One of the most pressing challenges facing health-care systems and the nursing community worldwide is the growing shortage of nurses. Globally, there is wide acknowledgment that the scarcity of nurses, combined with the short supply of other health workers, is rapidly establishing itself as a major threat to public health in many nations. In a number of countries, the shortage of health workers, particularly nurses, is placing a tremendous burden on already overtaxed health systems and is creating a major barrier to the provision of essential health services. For others, notably the least developed countries, inadequate human resources have become the most significant constraint on the attainment of national and international health and development goals. Show
Current and predicated nursing shortages, in both developed and developing countries, have been reported by a number of organizations including the World Health Organization, the World Bank, the Pan American Health Organization, the International Council of Nurses, Physicians for Human Rights, and the Global Health Trust. Nowhere in the world is the shortage said to be more pronounced or severe than in sub-Saharan Africa where deficiencies in supply are exacerbated by the international movement of nurses to more developed countries in search of better working conditions and quality of life. In countries of this subregion, it is not uncommon to find one nurse responsible for providing care to 50 to 100 patients at one time. Nursing shortages are not a new phenomenon. A number of developed countries, notably the United Kingdom, Canada, and the United States, have cycled through shortages in the past frequently as a result of demand for nursing services exceeding supply. However, the current shortage is unlike those of the past, as health systems worldwide are experiencing pressures exerted on both the supply of and demand for nurses. While the demand for health services and nurses is growing due to demographic and epidemiological changes, among other factors, the supply of available nurses in many countries is diminishing and is predicted to worsen in the absence of countermeasures. Inadequate human resources planning and management, including poor deployment practices, coupled with high attrition from the workforce (due to poor work environments, low professional satisfaction, and inadequate remuneration), international and internal migration, the impact of HIV/AIDS, and chronic underinvestments in health human resources are major factors driving the current nursing shortage. Additional factors affecting the supply of, and demand for nursing services are highlighted in Table 4. Table 4. Factors affecting the supply of and demand for nursing services Increased demandReduced supply• Reduced lengths of stay in hospitals increasing the acuity of care •A shrinking labor pool resulting from fewer young people entering and remaining in the profession •Shift from hospital to ambulatory, home, and community care creating a fast-growing labor market for nurses outside hospital facilities •Expanded career opportunities for women •Advances in medical science and technology heightening the need for nurses •Increased number of nurses leaving the profession in mid-career or through retirement •Rising consumer expectations and public demand for services •Aging nursing faculty workforce •An aging population, emphasizing long-term health-care services •Increased number of mature students with reduced potential years of professional practice •Growing burden of chronic and degenerative disease resulting in higher demands for nursing care •Past government decisions to reduce nursing student positions •Emergence of new diseases and the re-emergence of old ones •Increased career opportunities outside the health-care sector, offering better pay and working conditions •Greater nurse entrepreneurship opportunities expanding the labor market •Student attrition from nursing education programs •A growing private sector expanding the labor market •Poor image of the profession as a career •Globalization facilitating the mobility of nurses and further expanding the labor market •Increased opportunities and demand for nurses outside the nursing service, e.g., generic management Adapted from International Council of Nurses, 2001. Position Statement on Ethical Nurse Recruitment. International Council of Nurses, Geneva, Switzerland. Ironically, today's nursing shortages exist parallel with the unemployment of thousands of nurses, particularly in parts of Asia, Latin America, Eastern Europe, and Africa. High rates of unemployment are primarily the result of employment/hiring freezes caused by loan conditions placed on borrowing countries by donors and international monetary institutions. As well, a number of countries report underemployment of nurses due to policies and practices that deter them from obtaining full-time employment. In a number of countries, nursing shortages coexist with the shortage of nurse educators. These shortages are the result of an aging nursing faculty workforce and a limited pool of younger faculty to replace those retiring. The reduction in the availability of faculty is serving to intensify the current nursing shortage by reducing the ability of education providers to increase their intake of applicants to meet future demand. The international recruitment and migration of nurses has, in the past decade, become a growing concern for national governments, nursing organizations, employers, and the global health and development community. The World Health Assembly, the World Health Organization's highest decision-making body, has repeatedly drawn