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1.  Oral Health Nursing Education and Practice Program 
Nursing Research and Practice  2012;2012:149673.
Millions of Americans have unmet oral healthcare needs and profound oral health disparities persist in vulnerable and underserved populations, especially poor children, older adults, and racial and ethnic minorities. Nurses can play a significant role in improving the quality of oral health including access to care with appropriate education and training. The purpose of this paper is to describe New York University College of Nursing's response to this challenge. The Oral Health Nursing Education and Practice (OHNEP) program is a national initiative aimed at preparing a nursing workforce with the competencies to prioritize oral disease prevention and health promotion, provide evidence-based oral healthcare in a variety of practice settings, and collaborate in interprofessional teams across the healthcare system. The overarching goal of this national initiative is to create an educational infrastructure for the nursing profession that advances nursing's contribution to reducing oral health disparities across the lifespan.
doi:10.1155/2012/149673
PMCID: PMC3362947  PMID: 22685642
2.  Nurse Faculty Enrichment and Competency Development in Oral-Systemic Health 
Nursing Research and Practice  2012;2012:567058.
Nurses are positioned to play a significant role in oral health promotion and disease prevention across the life cycle. Oral health has not been a high priority in nursing practice, and educating nurses about oral health has been inadequate particularly regarding the interrelationship between oral health and overall health. The first step for developing a nursing workforce with core competencies in oral health promotion and disease prevention is to prepare nurse faculty with the requisite knowledge, skills, attitudes, and best practices in oral-systemic health. The purpose of this paper is to present Smiles for Life: A National Oral Health Curriculum as a knowledge framework that nurse faculty can use for faculty enrichment and competency development in oral health across the life cycle. A variety of teaching-learning strategies and resources are provided to assist nurse faculty with integrating oral-systemic health into existing nursing curricula.
doi:10.1155/2012/567058
PMCID: PMC3357600  PMID: 22655189
3.  Preventive Psychiatry 
Various forms of collaboration between the disciplines of public health and psychiatry are briefly reviewed and the 25-year-old mental health program of the Vancouver Health Department is described. The public health nurse has prime responsibility in all children with emotional disorders. She is supported by a psychiatric team which provides active treatment and educational and consultative help for the nurse and the school. During the year 1963, six social workers had 2357 contacts with nurses and school personnel but only 1049 treatment interviews. Of 401 children referred to the psychiatric team, 138 received active clinic treatment, 141 remained under supervision by the public health nurse, and 122 were referred elsewhere. In addition, 1330 children were identified as “mental hygiene cases” in the caseload of the 170 public health nurses in the community. By close co-ordination, the public health nurse and the psychiatric team can enhance each other's contributions to community mental health.
PMCID: PMC1928859  PMID: 5829399
4.  Perceptions of Malawian Nurses about Nursing Interventions for Malnourished Children and Their Parents 
In developing countries, malnutrition among children is a major public-health issue. The aim of the study was to describe perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. A qualitative method was used. Data were collected and analyzed according to the phenomenographic research approach. Twelve interviews were performed with 12 nurses at a rural hospital in northern Malawi, Southeast Africa. Through the analysis, two major concepts, comprising four categories of description, emerged: managing malnutrition today and promotion of a favourable nutritional status. The categories of description involved identification and treatment of malnutrition, education during treatment, education during prevention, and assurance of food security. The participating nurses perceived education to be the most important intervention, incorporated in all areas of prevention and treatment of malnutrition. Identification and treatment of malnutrition, education during treatment, education to prevent malnutrition, and assurance of food security were regarded as the most important areas of intervention.
PMCID: PMC3259724  PMID: 22283035
Child; Child nutrition disorders; Health education; Interventions; Nutrition education; Perceptions; Phenomenography; Malawi
5.  Infusing Oral Health Care into Nursing Curriculum: Addressing Preventive Health in Aging and Disability 
Nursing Research and Practice  2012;2012:157874.
