Providing psycho-social support by telephone: what is its potential in cancer patients?

This paper provides an overview of the use of supportive telephone interventions in cancer patients. The small number of studies that have been reported to date have demonstrated that such approaches are feasible and well accepted. Current telephone counselling programmes for cancer patients have utilized both one-to-one and group approaches. Given the promise of telephone interventions to provide assistance to patients who may not otherwise receive psycho-social care because of factors such as geographical isolation, physical limitations, or lack of comfort with face-to-face approaches, further development and evaluation of programmes in this area is critically needed. We identify priorities for future research, including determining the most effective ways to deliver telephone interventions, identifying patient groups in which they are most successful, and evaluating cost-effectiveness.

A 1996 NASN research award winner. Health services provided by school nurses for students with chronic health problems

Increased numbers of students are entering schools with chronic health problems and in need of nursing and other health services. Some studies have been conducted in recent years describing nursing practice in schools. However, further study of school nursing practice was warranted owing to two major problems. The first was limited financial resources to provide needed nursing services. The second was inadequate documentation of both the health needs of students and current school nursing practice in meeting those needs. The purpose of this descriptive study was to examine the nature and extent of nursing services provided in the schools in the late 1990s and to identify potentially reimbursable nursing services being provided to students with chronic health problems. A survey was mailed to active members of the School Nurse Organization of Minnesota (SNOM). The findings indicated the considerable diversity in the practice setting as well as the large volume of nursing services being delivered in schools. Results will be essential in the acquisition of financial resources, including collaboration with third-party payors for reimbursement of nursing and other health services.

Unmet health care needs. Comparison of rural and urban senior center attendees

Rural-dwelling older adults are in poorer health and have less access to health care resources than urban older adults. However, little is known about specific unmet needs which exist for urban and rural populations. This study compared self-reported health status, use of services, and unmet health care needs of 106 elderly individuals residing in rural and urban settings to determine if these variables differed based on geographic location. Data were gathered on the three dependent measures using the Elderly Health Care Needs Assessment Questionnaire. Findings revealed rural older adults were not in poorer self-reported health (chi 2 = 1.85, p = .60). However, a t test showed rural subjects were significantly poorer in objective health as measured by the number of reported symptoms (t = 224, p = .02). Despite having a greater number of specific health complaints, these rural elderly individuals did not use significantly more services (t = 1.16, p = .24) or report more unmet needs (chi 2 = 3.67, p = .055), thereby reinforcing traditional views of rural older adults being in poorer health but also more self-reliant in matters related to health care. The results of this study provide information which will improve nursing practice in rural and urban settings and provide direction for further research.

Delimiting 'rural': implications of an agreed 'rurality' index for healthcare planning and resource allocation

Rural and remote Australia is characterised by considerable geographical and social diversity. There is no 'natural' classification of what constitutes 'rural' or 'remote', and precise definition of what is meant by the term 'rural' has proved to be an elusive goal. Nonetheless, it is recognised that the differentiation of rural areas has important implications for healthcare planning and the research that underpins it. Whether it be the development of resource allocation formulae that determine the provision, location and type of rural health services, measuring service utilisation rates as an indicator of need for services or health outcome measures, the way in which populations and communities are delimited as urban, rural and remote will always influence and sometimes may even determine the assessment. The time is ripe for the development of an agreed classification for the investigation of rural health issues.

Training-needs analysis

This article introduces training-needs analysis (TNA) and places the process in the broad context of a training strategy. It aims to inform nurses on how the principles of TNA can be applied to their own practice.

Community analysis for health planning: strategies for primary care practitioners

Primary care practitioners have an important role in planning for the health of individuals and selected target populations. Community analysis and needs assessment are the first steps in health planning. Community analysis involves identifying health issues within a community; gathering data about the community, the target group, and the health concern; analyzing data; and assessing community needs. Community needs assessment involves identifying both existing and potential health problems as well as health promotion needs. By using appropriate skills in carrying out needs assessments, primary care practitioners become active contributors in planning for the health of individuals, groups, and the nation as a whole. This article provides strategies for identifying, analyzing, and evaluating the health needs of a community.

[Approach to the reality of life and health at "Recanto de Alegria" community: understanding and defining the strategy of intervention]

This article presents a process of investigation that was developed to identify life and health conditions of a community in order to propose changing strategies to the situation. It took place in Distrito do Grajaú (SP)--Brazil. All families were interviewed through the application of a survey in order to find personal/life conditions, and a health disease process profile. Data reveal a determined profile that was presented to the people to implement integrated actions to solve the main problems/issues at the community.

