A decade of faculty development for health professions educators: lessons learned from the Macy Faculty Scholars Program

Faculty development (FD) programs are critical for providing the knowledge and skills necessary to drive positive change in health professions education, but they take many forms to attain the program goals. The Macy Faculty Scholars Program (MFSP), created by the Josiah Macy Jr. Foundation (JMJF) in 2010, intends to develop participants as leaders, scholars, teachers, and mentors. After a decade of implementation, an external review committee conducted a program evaluation to determine how well the program met its intended goals and defined options for ongoing improvement.The committee selected Stufflebeam's CIPP (context, input, process, products) framework to guide the program evaluation. Context and input components were derived from the MFSP description and demographic data, respectively. Process and product components were obtained through a mixed-methods approach, utilizing both quantitative and qualitative data obtained from participant survey responses, and curriculum vitae (CV).The evaluation found participants responded favorably to the program and demonstrated an overall increase in academic productivity, most pronounced during the two years of the program. Mentorship, community of practice, and protected time were cited as major strengths. Areas for improvement included: enhancing the diversity of program participants, program leaders and mentors across multiple sociodemographic domains; leveraging technology to strengthen the MFSP community of practice; and improving flexibility of the program.The program evaluation results provide evidence supporting ongoing investment in faculty educators and summarizes key strengths and areas for improvement to inform future FD efforts for both the MFSP and other FD programs.

Uptake, translocation, weathering and speciation of gold nanoparticles in potato, radish, carrot and lettuce crops

Extensive use of nanomaterials in agriculture will inevitably lead to their release to the environment in significant loads. Thus, understanding the fate of nanoparticles in the soil-plant environment, and potential presence and consequent implication of nanoparticles in food and feed products, is required. We study plant uptake of gold nanoparticles from soil, and their distribution, translocation and speciation (in terms of particle size change and release of ionic Au) in the different plant tissues of four important crops (potato, radish, carrot and lettuce). Our new analytical protocol and experiments show the feasibility of determining the presence, concentration and distribution of nanoparticles in different plant parts, which differ from plant to plant. Critically, we identify the evident capacity of plants to break down (or substantially change the properties of) nanoparticles in the rhizosphere prior to uptake, as well as the evident capacity of plants to reorganize ionic metals as nanoparticles in their tissues. This could lead to nanoparticle exposure through consumption of crops.

Increasing Minority Representation in the Health Professions

Research indicates that health disparities may be reduced by increasing the number of ethnic minorities working in health occupations. Establishing health career pathway programs for immigrant and ethnic minority students is one way to address this problem. One such program, Cross-Cultural Education in Public Health (CCEPH), was developed, implemented, and evaluated to determine whether participants expressed greater interest in pursuing health care careers after program completion. A sample of 72 immigrant students in two high schools participated in the program, which was based on Bandura's theory of self-efficacy. Data were gathered using pre- and postprogram surveys that measured academic self-efficacy and career consideration. Results for academic efficacy were not statistically significant, but interest level in health care careers rose substantially. Although further research needs to be conducted to determine whether such programs increase self-efficacy, programs such as CCEPH can increase the consideration of health careers among immigrant and ethnic minority students.

The Patient Experience and Patient Satisfaction: Measurement of a Complex Dynamic

The concept of patient experience is surprisingly complex and generally linked with patient satisfaction. As reimbursement and performance policies have become more normative within healthcare, the patient experience has become a metric to measure payment systems for quality. However, we still have much to learn about the concept of patient experience and its influence on how patients report satisfaction with their care. This article discusses challenges for measurement of the patient experience, such as lack of consistent terminology and multiple contributing factors, by reviewing a brief selection of selected literature to help readers appreciate the complexity of measurement. Several examples from clinical practice will consider regulation, organizational environments, and research that can offer clarity around important factors that impact a patient’s experience and subsequent satisfaction with the provision of care.