attention to the international migration of skilled health workers and the challenges it poses for health systems, particularly in resource-poor countries. While not a new phenomenon, the international movement of nurses from developing to developed countries is accelerating. Increasingly, nurses are choosing to leave their native country seeking better working conditions and quality of life elsewhere. Their movement across national borders is attributed to a number of push and pull forces. On the push side are factors such as difficult working environments (often characterized by heavy workloads, risk of exposure to violence, abuse and occupational hazards, lack of autonomy and decision-making authority, limited access to supplies, medication, and technology), low pay, poor career advancement opportunities, lack of non-monetary incentives, and sociopolitical unrest. On the pull side, nurses may migrate to other countries in search of better opportunities for professional development, safer and better equipped working environments, improved remuneration and incentives, greater sociopolitical stability, and a desire for greater professional autonomy. However, large-scale, and often aggressive international recruitment by developed countries is cited as a major contributing factor to the current high levels of nurse migration. Developed countries have increasingly come to rely on recruiting foreign-trained nurses to fill their domestic shortfalls instead of addressing in-country recruitment and retention issues. The effects of this practice on developing countries include a loss of skilled human capital and economic investments and an inability to adequately meet national health service needs. Unethical recruitment practices are occurring worldwide and there is a lack of regulatory oversight at both national and international levels. The International Council of Nurses, the World Health Organization, and the Commonwealth Secretariat, while supporting the right of nurses to migrate, have all independently made calls in the form of position statements, resolutions, and codes of practice for better monitoring and more ethical approaches to nurse migration. In 2005, the International Council of Nurses and the Commission on Graduates of Foreign Nursing Schools teamed up to establish the International Centre on Nurse Migration – a global resource for the development, promotion, and dissemination of research, policy, and information on nurse migration. The Centre works to address gaps in policy, research, and information with regard to the migrant nurse workforce, including screening and workforce integration. Internationally, the scarcity of nurses is having a negative impact on patients, health systems, and nursing personnel and there is a significant body of research documenting its impact. For instance, nursing shortages have been linked to increased mortality, accidents, injuries, cross-infection, and adverse postoperative events. The International Council of Nurses has recently completed a major two-year research and global consultation initiative to document the state of today's nursing workforce and to inform future policy making. Through its work, the Council has identified five priority areas that require policy attention in the immediate, short, and long term, at both national and international levels. These areas are: macroeconomic and health sector funding policies; workforce policy and planning, including regulation; positive practice environments and organizational performance; recruitment and retention; addressing in-country maldistribution, and out-migration; and nursing leadership. Full details of this work can be obtained on the ICN website. In 2006, ICN established the International Centre for Human Resources in Nursing. The Centre, whose ultimate aim is to bring about improvements in the quality of patient care through the provision of better managed health care and nursing services, serves as an online gateway to comprehensive information, resources, and analysis on nursing human resources policy, management, and practice. The World Health Assembly has repeatedly recognized the essential role nurses and midwives play in the provision of effective health services and has made calls, through numerous resolutions, to strengthen the workforce. In 2006, during the 59th session of the Assembly, 192 member states unanimously adopted a major resolution to strengthen nursing and midwifery. The resolution urges member states to commit to strengthening the workforce by: (1) establishing comprehensive programmes for the development of human resources which support the recruitment and retention, while ensuring equitable geographical distribution, in sufficient numbers of a balanced skill mix, and a skilled and motivated nursing and midwifery workforce within their health services; (2) actively involving nurses and midwives in the development of their health systems and in the framing, planning and implementation of health policy at all levels, including ensuring that nursing and midwifery is represented at all appropriate governmental levels, and have real influence; (3) ensuring continued progress toward implementation at country level of WHO's strategic directions for nursing and midwifery; (4) regularly reviewing legislation and regulatory processes relating to nursing and midwifery in order to ensure that they enable nurses and midwives to make their optimum contribution in the light of changing conditions and requirements; (5) to provide support for the collection and use of nursing and midwifery core data as part of national health information systems; (6) to support the development