Information from anecdotal interviews at a practicum site indicated a lack of training for advanced practice providers (APPs) in core competencies critical for effective practice in a heart failure (HF) unit. The goal of this project was to assess the APPs' verbal reports and develop HF unit-specific training for APPs. The practice-focused question examined whether unit-specific training for HF APPs improved knowledge and skills in HF management. The Johns Hopkins nursing evidence-based practice model and Knowles's adult learning theory were used to create a survey, a focus group, and a pre/posttest assessment of knowledge and skills gap. Descriptive and inferential statistics could be used to analyze pre/post survey data, and thematic analysis could be used to analyze focus group data. Assessment data could be used to develop a targeted HF program based on identified skill deficiencies. The implications of this project related to social change are the potential to increase APPs' knowledge, job engagement, and retention. The program could affect length of stay and 30-day readmission of patients in the HF unit.

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in practice expectations and significant role transition stress and turnover. The purpose of this project was to construct from the scholarly literature a transition-to-practice residency program to support NP's in providing emergency department care in the CAH. The limbo to legitimacy theory guided the design and implementation of this project. Expected outcomes from this project include increased quality of care, increased patient safety, increased NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of 8 institutional leaders who designed the residency program and curriculum modules and the secondary products necessary to implement and evaluate the project. The project expands the understanding of the on-boarding needs of rural NPs and produces outcome data to evaluate results. Recommendations include collaboration between health care organizations and institutions of higher learning to promote postgraduate emergency care education leading to post-masters certificate or Doctor of Nursing Practice with emergency care subspecialization.

The term of ¡§migrant worker¡¨ appeared after the 1978 economic reform in China, since then, millions of farmers or rural inhabitants squeezed themselves into cities for better payment and life. However, the residency system restricts those workers with the rural residence registration from sharing the same working treatment and social welfare as the city residence. Until today, the migrant worker issue is not only become the toughest problem that Chinese government confronted, also this unfair condition increase the attentions of labor issue related I.O. and NGOs. Migrant workers and rural development are the developmental dilemma while Chinese government is perusing for higher GDP growth index. But, after 1990, big amount of social issue related NGOs increased, just in time for make up the insufficiency of government and enterprsies. This study focuses on the migrant workers problem, and its helping NGOs. To make a clear prove, this study provides four important migrant workers¡¦ educational and rights maintaining NGOs for case study. Through the research of these NGOs, we could figure out how those NGOs actually help those migrant workers. The amount of NGO is rapid growing, no matter how hard Chinese government intends to restrict those NGOs, it still represents that along with the trend of globalization, and the demand of civil society in China is also rising.

The purpose of this qualitative study was to explore intern's perspectives on how the professional environment impacts their well-being. In-depth, semi-structured interviews were conducted in March and April of 2009 with seventeen interns from residency programs in a variety of specialties at an urban teaching hospital. Investigators coded interview transcripts line-by-line, and identified recurrent themes through an iterative process of analyzing tagged quotations. Three themes (each with three sub-themes) characterized aspects of the professional environment that interns perceived as impacting their well-being: 1) high-quality education (workload, work hours, and quality and quantity of teaching), 2) professional development and satisfaction (making a meaningful contribution to patient care, positive feedback and extrinsic reward, and balance of autonomy and supervision), and 3) social and emotional support from colleagues (feeling supported by the residency program, cooperative team environment, and intern community). These aspects of the professional environment have the potential to significantly impact intern well-being, and should be taken into consideration when developing new systems, interventions and policies to improve the well-being of interns.