Access to oral health care is essential for promoting and maintaining overall health and well-being, yet oral health disparities exist among vulnerable and underserved populations. While nurses make up the largest portion of the health care work force, educational preparation to address oral health needs of elders and persons with disabilities is limited across nursing curricula. This descriptive study reports on the interdisciplinary development, implementation, and testing of an oral health module that was included and infused into a graduate nursing curriculum in a three-phase plan. Phase 1 includes evaluation of a lecture presented to eight gerontological nurse practitioner (GNP) students. Phase 2 includes evaluation of GNP students' perceptions of learning, skills, and confidence following a one-time 8-hour practicum infused into 80 required practicum hours. The evaluation data show promise in preparing nurse practitioner students to assess and address preventive oral health needs of persons aging with disabilities such that further infusion and inclusion in a course for nurse practitioners across five specialties will implemented and tested in Phase 3.
doi:10.1155/2012/157874
PMCID: PMC3350980  PMID: 22619708
6.  BMI, physical inactivity, cigarette and alcohol consumption in female nursing students: a 5-year comparison 
BMC Medical Education  2014;14:82.
Background
Nursing staff are often involved in counseling patients with regard to health behavior. Although care promoting healthy lifestyle choices is included in the curriculum of nursing students in Germany, several studies of nursing students have reported a high prevalence of unhealthy behavior. This paper focuses on the behavior of female nursing students with regard to body mass index (BMI), physical activity, and cigarette and alcohol consumption. It describes trends through the comparison of results from 2008 and 2013.
Methods
Data was collected in two waves at a regional medical training college. First, 301 nursing students were asked to fill out a 12 page questionnaire on health behavior in 2008. The questioning was repeated in 2013 with 316 participating nursing students using the previous questionnaire.
Results
259 female nursing students completed the questionnaire in 2013. 31.6% of them were either overweight or obese, 28.5% exercised less than once a week, 42.9% smoked between 10 and 20 cigarettes a day and 72.6% drank alcohol, wherefrom 19.7% consumed alcohol in risky quantities. In comparison to the data of 266 female nursing students from 2008, there were significant differences in the BMI and alcohol consumption: The percentage of overweight and obese students and the percentage of alcohol consumers at risk increased significantly.
Conclusions
Health behavior of female nursing students is often inadequate especially in regard to weight and cigarette and alcohol consumption. Strategies are required to promote healthy lifestyle choices.
doi:10.1186/1472-6920-14-82
PMCID: PMC3997793  PMID: 24742064
Nursing students; Health promotion; Alcohol; Cigarettes; Body mass index; Physical activity
7.  Primary care nurses’ awareness of and willingness to perform children’s oral health care 
BMC Oral Health  2014;14:26.
Background
The majority of young children receive no early dental examination while attending primary health care for routine check-ups. Our aim was to study primary care nurses’ knowledge of oral health care (OHC) and their attitudes toward delivering OHC, as well as to assess their willingness to obtain OHC information.
Methods
We conducted a cross-sectional survey of all primary-care nurses working in the public health centres of Tehran city. An anonymous self-administered questionnaire queried their knowledge in paediatric-, general and medicine-related areas of dentistry, providing knowledge scores for three domains. The nurses’ attitudes toward OHC and their willingness to obtain OHC information underwent evaluation with statements utilizing a five-point Likert scale. Altogether 680 nurses took part in the survey. The Chi-square test, t-test, one-way ANOVA and logistic regression model served for statistical analyses.
Result
The mean score for the paediatric dentistry domain (3.6, SD: 1.5) was lower than for the medical (4.4, SD: 2.3) and dental domains (5.8, SD: 1.5). Obtaining higher scores in the paediatric (OR = 1.2) and dental (OR = 1.3) domains, and a greater willingness to receive OHC information (OR = 5.3), were associated with a positive attitude toward OHC. Nurses with a lower education (OR = 1.9) and better oral health behaviour (OR = 1.1) as well as those working in a non-affluent region (OR = 1.6) had a more positive attitude toward OHC.
Conclusion
Primary care nurses’ low level of knowledge in OHC and their positive attitude and willingness to obtain more information point to the need for appropriate OHC training and encouragement for the nurses to promote oral health and prevent dental diseases.
doi:10.1186/1472-6831-14-26
PMCID: PMC3986874  PMID: 24670004
Attitude; Children; Knowledge; Nurses; Oral health; Primary care providers
8.  Postnatal Depression Is a Public Health Nursing Issue: Perspectives from Norway and Ireland 
Nursing Research and Practice  2013;2013:813409.
