Using focus groups to evaluate an education program

Two evaluation studies were carried out in 1995 and 1997. The first evaluation assessed tile effectiveness of the Psychiatric Nurse Practitioner's education program and its impact on mental health and psychiatry in Belize. The second study was done to determine if the mental health services were sustained in the country. Interviews and focus groups were used for data collection. In this paper the focus is on the findings from the focus groups. The findings show that the PNP's role performance was adequate, they have made an impact on the mental health services and the services are maintained (Au)

District nurses in Dominica - abstract

The aims of this study was to assess the work and workload of the district nurses, and to study other aspects relatd to the profession of a district nurse. The study was conducted from June to October 1995. All encounters of three district nurses were registered during periods of four weeks, using the Internatonal Classification of Primary Care. Information on other aspects of district nursing was collected by observation and the use of a questionnaire. In the study period, 411 clients were attended to in 495 encounters. Check-ups for hypertension, diabetes, pregnancy and immunizations were among the most common reasons for encounter. Together they constitute 40 percent of all reasons for encounter. "No disease" was the most frequent diagnosis, followed by hypertension, diabetes, pregnancy, fever and skin conditions. Partial medical examinations were conducted at almost all encounters. The ranking of the treatment given was medication, education and dressing. Prevention was the most frequent activity. The district nurses effectively dealt with 80 percent of all contacts; only 20 percent of patients were referred to the district medical officer. There were several factors that negatively affected nurses' motivation. On average, the nurses worked 43 hours a week. The long walking to do household visits and being on call were considered to be the most demanding aspects. In addition to being a nurse, each has her family and other obligations. Finally, career mobility is limited. Postgraduate training with diversified certification and upgrading of wages could contribute to a continued high motivation and job satisfaction. (AU)

The impact of the nurse practitioner on the Jamaican primary health care system

The nurse practitioner programme was introduced into the primary health care system in 1977 after much negotiation and consultation with relevant interest groups. Since the introduction of the programme there have been many frustrations due to unfilled promises, thus massive resignations have occurred and the number of persons entering the programme has decreased. Efforts have been made by the Ministry of Health on two occasions to discontinue training due to questions about its cost effectiveness. This study was conducted in an attempt to identify the impact of this programme on the health care system to see if it has been effective, thus worth continuing. It compared the Nurse Practitioner in the private and public sectors. Data collection was through self administered questionaires, checklists and interviews. Findings highlighted a definite improvement in the health status of individuals exposed to management of their health problems by the nurse practitioner. This was in keeping with previous studies done in North America. However, in quantifying the difference in production hours lost in industry due to ill health since the introduction of the programme, there was uncertainty as to any real achievement. The main limitation of the study was the small sample size. The study population was also small but scattered across the island thus limiting the possibility of studying it in its entirety in the very short time available for data collection (AU)

Neglecting legal status in health planning: nurse practitioners in Jamaica

The nurse practitioner (NP) was introduced as a member of the primary health care team in Jamaica in 1978 when it became evident that the demand for health centers which provided both curative and preventive care could not be met by medically-trained personnel alone. Despite the responsibilities taken on by NPs in practice, they have not been given legal recognition of or protection in their expanded role with the result that their relationships with others in the field have not been defined. This has led to pharmacists challenging the right of NPs to prescribe. This challenge has threatened the usefulness of NPs in the field. To facilitate understanding of how this situation arose, some background to the establishment of the program is presented, followed by a discussion of the current status of NPs and resolving the problems. The elements that have an important bearing on the appropriate legal status for NPs are: qualifications for recruitment to the course of training; the length and content of the course; the question of supervision as it relates to their deployment in the field; and the arrangements, if any, for their discipline in the performance of their expanded duties. The problems about prescribing, the uncertainties related to status, and in some instances relationships with other health workers have caused considerable problems for the NPs. The question of the legal status of the NP was raised as soon as difficulties about their practice began to be perceived. The issue crystallized around their right to prescribe. While discussions about a legal status for and formal recognition of the practice of NPs dragged on, the uncertainties and frustrations began to have an effect on the program. Applications from suitably qualified individuals began to drop markedly. Recruitment of nurses dropped to 9 in 1982 and to 7 in 1985 from 22 in 1978 and 21 in 1979. Since most of the problems encountered in the acceptance of NPs arose out of uncertainties and misunderstandings about their training and scope of practice, it was decided that protocols should be prepared for each of the common disorders which they would be likely to encounter in health centers. Eventually practice protocols directing the practice of NPs were prepared and accepted by all professional groups involved. Standing orders which define the relationship of NPs to other health workers also have been prepared with a view toward moving on to legislation as soon as possible. (AU)