[Public health service: what women say]

The way poor women, who live in a given reality, perceive institutional policies of the health sector and face them is the object of reflection presented in this study. As category of analysis, the authors make use of social representation, understood as share of the contradictory social relations and of the individual and collective history of the groups, Authors discuss the inequities in public health care, focusing the way popular segments reaffirm and deny dominant knowledge and practices. Their speech about in the health attention showed, at the same time, absorption/reproduction of the rules spread by "official" medical system and the incorporation/translation of their necessities, experiences and specifics interests.

[Effect of age on postoperative care in patients following heart surgery under extracorporeal circulation]

The mean age of patients with heart disease who require surgical treatment is increasing. In conjunction with the development of surgical and postoperative care techniques, the mortality rate of these patients has decreased. In our intensive care unit (ICU), we proposed to determine if older patients undergoing cardiac surgery had more morbidity and required more care than other patients. An evaluation was made of the differences in evolution and nursing requirements of patients over 70 and under 70 who had undergone heart surgery with extracorporeal circulation by assessing the complications. A retrospective comparative study was made of the records of 50 patients > or = 70 years and 50 patients < 70 years who had undergone cardiac surgery and were admitted to intensive care for postoperative care. An analysis was made of pathology before surgery, operative incidents, evolution and postoperative complications of different body systems, postoperative care in intensive care by examining nursing records, the duration of the ICU stay and the hospital stay. The results indicated that there were no significant differences between the two groups in mortality, ICU stay, and severe complications. Patients over 70 had more frequent arrhythmias and difficulties in maintaining an optimal respiratory function. Such patients require more nursing care and a longer hospital stay. However, it is concluded that age per se is not a contraindication for heart surgery.

Positions and training of the indigenous health workforce

A survey of community-controlled and state health services was conducted in 1995 as part of a needs assessment for a tertiary training initiative in applied epidemiology. Information for 792 Indigenous people in health-related occupations was obtained. Mean time in the current position was 4.8 years, 75% were in designated Aboriginal positions and 44% were health workers. Of the total, 49% had a diploma or certificate, but only 3% had a bachelors degree. The latter compares with 75% of the public health workforce generally which has a bachelors degree or higher. The high proportions of health worker and designated Aboriginal positions, short tenure and low level of degree training suggest that there are a range of employment and training issues which need to be addressed if an appropriate level of Indigenous workforce participation is to be achieved and Indigenous health professionals are to have access to the same vertical and lateral employment mobility as non-Indigenous workers. In particular, there is a huge need to enhance Indigenous participation in health workforce training, and to develop strategies for certification and recognition of the wide range of non-course-based training being undertaken.

[Metal worker's perception of health problems and environmental risks at the work place]

Research was carried out in Osasco, Greater São Paulo, to know the main health problems perceived by metalworkers' at their workplace and the need actions to prevent it or minimize them. With this objective in mind, 452 workers were interviewed at a metallurgic industry by means of a questionnaire in which they were asked first to mention five health problems perceived at the workplace, and then to select the most important one. They were also asked what they thought managers, supervisors and workers could do to avoid or minimize the main risk each worker had selected. According to their answer, although the chemical risk was the most frequently mentioned, the suggestions to actions to be implemented by supervisors and managers were related to psycho-social factors, that is, human problems of administration and organizational behavior.

Beyond community assessment into the real world of learning aggregate practice

One certainty for nursing, and therefore for nursing education, is that nurses of the 21st century will be called upon to deliver aggregate-based care. Faculty, seeking ways to prepare students for this challenge, often use community assessment as a strategy to help develop skills required to implement care at the aggregate level. In this unique program, community projects completed during an undergraduate community and family health nursing course are expanded in scope to include community diagnosis, planning, intervention, and outcome evaluation. Projects offer immediate benefit to the agency and may continue for several semesters, involving students in various phases of the nursing process.

The continuum of care: the process and development of a nursing model for stroke education

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.