The framework provided by the Millennium Development Goals includes maternal health as an area of priority. Postnatal depression (PND) is a serious public health issue because it occurs at a crucial time in a mothers' life, can persist for long periods, and can have adverse effects on partners and the emotional, behavioural, and cognitive development of infants and children. Internationally, public health nurses (PHNs) are key professionals in the delivery of health care to mothers in the postpartum period, and international research collaborations are encouraged. Two researchers from the European Academy of Nursing Science (EANS) identified a need to collaborate and strengthen research capacity and discussion on postnatal depression, a public health nursing issue in both countries. Within the context of public health and public health nursing in Ireland and Norway, the aim of this paper is to present a discussion on the concept of PND, prevalence, and outcomes; screening issues for PHNs; and the research evidence of the benefits of social support in facilitating recovery for new mothers.
doi:10.1155/2013/813409
PMCID: PMC3780656  PMID: 24089636
9.  Immunization for Children—Motivating Families to Complete a Series 
California Medicine  1969;110(3):207-212.
A communication gap in transmission of information from health professionals to indigent parents is demonstrated by the incomplete immunization of children attending pediatric health facilities. To bridge this gap, young women of similar ethnic and social backgrounds were recruited and trained briefly in counseling parents concerning adequate immunization.
The effectiveness of these Health Aides in motivating parents to complete an immunization series was less than that of Public Health Nurses. Even so, the Aides were able to motivate two-thirds of the families that they counseled.
Conclusions were that a significant number of children appearing in a large public emergency room facility are unimmunized. Many of these children are not seriously ill and an immunization series can be initiated “on the spot.” Motivation to complete the series can be done almost as satisfactorily by young rapidly trained indigenous Health Aides as by professionals.
PMCID: PMC1503459  PMID: 5773479
10.  Nurse Overestimation of Patients' Health Literacy 
Journal of Health Communication  2013;18(Suppl 1):62-69.
Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates.
doi:10.1080/10810730.2013.825670
PMCID: PMC3814908  PMID: 24093346
11.  Patient safety in surgical environments: Cross-countries comparison of psychometric properties and results of the Norwegian version of the Hospital Survey on Patient Safety 
Background
How hospital health care personnel perceive safety climate has been assessed in several countries by using the Hospital Survey on Patient Safety (HSOPS). Few studies have examined safety climate factors in surgical departments per se. This study examined the psychometric properties of a Norwegian translation of the HSOPS and also compared safety climate factors from a surgical setting to hospitals in the United States, the Netherlands and Norway.
Methods
This survey included 575 surgical personnel in Haukeland University Hospital in Bergen, an 1100-bed tertiary hospital in western Norway: surgeons, operating theatre nurses, anaesthesiologists, nurse anaesthetists and ancillary personnel. Of these, 358 returned the HSOPS, resulting in a 62% response rate. We used factor analysis to examine the applicability of the HSOPS factor structure in operating theatre settings. We also performed psychometric analysis for internal consistency and construct validity. In addition, we compared the percent of average positive responds of the patient safety climate factors with results of the US HSOPS 2010 comparative data base report.
Results
The professions differed in their perception of patient safety climate, with anaesthesia personnel having the highest mean scores. Factor analysis using the original 12-factor model of the HSOPS resulted in low reliability scores (r = 0.6) for two factors: "adequate staffing" and "organizational learning and continuous improvement". For the remaining factors, reliability was ≥ 0.7. Reliability scores improved to r = 0.8 by combining the factors "organizational learning and continuous improvement" and "feedback and communication about error" into one six-item factor, supporting an 11-factor model. The inter-item correlations were found satisfactory.
Conclusions
The psychometric properties of the questionnaire need further investigations to be regarded as reliable in surgical environments. The operating theatre personnel perceived their hospital's patient safety climate far more negatively than the health care personnel in hospitals in the United States and with perceptions more comparable to those of health care personnel in hospitals in the Netherlands. In fact, the surgical personnel in our hospital may perceive that patient safety climate is less focused in our hospital, at least compared with the results from hospitals in the United States.
doi:10.1186/1472-6963-10-279
PMCID: PMC2955019  PMID: 20860787
12.  Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial 
BMC Pediatrics  2013;13:50.
