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)

The contribution of the labour ward midwife in the prevention of low Apgar scores - abstract

The relationship between the workload of the labour ward midwife and neonatal outcome was retrospectively studied over a 3-year period. The Apgar scores were used as an index of neonatal outcome. The ratio of monthly deliveries to the number of midwives assigned to the labour ward for that month was used as an index of workload. There was a total of 8,066 live-births, with an average monthly delivery rate of 227.6. The average number of midwives assigned to the labour ward per month was 13.6. There were 15 midwives/month in the first year of the study as compared with 12 in the third year. As a result, the workload for each midwife increased from 15 deliveries per month in the first year to 18 in the third year. There were, on average, 14 deliveries per midwife each month between January and June and 20 between July and December. Within any particular month, workloads (X) were positively correlated with the proportion of deliveries with Apgar scores of less than 7 at 1 minute (Y = 0.9003 X 10.2034, p < 0.001), and of less than 4 at 5 minutes (Y = 0.1636 X - 0.9683, p < 0.01). Decreasing numbers of midwives (X) were correlated with increasing percentages of deliveries with an Apgar score of less than 7 at 1 minute (Y = 18.0483 - 0.4773 X p < 0.05). Decreasing numbers of midwives (X) were also correlated with increasing percentages of low birth weight infants with an Apgar score of less than 7 at 5 minutes (Y = 27.4813 - 1.1823 X, p < 0.05). It is suggested (1) that more midwives should be assigned to the labour ward during the July - December period, (2) that the work efficacy of midwives should be improved, and (3) that more midwives should be recruited (AU)