A collaborative communitywide health fair: the process and impacts on the community

The purpose of this article is to describe the process of conducting a collaborative communitywide health fair, and the impacts of such health intervention programs on community members. A community health fair addresses the health access needs of underserved populations. The success or effectiveness of such community-based programs requires systematic approach to assessment, planning, implementation, and evaluation. The PRECEDE˜PROCEED model was used as the guiding framework. The health fair described in this article was coordinated by nurses and drew resources from multiple health providers and organizations. The fair provided opportunities for vulnerable populations to access and utilize appropriate and comprehensive health services, resources and education.

Revisiting scope of practice facilitators and barriers for primary care nurse practitioners: a qualitative investigation

Revisiting scope of practice (SOP) policies for nurse practitioners (NPs) is necessary in the evolving primary care environment with goals to provide timely access, improve quality, and contain cost. This study utilized qualitative descriptive design to investigate NP roles and responsibilities as primary care providers (PCPs) in Massachusetts and their perceptions about barriers and facilitators to their SOP. Through purposive sampling, 23 NPs were recruited and they participated in group and individual interviews in spring 2011.The interviews were audio recorded and transcribed. Data were analyzed using Atlas.ti 6.0 software, and content analysis was applied. In addition to NP roles and responsibilities, three themes affecting NP SOP were: regulatory environment; comprehension of NP role; and work environment. NPs take on similar responsibilities as physicians to deliver primary care services; however, the regulatory environment and billing practices, lack of comprehension of the NP role, and challenging work environments limit successful NP practice.

Older adults' home- and community-based care service use and residential transitions: a longitudinal study

Background

As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions.

Methods

The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1) Community-Community-Community (CCC: Resided in community during the entire study period); (2) Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3); (3) Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3); (4) Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.).

Results

Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS) and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other services, such as senior center services or meal services, were associated with different directions in residential transition, such as CIC and CII respectively.

Conclusions

Older adults’ differing HCBS use patterns may be the key to explaining older adults’ transitions. Attention to older adults’ HCBS use patterns is recommended for future practice. However, this was an exploratory study and the analyses cannot establish causal relationships.

Expanding the role of nurse practitioners: effects on rural access to care for injured workers

CONTEXT

A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers' compensation system was implemented in 2004 (SHB 1691), amid concern about disparities in access to health care for injured workers in rural areas. SHB 1691 authorized NPs to independently perform most functions of an attending physician.

PURPOSE

The aims of this study were to (1) describe the contribution by NPs to Washington's workers' compensation provider workforce, (2) evaluate change in provider availability attributable to SHB 1691, and (3) evaluate the effect of SHB 1691 on timely accident report filing.

METHODS

Administrative data were used to evaluate this natural experiment, using a pre-post design with primary care physicians (PCPs) as a nonequivalent comparison group.

FINDINGS

NPs served injured workers with characteristics similar to those served by PCPs, but 22.0% of NPs were rural, compared with 17.3% of PCPs. Of claimants with NPs as their attending provider, 53.3% were injured in a rural county, compared with 24.7% for those with PCP attending providers. The number of NPs participating in the workers' compensation system rose after SHB 1691 implementation, more so in rural areas. SHB 1691 implementation was associated with a 16 percentage point improvement in timely accident report filing by NPs in both rural and urban areas.

CONCLUSIONS

Authorizing NPs to function as attending providers for injured workers may improve provider availability (especially in rural areas) and timely accident report filing, which in turn may improve worker outcomes and system costs.

Nurse Practitioners as Attending Providers for Workers With Uncomplicated Back Injuries: Using Administrative Data to Evaluate Quality and Process of Care

OBJECTIVE

The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers' compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs).

METHODS

Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression.

RESULTS

This study found little evidence of differences between NP and PCP claims in case mix or quality of care.

CONCLUSIONS

The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement.

The public health enterprise: examining our twenty-first-century policy challenges

This paper examines the public health enterprise and its policy challenges in the twenty-first century. Among the many challenges public health faces, we include here collaboration across a broad range of stakeholders, the public health infrastructure, agreement on public health's essential services, preparedness, accountability and measurement, workforce and a research agenda. Two Institute of Medicine reports on the future of public health have set the context for a more in-depth review of the public health workforce and infrastructure. Policy advocates must ask, however, why, if the way and the means are so clear, the public health system is still in disarray.