Perception of child oral health needs by antenatal clinic attenders in Ibadan, Nigeria

One hundred and eighty-three women, attending government owned antenatal clinics in Ibadan, a metropolitan city in the south western part of Nigeria participated in a questionnaire-based survey. The women's opinions on the oral health needs of their children were sought. These included the time of commencement of tooth-cleaning, types of materials recommended for cleaning at different ages, frequency of cleaning children's teeth as well as the perceived effects of certain food items and drugs on the teeth. The results showed that 140 (76.5%) of the respondents advised the use of cotton wool for cleaning babies mouths before the age of 6 months while 12 (6.6%) mentioned the use of polystyrene foam. One hundred and sixty six women (90.7%) felt that children's teeth should be cleaned with toothbrush between the ages of 2 years and 6 years. On the knowledge of the effects of drugs on the teeth, 11 (62.8%) believed that the ingestion of certain drugs, particularly tetracycline, in pregnancy could have adverse effects on the teeth. These findings showed that the majority of those in the study population had appreciable, though inaccurate knowledge of children's oral health needs. Nevertheless, the authors propose a programme of education on oral health for pregnant women which should enlighten them in the prevention disease of the oral cavity in themselves and their children.

Prostate disease patients: planning services to meet their coping needs

A committee comprising hospital and community-based urology and oncology nurses and social workers planned, organized, implemented, and evaluated an educational public seminar on prostate cancer (PC). Data relating to satisfaction with the seminar, reasons for attendance, perceived needs for further support/education, and demographics were collected using a feedback questionnaire. Results suggested a need for education and a significant interest in support groups and further educational forums for patients with PC or symptoms and their caregivers.

Using the Delphi technique to identify the content and context of nurses' continuing professional development needs

In order to identify and prioritize the development needs of medical and surgical nurses, their possible approaches to learning, and the contextual factors influencing their professional development, a Delphi survey was carried out using a panel of 28 participants. Current development needs included skills in essential clinical care, specialist nursing, changing roles, patient care management, research and practice development. Although there was ambivalence about changing nurses' clinical roles, participants expected roles to diversify in the future. The need for responsiveness to change was emphasized, as was the need to maintain current areas of expertise. Professional development activity could take many forms, but fostering an organizational climate in which development was inherent in everyday working practices was felt to be as valuable as formal course attendance. Restricting factors included lack of time, resources, support and recognition. The survey has enabled professional and practice development activities to be prioritized locally, and the method used could be readily applied to other settings.

Priorities for mental health and learning disability nurse education in the UK: a case study

The closure of psychiatric and mental handicap hospitals, the emphasis on community rather than hospital care and the distinction between health and social care for people in the community, with its funding implications, have demanded that mental health and learning disability nurses face the challenges of developing new skills and new ways of working. In this paper the findings of a study funded by the English National Board for Nursing, Midwifery and Health Visiting (ENB) are reported. This study explored the impact of these reforms on nurses and their practice, and identified the educational needs of mental health and learning disability nurses that have changed as a result. The study took a multiple-case study approach and involved interviews with 22 'key informants' and 88 mental health and 59 learning disability stakeholders in six sites, three in each nursing specialty. Inductive analysis of the interview data revealed 20 categories which summarize the major issues facing the two nursing specialties. These categories are discussed under seven themes and issues for nurse education are raised.

A faculty case management practice: integrating teaching, service, and research

Like many other schools, the faculty of the University of Oklahoma College of Nursing (OUCN) recently revised its baccalaureate and master's curricula to prepare students better for the evolving changes in the nursing profession and the health care job market. Our personal visions of needed changes, reviews of the literature, and feedback from nursing leaders and community employers supported the need for four significant changes. First, students needed more experiences in the community and clients' homes, with the aged, the chronically ill, and the disabled in all age brackets. Second, students needed greater familiarity with Medicare, Medicaid, and managed care, and more active involvement in the wise use of limited resources. Third, they needed more experience with interdisciplinary teams and with the management of care across sites and levels of acuity. Fourth, there was a need for more consistent integration of health promotion and research content into student learning related to emerging trends in health care and nursing practice.

A picture of locational--occupational diversity: an analysis of the needs of rural and remote healthcare workers when writing RHSET applications. Rural Health Support Education and Training

Methods for meeting the research needs of rural/remote health workers have been assessed on the assumption that these workers form a seemingly homogeneous group. This paper provides a picture of locational-occupational diversity not previously considered when addressing the needs of rural health workers writing research and project grant submissions. Rural/remote health workers and researchers were surveyed about their needs when seeking assistance with the development, implementation and evaluation of funded project/program proposals. New South Wales respondents were differentiated according to five geographical locations and 10 occupational categories. The results suggest that geographical location and occupational category are major factors in determining research requirements for rural/remote health workers and researchers, and should be considered when identifying barriers to the development and implementation of research projects in rural/remote health care issues. Those health workers most isolated required access to resource information and research and grant writing skills development, while researchers in metropolitan areas were more inclined to seek funding information and general assistance. Those in occupational categories who do not generally receive research and grant writing skills training are less likely to attract funding than their more 'academic' counterparts.