In November 1999, financial losses led the University of California at San Francisco Medical Center (UCSF) to close all inpatient services at Mount Zion Hospital, a community teaching hospital affiliated with UCSF since 1990. As a result of the closure, Mount Zions primary care residency program (MZPC) was merged with UCSFs university-based primary care program. We examined these events in the context of three major currents in U.S. health care: containment of rising health care costs, financial pressures on teaching hospitals, and the shifting priorities in graduate medical education with respect to subspecialty medicine and primary care. As part of this descriptive study, we investigated the impact of the Mount Zion closure on all UCSF internal medicine residents who were in training at the time. Using a cross-sectional survey, we found that a majority of residents felt the closure was harmful to their training, but that reasons varied by program affiliation. Many specific areas of training remained unaffected. Low morale correlated with abandonment of generalist career plans among some primary care residents (p=0.02). We concluded that the perception of harm reflected a temporary reaction to change rather than actual harm to the quality of the programs, and that while attrition from generalism may have resulted from disillusionment by some residents, it more likely reflected a national decline in interest in primary care since 1997. We also concluded that the closure of Mount Zion and its residency program was a consequence of the shifting emphasis toward subspecialization in the U.S. and is a harbinger of further changes in that direction.

Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. In many instances, a correlation has been noted between insufficient training and provision of adolescent medicine services in the practicing physician population. The American Medical Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology and Society for Adolescent Medicine recommend adolescent providers deliver comprehensive health services to teenagers. This study sought to assess and compare Pediatric, Family Medicine and Obstetric-Gynecology resident perceptions of their responsibility, training, experience and comfort with providing comprehensive health care services adolescents. We asked residents to identify the following: (1) adolescent health services they considered part of their scope of practice in their respective field; (2) the level of training they had received with regard to select adolescent health services; (3) the experience they had performing select clinical activities with adolescents; and (4) their comfort with aspects of adolescent care. We further asked two questions to test resident knowledge of an adolescents right to consent to contraception or an abortion without parental notification in the state of their residency. A total of 87 residents (31 Obstetric-Gynecology, 29 Family Medicine and 27 Pediatric) were surveyed. Most residents from all three fields felt the full range of adolescent preventive and clinical services represented in the survey fell under the scope of their practice. Most residents also reported high levels of comfort with examined aspects of adolescent care. In regard to some activities, the positive scope and comfort responses were matched by high reported levels of training and experience, including defining confidentiality; counseling about eating, exercise and obesity; counseling about substance abuse; and discussing STDs, sexual partners and contraception. However, for multiple key adolescent services, considerable discrepancies existed between reported levels of training and experience and the positive responses concerning scope and comfort. In particular the results of study suggested all residents need considerably more training and experience with mental health issues, referring teenagers for substance abuse treatment, and addressing physical and sexual abuse. Overall, there were also significant differences between fields. Family Medicine residents reported the greatest potential for providing comprehensive health care. However, they suffered from the overall deficiencies in training and experience noted above. Obstetric-Gynecology residents reported deficiencies in the provision of several preventive counseling and general health services. Pediatric residents reported multiple deficiencies in the provision of sexual health services. Our results indicate, at this time and in the near future, it is unlikely that adolescents will be able to obtain the full range of recommended preventive and clinical services in a single physician visit unless residencies programs actively incorporate increased training in the full range of adolescent preventive and clinical health services.

Since a substantial increase in lawsuits, settlements, jury trial awards, and insurance premiums involving nursing facilities began in the mid 1990s, addressing litigation has been a growing concern for the industry, consumers and their families, insurance carriers, and state and national elected officials. Curbing lawsuit growth has mirrored medical malpractice containment efforts, focusing on the addition of laws to inhibit litigation. The state of Florida initiated such tort reforms along with mandatory increased nursing facility staffing in 2001. Through secondary data analyses, this study examined the initial effects of Florida's tort reform measures. Lawsuits filed (N = 546) against any Hillsborough County nursing facility (N = 33) from 1999 through 2003 were reviewed. One-way analyses of variance and two-way contingency tables were used to identify variations in the elements, extent, and outcome of lawsuits between pre and post tort reform periods. Based on nursing facility admission dates, post tort reform lawsuits exhibited multiple significant changes. Lawsuits filed per month dropped to 14% of pre reform monthly filings. On average, lawsuits were associated with shorter residencies, were filed earlier, and settled six months sooner. They were less apt to include combined wrongful death and negligence survival damage claims, charges intentionally addressed by reform measures in order to eliminate double damage claims. Other lawsuit charges increased, e.g., lethal negligence and breach of fiduciary duty. Mediation was less likely and arbitration attempts more likely to be documented in lawsuits. Mean somatic allegations did not change significantly. Staff-related allegations decreased 21.5% to 8.51 per lawsuit, with 12 out of 22 staff-related allegations decreasing significantly. On average, settlement proposals, total settlements, and attorney fees decreased to 40% and net plaintiff awards to 25% of pre reform amounts. Overall, it appears that 2001 tort reform impacted post reform litigation substantially. However, further research examining a larger post reform lawsuit sample and longer post reform period is required to verify that research findings are stable and reflect sustained changes. Other factors, e.g., decreased nursing facility professional liability insurance coverage, may have affected the numbers and characteristics of lawsuits filed and require further investigation as well.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Masters Abstracts International, Volume: 45-05, page: 2467. Adviser: Alfred McAlister. Includes bibliographical references.

