Assessments of patients with a 5-category or a 3-category practical classification system: validaty and practicality

In order to implement preventive programs to prevent back pain in nurses, assessments of the degree of passivity and mobility of patients is imperative. After all, the load in health care ergonomics, is often the patient. The degree of cooperation or resistance determines the load on the back for the nurses and the necessity of the use of lifting devices like patient lifters or sliding sheets. These assessments must be done in both a practical and a reliable way. For this purpose a 3-category and a 5- category system to assess the degree of patient mobility and passivity was developed and tested. The results are presented on the poster.     

Content validity and utility of the Assessment of Work Performance (AWP)

In the area of work rehabilitation, many decisions about future interventions for the client are based on the results of various kinds of assessments. Therefore, it is important that the assessment instruments used are adequate, useful, and reliable. The purpose of this study was to investigate the content validity and utility of the instrument Assessment of Work Performance (AWP) which is used to assess an individual's observable (working) skills during work performance, i.e. how efficient and appropriate a client performs a work activity. A questionnaire was answered by 67 respondents who used the AWP in various work rehabilitation settings in Sweden. The result indicates content validity and utility for the AWP that supports further testing of the instrument.     

Design of ISD-1: an instrument for social diagnosis in care homes for older persons*

This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries.     

Public Perception of "Who is a Volunteer": An Examination of the Net-Cost Approach from a Cross-Cultural Perspective

Our aim is to enhance the knowledge regarding how the public assess and rate volunteerism. We begin by first developing the model for understanding the potential use of the net-cost concept in eliciting the public's subjective perceptions on the extent to which certain activities are perceived as volunteerism. Four hypotheses relevant to the use of the net-cost concept are developed. We developed a questionnaire consisting of 50 case scenarios and applied it in Canada, India, Italy, Netherlands, and Georgia and Philadelphia in the United States, each with a sample of 450 adults or more. With one exception, our net-cost hypotheses are supported, suggesting that the public perception of volunteering is strongly linked with the costs and benefits that accrue to the individual from the volunteering activity, and that this result holds true across different cultures. Finally, we suggest directions for future research that can shed further light on the relationship between net cost and public good.     

The international migration of nurses in long-term care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.     

Assessment of Work Performance (AWP)--development of an instrument

Adequate work assessments are a matter of importance both for individuals and society [5,29,31,38,40,46,52]. However, there is a lack of adequate and reliable instruments for use in work rehabilitation [14,15,20,21,31,44]. The purpose of this study was to develop and evaluate an observation instrument for assessing work performance, the AWP (Assessment of Work Performance). The purpose of the 14-item instrument is to assess the individual's observable working skills in three different areas: motor skills, process skills, and communication and interaction skills. This article describes the development and results of preliminary testing of the AWP. The testing indicates a satisfactory face validity and utility for the AWP and supports further research and testing of the instrument.     

Implementing critical health services for children in foster care.

This article reports recommendations that were developed at the California Conference on Health Care for Children in Foster Care, organized to discuss implementation in the state of CWLA's Standards for Health Care Services for Children in Out-of-Home Care. Programs and legislation developed in the state are also discussed.     

Designing the care environment in hospitals and nursing homes: a pilot for a new and reliable method for determining the optimum space to live in and work in

One of the major problems encountered in health care during the process of implementing ergonomic changes is the lack of space. There is often not enough space to work with larger equipment like patient lifters and shower chairs or other medical devices necessary in a preventive program. This leads to undesirable extra physical load for nurses. Therefore it is imperative that in the process of designing the health care environment ergonomic considerations are taken into account. A method to assess the optimum size and shape of the space required is developed and the value of the method is tested in a pilot setting. The pilot is currently underway and the results will be presented on the final poster.     

From behind dikes and dunes: communities that care in the Netherlands

This paper will provide a general overview of the implementation of the Communities that Care (CtC) programme in the Netherlands. It outlines the socio-historical development of the initiative and considers the rationale and starting point for the Dutch experiment and the tools used in the process. Attention will also be paid to the implementation of CtC and some of the problems met in trying to introduce the CtC scheme. The final part of this paper will consider the main outcomes of the first (process) evaluation of the experiment.     

The Influence of Agency Staffing on Quality of Care in Nursing Homes

ABSTRACT

Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N?=?1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.     

The social support. Social dissupport continuum

A person's network embodies "the good, the bad, and the ugly" of all social relationships. The nature of these relationships may be conceptualized as a continuum between social support and social dissupport. Social support, as a product of relationships that facilitate growth, generates self-esteem and assists in assuming appropriate societal roles. Social dissupport represents those relationships that hinder growth and/or promote disintegration. Clinically, nurses either formally or informally assess the degree of social support, but neglect the overall social support/dissupport ratio. The MSNI profiles the person's perception of social support/dissupport on four levels of social relationships and is an efficient instrument in assessing who is in the social network, what is provided, perceived helpfulness, and expectations. Preliminary use of the instrument with parents of the long-term mentally ill, acutely and long-term mentally ill clients, students, and a variety of clients of graduate students enrolled in a crisis intervention course are promising. Thus, nurses must be prepared to confront their clients' perceptions of the professional's role and to modify and adapt those interactions to facilitate goal achievement.     