and implementation of ethical recruitment of national and international nursing and midwifery staff (WHO, 2006: pp. 1–2). View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780128036785003052 Health PsychologyHelen R. Winefield, in Comprehensive Clinical Psychology, 1998 8.07.2 Key Health ProfessionsThis chapter will concentrate on the health disciplines which receive preregistration training in universities, including institutions of higher education which were formerly known as colleges of advanced education, polytechnics, or institutes of technology. Other disciplines which promise health care but for which training generally occurs outside universities include chiropractice, naturopathy, hypnotherapy, aromatherapy, and so on. While these “alternative” treatments sometimes win acceptance from doctors and nurses who recommend them to their patients, little information is publicly available about their training curricula or assessment methods. However, at least some of the material in this chapter seems likely to be applicable to them too. Many health professions provide continuing education for their members after entry to the workforce, in the form of workshops, seminars, conferences, and journals, either on a voluntary basis or in a formal way overseen by registration or professional bodies. With recognition of the ever-faster expansion of knowledge, and acknowledgement that undergraduate instruction cannot suffice for a life-long practicing career, we may expect that some form of regulated continuing professional education will become more rather than less common. Thus postregistration health psychology teaching and training seems likely to increase in extent in the relatively near future. Everything said below about mutual collaboration between health psychologists and members of the profession concerned, applies with even greater force to postregistration teaching. A great deal of variability exists in the methods and content of teaching health psychology to different sets of students. When we multiply the variations within different professions, undergraduate vs. postgraduate courses, teaching institutions, cities and countries, it is clearly unrealistic for a chapter such as this to give a detailed account of hours spent, methods used and course content in every case. Rather the goal here will be to convey a flavor of what aspect of health psychology are taught in the nonpsychology disciplines, largely based on a review of published textbooks. Learning via the Internet, which has been predicted to change academic methods radically, will be discussed later (see Section 8.07.4.1.4). Published teaching materials are probably only a small proportion of those in use. The existence of a textbook indicates that somebody, perhaps an individual, probably a curriculum committee but certainly a publisher, perceived a need for that educational resource. However every teacher is well aware that published materials may not accurately represent the examinable content of the course, and even less do they reflect the methods used to teach it. Another major problem for the comprehensiveness of a review such as this is the fact that we have limited understanding of the relationship between the teaching provided, and what students learn. Doubtless the teachers' credibility, skills, knowledge, enthusiasm, and similar factors mediate how the teaching is received and therefore what impact it may have on the later professional practice of graduates. Apart from some comments on when and by whom teaching should occur (in Section 8.07.4), such issues are beyond the scope of this chapter, but do need systematic attention and research by educators. The main health professions described below are not in order of status within the health care industry, nor in order of the competition for places and thus the prior academic qualifications of the students. Current numbers of Australian students have been chosen as an ordering principle. The health education system in Australia is very similar to the British, and Australian health professionals are found all over the world. While the number of students may not be proportional to the number of practitioners, it is reasonable to use student numbers in a chapter on training because the great bulk of formal training occurs before professional registration and practice. Table 1 shows the numbers of health and social work students who were enrolled in higher education in Australia in 1995. An average of 6.5% of students across health disciplines came from overseas and were paying full fees, with the highest proportions being in pharmacy (14%), medicine (12%), and dentistry (11%). Overseas students mostly speak English as a second language, and language-rich subjects such as psychology need to provide extra support and language tuition to help them succeed. The most effective support includes discussion of cultural assumptions as well as language help (Ballard & Clanchy, 1991; Chur-Hansen & Barrett, 1996). Asian and European cultures have different norms and expectations about health-relevant behavior, challenging what has sometimes been an unself-conscious Anglocentrism in health psychology. In health and health care, cultural differences in beliefs and practices need to be understood by teachers and trainers as well as by practitioners. To a less marked extent the same point applies to students of different social class backgrounds within the same language group. Table 1. Student enrollments in health by field of study, higher education, Australia, 1995. Field of study1995 enrollmentsBasic nursing23 228Postbasic nursing10209Medicine10471Medical science1973Medical radiography1549Medical technology1153Dentistry1408Dental therapy37Nutrition and dietetics671Optometry786Pharmacy2078Podiatry352Rehabilitation584Other rehabilitation512Occupational therapy2378Physiotherapy3037Speech pathology/audiology1235Health support1841Health administration2276Health counseling759Health surveying760Health science and technology1060Health sciences — other1280Health support — other660Health — general1840Total health72137Social work6050 Source: Department of Employment, Education, Training & Youth Affairs, Canberra. 