The public health enterprise: examining our twenty-first-century policy challenges

This paper examines the public health enterprise and its policy challenges in the twenty-first century. Among the many challenges public health faces, we include here collaboration across a broad range of stakeholders, the public health infrastructure, agreement on public health's essential services, preparedness, accountability and measurement, workforce, and a research agenda. Two Institute of Medicine reports on the future of public health have set the context for a more in-depth review of the public health workforce and infrastructure. Policy advocates must ask, however, why, if the way and the means are so clear, the public health system is still in disarray.

Advancement of health disparities research: a conceptual approach

Although nurse researchers have contributed in significant ways to the body of literature on health disparities, a broad framework and approach to health disparities is needed if we are to understand the complex interplay of variables that contribute to health disparities. This article reports on the work of the Center for the Advancement of Health Disparities Research and its development of a conceptual framework and method for approaching health disparities research and on a sample of nursing research consistent with this framework.

Building Sustainable Public Health Systems Change at the State Level

Reforming the public health infrastructure requires substantial system changes at the state level, including the reorganization of state agencies' plans, roles, and relationships with other sectors and communities. Beyond the limited time period of pilot programs and grants, how are these public health system changes to be sustained? Turning Point is an initiative of The Robert Wood Johnson Foundation to transform and strengthen the public health system. The 21 states participating in this initiative developed multisector partnerships to produce public health improvement plans and from these, chose one or more priorities for implementation. Reform efforts to strengthen the public health system occur within complex fiscal and political environments, however, and must cope with both uncertainty and turbulence in the process of implementing change. Turning Point state partners have developed a variety of approaches to the challenge of incorporating effective community collaborations as a permanent strategy for transforming public health systems. A qualitative, descriptive study design was used to analyze the strategies used by Turning Point state partnerships to meet the challenges of sustaining their system improvements. These strategies included: institutionalization within government, establishing "third sector" institutions, cultivating relationships with significant allies, and enhancing communication and visibility among multiple communities.

Increasing Minority Representation in the Health Professions

Research indicates that health disparities may be reduced by increasing the number of ethnic minorities working in health occupations. Establishing health career pathway programs for immigrant and ethnic minority students is one way to address this problem. One such program, Cross-Cultural Education in Public Health (CCEPH), was developed, implemented, and evaluated to determine whether participants expressed greater interest in pursuing health care careers after program completion. A sample of 72 immigrant students in two high schools participated in the program, which was based on Bandura's theory of self-efficacy. Data were gathered using pre- and postprogram surveys that measured academic self-efficacy and career consideration. Results for academic efficacy were not statistically significant, but interest level in health care careers rose substantially. Although further research needs to be conducted to determine whether such programs increase self-efficacy, programs such as CCEPH can increase the consideration of health careers among immigrant and ethnic minority students.

Increasing minority representation in the health professions

Research indicates that health disparities may be reduced by increasing the number of ethnic minorities working in health occupations. Establishing health career pathway programs for immigrant and ethnic minority students is one way to address this problem. One such program, Cross-Cultural Education in Public Health (CCEPH), was developed, implemented, and evaluated to determine whether participants expressed greater interest in pursuing health care careers after program completion. A sample of 72 immigrant students in two high schools participated in the program, which was based on Bandura's theory of self-efficacy. Data were gathered using pre- and postprogram surveys that measured academic self-efficacy and career consideration. Results for academic efficacy were not statistically significant, but interest level in health care careers rose substantially. Although further research needs to be conducted to determine whether such programs increase self-efficacy, programs such as CCEPH can increase the consideration of health careers among immigrant and ethnic minority students.

Public health finance: a conceptual framework

In an attempt to stimulate development of public health finance as a field of practice, policy, and scholarship, this article proposes a working definition of the term "public health finance," embeds it in the context of the maturing literature on the public health system and its infrastructure, and proposes a four-part typology that spans both public-sector and private-sector contributions to the financing of prevention and health promotion. A developmental strategy for the field--in applied research, training and education, and performance standards--is outlined as well.

