drug to use by or on the order of a licensed veterinarian.1 [43 FR 59058, Dec...

Burnout and Engagement: Relative Importance of Predictors and Outcomes in Two Health Care Worker Samples.

PubMed

Fragoso, Zachary L; Holcombe, Kyla J; McCluney, Courtney L; Fisher, Gwenith G; McGonagle, Alyssa K; Friebe, Susan J

2016-06-09

This study's purpose was twofold: first, to examine the relative importance of job demands and resources as predictors of burnout and engagement, and second, the relative importance of engagement and burnout related to health, depressive symptoms, work ability, organizational commitment, and turnover intentions in two samples of health care workers. Nurse leaders (n = 162) and licensed emergency medical technicians (EMTs; n = 102) completed surveys. In both samples, job demands predicted burnout more strongly than job resources, and job resources predicted engagement more strongly than job demands. Engagement held more weight than burnout for predicting commitment, and burnout held more weight for predicting health outcomes, depressive symptoms, and work ability. Results have implications for the design, evaluation, and effectiveness of workplace interventions to reduce burnout and improve engagement among health care workers. Actionable recommendations for increasing engagement and decreasing burnout in health care organizations are provided. © 2016 The Author(s).

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan.

PubMed

Hussain, Syed S; Khan, Murad; Gul, Raisa; Asad, Nargis

2018-05-03

In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial.

PubMed

Roets-Merken, Lieve M; Graff, Maud J L; Zuidema, Sytse U; Hermsen, Pieter G J M; Teerenstra, Steven; Kempen, Gertrudis I J M; Vernooij-Dassen, Myrra J F J

2013-10-07

Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age. In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis. The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated. ClinicalTrials.gov, NCT01217502.

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age. Methods/Design In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis. Discussion The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program’s potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated. Clinical trials registration ClinicalTrials.gov, NCT01217502. PMID:24099315

Do US Medical Licensing Applications Treat Mental and Physical Illness Equivalently?

PubMed

Gold, Katherine J; Shih, Elizabeth R; Goldman, Edward B; Schwenk, Thomas L

2017-06-01

State medical licensing boards are responsible for evaluating physician impairment. Given the stigma generated by mental health issues among physicians and in the medical training culture, we were interested in whether states asked about mental and physical health conditions differently and whether questions focused on current impairment. Two authors reviewed physician medical licensing applications for US physicians seeking first-time licensing in 2013 in the 50 states and the District of Columbia. Questions about physical and mental health, as well as substance abuse, were identified and coded as to whether or not they asked about diagnosis and/or treatment or limited the questions to conditions causing physician impairment. Forty-three (84%) states asked questions about mental health conditions, 43 (84%) about physical health conditions, and 47 (92%) about substance use. States were more likely to ask for history of treatment and prior hospitalization for mental health and substance use, compared with physical health disorders. Among states asking about mental health, just 23 (53%) limited all questions to disorders causing functional impairment and just 6 (14%) limited to current problems. While most state medical licensing boards ask about mental health conditions or treatment, only half limited queries to disorders causing impairment. Differences in how state licensing boards assess mental health raise important ethical and legal questions about assessing physician ability to practice and may discourage treatment for physicians who might otherwise benefit from appropriate care.

Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

PubMed

Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

2018-02-01

The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

Health and Safety in the Child Care Setting: Prevention of Infectious Disease. Module 1. Second Edition. A Curriculum for the Training of Child Care Providers.

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Cohen, Adena, Ed.

This curriculum module provides information and guidance on controlling communicable and infectious diseases in the childcare setting and is designed to fulfill the learning needs and licensing requirements of childcare providers in California. The curriculum provides 4 to 7 hours of training for childcare providers to be conducted by experienced…

Work Life Stress and Career Resilience of Licensed Nursing Facility Administrators.

PubMed

Myers, Dennis R; Rogers, Rob; LeCrone, Harold H; Kelley, Katherine; Scott, Joel H

2018-04-01

Career resilience provided a frame for understanding how Licensed Nursing Facility Administrators (LNFAs) sustain role performance and even thrive in stressful skilled nursing facility work environments. Quantitative and qualitative analyses of in-depth interviews with18 LNFAs, averaging 24 years of experience were conducted by a five-member research team. Analysis was informed by evidence-based frameworks for career resilience in the health professions as well as the National Association of Long-Term Care Administrator Boards' (NAB) five domains of competent administrative practice. Findings included six sources of work stressors and six sources of professional satisfaction. Also, participants identified seven strategic principles and 10 administrative practices for addressing major sources of stress. Recommendations are provided for research and evidence-based application of the career resilience perspective to LNFA practice aimed at reducing role abandonment and energizing the delivery of the quality of care that each resident deserves.

Evaluating the Implementation and Feasibility of a Web-Based Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings.

PubMed

Lawson, Beverley; Sampalli, Tara; Wood, Stephanie; Warner, Grace; Moorhouse, Paige; Gibson, Rick; Mallery, Laurie; Burge, Fred; Bedford, Lisa G

2017-03-07

Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice. This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative's feasibility and scalability. Methods will be informed by the 'Implementing the Frailty Portal in Community Primary Care Practice' logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR). The 'Frailty Portal' aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers' ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Test results management and distributed cognition in electronic health record-enabled primary care.

PubMed

Smith, Michael W; Hughes, Ashley M; Brown, Charnetta; Russo And, Elise; Giardina, Traber D; Mehta, Praveen; Singh, Hardeep

2018-06-01

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

The role of work environment in keeping newly licensed RNs in nursing: a questionnaire survey.

PubMed

Unruh, Lynn; Zhang, Ning Jackie

2013-12-01

In prior studies, newly licensed registered nurses (RNs) describe their job as being stressful. Little is known about how their perceptions of the hospital work environment affect their commitment to nursing. To assess the influence of hospital work environment on newly licensed RN's commitment to nursing and intent to leave nursing. Correlational survey. Newly licensed RNs working in hospitals in Florida, United States. 40% random sample of all RNs newly licensed in 2006. The survey was mailed out in 2008. Dependent variables were indicators of professional commitment and intent to leave nursing. Independent variables were individual, organizational, and work environment characteristics and perceptions (job difficulty, job demands and job control). Statistical analysis used ordinary least squares regressions. Level of significance was set at p<0.05. Job difficulty and job demand were significantly related to a lower commitment to nursing and a greater intent to leave nursing, and vice versa for job control. The strongest ranked of the job difficulties items were: incorrect instructions, organizational rules, lack of supervisor support, and inadequate help from others. Workload and other items were significant, but ranked lower. The strongest ranked of the job pressure items were: "having no time to get things done" and "having to do more than can be done well." The strongest ranked of job control items were "ability to act independent of others." Nurses with positive orientation experiences and those working the day shift and more hours were less likely to intend to leave nursing and more likely to be committed to nursing. Significant demographic characteristics related to professional commitment were race and health. Negative perceptions of the work environment were strong predictors of intent to leave nursing and a lower commitment to nursing among newly licensed RNs. These results indicate that retention of newly licensed RNs in nursing can be improved through changes in the work environment that remove obstacles to care-giving, increase resources and autonomy, and reduce workload and other job pressure factors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nursing delegation and medication administration in assisted living.

PubMed

Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

2010-01-01

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

Development of the Professional Self-Care Scale.

PubMed

Dorociak, Katherine E; Rupert, Patricia A; Bryant, Fred B; Zahniser, Evan

2017-04-01

In recent years, there has been an increased emphasis on the importance of self-care for psychologists and other mental health professionals. With the growth of positive psychology and preventive medicine, self-care is an emerging topic, promulgated as a means of avoiding the adverse effects of stress and promoting professional functioning and well-being. However, the research on self-care is limited because of the lack of an empirically based, psychometrically sound measure of this construct. Thus, the purpose of this project was to develop a measure of professional self-care. Professional psychologists were the focus of study, with the goal being to develop a measure that can be used in this population and similar groups of professionals. Based on expert feedback and a preliminary study of 422 licensed psychologists in Illinois, a 5-factor, 21-item scale was created. Factor analysis identified the following self-care factors: Professional Support, Professional Development, Life Balance, Cognitive Awareness, and Daily Balance. Preliminary analyses provided initial support for the validity of the 5 factors. A follow-up study was conducted with a second sample of clinical psychologists. The 5-factor structure provided a good fit to the data with the second sample. Thus, based on factor analysis and validity data, a 5-factor, 21-item Professional Self-Care Scale was established for further study and use in future research. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Medical spa marketing.

PubMed

Sadick, Neil S; Dinkes, Adam; Oskin, Larry

2008-07-01

Medical spas are different. We are not just selling medical and dermatology services; we are offering clients viable new solutions to their skin care, body care, and hair care challenges. Traditional medical marketing becomes blurred today, as the expansion and acceptance of medical spas helps you to effectively compete with traditional skin care clinics, salons, and spas, while offering more therapeutic treatments from professionally licensed doctors, nurses, aestheticians, massage therapists, spa professionals, and medical practitioners. We recommend that you make the choice to successfully and competitively become a market-driven medical spa with an annual strategic plan, rather than an operationally driven business.

Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS.

PubMed

Ecker, David J; Milan, Felise B; Cassese, Todd; Farnan, Jeanne M; Madigosky, Wendy S; Massie, F Stanford; Mendez, Paul; Obadia, Sharon; Ovitsh, Robin K; Silvestri, Ronald; Uchida, Toshiko; Daniel, Michelle

2018-05-01

Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.

Toward Customized Care Comment on "(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare".

PubMed

Minvielle, Etienne

2017-07-15

Patients want their personal needs to be taken into account. Accordingly, the management of care has long involved some degree of personalization. In recent times, patients' wishes have become more pressing in a moving context. As the population ages, the number of patients requiring sophisticated combinations of longterm care is rising. Moreover, we are witnessing previously unvoiced demands, preferences and expectations (eg, demand for information about treatment, for care complying with religious practices, or for choice of appointment dates). In view of the escalating costs and the concerns about quality of care, the time has now come to rethink healthcare delivery. Part of this reorganization can be related to customization: what is needed is a customized business model that is effective and sustainable. Such business model exists in different service sectors, the customization being defined as the development of tailored services to meet consumers' diverse and changing needs at near mass production prices. Therefore, its application to the healthcare sector needs to be seriously considered. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Licensed physicians who work in prisons: a profile.