8.07.2.1 NursingIn terms of student and practitioner numbers, the discipline of nursing is the dominant healthcare profession: there were three times as many nursing students as medical students (see Table 1). Nursing education has established itself in Australian universities since the early 1980s in contrast with the previous apprentice-style, bedside teaching methods (McCue & White, 1983). A recent review of nurse education concluded: The need now is to move beyond the era of the transfer [of nursing to higher education]… [to] the development of professional practice, the growth of nursing as an academic discipline, and the future contribution of education and research to the quality of nursing care. (Reid, 1994, p. 341) This review identified as core curriculum:
Doctor-nurse relationships have been described by sociologists and anthropologists (e.g., Campbell-Heider & Pollock, 1987) but there is now an interest among nurses themselves in understanding the political dimensions of health care and in improving community health through active advocacy (Gray & Pratt, 1992). The establishment of doctoral training programs in nursing which include coursework and fieldwork in addition to research training is intended to assist nurses who seek careers in consultancy, management, and policy making (Pearson, 1996). In the USA there is a very wide choice of masters and doctoral programs for nurses. At the undergraduate level there is longstanding and continuing interest in the psychological aspects of nursing (Byrne & Byrne, 1992; Hall, 1982; McGhie, 1973, Paton & Brown, 1991; Payne & Walker, 1996). One of the few texts to identify itself specifically as health psychology for nurses (Niven, 1994) includes in its preface an explicit articulation of a crucial issue in health psychology training for all nonpsychologists—namely what is the most desirable framework to adopt? Whereas early texts in nursing as in other health disciplines tended to adopt the framework of what aspects of psychology might be relevant to health care, Niven adopted instead the framework of a psychology of health. Taking health rather than psychology as the primary focus need not in fact result in vastly different contents from those of the more traditional approach (although they will be differently arranged and presented), but seems likely to have the important pedagogic advantage of being more attractive and credible to students (see Section 8.07.4). 8.07.2.2 MedicineMedical courses have included psychological content, often under titles such as “behavioral science,” “medical psychology,” and “behavioral medicine,” for many years now (DiMatteo, Friedman, & Robin 1982; Hetherington, Miller, & Neville, 1964; Pomerleau & Brady, 1979; Rachman, 1977; Stoudemire, 1994; Wedding, 1995; Weinman, 1987; Winefield & Peay, 1991). Health psychologists have seized the opportunity to teach medical students and thereby develop relationships with medical practitioners and engage in collaborative research (Winefield, 1991). While the technological advances of the post-World War II period have fostered a strong emphasis and high prestige within medicine for pharmaceutical, surgical, and diagnostic techniques—in general the “bio” element within the “biopsychosocial” model of health care (Engel, 1977)—health psychology with its focus on behaviors, beliefs, and feelings in relation to health and illness, adds the balance of a multivariate and holistic perspective on health care and health promotion. Just as clinical psychology has experienced border disputes with the medical specialty psychiatry, health psychology seems most likely to compete with consultation-liaison psychiatry, the clinical derivative of psychosomatic medicine with its interests in cardiovascular disease, oncology, and chronic pain (Wise, 1986). Some clinical health psychologists spend their time in the delivery of services to individual patients, but others such as occupational health psychologists work in ways more congruent with public health (Quick, 1996). 8.07.2.3 Medical Social WorkThe 1991 Australian census indicated that 35% of social workers will work in health settings (Martin, 1996), thus justifying the inclusion of this profession here. This profession shows large national differences in its organization; in the USA, for example, social workers much more often practice autonomously than in Britain and Australia. Teaching materials tend to have a strong practice orientation (Danbury, 1994; James and Vinson, 1989; Shulman, 1993), although Thompson (1995) has argued in favor of integrated theory and practice. Developmental and social psychology seem to have been most valued, but social workers in medical settings may learn to welcome health psychology input. 8.07.2.4 Physiotherapy/Physical TherapyThis discipline, like others traditionally seen as “adjunct,” “allied,” or even “para” in relation to medical services, was once taught using an apprenticeship model within the work (usually hospital) setting. Physiotherapists use exercise, manipulation, and physical interventions such as heat and ultrasound to treat problems of pain, restricted movement, and the consequences of injury or aging. An early textbook by Dunkin (1981) focused on learning, individual differences, and interpersonal relations, and encouraged students to search the literature to follow up their interests. 