| |  | Davies, B. | Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings read moreAbstract: ABSTRACT: BACKGROUND: Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. METHODS: A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD), foot complications in diabetes, smoking cessation and venous leg ulcers). Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review). Process and patient outcomes were assessed by chart audit (n=681 pre-implementation, 592 post-implementation). Outcomes were also assessed for four of six topics by in-hospital/home interviews (n=261 pre-implementation, 232 post-implementation) and follow-up telephone interviews (n = 152 pre, 121 post). Interviews were conducted with 83/95 (87%) CRNs, nurses and administrators to describe recommendations selected, strategies used and participants perceived facilitators and barriers to guideline implementation. RESULTS: While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%), diabetes foot care (83%) and venous leg ulcers (60%). Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time, workload pressure and staff resistance. CONCLUSIONS: Implementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse settings yet many indicators remained unchanged. Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare. | 2008 |
| | | Akerman, Marco | É possível avaliar um imperativo ético? read moreAbstract: Stakeholders and institutions involved in implementing public policies, of which health promotion is the main axis, have discussed the need to improve evaluation processes in order to appropriately understand the results of these actions. This issue has been approached with diverse emphasis - seeking elements that demonstrate the effectiveness of the actions, and developing participatory evaluation tools that address the philosophical principles of the health promotion . This article briefly presents the main current perspectives of health promotion assessment based primarily on the following references: a book published by WHO, in 2001, updates the state-of-the art in evaluation of health promotion; an initiative by PAHO implemented in the past years with an emphasis on participatory evaluation methodologies; and a project on evidence and effectiveness carried out by IUHPE, as of 2002. Finally, it addresses a set of values and principles that could guide health promotion assessment. Moreover, the paper discusses three critical variables related to developing a participatory evaluation process in a healthy city project.These perspectives demonstrate the importance of establishing a conceptual landmark for evaluation, and that health promotion assessment is not exempt from values and principles. | 2004 |
| | | Morrison, Jill | ABC of learning and teaching in medicine: Evaluation read moreAbstract: Sorry no abstract available for this article | 2003 |
| | | Smee, Sydney | ABC of learning and teaching in medicine: Skill based assessment read moreAbstract: Sorry no abstract available for this article | 2003 |
| | | Conill, Eleonor M. | Organização dos serviços de saúde: a comparação como contribuição read moreAbstract: This article discusses about a recent procedure in health care studies, the comparison as a methodology of analysis. The different analytical currents refer to a particular method of understanding health-disease process. They are: functionalism, the historical-materialism and the new currents. Their phylosophical and sociological basis, concepts, analysis instruments and purposes are showed here by a review of the principal works from representative authors as Navarro, Terris, Roemer, Fry, Illich, Capra and others. The paper suggests that comparative analysis can take two directions: the first is a operational approach for analysing the concrete situations of health's service organization, the second, a more conceptual one, aimed at identifying critical questions and international tendencies in health's systems. The recent discussion search for the overcoming of these dichotomies toward the progress of the production of knowledge and its efects in health's services organization. | 1991 |
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