Measuring time utilization in rural health centres.
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OBJECTIVES: During the recent re-design of the primary health care system in Cameroon a time-motion study was undertaken to determine how health workers at rural health centres use their time before redefining their roles. METHODS: The study developed a simple, effective and inexpensive tool which uses the activity sampling technique, and was applied to 20 health centres with a total of 19,080 observations being made of 64 health workers who represented all grades of worker in the government health services. RESULTS: The study developed a clear picture of how health centre staff apportion their time, and how the division of labour and tasks is carried out in a rural health centre. It found that only 27% of health workers' time is currently being spent on productive, health-related activities, and of this time, the largest proportion is spent on curative, clinical work. Less than 1% of health workers' time is spent on preventive and outreach activities. DISCUSSION: This study has developed a simple and inexpensive tool which can be used in any health facility to determine how health-related activities are carried out. This is an important step if changes in the delivery structure are to be made, because it establishes the discrepancy between expected and actual behaviour, and provides an important baseline for the evaluation of the effectiveness of any changes that are introduced within the system. (+info)
A successful tobacco cessation program led by primary care nurses in a managed care setting.
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We conducted a descriptive study of a tobacco cessation program sponsored by a health maintenance organization (HMO) and led by primary care nurses. The tobacco cessation program was conducted at 20 primary care clinics in northeastern and central Pennsylvania. We gauged the successfulness of the program by the patients' self-reported quit rates at 1 year. We also examined the association between quit rates and compliance with scheduled counseling visits, the impact of the availability of an HMO pharmacy benefit that supported the costs of nicotine replacement therapy, and the quit rates among patients with HMO insurance versus those with insurance other than managed care. Of 1,695 patients enrolled in the program from July 1993 to March 1996, 1,140 completed 1 year of follow-up. Of these, 348 (30.5%) reported they had quit using tobacco. Among the 810 HMO enrollees who participated in the program, the quit rate was 280 (34.6%); among the 330 non-HMO participants, the quit rate was 69 (20.9%), a statistically significant difference (P < 0.001). For all patients, keeping more than four visits with the program nurse was associated with a significantly higher likelihood of quitting (317/751 [42.2%] versus 32/389 [8.2%]; P < 0.001). Non-HMO patients were less likely than HMO enrollees to keep four or more visits (165 [50%] versus 586 [72.3%]; P < 0.001). We were unable to detect a difference in quit rates among those with and those without a pharmacy benefit (196/577 [34%] versus 84/233 [36.1%]). These data are limited by their descriptive nature and the lack of information about other factors important in determining the quit rate among program participants. Nevertheless, they suggest that HMOs can successfully sponsor nurse-led tobacco cessation programs in multiple primary care settings and achieve 1-year quit rates significantly higher than the 15% quit rate reported in the medical literature. In addition, successfully quitting tobacco use appeared to be associated with use of counseling visits but not with use of a pharmacy benefit to pay for nicotine replacement therapy. Even though tobacco cessation programs have the best chance of benefitting HMO enrollees, patients not enrolled in managed care plans also appear to benefit significantly. This finding has important implications for developing future strategies--including the role of managed care organizations, the need to defray the costs of nicotine replacement therapy, and the best approach to provide counseling to patients--to meet the Healthy People 2000 goal of reducing tobacco smoking. (+info)
Nurses' participation in audit: a regional study.