8.07.2.5 Occupational TherapyThe practice of this discipline seeks to foster the health benefits of occupation, in the sense of purposeful activity, especially for persons with psychiatric, intellectual or physical disabilities. While virtually theory free in the past, the profession recognizes a need to identify and evaluate its skills and to prepare practitioners for work in a variety of settings (Fransella, 1982; Kielhofner, 1992). 8.07.2.6 PharmacyThe Report of the Study Commission on Pharmacy (1975) found an imbalance in the curriculum of the day, with too much attention being given to drug products and their effects and too little to “human behavior, cultural determinants, health service systems and their economics…. Needed and optimally effective drug therapy results only when both drugs and those who consume them are fully understood” (pp. 126-127). Wertheimer and Smith (1989) aimed to redress this imbalance, including readings on topics such as the patient's view of the illness, compliance, choices of prescribed and nonprescribed drugs, tranquillizers and social control, and ethics and informed consent. Public attitudes to medicines, which seem to be increasingly ambivalent (Vuckovic & Nichter, 1997), need to be understood by many health professionals in addition to pharmacists. 8.07.2.7 DentistryTextbooks on the psychological aspects of dental practice have been available for some time (e.g., Ayer & Hirschman, 1972; Cinotti, Grieder, & Springob, 1972). Obvious topics of interest include dental anxieties and phobias, bruxism, oro-facial pain and compliance with self-care or orthodontic instructions. 8.07.2.8 Speech Pathology/TherapyDisorders of oral communication whether due to childhood lack of skill development or to loss of skills after stroke or head injury occupy speech pathologists, who treat them using graded exercises. Purser (1982) was an early contributor to their understanding of developmental and social psychology and behavior change. 8.07.2.9 Other Health-related OccupationsVarious forms of medical scientist, and support professions such as radiography, dietetics, podiatry (chiropody), and health administration are also taught in universities. It appears that their curricula are task-focused and in some cases their direct service roles limited; where health psychological input is required it may well be taught using materials originally prepared for other disciplines, or specific to the course and not commercially available. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B0080427073000845 Addressing Sexual Activity of EldersHelene L. Lohman, ... (Previous contributions from David Plutschack), in Occupational Therapy with Elders (Fourth Edition), 2019 Evidence Brief: Effectiveness of Interventions Addressing Sexual Activity of EldersGedin, T., & Resnick, B., 2014. Increasing risk awareness and facilitating safe sexual activity among older adults in senior housing. Journal of Community Health Nursing, 31 (4), 187–197. doi: 10.1080/07370016.2014.958390. The prevalence of HIV in older adults is rising. This increase can be attributed to inconsistent condom use, low perceived disease susceptibility, and a sexual health knowledge gap found in older adults. This study confirmed the feasibility of a group-based educational program in senior housing settings and considered the utility of a self-efficacy-based group education program on knowledge of disease risk and preventive techniques among older adults living in senior housing. MacDonald J, Lorimer K, Knussen C, Flowers P. Interventions to increase condom use among middle-aged and older adults: A systematic review of theoretical bases, behavior change techniques, modes of delivery and treatment fidelity. Journal of Health Psychology. 2016;21:2477–2492. doi: 10.1177/1359105315580462. A telephone-administered intervention, which had a higher number of behavior change techniques and employed more treatment fidelity strategies, was more effective in increasing condom use among this population. Negin J, Rozea A, Martiniuk A. HIV behavioral interventions targeted toward older adults: A systematic review. BMC Public Health. 2014;14:977–996. doi: 10.1186/1471–2458–14–507. Telephone-based interventions can reduce risky sexual behavior among older adults. Overall, however, more evidence is needed on what interventions work among older adults to support prevention, adherence, and testing. Wittmann D, Chang H, Mitchell S, et al. A 1-day couple group intervention to enhance sexual recovery for surgically treated elderly men with prostate cancer and their partners: A pilot study. Urological Nursing. 2013;33:140–147. doi: 10.7257/1053–816X.2013.33.3.140. Researchers evaluated the acceptance and effectiveness of a group intervention that provided education about postprostatectomy sexual recovery and peer support for couples. Couples valued the intervention and retained the information. Partners became accepting of erectile dysfunction and communicated more openly about upsetting topics. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323498463000123 The Role of Nonprofit, Nongovernmental Funding in Support of Biomedical ResearchRose Marie Robertson, Suzie Upton, in Clinical and Translational Science (Second Edition), 2017 Recipient TypeAcademic medical centers—Accredited medical schools or academic hospitals in which a majority of the physicians are faculty members; may include other health professional schools, such as public health, nursing, or graduate schools in the life sciences. Other medical centers—A single entity or loose conglomerate not directly affiliated with a medical school or university, usually focused on patient care and residency training. Medical associations—Professional membership organizations for physicians. Professional associations—Professional membership organizations for health-care professionals such as nurses, nurse practitioners, physician assistants, and pharmacists. Patient organizations—Nonprofit organizations that represent the interests of patients by providing information and services, support for increased medical research, and/or access to health care. Scientific associations—Organizations that exist to promote an academic or scientific discipline through activities including regular meetings or conferences for the presentation and discussion of new research results, and publishing or sponsoring academic journals. Civic organizations—Nonprofit organizations that promote social welfare. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780128021019000405 Relaxation Techniques and Guided ImageryCarla Rime, Frank Andrasik, in Pain Management, 2007 ▪ INDICATIONSIn 1996, the National Institute of Health organized a non-federal, non-advocate panel of representatives from the fields of medicine, psychiatry, psychology, public health nursing, and epidemiology.2 This 12-member panel conducted an extensive evaluation of the literature on behavioral and relaxation approaches for the treatment of pain and insomnia. Moreover, 23 experts in the fields of behavioral medicine, pain medicine, psychiatry, psychology, nursing, and neurology presented information to the panel during a conference. After deliberation, the panel concluded that “… the evidence is strong for the effectiveness of [relaxation] techniques in reducing chronic pain in a variety of medical conditions” (p. 315). The panel further stated that “… the data are insufficient to conclude that one technique is usually more effective than another for a given condition” (p. 315). Relaxation techniques are often combined into a treatment package in the clinical setting. Investigations of these therapies, either combined or in isolation, have been carried out to determine their effectiveness. Relaxation procedures and GI have been applied to a number of both acute and chronic pain conditions and their secondary symptoms. The following presents a sampling of the literature regarding these techniques as treatments. Neumann and associates16 compared pain tolerance between those who received pain-incompatible imagery training and a control group. A pain algometer, which is a cylinder placed on the finger that gradually applies pressure, was used to assess pain thresholds for the participants. Additionally, heart rate and skin resistance measures were obtained. The investigators found that those who had been trained in imagery had higher pain tolerance and lower heart rates than the control group did. There were no differences in skin resistance between the two groups. Relaxation and imagery are components of the Arthritis Self-Management Program (ASMP) for the treatment of rheumatoid arthritis and osteoarthritis.17 Other elements of this program include patient education, cognitive restructuring, problem solving, and communication skills. A review of the program indicated that there was an average 15% to 20% reduction from baseline in arthritis-related pain and disability.18 A study of a modified version of ASMP in which self-efficacy was emphasized reported that the reductions in pain were maintained after 4 years and that there was a 43% decrease in physician visits.19 Another study on rheumatic pain compared muscle strength and mobility exercises with an abbreviated form of PMR. The investigators found that PMR was significantly better than strength training with regard to muscle function of the lower extremities. Furthermore, the results suggested that PMR improved health-related quality of life.20 Likewise, a study using PMR and GI as treatment of osteoarthritis indicated that 12 weeks of this treatment led to a significant decrease in pain and mobility difficulties when compared with a control group.21 Other investigations on the use of relaxation techniques for chronic pain have focused on back pain. Turner and Chapman22 compared PMR, cognitive-behavioral therapy, and a waitlist/attention technique for chronic low back pain. Significant improvements in pain measures for the PMR and cognitive-behavioral groups were reported, and a 1.5- to 2-year follow-up showed that participants in these two groups had a notable decrease in healthcare use. A different study compared a relaxation intervention, an electromyogram (EMG) biofeedback intervention, and a placebo condition for chronic low back pain patients. The relaxation intervention was found to be superior to biofeedback and placebo on measures of reduced pain and increased activity.23 Relaxation techniques have also been applied to burn patients. Débridement is a painful procedure that involves scrubbing the dead skin from the burn area. This procedure is performed routinely for weeks or even moths.15 Achterberg and associates24 assessed the effectiveness of relaxation, relaxation combined with imagery, and relaxation combined with both imagery and biofeedback for burn victims undergoing débridement. These three interventions were compared with a control group. The study took place in a hospital burn care unit, so the practical implementation of these interventions was also assessed. Even though all three interventions produced improvements in