Nurse practitioners in primary health care: the Jamaican experience. Part II

This discussion of Jamaica's experience with nurse practioners in primary health care (PHC) reviews entry requirements, recruitments, and selection; selected specialist tracks; the curriculum; finance, administration, and management; program implementation; initial evaluation and continuing education; the 2nd class; subsequent intakes; class 4; and performance and problems. Minimum entry requirements include: registered general nurse; registered midwife or acceptable substitute post basic course for male nurses; and 5 year post registration practice in a relevant clinical specialty. Major curriculum components include: general subjects aimed at broadening skills in communication, social interaction, scientific problem solving, and other such behaviours; related/supporting sciences; nursing subjects; and medical subjects. There is a 6-week core curriculum followed by a 2-stranded specialist curriculum of 18 weeks, consisting of medical topics relevant to each sub-group. This period is followed by 6 months of internship. The nurse practitioner program is a cooperative/collaborative venture between the Ministry of Health and the Faculty of Medicine. The nurse practitioner program was launced in July 1977 with 25 students -- 18 in family nurse practitioner course and 7 in the course for nurse pediatricians. Following graduation of the 1st class, faculty members undertook a complete review and evaluation of the curriculum. Subsequently, some changes were made, including: increased pediatric content of the family nurse practitioner course; reorganization of content and hours devoted to research/epidemiology; increased pharmacology input; and modification in the scheme for student evaluation. A 2nd group, consisting of 22 students, began the courses on September 1, 1978. To date, 2 additional groups of students have been admitted to the program. To provide data on nurse practitioners' functioning in PHC settings in Jamaica, the Advanced Nursing Education unit encouraged its students to conduct a series of small research studies into various aspects of the nurse practioner progam. 2 studies were conducted and completed in 1979 and 1 study is now nearing completion. Thus far experience shows that the Jamaican nurse practitioner is well received by selected health care personnel with whom she works, and health care consumers express maximum satisfaction with care received from nurse practioners. Major problems associated with the program are of 2 types: those related to education/training; and those affecting the work and service of nurse practitioners. Despite problems, morale among teaching staff and students remains high, and a large majority of nurse paractitioners reported increased job satisfaction in their present role (AU)

Nurse practitioners in primary health care: the Jamaican experience. Part I

In September 1994 the Nurses Association of Jamaica (NAJ) submitted a proposal for the establishment of a nurse practitioner programme in Jamaica to the Ministry of Health. Underlying the development of the nurse practitioner proposal is the collective belief of Jamaican nurses that: access to adequate health care is a basic human right, not a privilege; this care should be available to the individual at the time of need regardless of his/her ability to pay; nursing forms an integral and indispensable part of health care services everywhere and must be available to individuals irrespective of nationality, race, color, social status, creed or political affiliation; the health care delivery system must reflect the inherent value of human life and the dignity of the individual; high level wellness of every man, woman and child is a desirable goal; and the social and economic progress of any country bears a direct relationship to the health status of its population. The nurse practioner is viewed as a senior professional nurse who has completed an approved program of education/training which prepares her to function in the expanded nursing role. The purpose of the nurse practitioner program is to prepare senior professional nurses for greater clinical responsibilities in the health services so as to make available more and better health care to all people. Specifically, the programme seeks to provide experienced nurse/midwives with advanced nursing/medical education and training so that they will be able to meet a wider spectrum of health care needs. To achieve the stated purpose, the ultimate goal is that each graduate of the program will be equiped to perform a series of various activities and functions in clinical

Clients views on the services of nurse practitioners in selected parishes

This study was done to elicit the views of clients on the services of the nurse practitioners in selected parishes. Information received from this study could be used to assist in evaluation of these services. A ten-item interview schedule was used to collect data over a three-day period. Because of inclement weather, only 164 of the total sample of 234 clients were interviewed. The data collected were manually processed, and the major findings are as follows: 1. An overwhelming majority of respondents (93 percent) expressed general satisfaction with the care being received from the nurse practitioner. 2. A vast majority of respondents (90.2 percent) are in favour of having more practitioners working in the health centres. 3. Respondents unanimously said they would recommend the services of the nurse practitioner to their family, friends, and others in need of health care. 4. 142 of the 164 respondents (87 percent) did not find it necessary to visit a doctor about the same illness after having been treated by the nurse practitioner. 5. The existing client demand for care is more than the nurse practitioner can adequately cope with at present, as evidenced by clients indicating that they had to wait a long time for care because many clients were attending the clinic. 6. The age or sex of clients did not seem to make any difference to the views expressed regarding the services of the nurse practitioner. 7. Most clients had been attending the clinic/health centres for over three years, but their views on the services offered by the nurse practitioners were no different from those of clients who had been attending the health centre for less than three years. (summary)

Approaches to primary health care in the Commonwealth Caribbean

In this article the authors present a brief review of the health problems of the Commonwealth Caribbean and of the primary care activities being implemented to solve them. Special attention is given to programs which develop new categories of health workers and direct manpower toward learning a technology appropriate to the conditions in which they work. These programs enable the health worker and allied health personnel to adapt to their roles and functions accordingly and thus provide quality health within limited resources. The main programs are: development of new category of health workers such as the community health aide and the nurse practitioner; education and training of allied health personnel; and training of primary health care physicians. An account is also given of primary health care in Jamaica and in the smaller territories of the Caribbean.(Summary)

Views on the introduction of nurse practitioners into the Jamaican health care system

The study was done to elicit views or reactions of selected health personnel to the introduction of the nurse practitioner into the Jamaican health care system. The information received from the study could be used as a basis for a more comprehensive study of the programme. A ten item questionnaire was administered to a sample of forty-seven persons; twenty-six health centre nurses, eleven physicians and ten public health nurses. The data collected were manually processed and the major findings are as follows: (i) The majority of the respondents (63.3 percent) had overseas experience, most of which was gained in the United Kingdom. (ii) The majority of respondents (78.7 percent) worked with the nurse practitioner five months and over. (iii) A large majority of the respondents expressed satisfaction in the improvement of patient care since the introduction of the nurse practitioner programme. (iv) A major concern expressed by respondents was the absence of legislation enabling the nurse practitioner to prescribe drugs independently. (v) Fifty-one percent of the respondents said they did not want more nurse practitioners, while forty-nine percent said they wanted more. (vi) Twelve respondents said they wanted more practitioners because more patients could be seen and an equal number said they did not want because they had adequate staff. (Summary)