PubMed Central

Lichtenstein, R L; Rykwalder, A

1983-01-01

A profile of the personal and professional characteristics of the physicians who work in America's prisons was obtained by analyzing data from a larger study of all licensed physicians in the United States who worked in a prison at least 12 hours a month during the fall of 1979. Psychiatrists were not included, nor were physicians working in jails. The population of 382 prison physicians comprised two major groups--those who worked in prisons full time and those who worked in them part time. Part-time physicians, who represented the majority of physicians involved in prison work (58 percent), were found to resemble closely the typical physician in the United States; they were predominantly trained in America, specialized, and board certified. In contrast, full-time prison physicians, who accounted for 73 percent of the total hours physicians spent working in prisons, differed significantly from the typical U.S. physician. They were older, less specialized, less likely to be board certified, and more likely to be graduates of non-U.S. medical schools. The professional characteristics of the full-time prison physicians raise serious questions about the quality of medical care they are likely to provide. It would seem, based on their professional attributes, that the part-time physicians are able to provide better quality care than their full-time colleagues. Prison health system could thus assure higher quality care to inmates by relying primarily on part-time rather than full-time practitioners. PMID:6419274

Oral Health Content of Early Education and Child Care Regulations and Standards

PubMed Central

Kranz, Ashley M.; Rozier, R. Gary

2012-01-01

Objective Almost two out of every three U.S. children younger than five receive child care from someone other than their parents. Health promotion in early education and child care (EECC) programs can improve the general health of children and families, but little is known about the role of these programs in oral health. We identified U.S. EECC program guidelines and assessed their oral health recommendations for infants and toddlers. Methods State licensing regulations were obtained from the National Resource Center for Health and Safety in Child Care’s online database. Professional standards were identified through a search of PubMed, early childhood organizations’ websites, and early childhood literature. All EECC guidelines were reviewed for key terms related to oral health promotion in children and summarized by domains. Results Thirty-six states include oral health in their licensing regulations, but recommendations are limited and most often address the storage of toothbrushes. Eleven sets of standards were identified, four of which make recommendations about oral health. Standards from the American Academy of Pediatrics/American Public Health Association (AAP/APHA) and the Office of Head Start (OHS) provide the most comprehensive oral health recommendations regarding screening and referral, classroom activities and education. Conclusions Detailed guidelines for oral health practices exist but they exhibit large variation in number and content. States can use the comprehensive standards from the AAP/APHA and OHS to inform and strengthen the oral health content of their licensing regulations. Research is needed to determine compliance with regulations and standards, and their effect on oral health. PMID:21070244

Explaining direct care resource use of nursing home residents: findings from time studies in four states.

PubMed

Arling, Greg; Kane, Robert L; Mueller, Christine; Lewis, Teresa

2007-04-01

To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

The Health Occupations Boom.

ERIC Educational Resources Information Center

Lozada, Marlene

1995-01-01

Profiles 10 health care jobs in terms of duties, work environment, education and training needs, and salary scale. Jobs profiled are physicians' assistants, recreational therapists, respiratory therapists, dental assistants and hygienists, medical assistants, nurses' aides, psychiatric aides, emergency medical technicians, licensed practical…

45 CFR 60.10 - Reporting negative actions or findings taken by peer review organizations or private...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., dentist, or entity by a peer review organization or private accreditation entity. The health care practitioner, physician, dentist, or entity must be licensed or otherwise authorized by the State to provide...

45 CFR 60.10 - Reporting negative actions or findings taken by peer review organizations or private...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., dentist, or entity by a peer review organization or private accreditation entity. The health care practitioner, physician, dentist, or entity must be licensed or otherwise authorized by the State to provide...

45 CFR 60.10 - Reporting negative actions or findings taken by peer review organizations or private...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., dentist, or entity by a peer review organization or private accreditation entity. The health care practitioner, physician, dentist, or entity must be licensed or otherwise authorized by the State to provide...

Demanding Quality When Foreign Nurses Are in Demand.

ERIC Educational Resources Information Center

Maroun, Virginia M.; Serota, Carol

1988-01-01

The Commission on Graduates of Foreign Nursing Schools was established to identify foreign nurse graduates who would be likely to pass the registered nurse licensing exam and to ensure high quality nursing care for the American public. (JOW)

Secondary-care costs associated with lung cancer diagnosed at emergency hospitalisation in the United Kingdom.

PubMed

Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J

2017-10-01

Lung cancer diagnosis during emergency hospital admission has been associated with higher early secondary-care costs and lower longer-term costs than outpatient diagnoses. This retrospective cohort study analyses the secondary-care costs of 3274 consecutive patients with lung cancer. Patients diagnosed during emergency admissions incurred greater costs during the first month and had a worse prognosis compared with outpatient diagnoses. In patients who remained alive, costs after the first month were comparable between diagnostic routes. In addition to improving patient experience and outcome, strategies to increase earlier diagnosis may reduce the additional healthcare costs associated with this route to diagnosis. 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/.

The Enhanced Nurse Licensure Compact (eNLC): Unlocking Access to Nursing Care Across the Nation.

PubMed

Kappel, Dawn M

2018-05-01

Nurses, including school nurses, may reside in a state with compact licensing. On July 20, 2017, an enhanced Nurse Licensure Compact (eNLC) was enacted with implementation beginning on January 19, 2018. Nurses must be knowledgeable about the status of their state's participation in the compact licensure, both their state of residence and their state of practice. Nurses must also be knowledgeable about what is entailed in compact licensure. This brief article provides basic information about compact licensing, along with considerations about nursing delegation, for the practicing school nurse.

Drug Licenses: A Better Model for Pharmaceutical Pricing

PubMed Central

Goldman, Dana P.; Jena, Anupam B.; Philipson, Tomas; Sun, Eric

2013-01-01

High drug prices are a substantial barrier to patient access and compliance. Yet, low drug prices are often argued to provide inadequate incentives for innovation. We propose a “drug-licensing” model for health care which has the promise of increasing drug utilization without altering patient out-of-pocket spending, health plan costs, or pharmaceutical profits. In such a model, individuals purchase annual drug licenses which guarantee unfettered access to a clinically optimal number of prescriptions over the course of a year. For the case of statins, we illustrate how such a model may be implemented in practice. PMID:18180487

Governance Must Dive Into Organizations to Make a Real Difference Comment on "Governance, Government, and the Search for New Provider Models".

PubMed

Denis, Jean-Louis; Usher, Susan

2016-07-03

In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizations, they are unlikely to improve care. It proposes three sets of levers influenced by governance that have potential to influence what happens at the point of care: harnessing the autonomy and expertise of professionals at a collective level to work towards better safety and quality; creating enabling contexts for cross-fertilization of clinical and organizational expertise, notably through teamwork; and patient and public engagement to achieve greater agreement on improvement priorities and overcome provider/manager tensions. Good governance provides guidance at a distance but also goes deep enough to influence clinical habits. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

PubMed

Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

2017-10-01

Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada

PubMed Central

Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

2016-01-01

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change. PMID:27417591

A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada.

PubMed

Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

2016-01-04

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

42 CFR 438.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., and certified nurse midwife), licensed certified social worker, registered respiratory therapist, and certified respiratory therapy technician. Health insuring organization (HIO) means a county operated entity... furnishes them. Primary care case management means a system under which a PCCM contracts with the State to...

42 CFR 438.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., and certified nurse midwife), licensed certified social worker, registered respiratory therapist, and certified respiratory therapy technician. Health insuring organization (HIO) means a county operated entity... furnishes them. Primary care case management means a system under which a PCCM contracts with the State to...

42 CFR 438.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., and certified nurse midwife), licensed certified social worker, registered respiratory therapist, and certified respiratory therapy technician. Health insuring organization (HIO) means a county operated entity... furnishes them. Primary care case management means a system under which a PCCM contracts with the State to...

42 CFR 438.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., and certified nurse midwife), licensed certified social worker, registered respiratory therapist, and certified respiratory therapy technician. Health insuring organization (HIO) means a county operated entity... furnishes them. Primary care case management means a system under which a PCCM contracts with the State to...

Physician survey examining the impact of an educational tool for responsible opioid prescribing.

PubMed

Young, Aaron; Alfred, Kelly C; Davignon, Philip P; Hughes, LaSharn M; Robin, Lisa A; Chaudhry, Humayun J

2012-01-01

In response to the need for physician education on proper opioid prescribing, the Federation of State Medical Boards (FSMB) and the FSMB Foundation, the philanthropic arm of the FSMB, commissioned and distributed Responsible Opioid Use: A Physician's Guide to more than 165, 000 licensed physicians in the United States. The book, written by pain management specialist Scott Fishman, MD, seeks tofurtherphysicians' continuing medical education by providing information on how to properly prescribe opioids to treat patients in pain. Although the book has been widely distributed, there have been no systematic studies of its impact. To address this knowledge gap, the authors surveyed licensed physicians in Georgia who received a copy of the book to determine whether it added to their knowledge about prescribing opioids, and if they planned to make changes in theirpractice based on reading the book. Six weeks after licensed physicians in Georgia received the book, a survey was sent to 12,666 of them via e-mail. A total of508 physicians completed the online survey. Of these, 82.1 percent rated the book either "very good" or "good" on providing pragmatic steps for improved care forpatients in pain, and more than 80 percent agreed that the book is a useful educational tool. Almost one-third (32.2percent) claimed that they intend to make changes to theirpractice after reading the book. The analysis also showed physicians in a solo practice were more likely to make changes (41.8percent) than their counterparts in office-based group practice (33.3 percent) and hospital-based (25.0 percent) settings. Primary care providers (41.6 percent) were also much more likely to make changes than physicians working in other specialty areas of medicine (22.8 percent). Well over half (57. 7percent) of the respondents indicated the book was better than other publications they had read on opioid prescribing and pain management. The results from this state-wide survey of licensed physicians demonstrate the value of educating physicians about how to appropriately prescribe, document, and treat patients who need opioid medications for pain management. The findings should be of value to organizations seeking to better educate physicians about appropriate opioid prescribing by providing insight into which physician population would be the most receptive to the type of information presented in Dr. Fishman's book. When faced with limited resources, an organizational strategy that first targets solo and primary care practitioners may improve physician educational efforts about prescribing opioids better than a strategy targeting medical and surgical specialists or those physicians participating in group practice settings.

Participation in the child and adult care food program is associated with more nutritious foods and beverages in child care.