Background
Second-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking.
Methods
This was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a “no smoking” sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women”s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups.
Results
A higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands’ willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands’ history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups.
Conclusions
A brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: ‘Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking’.
Trial registration
Current Controlled Trials ISRCTN72290421.
doi:10.1186/1471-2431-13-50
PMCID: PMC3626671  PMID: 23565835
Mothers of sick children; Nurse-led education; Paediatric settings; Randomised controlled trial; Smoking husband
13.  Oral Assessment and Nursing Interventions Among Nigerian Nurses-Knowledge, Practices and Educational Needs 
Background
Assessment of oral condition, oral care, and informing the attending doctor of unusual oral findings for possible consultation or referral to a dentist are the advocated roles of hospital nurses. The objective of the study was thus to assess the roles of Nigerian nurses in the assessment of oral conditions of hospitalized patients.
Methods
This questionnaire-based cross-sectional survey of all nurses caring for hospitalized patients in the University of Benin Teaching Hospital was conducted in the first half of 2010.
Results
Of the 384 studied participants, 94.3% considered oral care as an important aspect of nursing care and 73.4% had oral health component in their nursing school curriculum. A total of 80.7% reported suspicious and abnormal findings in hospitalized patients to the attending doctor. Amongst the respondents, 38.0% reported ability to conduct good oral tissue examination. Only 28.1% demonstrated good knowledge of common oral diseases. Three-quarters (73.4%) thought that it is compulsory for nurses to assess the oral condition of hospitalized patients. The 67.7% and 21.9% of the respondents did the assessment on admission and discharge respectively. The majority (90.1%) desired training on oral care of hospitalized patients.
Conclusion
There is a need to improve the skill and competence of nurses in the assessment of oral condition to make them a substantive partner in the oral care of hospitalized patients.
PMCID: PMC3847536  PMID: 24307826
hospitalized patients; nurses; oral condition; roles
14.  Relationship Between Rewards and Nurses' Work Motivation in Addis Ababa Hospitals 
Background
Nurses constitute the largest human resource element and have a great impact on quality of care and patient outcomes in health care organizations. The objective of this study was to examine the relationship between rewards and nurse motivation on public hospitals administrated by Addis Ababa health bureau.
Methods
A cross-sectional survey was conducted from June to December 2010 in 5 public hospitals in Addis Ababa. Among 794 nurses, 259 were selected as sample. Data was collected using self-administered questionnaire. After the data was collected, it was analysed using SPSS version 16.0 statistical software. The results were analysed in terms of descriptive statistics followed by inferential statistics on the variables.
Results
A total of 230 questionnaires were returned from 259 questionnaires distributed to respondents. Results of the study revealed that nurses are not motivated and there is a statistical significant relationship between rewards and the nurse work motivation and a payment is the most important and more influential variable. Furthermore, there is significant difference in nurse work motivation based on age, educational qualification and work experience while there is no significant difference in nurse work motivation based on gender.
Conclusion
The study shows that nurses are less motivated by rewards they received while rewards have significant and positive contribution for nurse motivation. Therefore, both hospital administrators' and Addis Ababa health bureau should revise the existing nurse motivation strategy.
PMCID: PMC3407833  PMID: 22876074
Rewards; Nurses; Motivation; Public Hospitals
15.  Parent experiences of inpatient pediatric care in relation to health care delivery and sociodemographic characteristics: results of a Norwegian national survey 
Background
The national survey of parent experiences with inpatient pediatric care contribute to the Norwegian system of health care quality indicators. This article reports on the statistical association between parent experiences of inpatient pediatric care and aspects of health care delivery, child health status and health outcome as assessed by the parents, and the parents’ sociodemographic characteristics.
Methods
6,160 parents of children who were inpatients at one of Norway’s 20 pediatric departments in 2005 were contacted to take part in a survey that included the Parent Experience of Pediatric Care questionnaire. It includes 25 items that form six scales measuring parent experiences: doctor services, hospital facilities, information discharge, information about examinations and tests, nursing services and organization. The six scales were analyzed using OLS-regression.