Rural public health service delivery: promising new directions

I describe variations in the structure and in the practice of rural public health and how rural communities meet the challenges of current public health practice, including primary methods of service delivery and partnership development. I present examples of promising models for the creation of rural public health capacity-the ability of local health departments to carry out core public health responsibilities.

Collaborative Partnerships at the State Level

Reforms in the public health infrastructure such as those called for in recent Institute of Medicine reports require stakeholder engagement on different levels than traditional grass-roots community work. The Turning Point Initiative, funded by The Robert Wood Johnson Foundation, involves 21 state-wide partnerships established for systems change and focused in specific areas of public health innovation and policy development. These partnerships represent a different model of strategic alliances and relationship-building than has been previously described in the literature on community-level and health-promotion collaborations. This article utilizes qualitative data to illustrate the ways in which state-level partnerships for systems change both confirm and extend previous models. Findings indicate that state-level public health partnerships share many of the challenges and opportunities of locally-based and health-promotion-oriented partnerships. Collaboration at the state level, however, involves more attention to organizational alliances, coordination of institutional change, and strategic responses to political changes. These partnerships depend on a combination of interpersonal skills, material resources, and organizational savvy to manage complex planning and implementation processes. Influencing policy development and organizational redesign in public health systems requires nuanced understanding of the opportunities provided by various kinds of organizational partners.

Public health infrastructure system change: outcomes from the turning point initiative

The Robert Wood Johnson and W.K. Kellogg Foundations created the Turning Point initiative to transform and strengthen the public health infrastructure. This study examined 135 public health system changes for their links to multiple sector collaborative engagement, essential public health services, health outcomes, and infrastructure building strategies. An on-line documentation system developed by the University of Kansas was used to record and analyze these linkages. The results showed that each state accomplished notable system changes; the majority involved more than one sector and primarily related to increasing local public health system capacity and organizational change.

Public health nursing practice: aftermath of September 11, 2001

America's experience on September 11, 2001, forms the backdrop of this review of the public health nursing role in bioterrorism preparedness. The risks and challenges to the public health infrastructure are reviewed in order to place bioterrorism preparedness in a public health context. A review of the literature provides background material on the extent to which public health has evolved in planning for a bioterrorism event. The skills and competencies that will prepare public health nurses in their planning for and response to threats of bioterrorism are addressed. Anthrax is used as an example to illustrate how public health nursing can assist in a bioterrorism response.

Arching the flood: how to bridge the gap between nursing schools and hospitals

A gap persists between what nurses can do and what they are employed to do, between the education nurses obtain and the work design of hospitals. Despite agonizing over standardization, current nursing education reflects the pluralistic nursing workforce, and nurses hold accountability for it. But nurses have not been proportionately or effectively involved in restructuring the hospital workplace. The result is that nurses are both overworked and underused. Fortunately, this gap may be bridged with a number of short- and long-term policy solutions.

Rural public health: policy and research opportunities

Changes in the health care system, medicine, and technology as well as in the characteristics of rural communities raise issues that impact the responsiveness of the rural public health system to emerging threats to health. These issues, which are systemic in nature and primarily involve the infrastructure of public health, include the capacity of rural public health to manage population health, utilize information technology, monitor performance of the essential public health functions, develop leadership and the public health workforce, and promote the interaction and integration of public health and health care. This article provides an overview of policy and research implications, and it suggests that each of these issues contributes to the capacity of public health to effectively improve the outcomes of health in rural communities.

Expanding American Nurses Association nursing quality indicators to community-based practices

Continuing its commitment to patient care quality, the American Nurses Association appointed a committee in 1997 to expand nursing-sensitive quality indicators beyond acute care. This article is the final report describing the processes used to identify a core set of community-based quality indicators relevant to nurses across the care continuum and identifies next steps. The indicator categories are (a) change in symptom severity, (b) strength of the therapeutic alliance, (c) utilization of services, (d) client satisfaction, (e) risk reduction, (f) increase in protective factors, and (g) level of function/functional status. Potential indicators requiring further research and development are also described.