PubMed

Ritchie, Lorrene D; Boyle, Maria; Chandran, Kumar; Spector, Phil; Whaley, Shannon E; James, Paula; Samuels, Sarah; Hecht, Ken; Crawford, Patricia

2012-06-01

Nearly two million California children regularly spend time in child care. Surprisingly little is known about the nutrition environments of these settings. The aim of this study was to compare foods and beverages served to 2- to 5-year-olds by type of child care and participation in the federally funded Child and Adult Care Food Program (CACFP). A statewide survey of child care providers (n = 429) was administered. Licensed child care was divided into six categories: Head Start centers, state preschools, centers that participate in CACFP, non-CACFP centers, homes that participate in CACFP, and non-CACFP homes. CACFP sites in general, and Head Start centers in particular, served more fruits, vegetables, milk, and meat/meat alternatives, and fewer sweetened beverages and other sweets and snack-type items than non-CACFP sites. Reported barriers to providing nutritious foods included high food costs and lack of training. CACFP participation may be one means by which reimbursement for food can be increased and food offerings improved. Further research should investigate whether promoting CACFP participation can be used to provide healthier nutrition environments in child care and prevent obesity in young children.

Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data.

PubMed

Browne, Joyce L; Kayode, Gbenga A; Arhinful, Daniel; Fidder, Samuel A J; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin

2016-03-18

This study aims to evaluate the effect of maternal health insurance status on the utilisation of antenatal, skilled delivery and postnatal care. A population-based cross-sectional study. We utilised the 2008 Demographic and Health Survey data of Ghana, which included 2987 women who provided information on maternal health insurance status. Utilisation of antenatal, skilled delivery and postnatal care. Multivariable logistic regression was applied to determine the independent association between maternal health insurance and utilisation of antenatal, skilled delivery and postnatal care. After adjusting for socioeconomic, demographic and obstetric factors, we observed that among insured women the likelihood of having antenatal care increased by 96% (OR 1.96; 95% CI 1.52 to 2.52; p value<0.001) and of skilled delivery by 129% (OR 2.29; 95% CI 1.92 to 2.74; p value<0.001), while postnatal care among insured women increased by 61% (OR 1.61; 95% CI 1.17 to 2.21; p value<0.01). This study demonstrated that maternal health insurance status plays a significant role in the uptake of the maternal, neonatal and child health continuum of care service. 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/

Trading legitimacy: everyday corruption and its consequences for medical regulation in southern Vietnam.

PubMed

Lê, Gillian

2013-09-01

Government regulation of health professionals is believed to ensure the efficacy and expertise of practitioners for and on behalf of patients. Certification and licensing are two common means to do so, legalizing a physician to practice medicine. However, ethnography from Ho Chi Minh City (HCMC) suggests that in corrupt socioeconomic environments, certification and licensing can alternatively produce a trade in legitimacy. Drawing on participant observations during 15 months of fieldwork with 25 medical acupuncturists in private practice in HCMC, southern Vietnam, and their patients, I argue that everyday practices of corruption and the importance of personal networks meant that legality, efficacy, and expertise separated. Certificates and licenses did not unproblematically validate expertise and efficacy. Consequently, compliance and enforcement of regulations as solutions to inadequate medical care may not achieve the effects intended. © 2013 by the American Anthropological Association.

Long-term care planning study: strengths and learning needs of nursing staff.

PubMed

Cruttenden, Kathleen E

2006-01-01

This planning study was designed and conducted in a predominantly rural Canadian province to examine the strengths and learning needs of four categories of nursing staff practising in New Brunswick nursing homes. Participants included directors of care, registered nurses, licensed practical nurses, and resident attendants. The nursing homes ranged in size from 38 to 196 beds and were located throughout the province. In health and planning studies, ethnography conveys a coherent statement of peoples' local knowledge as culture-sharing groups (Muecke, 1994). The study derived information from the Nursing Home Act, reports, the literature, key informants, and direct observations of and interviews with participants. Leadership strengths defined the roles for categories of staff and supported the capacity of each category to identify their learning needs. In conclusion, nurses practising in nursing homes can and must take an active role in decision making for their learning.

Pharmacovigilance in practice: erythropoiesis-stimulating agents.

PubMed

Hedenus, Michael; Ludwig, Heinz; Henry, David H; Gasal, Eduard

2014-10-01

Pharmacovigilance (PV) is the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or other problems related to medical products after they have been licensed for marketing. The purpose of PV is to advance the safe use of marketed medical products. Regulatory agencies and license holders collaborate to collect data reported by health care providers, patients, and the public as well as data from systematic reviews, meta-analyses, and individual clinical and nonclinical studies. They validate and analyze the data to determine whether safety signals exist, and if warranted, develop an action plan to mitigate the identified risk. Erythropoiesis-stimulating agents (ESAs) provide an example of how PV is applied in reality. Among other approved indications, ESAs may be used to treat anemia in patients with chemotherapy-induced anemia. ESAs increase hemoglobin levels and reduce the need for transfusions; they are also associated with a known increased risk of thromboembolic events. Starting in 2003, emerging data suggested that ESAs might reduce survival. As a result of PV activities by regulatory agencies and license holders, labeling for ESAs addresses these risks. Meta-analyses and individual clinical studies have confirmed that ESAs increase the risk of thromboembolic events, but when used as indicated, ESAs have not been shown to have a significant effect on survival or disease progression. Ongoing safety studies will provide additional data in the coming years to further clarify the risks and benefits of ESAs. © 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Unequal socioeconomic distribution of the primary care workforce: whole-population small area longitudinal study.

PubMed

Asaria, Miqdad; Cookson, Richard; Fleetcroft, Robert; Ali, Shehzad

2016-01-19

To measure changes in socioeconomic inequality in the distribution of family physicians (general practitioners (GPs)) relative to need in England from 2004/2005 to 2013/2014. Whole-population small area longitudinal data linkage study. England from 2004/2005 to 2013/2014. 32,482 lower layer super output areas (neighbourhoods of 1500 people on average). Slope index of inequality (SII) between the most and least deprived small areas in annual full-time equivalent GPs (FTE GPs) per 100,000 need adjusted population. In 2004/2005, inequality in primary care supply as measured by the SII in FTE GPs was 4.2 (95% CI 3.1 to 5.3) GPs per 100,000. By 2013/2014, this SII had fallen to -0.7 (95% CI -2.5 to 1.1) GPs per 100,000. The number of FTE GPs per 100,000 serving the most deprived fifth of small areas increased over this period from 54.0 to 60.5, while increasing from 57.2 to 59.9 in the least deprived fifth, so that by the end of the study period there were more GPs per 100,000 need adjusted population in the most deprived areas than in the least deprived. The increase in GP supply in the most deprived fifth of neighbourhoods was larger in areas that received targeted investment for establishing new practices under the 'Equitable Access to Primary Medical Care'. There was a substantial reduction in socioeconomic inequality in family physician supply associated with national policy. This policy may not have completely eliminated socioeconomic inequality in family physician supply since existing need adjustment formulae do not fully capture the additional burden of multimorbidity in deprived neighbourhoods. The small area approach introduced in this study can be used routinely to monitor socioeconomic inequality of access to primary care and to indicate workforce shortages in particular neighbourhoods. http://creativecommons.org/licenses/by/4.0. 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/

Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care.

PubMed

Poksinska, Bozena Bonnie; Fialkowska-Filipek, Malgorzata; Engström, Jon

2017-02-01

Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. 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/.

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

PubMed Central

Arling, Greg; Kane, Robert L; Mueller, Christine; Lewis, Teresa

2007-01-01

Objective To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. Data Sources/Study Setting Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident- and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods Time study data were recorded with hand-held computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents. PMID:17362220

The adoption of care robots in home care-A survey on the attitudes of Finnish home care personnel.

PubMed

Rantanen, Teemu; Lehto, Paula; Vuorinen, Pertti; Coco, Kirsi

2018-05-01

This article examines the attitudes of Finnish home care registered nurses, licensed vocational nurses and other health and social care personnel towards the introduction and use of care robots in home care. The significance of care robotics has been highlighted in recent years. However, personnel-related social psychological barriers to the introduction of care robots have been given very little study. Cross-sectional study conducted by questionnaire. The theoretical framework of the study is based on Ajzen's theory of planned behaviour and the research discussion about attitudes towards robots. The research data were collected in five municipalities in different parts of Finland in 2016, and the questionnaire was answered by a total of 200 home care workers. The research data were analysed using exploratory factor analysis, Pearson product-moment correlation, one-way analysis of variance and linear regression analysis. The results are consistent with Ajzen's theory and previous studies on the acceptance of information systems in health care. Personnel behavioural intentions related to the introduction of robot applications in home care are influenced by their personal appreciation of the usefulness of robots, the expectations of their colleagues and supervisors, as well as by their own perceptions of their capacity to learn to use care robots. In particular, personnel emphasised the value of care robots in providing reminders and guidance, as well as promoting the safety of the older people. The study shows that an intimate human-robot relationship can pose a challenge from the perspective of the acceptance of care robots. From the perspective of the introduction of care robots in home care, personnel training and the construction of a positive working atmosphere play a key role. In addition, the introduction of robots requires further consideration of a number of ethical issues. © 2018 John Wiley & Sons Ltd.

42 CFR 130.20 - Form of medical documentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., records maintained by a physician, nurse, or other licensed health care provider, test results... under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the... an affidavit must include the physician's, nurse practitioner's or physician assistant's State of...

42 CFR 130.20 - Form of medical documentation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the... an affidavit must include the physician's, nurse practitioner's or physician assistant's State of..., records maintained by a physician, nurse, or other licensed health care provider, test results...

42 CFR 130.20 - Form of medical documentation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the... an affidavit must include the physician's, nurse practitioner's or physician assistant's State of..., records maintained by a physician, nurse, or other licensed health care provider, test results...

42 CFR 130.20 - Form of medical documentation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the... an affidavit must include the physician's, nurse practitioner's or physician assistant's State of..., records maintained by a physician, nurse, or other licensed health care provider, test results...

42 CFR 130.20 - Form of medical documentation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... under penalty of perjury, by a physician, nurse practitioner or physician assistant, verifying that the... an affidavit must include the physician's, nurse practitioner's or physician assistant's State of..., records maintained by a physician, nurse, or other licensed health care provider, test results...

Striking a balance: conscientious objection and reproductive health care from the Colombian perspective.