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OBJECTIVES: To find out to what extent nurses were perceived to be participating in audit, to identify factors thought to impede their involvement, and to assess progress towards multidisciplinary audit. RESEARCH DESIGN: Qualitative. METHODS: Focus groups and interviews. PARTICIPANTS: Chairs of audit groups and audit support staff in hospital, community and primary health care and audit leads in health authorities in the North West Region. RESULTS: In total 99 audit leads/support staff in the region participated representing 89% of the primary health care audit groups, 80% of acute hospitals, 73% of community health services, and 59% of purchasers. Many audit groups remain medically dominated despite recent changes to their structure and organisation. The quality of interprofessional relations, the leadership style of the audit chair, and nurses' level of seniority, audit knowledge, and experience influenced whether groups reflected a multidisciplinary, rather than a doctor centred approach. Nurses were perceived to be enthusiastic supporters of audit, although their active participation in the process was considered substantially less than for doctors in acute and community health services. Practice nurses were increasingly being seen as the local audit enthusiasts in primary health care. Reported obstacles to nurses' participation in audit included hierarchical nurse and doctor relationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work load pressures and lack of protected time, availability of practical support, and lack of knowledge and skills. Progress towards multidisciplinary audit was highly variable. The undisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary audit was more successfully established in areas already predisposed towards teamworking or where nurses had high involvement in decision making. Audit support staff were viewed as having a key role in helping teams to adopt a collaborative approach to audit. CONCLUSION: Although nurses were undertaking audit, and some were leading developments in their settings, a range of structural and organisational, interprofessional and intraprofessional factors was still impeding progress. If the ultimate goal of audit is to improve patient care, the obstacles that make it difficult for nurses to contribute actively to the process must be acknowledged and considered. (+info)
The effect of a special nurse on patients' knowledge of epilepsy and their emotional state. Epilepsy Evaluation Care Group.
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BACKGROUND: People with epilepsy often report being given insufficient information and support. However, there is little evidence from general practice about how much they know and how they feel. AIM: To describe social differences in the knowledge of epilepsy of people with the condition and test the potential effect of a nurse intervention in general practice on patients' knowledge and depression levels. METHOD: A questionnaire that included measures of knowledge, anxiety, and depression was sent to people with epilepsy aged over 15 years who were registered with 37 general practitioners. Responders were randomized to a controlled trial, offering either two appointments with an epilepsy nurse or usual care. Six months later they were reassessed. RESULTS: Two hundred and fifty-one out of 283 (89%) of the patients with epilepsy completed questionnaires and entered the study at Stage 1. One hundred and ninety-six out of 232 (84%) of those who entered the study, who remained in the practices and were eligible, returned questionnaires at Stage 2. The average duration of epilepsy was 23 years (range 2-79 years). There were significant differences in patients' levels of knowledge of epilepsy at Stage 1. Younger people, those who had left school after 16 years of age, those with GCSEs, and people who belonged to self-help groups had higher knowledge levels, and these were independent effects. Older people and those with a recent epilepsy attack had significantly higher depression scores. Knowledge scores did not differ significantly after the nurse intervention (Stage 2). At Stage 2, the risk of depression was less in the group randomized to be offered nurse input; the effect was mainly in a subgroup of patients with no recent epilepsy attack; their risk of depression was a third of the risk in the control group. CONCLUSIONS: Knowledge of epilepsy differs significantly, with social factors and self-help group membership having independent effects. A nurse-run clinic reduced the risk of depression for people with no recent epilepsy attack, but knowledge levels were not affected. This does not exclude the potential for patients learning more about epilepsy; it may be useful to suggest that patients join self-help groups early on. (+info)
Significant event audit in practice: a preliminary study.
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BACKGROUND: While well described and promoted as a useful activity, there remains a paucity of evidence on the process and experience of significant event audit (SEA) in primary care. To date, the most comprehensive evaluation of the process has been produced by comparing SEA with conventional audit. The current study intends to contribute to the debate by examining the attitudes and perceptions of a range of primary care staff who have been involved in the process. OBJECTIVES: The aim of this study was to identify participants' perceptions of the benefits and problems associated with SEA in the context of primary care, and to derive suggestions which might improve the process of SEA. METHODS: Semi-structured interviews of 12 participants from a variety of primary care disciplines were conducted, using grounded theory to analyse the results. RESULTS: A set of six perceptions and seven recommendations for the facilitation of SEA were produced. CONCLUSIONS: SEA constitutes a powerful tool, which can contribute to team building, enhanced communication and improved patient care, and represents a vital contributor to the development of clinical governance in primary care. However, its implementation and sustenance require sensitive handling for optimal benefit and to minimize difficulties. Our research has enabled us to propose suggestions to facilitate these processes. (+info)
Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study.