Results
3,308 (53.8%) responded. Mean scores ranged from 62.81 (organization) to 72.80 (hospital facilities) on a 0–100 scale where 100 is the best possible experience. Disappointment with staff, unexpected waiting, information regarding new medication, whether the staff were successful in easing the child’s pain, incorrect treatment and number of previous admissions had a statistically significant association with at least five of the PEPC scale scores. Disappointment with staff had the strongest association. Most sociodemographic characteristics had weak or no associations with parent experiences.
Conclusions
The complete relief of the child’s pain, reducing unexpected waiting and disappointment with staff, and providing good information about new medication are aspects of health care that should be considered in initiatives designed to improve parent experiences. In the Norwegian context parent experiences vary little by parents’ sociodemographic characteristics.
doi:10.1186/1472-6963-13-512
PMCID: PMC3866943  PMID: 24325153
Parent experiences; Parent satisfaction; Quality of care; Inpatient pediatric care; Norway
16.  Supporting parents of preschool children in adopting a healthy lifestyle 
BMC Nursing  2012;11:12.
Background
Childhood obesity is a public health epidemic. In Canada 21.5% of children aged 2–5 are overweight, with psychological and physical consequences for the child and economic consequences for society. Parents often do not view their children as overweight. One way to prevent overweight is to adopt a healthy lifestyle (HL). Nurses with direct access to young families could assess overweight and support parents in adopting HL. But what is the best way to support them if they do not view their child as overweight? A better understanding of parents’ representation of children’s overweight might guide the development of solutions tailored to their needs.
Methods/design
This study uses an action research design, a participatory approach mobilizing all stakeholders around a problem to be solved. The general objective is to identify, with nurses working with families, ways to promote HL among parents of preschoolers. Specific objectives are to: 1) describe the prevalence of overweight in preschoolers at vaccination time; 2) describe the representation of overweight and HL, as reported by preschoolers’ parents; 3) explore the views of nurses working with young families regarding possible solutions that could become a clinical tool to promote HL; and 4) try to identify a direction concerning the proposed strategies that could be used by nurses working with this population. First, an epidemiological study will be conducted in vaccination clinics: 288 4–5-year-olds will be weighed and measured. Next, semi-structured interviews will be conducted with 20 parents to describe their representation of HL and their child’s weight. Based on the results from these two steps, by means of a focus group nurses will identify possible strategies to the problem. Finally, focus groups of parents, then nurses and finally experts will give their opinions of these strategies in order to find a direction for these strategies. Descriptive and correlational statistical analyses will be done on the quantitative survey data using SPSS. Qualitative data will be analyzed using Huberman and Miles’ (2003) approach. NVivo will be used for the analysis and data management.
Discussion
The anticipated benefits of this rigorous approach will be to identify and develop potential intervention strategies in partnership with preschoolers’ parents and produce a clinical tool reflecting the views of parents and nurses working with preschoolers’ parents.
doi:10.1186/1472-6955-11-12
PMCID: PMC3489519  PMID: 22852762
Overweight; Childhood; Preschool; Parental opinion; Health promotion; Action research
17.  Recent Developments in Public Health Nursing in the Americas 
This study presents an assessment of the participation and training of nurses in public health areas in the Americas. Information was gathered through a literature review and interviews with key informants from Mexico, Colombia, and Paraguay. Results demonstrate that there is significant variation in definitions of public health nursing across the region and current systematized data about the workforce profile of public health nursing personnel is not available for many countries in the Americas. There are significant regional differences in the levels and types of training of nurses working in public health areas and an increasing number of nurses are pursuing training in public health at the master’s and doctoral levels. Many nurses carry out some or all of the essential functions of public health, but are not considered to be public health nurses. Generally, auxiliary and technical nurses have a broader presence in public health areas than professional nurses. In the future, regional health systems reforms should support increased recruitment and training of public health nurses, as well as stronger roles in public health research and health care at the individual, community, and population levels.
doi:10.3390/ijerph7030729
PMCID: PMC2872314  PMID: 20617000
public health nursing; nursing; public health; the Americas; Latin America; essential functions of public health
18.  Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs 
BMC Oral Health  2008;8:30.
Background
The oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs.
Methods
This study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters.