Made available in DSpace on 2018-06-18T13:12:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2016 / Este trabalho tem por objetivo analisar o papel docente dos profissionais envolvidos com a atividade de preceptoria no Programa de Residência Multiprofissional em Saúde da Universidade Federal do Amazonas. Trata-se de uma pesquisa qualitativa, de caráter descritivo-exploratório. O estudo foi realizado em um hospital universitário na cidade de Manaus – AM. Os dados foram coletados por meio de análise documental, entrevista semi-estruturada e aplicação de instrumento atitudinal tipo Likert. A população foi composta por preceptores e residentes. A coleta de dados foi dividida em duas etapas. Na primeira etapa, foi realizada entrevista com 10 preceptores do programa. As entrevistas foram gravadas, transcritas e os dados analisados por meio da técnica de análise de conteúdo, modalidade temática. Por meio da análise das entrevistas, foi possível conhecermos à luz dos preceptores, o significado de uma preceptoria ideal. Quatro eixos direcionadores organizaram o processo da análise de conteúdo: A Relevância da Preceptoria para o Processo de Formação em Saúde; A Preceptoria como Atividade Pedagógica e o Preceptor Ideal; A Educação Permanente em Saúde – EPS e o Aprimoramento da Preceptoria; A Preceptoria e a Articulação Teórico/Prática. As percepções colhidas por meio do instrumento do tipo Likert junto a esses preceptores acrescida da participação dos residentes em seu primeiro e segundo ano apontaram para uma assertividade no desenho do Programa. O estudo está em consonância com os preceitos éticos de pesquisa e teve autorização concedida pelo Comitê de Ética em Pesquisa da Universidade Federal de São Paulo, mediante CAAE: 43331215.0.0000.5505. Portanto, acredita-se que o estudo trouxe informações novas e relevantes consideradas e destacadas por preceptores e residentes: a adequada construção teórica e prática desenvolvida como elemento qualificador para o processo de formação a partir das necessidades apresentadas pelos residentes; o estímulo a uma postura crítica e reflexiva sobre o cuidado prestado pelos mesmos; a defesa dos determinantes de saúde e os condicionantes biológicos e sociais da doença; o estímulo ao desenvolvimento do trabalho em rede numa perspectiva integral do cuidado, e a opção pela multiprofissionalidade e o trabalho colaborativo como caminho para interprofissionalidade em sintonia com o preconizado no Projeto Político Pedagógico da Residência Multiprofissional em Saúde, bem como na Coordenação da Residência Multiprofissional. / This study had as objective to analyse the teaching role of the professionals involved with the mentoring activity in the Multidisciplinary Residency Program in Health of the Federal University of Amazonas. It’s a qualitative research, with descriptive and exploratory character. The study was accomplished in a university hospital in the city of Manaus - AM. The data were collected by means of documental analysis, half-structured interview and application of attitudinal instrument Likert type. The population was composed for preceptors and residents. The data collection was divided in two stages. In the first stage, interview with 10 preceptors of the program was accomplished. The interviews were recorded, transcribing and the data analysed by means of the technique of content analysis, thematic modality. By means of the analysis of the interviews, it was possible to know to the light of the preceptors, the meaning of an ideal preceptorship. Four axles drivers had organized the process of the content analysis: the relevance of the preceptorship for the process of training in health; the preceptorship as pedagogical activity and the ideal preceptor; the permanent education in health – EPS and the improvement of the preceptorship; the preceptorship and the theoretical joint/practice. The perceptions harvested by means of the instrument of the Likert type next to these preceptors increased of the participation of the residents in its first and according to year had pointed with respect to a assertiveness in the drawing of the Program. The study is in consonance with the ethical principles of research and had an authorization granted by the Ethics Committee on Research of the Federal University of São Paulo, by CAAE: 43331215.0.0000.5505. Therefore, it is believed that the study has brought new and relevant information considered and highlighted by preceptors and residents: adequate theoretical construction and practice developed as a qualifying element for the training process from the needs presented by the residents; the encouragement of a critical and reflective attitude about the care provided by them; the defense of the determinants of health and the biological and social determinants of disease; encouraging the development of networking an integral perspective of care, and the option for multiprofessional and collaborative work as a way to interprofissionalidade in line with the recommendations in the Pedagogical Political Project of the Multidisciplinary Residency in Health and the Coordination of Multidisciplinary Residency.