PubMed

Cabal, Luisa; Olaya, Monica Arango; Robledo, Valentina Montoya

2014-12-11

Conscientious Objection or conscientious refusal (CO) in access to reproductive health care is at the center of current legal debates worldwide. In countries such as the US and the UK, constitutional dilemmas surrounding CO in the context of reproductive health services reveal inadequate policy frameworks for balancing CO rights with women's rights to access contraception and abortion. The Colombian Constitutional Court's holistic jurisprudence regarding CO standards has applied international human rights norms so as to not only protect women's reproductive rights as fundamental rights, but to also introduce clear limits for the exercise of CO in health care settings. This paper reviews Latin American lines of regulation in Argentina, Uruguay, and Mexico City to argue that the Colombian Court's jurisprudence offers a strong guidance for future comprehensive policy approaches that aim to effectively balance tensions between CO and women's reproductive rights. Copyright © 2014 Cabal, Olaya, Robledo. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Outbreak of group A Streptococcus infections in an outpatient wound clinic-Colorado, 2014.

PubMed

Hancock-Allen, Jessica B; Janelle, Sarah J; Lujan, Kate; Bamberg, Wendy M

2016-10-01

In September 2014, wound clinic A reported a cluster of group A Streptococcus (GAS) infections to public health authorities. Although clinic providers were individually licensed, the clinic, affiliated with hospital A, was not licensed or subject to regulation. We investigated to identify cases, determine risk factors, and implement control measures. A case was defined as GAS isolation from a wound or blood specimen during March 28-November 19, 2014, from a patient treated at wound clinic A or by a wound clinic A provider within the previous 7 days. All wound clinic A staff were screened for GAS carriage. Wound care procedures were assessed for adherence to infection control principles and possible GAS transmission routes. We identified 16 patients with 19 unique infections: 9 (56%) patients required hospitalization, and 7 (44%) required surgical debridement procedures. One patient died. Six (37%) patients received negative pressure wound therapy at GAS onset. Staff self-screening found no GAS carriers. Breaches in infection control and poor wound care practices were widespread. This GAS outbreak was associated with a wound care clinic not subject to state or federal regulation. Lapses in infection control practices and inadequate oversight contributed to the outbreak. Published by Elsevier Inc.

The relationship between individualized care and the practice environment: an international study.

PubMed

Papastavrou, Evridiki; Acaroglu, Rengin; Sendir, Merdiye; Berg, Agneta; Efstathiou, Georgios; Idvall, Ewa; Kalafati, Maria; Katajisto, Jouko; Leino-Kilpi, Helena; Lemonidou, Chryssoula; da Luz, Maria Deolinda Antunes; Suhonen, Riitta

2015-01-01

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. This study had an international, multisite, prospective, cross-sectional, exploratory survey design. The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.

PubMed

Roets-Merken, Lieve M; Vernooij-Dassen, Myrra J F J; Zuidema, Sytse U; Dees, Marianne K; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

2016-11-17

To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions. Qualitative study alongside a cluster randomised controlled trial. 17 long-term care homes spread across the Netherlands. 34 licensed practical nurses supporting 54 dual sensory impaired older adults. A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care. Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports. Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not. Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time. NCT01217502, Post-results. 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/.

“Terms and conditions of use” for journal articles and scholarly journals : A survey on the licensing processes associated with electronic scholarly materials

NASA Astrophysics Data System (ADS)

Hidaka, Masako

Copyright policies and terms directly affect the approach taken by journal editors, authors and readers regarding dealing with of articles and/or copyrighted materials. However Japanese academic society publishers have some trouble in licensing processes for copyrighted materials as previous studies pointed out. In 2011 we conducted a survey on “terms and conditions of use” of electronic journal and the licensing practices associated with electronic scholarly materials. The survey showed commercial publishers have enough announcements on reuse of copyrighted materials for readers. On the other hand Japanese academic societies' cares for readers tend to not enough. They publish journals both in Japanese and in English. Subsequently, English and Japanese templates of “terms and conditions of use” for Japanese academic society publishers were proposed. The templates were developed based on an understanding of the International Association of Scientific, Technical and Medical Publishers' “STM Permissions Guidelines,” which were designed to establish a standard and reasonable approach to granting permission for republication to all signatory publishers.The survey showed that Japanese academic society publishers and commercial publishers are facing the same issues regarding acceptable use of electronic supplemental materials for journal articles. This issue remains to be solved.

Medical Practices and Attitudes of Dual-Licensed Medical Doctors in Korea

PubMed Central

Ryu, Jiseon; Choi, Byunghee; Lim, Byungmook; Kim, Sina; Yun, Youngju

2013-01-01

Unique dual medical system in Korea has resulted in the emergence of dual-licensed medical doctors (DLMDs) who have both traditional Korean medicine (KM) and Western medicine (WM) licenses. There have been few studies on DLMDs in spite of their growing number and importance within the medical system. We surveyed the current status and attitudes of DLMD to assess their role in integrative medicine. Questionnaires were administered to the members of the association of DLMD. Data from 103 DLMD were collected and statistically analyzed. 41.4% of DLMD were copracticing both WM and KM at a single clinic, preferring the WM approach for physical examinations, laboratory tests, and education for patients—and the KM approach for treatment and prescription. Musculoskeletal, gastroenterologic, and allergic diseases were considered to be effectively treated with co-practice. DLMD highly agreed on the efficiency of copractice for disease control and patients' satisfaction. On the other hand, they regarded the lack of health insurance coverage for copractice and increased medical expenditure as major problems in providing co-practice. To expand the role of DLMD as mediators of integration in primary health care, the effectiveness of their co-practice should be evaluated and a corresponding health insurance reimbursement system should be established. PMID:23476682

Trust, Growth Mindset, and Student Commitment to Active Learning in a College Science Course.

PubMed

Cavanagh, Andrew J; Chen, Xinnian; Bathgate, Meghan; Frederick, Jennifer; Hanauer, David I; Graham, Mark J

2018-01-01

There is growing consensus regarding the effectiveness of active-learning pedagogies in college science courses. Less is known about ways that student-level factors contribute to positive outcomes in these contexts. The present study examines students' ( N = 245) trust in the instructor-defined as perceptions of their instructor's understanding, acceptance, and care-and students' attitudes toward learning within an anatomy and physiology course featuring active learning. Analyses indicate that student trust of instructor and students' views of their own intelligence are both associated with student commitment to, and engagement in, active learning. Student-reported trust of the instructor corresponded to final grade, while students' views of their own intelligence did not. In an active-learning context in which students are more fully engaged in the learning process, student trust of the instructor was an important contributor to desired student outcomes. © 2018 A. J. Cavanagh et al. CBE—Life Sciences Education © 2018 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Modeling Safety Outcomes on Patient Care Units

NASA Astrophysics Data System (ADS)

Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

Applying the chronic care model to prenatal care: Patient activation, productive interactions, and prenatal outcomes.

PubMed

Ledford, Christy J W; Sadler, Kerry P; Jackson, Jeremy T; Womack, Jasmyne J; Rider, Heather A; Seehusen, Angela B

2018-04-30

To demonstrate how the chronic care model can be applied in prenatal care. This study was conducted through analysis of data generated in the women's health and family medicine departments of one community hospital and two medical centers across three states (Georgia, Nevada, and Virginia). 159 low-risk obstetric patients were monitored throughout their pregnancy for patient activation and biometric measures including: blood pressure at each appointment, baby's gestational age at birth, and mode of delivery. Patient activation was assessed with the validated, licensed patient activation measure. Patient activation was strongly associated with the Prenatal Interpersonal Processes of Care metric (F (2, 155) = 3.41, p < .05). Also, increased age, decreased Prenatal Interpersonal Processes of Care, fewer pregnancies, and increased diastolic blood pressure were associated with an increased likelihood of cesarean delivery and the model correctly predicted 81% of cases. Women who identified as feeling more activated reported more positive pregnancy experiences, and women who reported more positive pregnancy experiences were more likely to experience a vaginal delivery. Activated patients, more positive prenatal experience, and improved delivery outcomes can be achieved through applying the chronic care model. Copyright © 2018 Elsevier B.V. All rights reserved.

Implementing Culture Change in Nursing Homes: An Adaptive Leadership Framework

PubMed Central

Corazzini, Kirsten; Twersky, Jack; White, Heidi K.; Buhr, Gwendolen T.; McConnell, Eleanor S.; Weiner, Madeline; Colón-Emeric, Cathleen S.

2015-01-01

Purpose of the Study: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. Design and Methods: The study design was a qualitative, observational study of nursing home staff perceptions of the implementation of culture change in each of 3 nursing homes. We conducted 7 focus groups of licensed and unlicensed nursing staff, medical care providers, and administrators. Questions explored perceptions of facilitators and barriers to culture change. Using a template organizing style of analysis with immersion/crystallization, themes of barriers and facilitators were coded for adaptive challenges and leadership. Results: Six key themes emerged, including relationships, standards and expectations, motivation and vision, workload, respect of personhood, and physical environment. Within each theme, participants identified barriers that were adaptive challenges and facilitators that were examples of adaptive leadership. Commonly identified challenges were how to provide person-directed care in the context of extant rules or policies or how to develop staff motivated to provide person-directed care. Implications: Implementing culture change requires the recognition of adaptive challenges for which there are no technical solutions, but which require reframing of norms and expectations, and the development of novel and flexible solutions. Managers and administrators seeking to implement person-directed care will need to consider the role of adaptive leadership to address these adaptive challenges. PMID:24451896

Immigration and contract problems experienced by foreign-educated nurses.

PubMed

Pittman, Patricia; Herrera, Carolina; Spetz, Joanne; Davis, Catherine R

2012-06-01

More than 8% of employed RNs licensed since 2004 in the United States were educated overseas, yet little is known about the conditions of their recruitment or the impact of that experience on health care practice. This study assessed whether the labor rights of foreign-educated nurses were at risk during the latest period of high international recruitment: 2003 to 2007. Using consensus-based standards contained in the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals to the United States, this study found 50% of actively recruited foreign-educated nurses experienced a negative recruitment practice. The study also found that nurses educated in low-income countries and nurses with high contract breach fees, were significantly more likely to report such problems. If, as experts believe may occur, the nursing shortage in the United States returns around 2014, oversight of international recruitment will become critically important to delivering high-quality health care to Americans.

Careers in Optometry.

ERIC Educational Resources Information Center

Kitchell, Frank M.