Results
Fifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years) and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7%) were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5) and parents' educational status (p = 0.43). The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6). Twenty-five (46.3%) had good oral hygiene, 17 (31.5%) had fair oral hygiene and 12 (22.2%) had poor oral hygiene, with no significant difference across gender (p = 1.11) and age groups (p = 0.07). Fifteen (27.8%) had gingivitis with no significant difference across age groups (p = 0.17). Forty-five (83.3%) had Angle's class I malocclusion, 6(11.1%) class II and 3 (5.6%) class III. Chronologic enamel hypoplasia was found in 9 (16.7%) of the total population. Up to 53.7% of the total population will require oral prophylaxis, 33.3% required restorations on their posterior teeth and 12.9% required veneers for labial facing of hypoplastic enamel.
Conclusion
The subjects in this study had a high prevalence of dental caries and need for restorative care. They would benefit from parental education on diet modification, improvement of oral hygiene practices and regular dental visits.
doi:10.1186/1472-6831-8-30
PMCID: PMC2579283  PMID: 18945371
19.  Early experiences with the multidose drug dispensing system – A matter of trust? 
Objective
To study early experiences with multidose drug dispensing (MDD) among different groups of health personnel.
Design
Qualitative study based on focus-group interviews.
Setting
Primary health care, Trondheim, Norway.
Main outcome
The importance of trust in the technology and in collaborating partners is actualized in the early implementation of MDD.
Results
GPs, home-care nurses, pharmacists, and medical secretaries trusted the new MDD technology. The quality of the GPs’ medication records improved. However, health personnel, including the GPs themselves, would not always trust the medication records of the GPs. Checking the multidose bags arriving from the pharmacy was considered unnecessary in the written routines dealing with MDD. However, home-care nurses experienced errors and continued to manually check the bags. Nurses in the home-care service felt a loss of knowledge with regard to the patients’ medications and in turn experienced reduced ability to give medical information to patients and to observe the effects of the drugs. The home-care services’ routines for drug handling were not always trusted by the other groups of health personnel involved.
Conclusion
Health personnel faced some challenges during the implementation of the MDD system, but most of them remained confident in the new system. Building trust has to be a process that runs in parallel with the introduction of new technology and the establishment of new routines for improving the quality in handling of medicines and to facilitate better cooperation and communication.
doi:10.3109/02813432.2011.554002
PMCID: PMC3347930  PMID: 21323496
Drug packaging; family practice; home-care services; information sharing; medication errors; medication records; pharmacy; trust
20.  Parental beliefs and attitudes towards child caries prevention: assessing consistency and validity in a longitudinal design 
BMC Oral Health  2008;8:1.
Background
Exploring the stability of self-reports over time in observational studies may give valuable information for the planning of future interventions. The aims of the present study were: 1) to explore the consistency of parental self-reports of oral health habits, beliefs and attitudes towards child oral health care over a two-year period; 2) to evaluate possible differences in item scores and consistency between parents with different immigrant status; and 3) to assess the construct validity of items measuring parental beliefs and attitudes towards child oral health care.
Methods
The sample (S1, n = 304) included parents of 3-year-old children in Oslo, Norway; 273 mothers of western origin (WN-group) and 31 of non-western origin (IM-group). They were surveyed in 2002 (child age 3 years) and in 2004 (child age 5 years). Two additional samples of parents were also included; one with 5-year old children in 2002 (S2, n = 382) and one with 3-year-old children in 2004 (S3, n = 427). The questionnaire included items measuring child oral health habits and parental beliefs and attitudes towards child oral health care.
Results
In 2002, 76.8% of the parents reported that they started to brush their child's teeth before the age of 1 year. Eighty-five percent of them reported the same in 2004; 87.0% of the WN-group and 33.3% of the IM-group (P < 0.001). For 17 of 39 items measuring beliefs and attitudes the responses were more positive for the WN-compared to the IM-group. Parents of caries-free children in 2004 reported significantly more positive beliefs and attitudes towards child oral health care in 2002 compared to parents of children with caries in 2004 (P < 0.05, P < 0.01 and P < 0.001). No differences in mean item scores were found between the three samples S1, S2 and S3.