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OBJECTIVES: To assess the prevalence of varicella zoster virus (VZV) antibodies in Flemish (Belgian) healthcare workers, to investigate the association between seronegativity and selected variables, and to assess the reliability of recall about disease as a predictor of immunity. METHODS: A seroprevalence study of VZV antibodies (IgG) was conducted among a systematic sample of 4923 employees in various professional groups, employed in 22 hospitals in Flanders and Brussels (Belgium). Information about sex, age, department, job, and years of employment, the country of origin, and history of varicella was obtained. The presence of VZV antibodies was investigated with the enzyme linked immunosorbent assay (ELISA), Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis was performed by calculating prevalences and prevalence ratios (PRs) and their 95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the recalled history were determined. RESULTS: The prevalence of VZV seropositivity in Flemish healthcare workers was 98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age and job, increasing with both older and younger age. The prevalence of seronegative workers was significantly less in nursing staff than non-nursing staff. There was no significant difference for sex and years of employment. The PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity were 83% and 38.9%. CONCLUSION: The prevalence of VZV seropositivity was very high in this sample of Flemish healthcare workers. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers in Flanders. The increasing seronegativity above the age of 45 is possibly due to a loss of detectable antibodies. A positive history of varicella was a good predictor of immunity, but a negative history had no value as a predictor of susceptibility in adults. (+info)
Study on work load of matrons under shift work in a special nursing home for the elderly.
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In order to find out the work load of matrons under shift work in a special nursing home for the elderly (SNH), six healthy female matrons volunteered to participate in the present study. For each subject, care working time, heart rate, walking steps, estimated energy expenditure and working time in different postures were determined during day shift work (540 min) and night shift work (960 min). Although the time on duty, working and recess were significantly longer in night shift work than day shift work, the percentages of working and recess time to duty time were nearly the same regardless of shift work. The longest care work in each shift work was individual care of residents in the SNH. The maximum, minimum and mean heart rate and percentages to estimated maximal heart rate were similar in each shift work. Although total walking steps in night shift work were significantly larger than those in day shift work, steps per hour did not differ between them. The estimated total energy expenditure (kcal) was significantly higher in night shift work than in day shift work; however, the work intensity (kcal/kg/min) was significantly higher in day shift work. The longest length and larger percentage of working time were observed in standing posture in each shift work. These findings suggest that physical activity and energy expenditure of matrons under either shift work in the SNH seem to be high. Further studies are needed to clarify the work load of matrons engaged in SNH to formulate countermeasures. (+info)
Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians' and nurses' perceptions.
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BACKGROUND: Antibiotic therapy for asymptomatic bacteriuria in institutionalized elderly people has not been shown to be of benefit and may in fact be harmful; however, antibiotics are still frequently used to treat asymptomatic bacteriuria in this population. The aim of this study was to explore the perceptions, attitudes and opinions of physicians and nurses involved in the process of prescribing antibiotics for asymptomatic bacteriuria in institutionalized elderly people. METHODS: Focus groups were conducted among physicians and nurses who provide care to residents of long-term care facilities in Hamilton, Ont. A total of 22 physicians and 16 nurses participated. The focus group discussions were tape-recorded, and the transcripts of each session were analysed for issues and themes emerging from the text. Content analysis using an open analytic approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent themes and issues. RESULTS: We observed that the ordering of urine cultures and the prescribing of antibiotics for residents with asymptomatic bacteriuria were influenced by a wide range of nonspecific symptoms or signs in residents. The physicians felt that the presence of these signs justified a decision to order antibiotics. Nurses played a central role in both the ordering of urine cultures and the decision to prescribe antibiotics through their awareness of changes in residents' status and communication of this to physicians. Education about asymptomatic bacteriuria was viewed as an important priority for both physicians and nurses. INTERPRETATION: The presence of non-urinary symptoms and signs is an important factor in the prescription of antibiotics for asymptomatic bacteriuria in institutionalized elderly people. However, no evidence exists to support this reason for antibiotic treatment. Health care providers at long-term care facilities need more education about antibiotic use and asymptomatic bacteriuria. (+info)