This publication, a pamphlet included in the B'nai B'rith Occupational Brief Series, directs its attention to that profession specifically licensed to care for human vision. The nature of work and the fields of specialization within the profession are described. Personal qualifications, educational and national (governmental) requirements, and…

76 FR 80741 - TRICARE: Certified Mental Health Counselors

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

...] TRICARE: Certified Mental Health Counselors AGENCY: Office of the Secretary, Department of Defense. ACTION... would allow licensed or certified mental health counselors to be able to independently provide care to... health counselors (MHCs) are authorized to practice only with physician referral and supervision. This...

42 CFR 482.51 - Condition of participation: Surgical services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... applicable State laws and approved medical staff policies and procedures, LPNs and surgical technologists may... of medicine or osteopathy. (2) Licensed practical nurses (LPNs) and surgical technologists (operating... surgical care must be designed to assure the achievement and maintenance of high standards of medical...

The Moral Education of Journal Editors

ERIC Educational Resources Information Center

Krimsky, Sheldon

2010-01-01

Refereed journals in science and medicine are the gatekeepers and repositories of knowledge in their respective fields. Research reported in peer-reviewed journals builds professional careers, determines which drugs and medical devices are licensed, influences what medical treatments become standards of care, and establishes the veracity of…

29 CFR 1910.1051 - 1,3-Butadiene.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., duration, and results of samples taken; (E) Type of protective devices worn, if any; and (F) Name, social... social security number of the employee; (B) Physician's or other licensed health care professional's...: Good industrial hygiene practices recommend that engineering and work practice controls be used to...

38 CFR 70.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... independent licensed practitioner. Emergency treatment means treatment for a condition of such a nature that a... layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of... domiciliary care due to: refusal, neglect or obstruction of examination or treatment; leaving without the...

Licensing Surrogate Decision-Makers.

PubMed

Rosoff, Philip M

2017-06-01

As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for ineffective, inappropriate and prolonged interventions. In 1980 LaFollette called for the licensing of prospective parents, basing his argument on the harm they can do to vulnerable people (children). In this paper, I apply his arguments to surrogate decision-makers for cognitively incapacitated patients, rhetorically suggesting that we require potential surrogates to qualify for this position by demonstrating their ability to make reasonable and rational decisions for others. I employ this theoretical approach to argue that the loose criteria by which we authorize surrogates' generally unchallenged power should be reconsidered.

Voices That Care: Licensed Practical Nurses and the Emotional Labour Underpinning Their Collaborative Interactions with Registered Nurses

PubMed Central

Huynh, Truc; Alderson, Marie; Nadon, Michelle; Kershaw-Rousseau, Sylvia

2011-01-01

Recognizing the emotional labour underlying interprofessional collaborations (IPCs) could be considered a crucial step towards building a cohesive nursing team. Although IPCs between registered nurses (RNs) and licensed practical nurses (LPNs) have been linked to quality nursing care, little is known about the emotions experienced by LPNs during their interactions with RNs or those factors that influence IPCs. A questionnaire administered to 309 LPNs found that (1) the professional identity of LPNs has evolved into a that of a unique social group; (2) LPNs define IPC as an interpersonal process of exploring similar or dissimilar assessments of a patient's status with RNs and, together, establishing a course of nursing actions; (3) the primary organizational factor facilitating IPCs is inclusive nursing leadership; (4) the interpersonal factor promoting IPCs is the level of trust RNs extend to LPNs; and (5) an LPN's emotional labour (i.e., internal emotional regulation) is most tangible during uncollaborative interactions with RNs. PMID:22135732

Navigating the legal and ethical foundations of informed consent and confidentiality in integrated primary care.

PubMed

Hudgins, Cathy; Rose, Sandra; Fifield, Peter Y; Arnault, Steve

2013-03-01

This article describes findings from ongoing research and analysis of current literature in addition to discussions with leaders in the field, communications with lawyers and administrators of advocacy and government agencies pertaining to integrated primary care (IPC). Standards of care are established based on a myriad of factors, including professional codes of ethics, case law, state and federal laws, professional standards, existing best practices, current professional guidelines, administrative rules and regulations, and licensing board regulations. Regulations may differ for behavioral health and medical providers, posing challenges in IPC settings. This article provides a review of these regulations, particularly 42CFR Part 2, a federal law governing confidentiality for substance abuse programs, Health Insurance Portability and Accountability Act (HIPAA), and state laws relevant to patient care in IPC settings. On the basis of findings from the study, the authors make recommendations related to patient care practices concerning informed consent and release of information procedures, treatment and warm hand-off protocols, documentation and electronic record keeping, agreements with other providers, and billing. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Recruitment and retention of mental health care providers in rural Nebraska: perceptions of providers and administrators.

PubMed

Watanabe-Galloway, Shinobu; Madison, Lynda; Watkins, Katherine L; Nguyen, Anh T; Chen, Li-Wu

2015-01-01

The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities. The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes. A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and mental health practitioners, financial reimbursement for time spent in this activity was identified as important. The present study showed that a comprehensive approach is needed to address workforce shortage issues for different types of professionals. In addition, systemic issues related to reimbursement and other financial aspects must be resolved to strengthen the overall rural mental healthcare delivery system.

Bioethics, Human Rights, and Childbirth.

PubMed

Erdman, Joanna

2015-06-11

The global reproductive justice community has turned its attention to the abuse and disrespect that many women suffer during facility-based childbirth. In 2014, the World Health Organization released a statement on the issue, endorsed by more than 80 civil society and health professional organizations worldwide.The statement acknowledges a growing body of research that shows widespread patterns of women's mistreatment during labor and delivery-physical and verbal abuse, neglect and abandonment, humiliation and punishment, coerced and forced care-in a range of health facilities from basic rural health centers to tertiary care hospitals. Moreover, the statement characterizes this mistreatment as a human rights violation. It affirms: "Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care throughout pregnancy and childbirth."The WHO statement and the strong endorsement of it mark a critical turn in global maternal rights advocacy. It is a turn from the public health world of systems and resources in preventing mortality to the intimate clinical setting of patient and provider in ensuring respectful care. Copyright 2015 Erdman. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

A meta-analytic review of moral licensing.

PubMed

Blanken, Irene; van de Ven, Niels; Zeelenberg, Marcel

2015-04-01

Moral licensing refers to the effect that when people initially behave in a moral way, they are later more likely to display behaviors that are immoral, unethical, or otherwise problematic. We provide a state-of-the-art overview of moral licensing by conducting a meta-analysis of 91 studies (7,397 participants) that compare a licensing condition with a control condition. Based on this analysis, the magnitude of the moral licensing effect is estimated to be a Cohen's d of 0.31. We tested potential moderators and found that published studies tend to have larger moral licensing effects than unpublished studies. We found no empirical evidence for other moderators that were theorized to be of importance. The effect size estimate implies that studies require many more participants to draw solid conclusions about moral licensing and its possible moderators. © 2015 by the Society for Personality and Social Psychology, Inc.

A COMPARATIVE STUDY OF STATE LICENSING BOARDS FOR SCHOOL ADMINISTRATION AND OTHER SELECTED PROFESSIONS.

ERIC Educational Resources Information Center

MOLINARI, RALPH G.; AND OTHERS

COMPARISON OF THE COMPOSITION, CHARACTERISTICS, AND CURRENT LICENSING PRACTICES OF STATE LICENSING BOARDS FOR EDUCATIONAL ADMINISTRATION WITH LICENSING PROGRAMS FOR SEVEN OTHER PROFESSIONS, (ACCOUNTANCY, ARCHITECTURE, DENTISTRY, ENGINEERING, LAW, MEDICINE, AND NURSING) WAS THE PURPOSE OF THIS NATIONWIDE STUDY. THE RESEARCH PROCEDURES WERE DIVIDED…

Telemedicine: the invisible legal barriers to the health care of the future.

PubMed

Daly, H L

2000-01-01

Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.

Primary care nursing role and care coordination: an observational study of nursing work in a community health center.

PubMed

Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

2012-05-31

Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities.

PubMed

McLaughlin, Dorry; Barr, Owen; McIlfatrick, Sonja; McConkey, Roy

2015-12-01

Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals' perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training. A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed. Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: 'information and preparation', 'provision of care' and 'family-centred care'. This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians. 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/

5 CFR 890.1025 - Cases where additional fact-finding is not required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1025 Cases where additional fact..., suspension, restriction, or nonrenewal by a State licensing authority; (2) Debarment, exclusion, suspension... additional fact-finding proceeding is not required when: (a) Prior adjudication. The proposed debarment is...

34 CFR 99.3 - What definitions apply to these regulations?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Internet, or other electronic information and telecommunications technologies for students who are not... State funding; (b) A State licensed or regulated child care program; or (c) A program that— (1) Serves children from birth through age six that addresses the children's cognitive (including language, early...

38 CFR 17.900 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Benefits for Certain Children of Vietnam Veterans-Spina Bifida and Covered Birth Defects § 17.900... scope of the approval, license, or certificate. Child for purposes of spina bifida means the same as... child's family or household in the care of the child; and the provision of such pharmaceuticals...

34 CFR 685.219 - Public Service Loan Forgiveness Program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... entity; (2) A public child or family service agency; (3) A non-profit organization under section 501(c)(3... interest law services, early childhood education (including licensed or regulated child care, Head Start... partisan political organization, or an organization engaged in religious activities, unless the qualifying...

Assessing the contribution of the dental care delivery system to oral health care disparities.

PubMed

Pourat, Nadereh; Andersen, Ronald M; Marcus, Marvin

2015-01-01

Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities. © 2014 American Association of Public Health Dentistry.

Patient Involvement: A New Source of Stress in Health Care Work?

PubMed

Arnetz, Judith E; Zhdanova, Ludmila; Arnetz, Bengt B

2016-12-01

Patients have become increasingly well informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers' partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N = 488, response rate 67%). The sample was comprised of registered nurses (RNs, n = 303), licensed practical nurses (LPNs, n = 132), and physicians (MDs, n = 53). Confirmatory factor analysis was used to examine seven questionnaire statements concerning implications of patient involvement for one's clinical work. Regression analyses were used to examine factors associated with staff's partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negative-"Hassles"-and positive-"Uplifts"-aspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study.

PubMed

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-04-21

To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. Longitudinal study with three points of measurement. Primary care practices in Switzerland. In total, 45 of 91 primary care practices completed European Practice Assessment three times. The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. 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.

Study of the Performance and Characteristics of U.S. Academic Research Institution Technology Commercialization (ARITC)

ERIC Educational Resources Information Center

Kim, Jisun

2012-01-01

This dissertation aims to provide a better understanding of the technology licensing practices of academic research institutions. The study identifies time durations in licensing and incorporates these into a model to evaluate licensing performance. Performance is measured by the efficiency of an institution's technology licensing process and…

Biosimilars for Immune-Mediated Chronic Diseases in Primary Care: What a Practicing Physician Needs to Know.