Conclusion
The results showed a fair to good consistency of parental self-reports from 2002 to 2004. They also indicate that parents with different cultural backgrounds should be evaluated separately and in a cultural context.
doi:10.1186/1472-6831-8-1
PMCID: PMC2258292  PMID: 18215270
21.  Improving Collaboration between Public Health and Family Health Teams in Ontario 
Healthcare Policy  2013;8(3):e93-e104.
Objectives:
To identify and explore areas where responsibilities may overlap between family health teams (FHTs) and public health units (PHUs); to identify facilitators or barriers to collaboration; and to identify priority areas for increased collaboration.
Design and context:
Cross-sectional mixed-methods study of FHTs and PHUs in Ontario, Canada, consisting of a postal survey, key informant interviews and a roundtable meeting.
Results:
The survey response rate was 46%. Direct client-based services such as giving immunizations, promoting prenatal health and nutrition, and counselling related to smoking cessation were identified as the top three areas of perceived overlap. The greatest interest in collaboration was expressed in the areas of emergency planning and preparedness, immunization, and prenatal health and nutrition. Good communication with a clear understanding of roles and functions was the most important facilitator, and lack of resources and absence of a clear provincial mandate and direction to collaborate were identified as significant barriers.
Conclusions:
Small, simple client-based projects of interest to both kinds of organization would be the best way to move forward in the short term. Improving communication between FHTs and PHUs, understanding of roles and functions, the use of shared or interoperable information systems and greater clarity from government on the ways in which these two key sectors of the healthcare system are intended to work together were identified as important for the success of increased collaboration.
PMCID: PMC3999554  PMID: 23968630
22.  Integrating Asthma Education and Smoking Cessation for Parents: Financial Return on Investment 
Pediatric pulmonology  2012;47(10):950-955.
Summary
Background
Caregivers who smoke and have children with asthma are an important group for intervention. Home-based interventions successfully reduce asthma morbidity, yet are costly. This study evaluated the financial return on investment (ROI) of the Parents of Asthmatics Quit Smoking (PAQS) program, a combined asthma education and smoking cessation intervention.
Methods
Participants included caregivers (n = 224) that smoked, had a child with asthma, and were enrolled in a Medicaid managed care plan. Participants received nurse-delivered asthma education and smoking counseling in three home visits. Program implementation costs were estimated, and health care expenses were obtained from insurance claims data 12 months pre- and 12 months post intervention. ROI was calculated for all participants, children < 6 years, children 6–18 years, and children with moderate/severe persistent asthma.
Results
Total program implementation cost was $34,481. After intervention, there was increased mean annual refills of beta-agonist (0.51 pre, 1.64 post; p<0.001), and controller medications (0.65 pre, 2.44 post; p<0.001). Reductions were found in mean annual emergency department visits (0.33 pre, 0.14 post; p<0.001), hospitalizations (0.23 pre, 0.08 post; p<0.001), and outpatient visits (2.33 pre, 1.45 post, p<0.001). The program had negative ROI (−21.8%) for the entire sample. The ROI was positive (+106.9) for children < six years, negative (−150.3) for children 6–18, and negligible for moderate/severe persistent asthma (+6.9%).
Conclusion
PAQS was associated with increased medication use and decreased health care utilization. While the overall ROI for PAQS was negative, PAQS had a positive ROI for caregivers of young children with asthma.
doi:10.1002/ppul.22559
PMCID: PMC3407822  PMID: 22467563
Asthma; Pediatrics; Smoking Cessation; Education
23.  Providers’ perspectives on collaboration 
Objective
Changes in models of health care are required to better meet the needs of diverse, underserved patient populations. Collaboration among providers is one way to promote accessible, comprehensive and continuous care in healthcare organizations. This paper describes the quantitative findings from two time points that examined providers’ views of collaboration among a sample of diverse personnel (e.g. clinical nurses, social workers, dental providers, mental health providers, clerical staff, medical assistants, public health staff, and administrators) within a federally qualified nurse managed health care centre in the United States.
Methods
The quantitative arm of a mixed-method study is presented in this paper. Two instruments, the Collaboration and Satisfaction About Care Decisions Scale and the University of the West of England Interprofessional Questionnaire (comprised of 4 subscales–Communication and Teamwork Scale, Interprofessional Learning Scale, Interprofessional Interaction Scale, and Interprofessional Relationships Scale) were administered to providers at baseline and three to eight months following six same discipline focus group discussions on collaboration, in order to evaluate whether participating in the focus group discussions changed providers’ views of collaboration. A summary of the focus group data which were published elsewhere is additionally summarized to help provide insight to the quantitative findings. Thirty-nine staff participated.
