"Safe sex advice is good - but so difficult to follow". Views and experiences of the youth in a health centre in Kampala. From Kiswa Youth Clinic, Kampala, Uganda

BACKGROUND

Young people in Uganda are advised by the Ministry of Health and other authorities to abstain from sex in order to avoid the human immunodeficiency virus (HIV), other sexually transmitted diseases (STD) and early pregnancies. If they cannot abstain they should use condoms and they should stay faithful to their partner.

OBJECTIVE

To find out how young people perceive this advice and if they find it possible and realistic to follow.

METHOD

In May and June 2000 twenty informants were selected by purposeful sampling and were interviewed in English. Given items were discussed. The interviews were recorded on tape, transcribed, extracted and sorted into categories in a qualitative research method.

RESULTS

Most of the interviewed youth claimed that the advice is good and helpful but there are many obstacles. The results showed that information given in schools about condom use and safer sex behaviour is not always adequate. However, despite lack of clear health education messages, the risk of being HIV positive is of major concern to many youth. In addition, the expected lack of support if the test is positive is a common reason for abstaining from HIV testing.

CONCLUSIONS

More discussions in society are needed to create consensus on safe sex messages presented to young people. HIV infection is a major concern but many young people abstain from testing, as they expect to receive inadequate support.

Under surveillance: is it time to reexamine your facility's security model

The many different security models in place in health facilities across the country--including 'campus police,' off-duty officers, proprietary programs, contract security, and combined proprietary and contract security--will come under increased scrutiny by JCAHO in the event of an internal or external disaster situation. In this article, the author addresses the need for reevaluating current security models so that they can be defended as reasonable and appropriate should a future incident or litigation call them into question.

Knowledge management a critical component of ongoing excellence

Leaders, managers must learn to become better educators. Tacit knowledge has to be transformed into tangible knowledge. Lessons learned in one department must be disseminated throughout the organization.

Staffing requirements for infection control programs in US health care facilities: Delphi project

BACKGROUND

The guideline for staffing infection control programs of 1 infection control professional (ICP) for every 250 occupied acute care beds has been used in many health care facilities in the United States since 1985. Since that time, the health care system, patient populations, and expectations about the work of infection prevention and control programs have changed substantially.

METHODS

The Delphi method was used; data were obtained from a group of ICPs through a series of 10 surveys. Through this iterative process, participant responses were progressively synthesized and areas of agreement and disagreement identified. These surveys were conducted by electronic and paper mail to identify the personal ICP characteristics and structural variables associated with performance of activities required for contemporary infection prevention and control programs in a variety of health care settings.

RESULTS

Delphi panel members (n = 32) from 20 states and who represented acute care, long-term care, and community care settings reported tasks in addition to those identified in earlier task analyses as well as expanded responsibilities. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel.

CONCLUSIONS

Infection control responsibilities have expanded beyond the traditional acute care setting. Recommendations for staffing must not only consider the number of occupied beds (average daily census) but also include the scope of the program, the complexity of the health care facility or system, the characteristics of the patient population, and the unique or urgent needs of the facility and community.

Practical advice for perioperative travel nurses

Travel nursing presents unique opportunities that permanent employees may never experience. Today's nursing shortage allows travel nurses to fill temporary staff positions while experiencing the sights, culture, and cuisine of a location of their choosing. This creates a beneficial situation for travel nurses, hospitals, travel companies, and, ultimately, patients. Knowledgeable, flexible nurses and traveler-friendly hospitals can extend contracts if mutually agreeable, thus prolonging the benefits. Before beginning the adventure, however, travelers must have realistic expectations. Many disappointed travelers may have been more successful had they done better research.

Benefit Analysis of Administrative and Clinical Computerization of a Large Transplant Center

Purpose

To evaluate the implementation of a computer system that fully integrates all activities of a transplant center and coordinates secure, live data across the continuum of care.

Methods

Our center implemented a comprehensive patient tracking solution customized at each point of patient entry. Benefits were measured by provider, patient, and staff feedback; time study; and retrospective cost analysis.

Results

Computerization of each patient file maintained current clinical information, which facilitated patient monitoring, expeditious evaluations and listings, marketing, automated correspondence, and regulatory reporting. Enhanced data have allowed for clinical analysis, which has improved outcomes. Data availability has promoted consistency in negotiations with commercial insurers to ensure profitability. Research capacity has been increased through standardized budgets, time study, and cost analysis and has facilitated patient recruitment.

Conclusion

The need to integrate information is vital for data accuracy and integrity. Data integration has maximized performance, profitability, and accuracy while decreasing administrative time and costs.

[Beyond the clinical act. Role and responsibilities of health professions in modern health care organizations]

The increase in knowledge, the advance of diagnostic or therapeutic technologies and the universal right to health demand new roles and responsibilities from health organizations beyond clinical care itself. These include the construction of health organizations of professionals and not with professionals, in which importance is placed on knowledge and this is applied to improved service. Other concepts bear importance and must be kept in mind: an organization as a tool, autonomous management of centers, new management of public services,... All these factors lead us to conclude that professionals must get involved, assuming risks and decision making capacities; there also exists a need to be judged by society about how the resources which citizens provide through their taxes are utilized by health organizations.