PubMed

Feldman, Steven R; Bagel, Jerry; Namak, Shahla

2018-05-01

The introduction of biologics has revolutionized the treatment of immune-mediated diseases, but high cost and limited patient access remain hurdles, and some physicians are concerned that biosimilars are not similar enough. The purpose of this narrative review is to describe biosimilar safety, efficacy, nomenclature, extrapolation and interchangeability. In the United States, the Biologics Price Competition and Innovation Act created an abbreviated pathway for licensing of a biologic that is biosimilar to another licensed product (i.e., the reference product). This approval pathway differs from that of generic small-molecule drugs because biologics are too complex to be perfectly duplicated, and follows a process designed to demonstrate that any differences between the biosimilar and its reference product have no significant impact on safety and efficacy. The US approval process requires extensive analytical assessments, animal studies and clinical trials, assuring that biosimilar products provide clinical results similar to those of the reference product. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers.

PubMed

Sarmento, Vera P; Gysels, Marjolein; Higginson, Irene J; Gomes, Barbara

2017-12-01

To understand patients and family caregivers' experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users. We performed a meta-ethnography of qualitative evidence following PRISMA recommendations for reporting systematic reviews. The studies were retrieved in 5 electronic databases (MEDLINE, EMBASE, PsycInfo, BNI, CINAHL) using 3 terms and its equivalents ('Palliative', 'Home care', 'Qualitative research') combined with 'AND', complemented with other search strategies. We included original qualitative studies exploring experiences of adult patients and/or their family caregivers (≥18 years) facing life-limiting diseases with palliative care needs, being cared for at home by specialist or intermediate home palliative care services. 28 papers reporting 19 studies were included, with 814 participants. Of these, 765 were family caregivers and 90% were affected by advanced cancer. According to participants' accounts, there are 2 overarching components of home palliative care: presence (24/7 availability and home visits) and competence (effective symptom control and skilful communication), contributing to meet the core need for security. Feeling secure is central to the benefits experienced with each component, allowing patients and family caregivers to focus on the dual process of living life and preparing death at home. Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care. 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/.

RNs and LPNs: emotional exhaustion and intention to leave.

PubMed

Havaei, Farinaz; MacPhee, Maura; Dahinten, V Susan

2016-04-01

To describe and compare registered nurse (RN) and licensed practical nurse (LPN) emotional exhaustion, intention to leave and reasons for leaving. Different skill mix/care delivery models are being used to address nurse shortages and rising health-care costs. Skill mix may include RNs and LPNs. More LPNs are being employed in areas, such as acute care, that have been previously staffed by all RNs. Little is known about nurse outcomes since the introduction of LPNs to acute care settings. This study was a cross-sectional correlational design. A stratified, random sample of acute care nurses completed surveys via Fluidsurveys. The survey was modelled after the RN4CAST nursing workforce survey. For both groups of nurses higher levels of emotional exhaustion were associated with intention to leave and workload was the most frequent reason cited for intention to leave. More RNs than LPNs cited career advancement as a reason to leave, and more LPNs than RNs identified poor salary as a reason to leave. Emotional exhaustion is linked to intention to leave health care. Nurse managers should address work environment factors associated with turnover intentions, such as professional development opportunities and shared decision-making. © 2015 John Wiley & Sons Ltd.

Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis.

PubMed

Shakibazadeh, E; Namadian, M; Bohren, M A; Vogel, J P; Rashidian, A; Nogueira Pileggi, V; Madeira, S; Leathersich, S; Tunçalp, Ӧ; Oladapo, O T; Souza, J P; Gülmezoglu, A M

2017-11-08

What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. To develop a conceptualisation of RMC. Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. Sixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. This review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies. © 2017 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Magnetic Resonance Imaging of Heart Failure Using a Swine Model

DTIC Science & Technology

2011-03-21

Defense or the Uniformed Services University of the Health Sciences. / Ma een N. Hood, MR, RN, RT (R)(MR), FSMRT Gr duate School of Nursing U iformed...2652710212087 License date Apr 19, 2011 Licensed content publisher Wolters Kluwer Health Licensed content publication Journal of Cardiovascular Nursing ...Licensed content title A Review of Cohort Study Design for Cardiovascular Nursing Research Licensed content author Maureen Hood Licensed content date Jan

State/University Collaboration to Strengthen Children's Residential and Placement Services

ERIC Educational Resources Information Center

Watson, Larry; Hegar, Rebecca L.; Patton, Joy D.

2011-01-01

This article presents a model of collaboration between a state child welfare licensing division and a public university to develop and administer online examinations for persons seeking licensure as administrators of residential child care facilities or child placing agencies. The exams assess knowledge of state standards and various practice…

42 CFR 483.460 - Condition of participation: Health care services.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy. (j) Standard: Drug regimen review. (1) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly. (2) The pharmacist must...

42 CFR 483.460 - Condition of participation: Health care services.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy. (j) Standard: Drug regimen review. (1) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly. (2) The pharmacist must...

42 CFR 483.460 - Condition of participation: Health care services.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy. (j) Standard: Drug regimen review. (1) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly. (2) The pharmacist must...

42 CFR 483.460 - Condition of participation: Health care services.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy. (j) Standard: Drug regimen review. (1) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly. (2) The pharmacist must...

42 CFR 483.460 - Condition of participation: Health care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy. (j) Standard: Drug regimen review. (1) A pharmacist with input from the interdisciplinary team must review the drug regimen of each client at least quarterly. (2) The pharmacist must...

Industrial Organizational Psychology: Today's Critical Issues.

ERIC Educational Resources Information Center

Sharf, James C.

The Board of Professional Affairs (BPA) of the American Psychological Association is dominated by the health care providers whose agenda in issuing accreditation standards and influencing state licensing requirements may be as much to protect the clinician from less expensive competition as it is to protect the client. Tension exists between the…

Pennsylvania Pre-K Counts: End of Year Report, 2009-2010

ERIC Educational Resources Information Center

Pennsylvania Department of Education, 2010

2010-01-01

Pennsylvania Pre-K Counts was created to provide research-based, high quality pre-kindergarten opportunities to at-risk children across the commonwealth by leveraging the existing early education services in schools, Keystone STARS child care programs, Head Start, and licensed nursery schools. The standards are high and the accountability…

Recovering from Hurricane Katrina

ERIC Educational Resources Information Center

Coleman, Nadine

2006-01-01

The Gulf Coast region suffered an unusually severe hurricane season in 2005: Hurricane Katrina (August 28-29, 2005) devastated much of southern Mississippi and Louisiana. Approximately 2,700 licensed early care and education facilities in those states and in Alabama were affected by Katrina, in addition to an unknown number of family child care…

20 CFR 416.938 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and... drug addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b... refer persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care...

20 CFR 416.938 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and... drug addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b... refer persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care...

20 CFR 416.938 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and... drug addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b... refer persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care...

20 CFR 416.938 - What we mean by approved institutions or facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Drug Addiction and... drug addiction or alcoholism in conformity with applicable Federal or State laws and regulations; (b... refer persons for treatment of drug addiction or alcoholism; (c) State licensed or certified care...

42 CFR 482.94 - Condition of participation: Patient and living donor management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for post-transplant care. (d) Standard: Social services. The transplant center must make social services available, furnished by qualified social workers, to transplant patients, living donors, and their families. A qualified social worker is an individual who meets licensing requirements in the State in which...

42 CFR 482.94 - Condition of participation: Patient and living donor management.

Code of Federal Regulations, 2012 CFR

2012-10-01

... for post-transplant care. (d) Standard: Social services. The transplant center must make social services available, furnished by qualified social workers, to transplant patients, living donors, and their families. A qualified social worker is an individual who meets licensing requirements in the State in which...

42 CFR 482.94 - Condition of participation: Patient and living donor management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... for post-transplant care. (d) Standard: Social services. The transplant center must make social services available, furnished by qualified social workers, to transplant patients, living donors, and their families. A qualified social worker is an individual who meets licensing requirements in the State in which...

42 CFR 482.94 - Condition of participation: Patient and living donor management.

Code of Federal Regulations, 2014 CFR

2014-10-01

... for post-transplant care. (d) Standard: Social services. The transplant center must make social services available, furnished by qualified social workers, to transplant patients, living donors, and their families. A qualified social worker is an individual who meets licensing requirements in the State in which...

42 CFR 482.94 - Condition of participation: Patient and living donor management.

Code of Federal Regulations, 2013 CFR

2013-10-01

... for post-transplant care. (d) Standard: Social services. The transplant center must make social services available, furnished by qualified social workers, to transplant patients, living donors, and their families. A qualified social worker is an individual who meets licensing requirements in the State in which...

Compete or Die! How To Increase Enrollment in a Competitive Market: Part II.

ERIC Educational Resources Information Center

Wassom, Julie

1998-01-01

Discusses how child care center directors can educate target audiences about their centers. Target audiences include prospective customers; current customers; referral sources such as public schools, pediatricians, legislators and licensing personnel, the media, and corporations; colleagues; the general public; and competitors. Suggests delivering…

38 CFR 17.900 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Benefits for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... provider only when acting within the scope of the approval, license, or certificate. Child for purposes of... appropriate members of a child's family or household in the care of the child; and the provision of such...

38 CFR 17.900 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Benefits for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... provider only when acting within the scope of the approval, license, or certificate. Child for purposes of... appropriate members of a child's family or household in the care of the child; and the provision of such...

38 CFR 17.900 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Benefits for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... provider only when acting within the scope of the approval, license, or certificate. Child for purposes of... appropriate members of a child's family or household in the care of the child; and the provision of such...

38 CFR 17.900 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Benefits for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... provider only when acting within the scope of the approval, license, or certificate. Child for purposes of... appropriate members of a child's family or household in the care of the child; and the provision of such...

Assisted living: opportunities for partnerships in caring.

PubMed

Marosy, J P

1997-10-01

Throughout the United States, a variety of state government bodies license or certify assisted-living facilities. States have taken a variety of approaches in setting standards and protecting consumers. Consumers will respond to innovative solutions that enable elders to remain independent while assuring peace of mind of their adult children.

Lessons Learned from Litigation: Legal and Ethical Consequences of Social Media.