pain and anxiety measures in comparison to the control group, the relaxation/imagery and the relaxation/imagery/biofeedback interventions had superior and nearly equivalent results. The relaxation/imagery intervention was considered the most practical in terms of administration in the busy burn unit of the hospital. A meta-analysis examining imagery training for cancer pain concluded that this form of treatment significantly decreases the sensory experience of pain, significantly reduces depression and anxiety, but has no effect on the functional status of daily living.25 Syrjala and colleagues26 evaluated the following interventions in patients undergoing bone marrow transplantation: (1) relaxation and imagery, (2) cognitive-behavioral treatment combined with relaxation and imagery, (3) therapist support, and (4) treatment as usual, which served as the control condition. This study demonstrated that both the relaxation/imagery and cognitive-behavioral/relaxation/imagery interventions resulted in significant pain reductions on self-report measures but that the inclusion of cognitive-behavioral treatment did not add incremental value. Furthermore, the therapist support group did not significantly reduce pain in comparison to the treatment-as-usual group. Burish et al.27 examined the utility of PMR and GI in cancer patients undergoing chemotherapy. The investigators found that patients in the treatment group had significantly less nausea and vomiting than the control group did. Moreover, the intervention group had lower blood pressure, pulse rate, and anxiety. Several meta-analytic reviews have found that behavioral interventions are effective in preventing and treating tension-type and migraine headaches in both adults and children. The interventions include relaxation training, biofeedback, cognitive-behavioral therapy, and stress management training, either combined or in isolation. The reviews consistently reveal a 35% to 50% improvement in headache activity with the use of these behavioral interventions.28,29 Other literature reviews have found that behavioral interventions for pediatric headache are also effective treatments.30,31 Relaxation techniques and imagery have also been used in a number of pre-surgical and post-surgical settings to reduce both anxiety and pain. For example, Cupal and Brewer32 randomly assigned individuals who were in rehabilitation for anterior cruciate ligament reconstruction to one of three groups. The first consisted of 10 relaxation and GI sessions, the second consisted of attention and encouragement (placebo group), and the third group did not receive any intervention (control group). The investigators found that participants in the relaxation/imagery group had significantly more knee strength and significantly less pain and re-injury anxiety than did the placebo and control participants at 24 weeks after surgery. The authors of this study offered a few possible explanations for the beneficial results of the relaxation/ imagery intervention. The first is that the intervention gave the participants a sense of control of their recovery. Another explanation is that with pain and anxiety reduced, the participants were more able to take part in their knee rehabilitation. Finally, the relaxation/imagery treatment may have facilitated healing through regeneration-repair and immune-inflammatory responses. Lawlis and associates33 examined the effects of a 1-hour relaxation intervention the evening before spine surgery. Those who received the relaxation treatment had a significant reduction in hospitalization days and medication use when compared with those in a control group. Furthermore, nurses noted fewer pain complaints from those in the relaxation intervention than in patients in the control group. Relaxation techniques have also been used to alleviate pain from both ulcerative colitis and peptic ulcers. Shaw and Ehrlich34 compared the pain ratings of a relaxation intervention group and an attention control group in patients with ulcerative colitis. Immediately after the 6-week intervention, patients in the relaxation group had significant reductions in pain ratings, frequency, and distress. These results were maintained at 6-week follow-up. Brooks and Richardson35 found a decrease in recurrence of ulcerative symptoms over a period of 3 years after individuals received relaxation and assertiveness training when compared with individuals in a control group. As this section has demonstrated, there are a number of well-documented studies in which relaxation techniques and GI have produced beneficial outcomes. These therapies can be applied to a variety of medical conditions where pain and anxiety are implicated. Even though relaxation techniques may not be favorable for clinical depression, there is support that relaxation therapies offer relief for secondary depressive symptoms, as may be the case in pain disorders.5 Pain, as well as its accompanying stress and anxiety, can be combated with relaxation therapy, where the relaxation response replaces the stress response. Relaxation techniques and GI may operate at the emotional and cognitive dimensions of the pain experience, whereas the physical experience may remain the same.36 These therapies provide cultivated skills in coping that reduce the suffering and distress associated with pain. In some cases (e.g., headaches, ulcers), this skill may prevent the occurrence of a painful episode. View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780721603346501278 Health Professionals, AlliedL.H. Aiken, in International Encyclopedia of the Social & Behavioral Sciences, 2001 3.1 Historical ContextWhile nursing's