Advective transport in the percolation backbone in two dimensions

We show that, in the case of advective transport on the percolation backbone, the relevant structure below the correlation length is an ensemble of tortuous paths, rather than the classical links-nodes-blobs system. These paths are embedded in the few largest blobs that dominate the structure of the backbone. We find numerically that the mean particle displacement differs from the prediction given by classical finite-size scaling arguments. We also show that because of the complex velocity distribution between the paths, the mean first-passage time of the particles cannot be inferred directly from the mean particle displacement.

Application of continuous time random walk theory to tracer test measurements in fractured and heterogeneous porous media

We examine a set of analytical solutions based on the continuous time random walk (CTRW) approach, which can be evaluated numerically and used to analyze breakthrough data from tracer tests. Practical application of these solutions, with discussion of the physical meaning of the relevant model parameters, is emphasized. The CTRW theory accounts for the often observed non-Fickian (or scale-dependent) dispersion behavior that cannot be properly quantified by using the advection-dispersion equation. The solutions given here, valid for a wide range of dispersive behaviors of conservative tracers, and useful for both characterization and prediction, have been integrated into a library of external functions for use with the GRACE graphical display and analysis package. Example applications of these solutions are presented. The library and graphics software are freely accessible from a Web site.

Studying the outcomes of community-based coalitions

Community-based coalitions are popular structures for creating community benefits. But desired effects have been reported only for single cases, the overall documented evidence to date for positive coalition outcomes being weak. Methodological obstacles may account for much of the missing evidence, and research possibilities for addressing these obstacles are suggested. Alternative interpretations include the positions that coalitions in general are not effective intervention mechanisms, that traditional scientific methodology is poorly suited for capturing fine-grained coalition outcomes, and that coalitions and similar collaborative organizations are too complex to be adequately evaluated by the methodology that is now available.

Analysis of field observations of tracer transport in a fractured till

We analyze a set of observations from a recently published, field-scale tracer test in a fractured till. These observations demonstrate a dominant, underlying non-Fickian behavior, which cannot be quantified using traditional modeling approaches. We use a continuous time random walk (CTRW) approach which thoroughly accounts for the measurements, and which is based on a physical picture of contaminant motion that is consistent with the geometric and hydraulic characterization of the fractured formation. We also incorporate convolution techniques in the CTRW theory, to consider transport between different regions containing distinct heterogeneity patterns. These results enhance the possibility that limitations in predicting non-Fickian modes of contaminant migration can be overcome.

Collaboration for health improvement: models for state, community, and academic partnerships

The value of approaching health improvement through collaborative models seems self-evident, especially at the community level. A review of the literature, however, reveals a number of challenges in terms of helping us understand precisely what it is that makes collaborative models effective in influencing health. The purpose of this article is to describe important elements of collaboration that state, local, and academic partners may wish to consider when developing models for health improvement. The author will provide examples of collaborative strategies that are emerging from the Turning Point: Collaborating for a New Century in Public Health initiative.

The Community Tool Box: a Web-based resource for building healthier communities

Building healthier cities and communities requires an array of community-building skills that are not always taught in formal education. The Community Tool Box (http://ctb.ukans.edu) is an Internet-based resource for practical, comprehensive, accessible, and user-friendly information on community-building, which both professionals and ordinary citizens can use in everyday practice. It connects people, ideas, and resources, offering more than 200 how-to sections and more than 5,000 pages of text.

Health system reform: a blueprint for the future of public health

As the state of Washington formulated its health reform legislation, public health successfully advocated for its inclusion as integral to successful reform. The blueprint for public health's role within health reform is The Public Health Improvement Plan. The plan describes standards for the infrastructure and performance required to carry out the core functions of public health. It contains outcome standards, threshold standards, and interventions for key problems currently affecting the health status of Washington residents. The plan also recommends the shared financing and governance responsibilities for public health functions within a reformed health system.