PubMed

Brous, Edie; Olsen, Douglas P

2017-09-01

Editor's note: To the surprise of many, a Canadian nurse's Facebook post complaining about the medical care a family member had received resulted in disciplinary action by the licensing board. We asked our legal and ethical contributing editors to provide some insight on the issues of this case.

20 CFR 404.2040a - Compensation for qualified organizations serving as representative payees.

Code of Federal Regulations, 2010 CFR

2010-04-01

... is a community mental health center holding a State license to provide community mental health... responsibilities or whose mission is to carry out income maintenance, social service, or health care-related activities; or (2) Any community-based nonprofit social service organization founded for religious...

42 CFR 493.1455 - Standard; Clinical consultant qualifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... clients concerning the diagnosis, treatment and management of patient care. The clinical consultant must... subspecialty of oral pathology, § 493.1443(b)(6); or (b) Be a doctor of medicine, doctor of osteopathy, doctor of podiatric medicine licensed to practice medicine, osteopathy, or podiatry in the State in which...

42 CFR 493.1417 - Standard; Clinical consultant qualifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... clients concerning the diagnosis, treatment and management of patient care. The clinical consultant must... of medicine, doctor of osteopathy or doctor of podiatric medicine and possess a license to practice medicine, osteopathy or podiatry in the State in which the laboratory is located. [57 FR 7172, Feb. 28...

Problems Related to the Use of Human Subjects in Clinical Evaluation/Responsibility for Follow-up Care.

ERIC Educational Resources Information Center

Buchanan, Richard N.

1991-01-01

This presentation on licensing and credentialing in dentistry denounces the use of human subjects for entry level clinical examinations in dentistry as contrary to the values of the profession that the patient's welfare is paramount. Recommended, instead, are various forms of simulation. (DB)

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

38 CFR 51.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... NURSING HOME CARE OF VETERANS IN STATE HOMES General § 51.2 Definitions. For purposes of this part: Clinical nurse specialist means a licensed professional nurse who has a Master's degree in nursing with a major in a clinical nursing specialty from an academic program accredited by the National League for...

Nuclear Powerplant Safety: Operations.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC. Nuclear Energy Office.

Powerplant systems and procedures that ensure the day-to-day health and safety of people in and around the plant is referred to as operational safety. This safety is the result of careful planning, good engineering and design, strict licensing and regulation, and environmental monitoring. Procedures that assure operational safety at nuclear…

▼ Bezlotoxumab for prevention of recurrence of Clostridium difficile infection.

PubMed

2018-05-01

Clostridium difficile infection is a significant cause of infectious diarrhoea and is associated with considerable morbidity and mortality. 1,2 Management of Clostridium difficile infection often requires treatment with antibiotics (metronidazole, vancomycin or fidaxomicin) alongside supportive care to manage hydration, electrolytes and nutrition. However, the risk of recurrence is approximately 20%. 2 Here, we review the evidence for bezlotoxumab (▼ Zinplava - Merck Sharp & Dohme Limited), a monoclonal antibody licensed for the prevention of recurrence of Clostridium difficile in adults who are at high risk of recurrence. 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/.

Multilevel Assessment of Middle School Students' Interest in the Health Sciences: Development and Validation of a New Measurement Tool.

PubMed

Romine, William L; Miller, Michele E; Knese, Shawn A; Folk, William R

2016-01-01

Using the context of a 2-wk instructional unit focused on eye and vision health, we developed and validated a multilevel measure of middle school students' interest in science and health careers. This survey contained three subscales positioned differently with respect to curricular content. Interest in Vision Care was most related, but less transferrable to other contexts. Interest in Science was most general, and Interest in Healthcare was positioned between the two. We found that, with two exceptions, items fitted well with validity expectations and were stable across a 2-wk intervention. Further, measures of interest in science, health, and vision-care careers were shown to be reliable and valid. We found that ease of facilitating change across the intervention was generally greater in subscales closely related to the curricular context but that the average magnitude of change in Interest in Healthcare and Interest in Science was not significantly different. We discuss use of these measures in informing instructional efforts and advise that changes in students' perceptions of how science and healthcare relate should be considered in longitudinal analyses. © 2016 W. L. Romine et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

“Click for Closer Care”: A Content Analysis of Community Pharmacy Websites in Four Countries

PubMed Central

2017-01-01

Background Combinations of professional and commercial communication are typically very controversial, particularly in health care communication on the Internet. Websites of licensed community pharmacies on the other hand tend to raise remarkably little controversy, although they typically contain controversial combinations of clinical and commercial services previously unprecedented in professional health care communication. Objective The aim of this study was to fill the void of knowledge about the combination of clinical and commercial services presented on the websites of licensed community pharmacies. Methods A content analysis of clinical and commercial services presented in a random sample of 200 licensed community pharmacy websites from Great Britain, the Netherlands, the Canadian provinces British Columbia and Manitoba, and the Australian states New South Wales and Western Australia was conducted. Results The top five specific services mentioned on the community pharmacy websites were cosmetic products (126/200, 63.0%), medication refill request options (124/200, 62.0%), over-the-counter medicine (115/200, 57.5%), complementary and alternative medicine (107/200, 53.5%), and home medical aids (98/200, 49.0%). On average, 72.5% (145/200) of the community pharmacy websites across the 4 countries included a combination of clinical and commercial services. A combination of clinical and commercial services was more often present on chain pharmacy websites (120/147, 82.8%) than single pharmacy websites (25/53, 47%; P<.001), and most often on the Canadian community pharmacy websites, followed by the Australian, British, and Dutch pharmacy websites, respectively (P<.02). Furthermore, more than half of the pharmacies’ homepages contained a combination of clinical and commercial images (107/200, 53.5%), and almost half of the homepage menus contained a combination of clinical and commercial items (99/200, 49.5%). The latter were, again, more common on chain pharmacy than single pharmacy websites (P<.001), with significant differences between countries (P<.001). Conclusions A considerable share of websites of licensed community pharmacies in Great Britain, the Netherlands, Canada, and Australia combine clinical services with commercial services. Previous research into the presence of a combination of commercial and professional services suggests that such a combination may lead to increased interest in commercial services that may be unnecessary or inappropriate to patients’ health. PMID:28615153

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study.

PubMed

Baker, Richard; Honeyford, Kate; Levene, Louis S; Mainous, Arch G; Jones, David R; Bankart, M John; Stokes, Tim

2016-02-11

Health systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality. We developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years. The premature standardised mortality ratios (SMRs) for each practice, available from the Department of Health, had been calculated from numbers of deaths in the 5 years from 2006 to 2010. A regression model was undertaken with explanatory variables for the year 2009/2010, and repeated to check stability using data for 2008/2009 and 2010/2011. All general practices in England were eligible for inclusion and, of the total of 8290, complete data were available for 7858. Population variables, particularly deprivation, were the most powerful predictors of premature mortality, but the mechanisms of primary care depicted in our model also affected mortality. The number of GPs/1000 population and detection of hypertension were negatively associated with mortality. In less deprived practices, continuity of care was also negatively associated with mortality. Greater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care (England). Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups. 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/

Quality geriatric care as perceived by nurses in long-term and acute care settings.

PubMed

Barba, Beth Ellen; Hu, Jie; Efird, Jimmy

2012-03-01

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings. Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide. Descriptive design. The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings. Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities. Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities. Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care. © 2011 Blackwell Publishing Ltd.

Rural physicians, rural networks, and free market health care in the 1990s.

PubMed

Rosenthal, T C; James, P; Fox, C; Wysong, J; FitzPatrick, P G

1997-01-01

The changes brought about by managed care in America's urban communities will have profound effects on rural physicians and hospitals. The rural health care market characterized by small, independent group practices working with community hospitals is being offered affiliations with large, often urban-based health care organizations. Health care is evolving into a free market system characterized by large networks of organizations capable of serving whole regions. Rural provider-initiated networks can assure local representation when participating in the new market and improve the rural health infrastructure. Although an extensive review of the literature from 1970 to 1996 reveals little definitive research about networks, many rural hospitals have embraced networking as one strategy to unify health care systems with minimal capitalization. These networks, now licensed in Minnesota and New York, offer rural physicians the opportunity to team up with their community hospital and enhance local health care accessibility.

Patient involvement: A new source of stress in healthcare work?

PubMed Central

Arnetz, Judith E.; Zhdanova, Ludmila; Arnetz, Bengt B.

2016-01-01

Patients have become increasingly well-informed with higher expectations to be involved in decision-making processes regarding their care and treatment. However, few studies have examined the impact of patient involvement on health care providers’ partnership-building communication. The aim of this study was to measure and explore the self-reported effects of patient involvement on the work of physicians and nurses. A questionnaire survey was distributed among cardiology staff in 12 Swedish hospitals (N=488, response rate 67%). The sample was comprised of registered nurses (RNs, n=303), licensed practical nurses (LPNs, n=132) and physicians (MDs, n=53). Confirmatory factor analysis was used to examine 7 questionnaire statements concerning implications of patient involvement for one’s clinical work. Regression analyses were used to examine factors associated with staff’s partnership-building communication. Analysis confirmed two distinct factors accounting for 57% of the total variance, representing both negative – “Hassles”– and positive –“Uplifts” – aspects of patient involvement. Regression analyses revealed that only positive aspects (i.e., uplifts) of patient involvement predicted staff behavior aimed at involving patients. Working with actively involved patients may be a source of stress, both negative and positive, for health care professionals. By developing work routines for involving patients in their care, health care workplaces may help health care professionals to buffer the negative effects, and enhance the positive effects, of that stress. PMID:27054396

Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International.

PubMed

Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

2015-06-17

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014-up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI's 17 and PSI's 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations' operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential to contribute to universal health coverage. © Thurston et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Licensing in an international triopoly

NASA Astrophysics Data System (ADS)

Ferreira, Fernanda A.; Ferreira, Flávio

2011-12-01

We study the effects of entry of two foreign firms on domestic welfare in the presence of licensing, when the incumbent is technologically superior to the entrants. We consider two different situations: (i) the cost-reducing innovation is licensed to both entrants; (ii) the cost-reducing innovation is licensed to just one of the entrants. We analyse three kind of license: (lump-sum) fixed-fee; (per-unit) royalty; and two-part tariff, that is a combination of a fixed-fee and a royalty. We prove that a two part tariff is never an optimal licensing scheme for the incumbent. Moreover, (i) when the technology is licensed to the two entrants, the optimal contract consists of a licensing with only output royalty; and (ii) when the technology is licensed to just one of the entrants, the optimal contract consists of a licensing with only a fixed-fee.