Pretesting Experimental Instructions

Laboratory experiments, well established in sociology and social psychology, are alternate realities constructed for assessing derivations from theories. Experiments instantiate a theory's scope and initial conditions, and that information is usually delivered through instructions to participants. Because experiments often use video and computer technology and often test very precise predictions of new theories, we suggest developing objective means to assess information delivery. We illustrate these points by reference to a widely used standard experiment to assess theories of status processes. We first describe elements of good experimental design with their justifications. Next, we describe new techniques we have developed and illustrate their usefulness, showing results of a first use of the new techniques. While the assessment still relies somewhat on judgments, we find the technique useful and suggest further developments that might improve it for experimental and other research uses.     

Cytochrome P450 testing for better psychiatric care

Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental health professionals prescribe psychiatric medications for their patients. Cytochrome P450 testing uses a blood sample to determine an individual's required dosage of identified drugs that are metabolized by the two enzymes. To provide care for patients and families, nurses should be able to demonstrate identified essential nursing competencies related to genetics and genomics, which include an understanding of cytochrome P450 testing. As patient advocates, nurses are expected to understand how to identify patients most likely to benefit from CYP2D6 and CYP2C19 testing, how to ensure informed consent for such testing, and how to educate patients about testing and test results.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Construct validity of the instrument DOA: a dialogue about ability related to work

This study examined the construct validity of the newly developed instrument A Dialogue About Ability Related To Work (DOA). DOA [18] was developed using concepts from the Model of Human Occupation [20] as theoretical framework. The instrument assumes the assessment of work ability by both the client and the occupational therapist, and is followed by a dialogue which is expected to distinguish possible goal-setting for further rehabilitation [18,19]. Twenty-one professionals and 126 clients from three clinics in Sweden participated in the study. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. Results of a Rasch analysis test indicated that items are well separated and generally work together in five unidimensional continuums to measure work ability. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from > or = 0.6 to < or = 1.4 in association with Z values from -2 to 2. The five misfit items have to be revised. The study has indicated that DOA is a valid instrument in psychiatric work rehabilitation and ought to be useful in the dialogue between occupational therapists and clients about goalsetting and treatment planning.     

Up-skilling and the intensification of work: the 'extended role' in intensive care nursing and midwifery

In his seminal work Braverman (1974) suggested that, like manual workers, the majority of ‘non-productive’ workers are equally subject to scrutiny and Tayloristic methods of rationalisation and differentiation (sub-division of work into simple, repetitive operations) of the tasks they perform. The result is ‘de-skilling’ whereby labour is reduced to the repetitive performance of mechanical tasks and an intensification of work is achieved. Following the debate that has arisen from Braverman's work, concentrating largely on either de-skilling and/or strategies of management control, there have been wide-ranging qualifications to Braverman's core theory. I wish to suggest that ‘up-skilling’ (as opposed to de-skilling) may also represent an intensification of work, since the terms and conditions under which skill is enhanced is centrally relevant. This is argued in relation to the ‘extended role’ functions of midwives and Intensive Care nurses, whereby the tasks normally carried out by doctors are performed in a proxy capacity by nurses/midwives, while remaining in the ‘ownership’ of the medical profession. In the course of the above discussion, the article explores the way in which the sexual division of labour (between the female gendered profession of nursing and the male gendered medical profession) changed but survived in a negotiated form.     

Assessment of the needs of youth in residential care: Development and validation of an instrument

This article presents the development of a Residential Care Youth Needs Assessment (RCYNA) instrument. In two studies, initial evidence regarding the RCYNA psychometric properties was obtained using a sample of youth in residential care. Results show adequate levels of content and face validity, reliability and concurrent validity.     

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.     

Assessing state substance abuse prevention infrastructure through the lens of CSAP's Strategic Prevention Framework

Although the organizational structures and operating procedures of state substance abuse prevention systems vary substantially across states, there is scant empirical research regarding approaches for rigorous assessment of system attributes and which attributes are most conducive to overall effectiveness. As one component of the national cross-site evaluation of the SPF State Incentive Grant Program (SPF SIG), an instrument was developed to assess state substance abuse prevention system infrastructure in order to measure infrastructure change and examine the role of state infrastructure in achieving prevention-related outcomes. In this paper we describe the development of this instrument and summarize findings from its baseline administration. As expected, states and territories were found to vary substantially with respect seven key characteristics, or domains, of state prevention infrastructure. Across the six domains that were assessed using numeric ratings, states scored highest on data systems and lowest on strategic planning. Positive intercorrelations were observed among these domains, indicating that states with high capacity on one domain generally have relatively high capacity on other domains as well. The findings also suggest that state prevention infrastructure development is linked to both funding from state government and the presence of a state interagency coordinating body with decision-making authority. The methodology and baseline findings presented will be used to inform the ongoing national cross-site evaluation of the SPF SIG and may provide useful information to guide further research on state substance abuse prevention infrastructure.