Made available in DSpace on 2015-07-22T20:49:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27. Added 1 bitstream(s) on 2015-08-11T03:25:24Z : No. of bitstreams: 1 Publico-00201.pdf: 1635935 bytes, checksum: 72921c7c9adb27be0c88d95595380ab7 (MD5) / O presente estudo teve como tema de pesquisa a vivência clínica hospitalar do enfermeiro na Residência Multiprofissional em Saúde da Família. Trata-se de pesquisa qualitativa na vertente fenomenológica e almejou compreender o significado da vivência clínica hospitalar na formação do enfermeiro na Residência Multiprofissional em Saúde da Família (RMSF). O estudo foi desenvolvido no curso de Residência Multiprofissional em Saúde da Família de uma Instituição de Ensino da Cidade de São Paulo. A coleta dos dados utilizou a entrevista, tendo como população do estudo oito enfermeiros residentes. Busquei, nos discursos dos residentes suas vivências, por meio da seguinte questão norteadora: “Fale de sua vivência hospitalar, como ela se mostra na sua formação enquanto residente”? Das descrições dos sujeitos, emergiram três categorias abertas: “Aproximando a vivência hospitalar e a Atenção Primária à Saúde”; “Uma aprendizagem significativa”, “Vivenciando o cotidiano da Residência”. A vivência hospitalar é descrita como importante na formação do residente, pela possibilidade de aprimorar competências, dentre elas, a competência clínica. Dos significados atribuídos à vivência hospitalar, encontra-se a necessidade e relevância da vivência clínica hospitalar como parte integrante do currículo da Residência Multiprofissional em Saúde da Família para os enfermeiros. / The purpose of this study was to evaluate the hospital clinical experience of the Family Health nurse in a Multiprofessional Residency. This qualitative research in phenomenological design aimed at understanding the meaning of hospital clinical experience in the nurse’s training in a Multiprofessional Family Health Residency. The study was developed in a Multiprofessional Family Health Residency course conducted by a teaching institution in São Paulo city. The data collection was based on interviews and had as study population eight resident nurses. I investigated the residents’ experience according to their speeches, by making the following guiding question: “Talk about your hospital experience, how does it show itself in your training as a resident”? Three open categories emerged from the subjects’ descriptions: “Causing to approach the hospital experience and the Primary Health Care”; “A significant learning”, ” Experiencing the day-to-day of the Residency”. The hospital experience is described as an important issue in the resident’s training, due to the possibility of improving competences, among them, the clinical competence. Among the meanings attributed to the hospital experience, there is the need and relevance of the hospital clinical experience as an integrant part of the curriculum vitae of the Multiprofessional Family Health Residency for the nurses. / TEDE / BV UNIFESP: Teses e dissertações