Results
Paired t-tests revealed that only one scale out of the five, Collaboration and Satisfaction About Care Decisions Scale (33.97 at time one and 37.45 at time two), significantly and positively changed after the focus group discussion (p=0.046). Providers’ views on collaboration ranged from positive to moderate views of collaboration; most measures revealed a non-significant improvement after the focus group discussions. Staff with some graduate school reported the greatest satisfaction with decisions for the patient, and those with high school reported the lowest satisfaction with decisions for the patient. Respondents with a graduate degree had the most positive views of interprofessional relationships, whilst those with either a high school degree or bachelor’s degree had the most negative views of interprofessional relationships. ANOVAs by professional role revealed the least positive views of collaboration for provider groups with lower levels of education, with upper administration reporting the most positive views on collaboration.
Conclusion
Although the discussion generated by the focus groups was expected to facilitate communication, and research has suggested that communication between providers facilitates collaboration, only one subscale evaluating providers’ views of collaboration positively and significantly changed after the focus group discussion. The wide range of views on collaboration suggests there are diverse perspectives on collaboration among the staff based on professional roles and levels of education, with upper administration and those with higher levels of education reporting the most positive views of collaboration and staff with lower levels of education reporting more negative views of collaboration. A major limitation of this study was a low time two return among support staff, comprised of primarily African American women. Due to their marginalized professional and racial status, future research needs to explore the perspectives of this important and often overlooked group of staff.
PMCID: PMC3564422  PMID: 23390411
collaborative care; hierarchy; health disparities
24.  Parental Perception of Oral Health Status of Children in Mainstream and Special Education Classrooms 
The aim of this study was to compare parental perceptions of oral health status and access to dental services by children in 34 special education and 16 mainstream public elementary school classes in San Mateo County, CA. A self-administered parental survey was utilized and included questions about demographics, oral health and dental utilization. The overall response rate was 58.8%. After adjusting for age and gender of the child, compared to mainstream, parents of special education students were significantly more likely to report their child to have: worse oral health (OR= 2.4, 95% CI 1.54, 3.67) lacking a past year dental visit (OR= 1.96, 95% CI 1.01, 3.84), and missed school days due to dental reasons (OR = 2.5, 95% CI 1.55, 4.17). Both groups rated the child’s oral health inferior to overall health rating (p<0.001). The authors concluded that disparities exist between the two groups in parental perceptions of their children’s oral health status and dental service utilization.
doi:10.1111/j.1754-4505.2009.00086.x
PMCID: PMC3106150  PMID: 19573042
Dental care; health status; health care disparities; parental perception; special education; child
25.  Nursing faculties’ knowledge and attitude on evidence-based practice 
Background:
Evidence-based practice (EBP) is one of the main professional competencies for health care professionals and a priority for medicine and nursing curriculum as well. EBP leads to improve effective and efficient care and patient outcomes. Nurse educators have responsibility to teach the future nurses, and an opportunity to promote patient outcomes. Therefore, the aim of this study was to describe nurse educators’ knowledge and attitude on EBP.
Materials and Methods:
This was a descriptive study conducted in nursing faculties of two major universities of medical sciences affiliated to Ministry of Health and Medical Sciences in Tehran, Iran. Data were gathered using a three-section questionnaire. Content and face validity was further enhanced by submitting it to nursing research and education experts. Statistical analysis was carried out using SPSS 11 software.
Results:
According the results, nursing faculties’ knowledge of EBP was mainly moderate (47.1%). Significant statistical relationship was found between the level of knowledge with education and teaching experience in different nursing programs. Nurses generally held positive attitudes toward EBP (88.6%) and there was no statistical significant relationship with demographic variables.
Conclusion:
Nursing educators are in a position to influence nursing research in clinical practice in the future. Therefore, it is critical to achieve implementation of EBP and be a change agent for a paradigm shift toward EBP.
PMCID: PMC3730454  PMID: 23922597
Attitude; evidence-based practice; Iran; knowledge

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