Implementing a collaborative coaching intervention for professionals providing care to children and their families: An exploratory study.

PubMed

Tatla, Sandy K; Howard, Dori; Antunes Silvestre, Alda; Burnes, Stacey; Husson, Meghan; Jarus, Tal

2017-09-01

The growing complexity of healthcare requires family and interprofessional partnerships to deliver effective care. Interprofessional coaching can enhance family-centred practice and collaboration. The purpose of this study was to explore the acceptability and feasibility of collaborative coaching training to improve family centredness within acute paediatric rehabilitation. Using a participatory action design, service providers (SPs; n = 36) underwent a 6-month coaching programme involving coaching workshops, learning triads, and tailored sessions with a licensed coach. The feasibility and acceptability of coaching on SPs' family interactions and care was explored. Measure of Processes of Care (MPOC) and MPOC-SP, a coaching skills questionnaire, and focus groups were used to evaluate the acceptability of coaching training. We found that structured coaching training was feasible and SPs reported significant improvements in their coaching skills; however, MPOC and MPOC-SP scores did not reveal significant differences. Qualitative themes indicated that clinicians are developing coaching competencies and applying these skills in clinical practice. Participants perceived that the coaching approach strengthened relationships amongst colleagues, and they valued the opportunity for interprofessional learning. Findings suggest that coaching offers promise as an approach to facilitate successful patient outcomes and improve processes of care. Preliminary findings indicate that interprofessional coaching training is acceptable, feasible, and can significantly improve SP coaching skills and improve team cohesion. Further research to study the effects of coaching on interprofessional care using validated outcome measures and to assess the impact on service delivery is recommended.

Identifying the key elements of an education package to up-skill multidisciplinary adult specialist palliative care teams caring for young adults with life-limiting conditions: an online Delphi study.

PubMed

Sivell, Stephanie; Lidstone, Victoria; Taubert, Mark; Thompson, Catherine; Nelson, Annmarie

2015-09-01

To collect the views of experts to inform the development of an education package for multidisciplinary adult specialist palliative care (SPC) teams caring for young people with life-limiting conditions. A modified online Delphi process collated expert opinion on format, delivery and content of an education package to up-skill adult SPC teams. Round 1 participants (n=44) answered free-text questions, generating items for Round 2. In Round 2, 68 participants rated the extent to which they agreed/disagreed with the items on 5-point Likert-type scales. Median and mean scores assessed the importance of each item. IQR scores assessed level of consensus for each item; items lacking consensus were rerated by 35 participants in Round 3. In the Delphi, consensus was reached on a range of suggested formats, on who should deliver the training, and on several clinical, psychosocial and practical topics. Development of a continuous/rolling programme of education, tailored for content and mode of delivery and incorporated into working practice is recommended. As a direct outcome of the results of this study, a series of six linked study days has been established, focusing specifically on the issues around caring for young adults with life-limiting conditions and palliative care needs. 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.

Intangible asset valuation, damages, and transfer price analyses in the health care industry.

PubMed

Reilly, Robert F

2010-01-01

Most health care industry participants own and operate intangible assets. These intangible assets can be industry-specific (e.g., patient charts and records, certificates of need, professional and other licenses), or they can be general commercial intangible assets (e.g., trademarks, systems and procedures, an assembled workforce). Many industry participants have valued their intangible assets for financial accounting or other purposes. This article summarizes the intangible assets that are common to health care industry participants. This article describes the different types of intangible asset analyses (including valuation, transfer price, damages estimates, etc.), and explains the many different transaction, accounting, taxation, regulatory, litigation, and other reasons why industry participants may wish to value (or otherwise analyze) health care intangible assets.

Delegation in Correctional Nursing Practice.

PubMed

Tompkins, Frances

2016-07-01

Correctional nurses face daily challenges as a result of their work environment. Common challenges include availability of resources for appropriate care delivery, negotiating with custody staff for access to patients, adherence to scope of practice standards, and working with a varied staffing mix. Professional correctional nurses must consider the educational backgrounds and competency of other nurses and assistive personnel in planning for care delivery. Budgetary constraints and varied staff preparation can be a challenge for the professional nurse. Adequate care planning requires understanding the educational level and competency of licensed and unlicensed staff. Delegation is the process of assessing patient needs and transferring responsibility for care to appropriately educated and competent staff. Correctional nurses can benefit from increased knowledge about delegation. © The Author(s) 2016.

An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa.

PubMed

A Mabunda, Sikhumbuzo; London, Leslie; Pienaar, David

2017-05-14

A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care. A multi-method design was used. Sixty-eight patients were recruited over one month in mid-2011 in a prospective cohort. Patient data were collected from clinical record review and an interviewer-administered questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution, knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A telephonic questionnaire at 9-weeks post-discharge recorded their vital status, use of HBC post-discharge and their satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics and skills. Cox regression was used to identify predictors of survival. Of the 68 participants, 38% and 24% were referred from a secondary and tertiary hospital, respectively. Stroke (35%) was the most common single reason for admission. The three most common reasons reported why care was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most patients reported admission to another health facility in the preceding year, only 13 patients (21%) had ever accessed HBC and only 25% (n=15) of discharged patients used HBC post-discharge. Of the 57 patients traced on follow-up, 21(37%) had died. The presence of a Care-plan was significantly associated with a 62% lower risk of death (hazard ratio: 0.38; CI 0.15-0.97). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. Clients understood this service as a caring environment primarily responsible for rehabilitation services. A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation with HBC services. IC services should be recognised as an integral part of the health system and should be accessible. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An evaluation of lead contamination in plastic toys collected from day care centers in the Las Vegas Valley, Nevada, USA.

PubMed

Greenway, Joseph A; Gerstenberger, Shawn

2010-10-01

Childhood exposure to environmental lead continues to be a major health concern. This study examined lead content within the plastic of children's toys collected from licensed day care centers in the Las Vegas valley, Nevada. It was hypothesized that the use of lead as a plastics stabilizer would result in elevated lead (≥600 ppm) in polyvinyl chloride plastics (PVC) compared to non-PVC plastics. It was also hypothesized that, due to the use of lead chromate as a coloring agent, yellow toys would contain higher concentrations of lead (≥600 ppm) than toys of other colors. Toy samples were limited to those found in day care centers in Las Vegas, Nevada. 10 day care centers were visited and approximately 50 toy samples were taken from each center. Of the 535 toys tested, 29 contained lead in excess of 600 parts per million (ppm). Of those 29 toys, 20 were PVC and 17 were yellow. Both of the two hypotheses were strongly supported by the data.

Cystic Fibrosis Patents: A Case Study of Successful Licensing

PubMed Central

Minear, Mollie A.; Kapustij, Cristina; Boden, Kaeleen; Chandrasekharan, Subhashini; Cook-Deegan, Robert

2013-01-01

From 2006–2010, Duke University’s Center for Public Genomics prepared eight case studies examining the effects of gene patent licensing practices on clinical access to genetic testing for ten clinical conditions. One of these case studies focused on the successful licensing practices employed by the University of Michigan and the Hospital for Sick Children in Toronto for patents covering the CFTR gene and its ΔF508 mutation that causes a majority of cystic fibrosis cases. Since the licensing of these patents has not impeded clinical access to genetic testing, we sought to understand how this successful licensing model was developed and whether it might be applicable to other gene patents. We interviewed four key players who either were involved in the initial discussions regarding the structure of licensing or who have recently managed the licenses and collected related documents. Important features of the licensing planning process included thoughtful consideration of potential uses of the patent; anticipation of future scientific discoveries and technological advances; engagement of relevant stakeholders, including the Cystic Fibrosis Foundation; and using separate licenses for in-house diagnostics versus kit manufacture. These features led to the development of a licensing model that has not only allowed the patent holders to avoid the controversy that has plagued other gene patents, but has also allowed research, development of new therapeutics, and wide-spread dissemination of genetic testing for cystic fibrosis. Although this licensing model may not be applicable to all gene patents, it serves as a model in which gene patent licensing can successfully enable innovation, investment in therapeutics research, and protect intellectual property while respecting the needs of patients, scientists, and public health. PMID:24231943

Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol.

PubMed

Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

2015-07-31

Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected--intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country's ethical committee. A variety of dissemination activities are implemented addressing the main stakeholders. Registration No.257 Clinical Research Register of the Santa Fe Health Department, Argentina. 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.

[Audit of general hospitals and private surgical clinics in Israel].

PubMed

Freund, Ruth; Dor, Michael; Lotan, Yoram; Haver, Eitan

2007-12-01

Supervision and inspection of medical facilities are among the responsibilities of the Ministry of Health (MOH) anchored in the "Public Health Act 1940". In order to implement the law, the General Medical Division of the MOH began the process of auditing hospitals and private surgical clinics prior to considering the reissue of their license. The audit aimed to implement the law, activate supervision on general hospitals and private surgical clinics, provide feed-back to the audited institution and upgrade quality assurance, regulate medical activities according to the activities elaborated in the license and recommend the license renewal. Prior to the audits, 20 areas of activity were chosen for inspection. For each activity a check list was developed as a tool for inspection. Each area was inspected during a 4-5 hour visit by a MOH expert, accompanied by the local service manager in the institution under inspection. A comprehensive report, summarizing the findings was sent to the medical institute, requesting correction in those areas where improvements were needed. Recommendation for license renewal was sent to the Director of Licensing Division Ministry of Health. Between June 2003 and July 2006, 91 structured audits took place. A total of 47 general hospitals and 24 private surgical clinics were visited at least once. Most general hospitals were found abiding, functioning according to the required standards and eligible for license renewal. Licenses of institutions that complied with the standards determined by the audit teams, were renewed. Two private hospitals in central Israel, that were given an overall poor evaluation, were issued with a temporary license and subsequently re-audited 4 times over the next two years. Generally, the standards in private surgical clinics were lower than those found in general public hospitals. In one clinic the license was not renewed, and in another an order was issued to cease surgical procedures requiring general anesthesia. The evaluations were mainly qualitative, deliberately avoiding numerical rating. In order to improve the process in the future and facilitate common scale rating to establish an equitable comparison system between institutions, it will be necessary to develop more quality measures and compulsory standards, based on the measures used during the first round of audits. Publication of the results of such comparisons, will elevate medical performance, and ultimately improve the quality of services and medical care in Israel.