[Management of surgical waiting lists by health centers and health professionals]

Waiting lists for non-urgent medical care, in diagnostic or therapeutic procedures, occur mainly in public health systems such as those found in Spain and many other European countries. If waiting lists are moderate they can be useful in the process of managing these patients and are accepted by health professionals and health services users. Waiting lists for surgical procedures can be interpreted, erroneously, as a simple imbalance between the supply and demand for a particular procedure. If that were the case, we would only have to progressively increase resources until eliminating the lists.However, considerable evidence suggests that the isolated increase of resources does not solve the problem since the mean waiting time is reduced but the waiting list becomes longer. Therefore, other management measures are required. The management of waiting lists is necessary at the levels of society, health administration and especially health centers. Clinical management by departments and individual health professionals is essential, using the criteria of inclusion of scientific evidence in the indication for treatment and in the results expected for each patient (effectiveness of the procedure) as well as ethical criteria and considerations of resource use efficiency. Prioritizing patients according to severity, probability of improvement and social criteria is an unavoidable obligation in improving the problem of waiting lists. In this process of prioritization, society should also be able to voice an opinion since non-medical factors may influence the distribution and prioritization of resources and in this context the experience of other countries should be analyzed. Finally, as Archie Cochrane said "all effective treatment should be free" which, put another way would be: in a public system, the financing of procedures that do not provide significant benefits to patients is not justified.

Facilitating the use of evidence in practice: evaluating and adapting clinical practice guidelines for local use by health care organizations

This article describes a framework for evaluating and adapting existing practice guidelines for local use by health care organizations and groups. The framework presents the major issues related to guideline adaptation and breaks them down into manageable steps. Many steps of the framework are illustrated using the process used by the Registered Nurses Association of Ontario to develop best practice guidelines for breastfeeding.

[The institutional accreditation process in the Italian Regions of Emilia Romagna and Lazio: professional contents]

The problems related to the institutional accreditation of the structures of Nephrology, Dialysis and Transplantation has been dealt with in various documents of the Regional Scientific Societies and in Regional Legislative Decrees. Two of these documents are particularly important, one is a special experimental project by the city councillor office for Health Policies issued by the region of Lazio and the other drafted by the Regional Health Agency for the region of Emilia Romagna. What is special about these documents is the fact that nephrologists have actually participated in the drafting process and consequently great attention was given to the professional aspects of the specialised activity. The document issued by the region of Lazio tends to monitor - through criteria, indicators and standards - the various phases of health intervention in Nephrology, by following the different sectors of the process and health care areas identified by the Manual of Accreditation of the Italian Nephrology Society. The document of the region of Emilia Romagna, more complex and articulated, deals systematically with specific requirements (structural, technological, organisational), services, clinical competence and teaching, qualification of diagnostic and therapeutic processes and health care. The Italian Society of Nephrology has been asked to give an official evaluation of both documents. At this particularly uncertain stage, this approach is to be considered as being essential in maintaining consistent performance in the protection of the professional quality of the specialisation in Nephrology.

A collaborative model: twenty healthcare agencies and academic institutions share resources to educate preceptors

The Boston Collaborative Learning Group (BCLG), a 20-member consortium of healthcare agencies and academic institutions, originated in 1996 in response to a demand for innovative cost-effective measures. Directors of Staff Development and academicians collaborate and share resources in planning preceptor education programs. Over 750 Boston area nurses have attended 1 of 10 programs offered. This article provides an historical perspective on forming a consortium and the benefits of this collaborative model.

[Quality and efficiency of the Health Service in the Italian Region of Lombardy]

The Regional Law No. 31 of 1997 has revised the Lombardy Health Service as a whole, separating "providers", credited Public and Private Health Institutions, from "purchasers", Local Health Agencies. To this purpose, the improvement of the quality of assistance has been enhanced through an accreditation process aimed at implementing second level regional requirements considered as being necessary for carrying out effective treatment and meeting patient needs. Training, implementation and evaluation of quality service within Health Institutions have been carried out with the assistance of the Regional Observatory on the Quality of Health Service, which helped to identify initial intervention areas, define process indicators, activities and outcomes and verify patient satisfaction, all this to improve performance, reduce risks and control costs. To fully develop the Institutions in the accreditation process, the complex and difficult aspect of health care quality has been more extensively and deeply dealt with by adopting an "Excellence accreditation" model in cooperation with the Joint Commission International Accreditation and by experimenting with Professional accreditation supported by Scientific Societies to further contribute to the development of technical skills and knowledge. The Quality Project carried out so far is based on the integration of various projects, which will be the object of practical interventions by the General Health Direction. All the information and results gathered from this project will be very helpful in finding solutions that will enable all Health Institutions in Lombardy to reach an adequate level of quality.

Medical facilities as moral worlds

Bioethics is dominated by an emphasis on rule making and quandary solving. Teaching and research in ethics often focuses upon dramatic, controversial issues at the margins of life and death. Much less attention is given to the relationship between moral reflection and the ethos of place. Medical facilities, however, are moral worlds. To discuss the ethos of place is to focus on the character or atmosphere of particular dwellings. Architecture, interior design, and the interior creation of built environments have moral, spiritual, and aesthetic dimensions. Discussions of "ethics" need to be less oriented to rules and dilemmas, and more attuned to practical matters of everyday social experience. Instead of developing all-encompassing critiques of medical facilities as impersonal, alienating institutions, scholars from various fields need to explore the incremental steps that can make particular settings more decent, humane, and caring.

Creating an education and research consortium. Framework and development

Today's schools of nursing and clinical organizations providing nursing care need to synchronize their efforts to maximize one another's achievements. This article describes how complementary goals of two or more organizations can be achieved through mutual efforts, and briefly details the process of consortium development and the role of leaders in this process. Interorganizational collaboration examples are discussed at two institutions in two different regions of the country, and the authors offer a number of ways that nursing education and practice can work together to meet their overlapping needs, attack the nursing shortage, and move nursing education and practice toward evidence-based care.