history and evolution is strongly tied to the development of the modern hospital, nurses have a long and distinguished history in public health and home care, settings in which they exercised considerable autonomy and professional leadership. Lillian Wald invented the term ‘public health nurse’ in 1893 to describe a role for nurses that was a combination of health promotion, illness care, and social reform (Buhler-Wilkerson 1993). Public health nursing and public health in general underwent substantial erosion in the USA with the rise of health insurance after World War II. However, the foundation for the emergence of nurse practitioners was the legacy of public health nursing. The evolution of expanded roles for nurses and the development of physician assistants is often linked to a perceived shortage of generalist physicians in the USA in the 1960s and the market demand for physician substitutes. In the case of nurse practitioners, however, these factors created a favorable environment for expanding the scope of nursing practice that had long been advocated by nursing's leaders and that was exemplified by the early public health nurses. Thus, nurse practitioners, while often considered new allied health professionals, are really not new at all but nurses with legally sanctioned expanded scope of practice including some domains formerly controlled solely by physicians, such as drug prescription authority (Lynaugh and Brush 1996, Mezey and McGivern 1999). While educational and legal requirements for advanced nursing practice vary across countries, there is a global trend to replicate the successful US model (Fagin 1990, British Medical Journal2000). The origins of the new occupation of physician assistants in the USA stem from the return to the civilian workforce of military medical corps personnel in the 1960s at a time of a perceived domestic physician shortage. Most initial recruits to physician assistant programs were experienced medical corps personnel and the initial training programs were short-term on-the-job training. While the profession was predominantly male in its inception, it is now almost equally male and female, and the most recent graduating classes are over 60 percent female (Hooker and Cawley 1997). The early programs were located at medical schools but did not have academic standing or lead to degrees. Over time, degree-granting programs have been incorporated into schools of allied health. Nurse practitioner education was rapidly incorporated into the large existing university-based infrastructure of schools of nursing. Enrollments in nurse practitioner programs grew steadily and by 1996 over 70,000 nurses in the USA had formal preparation as nurse practitioners, primarily at the master's level (Moses 1997). There was no comparable existing educational infrastructure for physician assistant education, and thus their numbers have grown more slowly than those of nurse practitioners, reaching 29,000 in 1997 (Cooper et al. 1998). View chapterPurchase book Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B0080430767039140 Nurse Education in the Digital Age—A Perspective From the United KingdomSharon Levy, in Health Professionals' Education in the Age of Clinical Information Systems, Mobile Computing and Social Networks, 2017 Nurses and IT—Ready for the Revolution?The term revolution is often associated with images of violence and bloodshed and may not fit well with the common public perception of the caring professional. Yet, as far back as 1983 Berg argued that: “[T]he choice is there and the time to make the choice is now. The decision must be whether to act traditionally and have change thrust upon the profession [nursing] from the outside or to anticipate this revolution in nursing practice, familiarize nurses with it, and prepare them to take an active part in the introduction of computers into the nursing community” [2]. The commitment to spending billions of pounds on clinical IT systems, in the NHS in England back in 2003, led to a flurry of activity concerning the development of systems and implementation plans. During the early days of the NPfIT, the issues concerning workforce readiness and the impact the programme may have on clinicians were not set as a priority. The medical profession and their trade union were very vocal in expressing concerns about the approach taken but the voice of nursing was noticeably limited. Which is an example of the primary goal of public health?From conducting scientific research to educating about health, people in the field of public health work to assure the conditions in which people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease.
What are the 8 principles of public health nursing?population. The client or the "unit of care" ... . greatest good. The primary obligation to achieve the greatest good for the greatest number of people or the population as a whole.. primary prevention. ... . partner with clients. ... . conditions. ... . reach out to ALL. ... . optimal use of resources. ... . collaboration.. Which of the following defines community health quizlet?Community health refers to the health status of a defined group of people and the actions and conditions to promote, protect and preserve their health.
Which is the primary goal of community health nursing quizlet?1. Which is the primary goal of community health nursing? 1. Answer: (B) To enhance the capacity of individuals, families and communities to cope with their health needs.
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Which of the following is considered the core unit of service in public health
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