Understanding rural and remote divisions under a workforce framework

In Australia, divisions of general practice are the organisational structures for local networks of general practitioners. They facilitate communication across the profession and with other parts of the health system and are established in urban, rural and remote areas. Funding is provided contractually to divisions through the Federal Government's Divisions and Projects Grants Program. The under-supply of doctors and other health professionals in rural and remote areas of Australia is a serious problem that has far-reaching effects. The present paper argues that if the Divisions and Projects Grants Program is to be effective in achieving its aims and objectives, then the Program's policies must be responsive to the different needs, roles, constraints, expectations and capabilities of divisions and their members as well as the structural impediments imposed by the medical workforce.

Reexamining the associate degree curriculum. Assessing the need for community concepts

Significant changes taking place in health care delivery in our community in Louisiana have led faculty to reexamine the associate degree nursing curriculum. We recognized the trend toward the decreased need for inpatient care and the greater need for outpatient care and home care in the community. In addition, we noted the need for nursing care to assist the elderly in the management of chronic illness and provide education on health promotion and disease prevention.

Community nurses' assessment of the needs of Hong Kong family carers who are looking after stroke patients

This research aimed to identify the current practice of community nurses in Hong Kong in assessing stroke patients and their carers, and to pilot a scale for inclusion in the routine assessment of Chinese carers and their families. Qualitative and quantitative methods were used. In Phase 1, information was gained about the current practice of Community Nurses in assessing the needs of carers, and appropriate areas for inclusion in a scale for assessing those needs were identified. In Phase 2, the Carer Assessment Scale was completed by 14 Community Nurses and subsequently administered by a research assistant independently to the carers themselves. The perceptions of the two groups of respondents were compared, agreements and differences noted, and conclusions drawn, as to the real needs of carers.

Discharge planning for elderly patients

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.

The Bridge to Health Project: a collaborative model for assessing the health of a community

The Bridge to Health Project, a collaborative effort of 70 health related organizations, was designed to collect population-based health status data about approximately a half million residents in a primarily rural region in northeast Minnesota and northwest Wisconsin. Funding and staff support were provided by a regional medical center. The importance of sound survey methodology, role clarification, adequate staff support, and a well organized process to foster collaboration have applicability to other regions considering a collaborative process of health status assessment.

How to understand a community--community assessment for the promotion of health-related physical activity

A definition of the concept of community is given and the principles and the major components of community assessment for health-related physical activity are presented. Definitions of community can include a focus on geographic, social or cultural elements. Basically community assessment deals with a process having two main aspects. The first, quantitative and descriptive aspect consists of a community profile, a wellness profile, a behavioural profile and a service profile. The second, qualitative and analytical aspect deals with organizational capabilities and the community's readiness for change. This information can be used for programme planning, implementation, and evaluation in the process of community development.

Final report April 1997 of the National League for Nursing Commission on a workforce for a restructured health care system

The Commission based its deliberations on four sources of data: The experiences of Commission members. The published literature. Focus groups from rural and urban sectors across the United States. Survey data from health care bellwether cities.

[Nursing is education and needs sensitivity. The relationship between teaching and nursing]

There is no doubt: Active nursing as a profession needs training in many respects, in higher education, and--last but not least--needs intensive sensitivity. The author goes even further: Practice of nursing must be a specific part of education. Nursing is--likewise education--part of corporative life under special conditions and needs dialogue as a basis to acquire knowledge about the world. Being isolated from social life, from dialogue and self-acting means isolation and nonparticipating in reality.

Algorithms for resource allocation of substance abuse prevention funds based on composite risk-factor index score: a case study on state of Florida--Part 2

The purpose of Part 2 is to develop a model for resource allocation of state prevention funds to be distributed to its substate jurisdictions based on the relative need for prevention services measured in terms of composite risk-factor index (COMRISK) scores computed for each county. The risk factors are extracted from an extensive review of risk and protective factors addressed in the prevention literature. Based on twenty-two risk and protective factors identified, we were able to explain 71.3 percent of the total variation in student drug using behavior observed at the individual level. By aggregating individual COMRISK scores to the county level, we were able to determine aggregated COMRISK index scores at the county level. By determining the proportion of each county's share of the total statewide COMRISK and by weighting the latter proportion by the population size of each county, we have devised Prevention Needs Index (PNI) score based on the risks for each county. Finally, the county's share of PNI score as a proportion of the total statewide PNI score is computed. The latter proportion is then multiplied by the total amount of prevention resources available at the state. In this way, we were able to develop an alternative resource allocation model solely based on risk and protective factors for determining prevention needs of each county, independent of composite index score of drug use (COMDRUG) presented in Part 1. A comparison of three models for resource allocation has shown a significant amount of similarity of the total funds computed for each county. Accordingly, no preference is made among the resource allocation models suggested, although it is emphasized that the final decision concerning the level of funding must be made on the selection of the resource allocation algorithms rather than the suggested amount of funding computed for each county.

Meeting the need. A primary health care model for a community-based/nurse-managed health center

Long before the World Health Conference at Alma-Ata, when 113 nations agreed to incorporate the concepts and principles of primary health care in their health care systems (World Health Organization [WHO], 1978), nurses were practicing primary health care. Indeed, such care has been practiced since the time of Florence Nightingale. Here, in the United States, the records show that public health nurses were involved in numerous primary health care activities in the early and mid-1900s (Fitzpatrick, 1975).

[The use of the quality function deployment (QFD) in the planning of care]

This research aimed at suggesting an alternative to achieve quality in Nursing Service through an exploratory-descriptive study with 114 patients. A planning model was has been elaborated the steps and actions outlined by the Quality Function Deployment Method. It was based on Total Quality Control management approach. Seventeen steps has been established in order to seek clients' needs and through successive deployment and priority, the main Quality Features and Procedures which supported standardisation and monitoring of proposed actions has been determined. The outcomes showed that this method is feasible for Nursing Service Quality Planning because it has enabled to review the context as a whole, providing major degree of certainty on decisions.

Functional analysis and occupational standards: their role in curriculum development

National Vocational Qualifications and national occupational standards have been criticized by many academics and professionals, seemingly without a true knowledge of the processes and principles that underpin their development. This paper attempts to clarify the role that functional analysis and occupational standards can play in meeting the demands of central government and purchasers in providing educational programmes that meet individual, organizational and society's needs. An overview of the processes and principles relating to functional analysis and occupational standards is provided, and issues arising from their incorporation into professional education programmes are debated.

[A study of leadership training program demands of first-line nurse managers in university hospitals]

There is an important concern regarding the First-line nurse manager's leadership because of the recognition that effectiveness of Leadership in this position results in benefits for the whole health care organization. So knowledge and practice of effective leadership behavior are now more essential to nursing than ever before. First-line Nurse Managers must be effective leaders to meet today's challenge because staff nurse, patient are affected by them. So the purpose of this study was to identify and to analyse the need for Leadership program of First Line nurse managers in university hospitals. There were three major purposes of this study. First, identify First-line nurse managers general characteristic, second, identify their experience of leadership training, third, identify and analysis their demands for leadership training program. The subjects for this study was 167 First-line nurse manager randomly from 18 university hospitals in Korea. The data were collected through questionnaires from Oct. 13th to Nov. 20th, 1997, data was analysed using frequencies and percentages. Especially the steps of analysis of descriptions were as follows: Initial analysis centered on the identification of the demands of first-line nurse managers. Later analysis collapsed the demands into broad categories. From the collect data, 283 demands of first-line nurse managers were identified. These demands were then sorted into 3 broad categories that included: Self development as first-line nurse managers, relationship with others, and practice The result of the study were as follows: 1) Most of nurse managers (79.6%) had leadership training course and had good experience to improve self leadership. 2) Their demands of leadership training course are as follows: First, for self as first-line nurse managers, they want to learn leadership theory, identify their leadership style and then develop their leadership skill. Second, for others as first-line nurse managers, they want to improve their communication skill, empowering others, relationship with others. Third, for patients as first-line nurse managers, improve their knowledge of practice. From the above finding, this study can be suggested the following: 1. Develop a leadership training course to improve first-line nurse manager's leadership skill according to their demands, so they will be better able to lead staff nurses for organization purposes. 2. When develop leadership training program, it must be contained the factors which first-line nurse managers want to learn.