Measuring implementation of evidence-based guidance on promoting workers' health.

BACKGROUND: The National Health Service (NHS) employs 1.4 million people in England. In health care, improved workforce health has been associated with improved outcomes for patients. The UK's National Institute for Health and Clinical Excellence (NICE) has produced evidence-based guidance on improving workers' health. However, the extent of implementation of evidence-based guidance has not previously been measured. AIMS: To measure progress with implementation of NICE guidance on workplace health and identify opportunities to improve this. METHODS: All NHS organizations in England were invited to participate in an audit of implementation of NICE guidance. A web-based tool was developed to collect information on the extent to which each organization had implemented NICE guidance addressing health promotion in the workplace. RESULTS: The number of organizations that participated was 282. These employed a total of 868 979 workers. Organizations were more likely to involve staff in planning and designing an organizational approach to each topic where health and well-being was a regular board agenda item. Those with an overarching strategy were more likely to have staff health and well-being as a regular board agenda item (P < 0.05) and more likely to have specific policies for obesity, physical activity and promoting mental well-being (all P <0.01). CONCLUSIONS: Implementation of NICE guidance on health at work is incomplete across the NHS in England. Implementation was more complete where boards were leading health and well-being plans and the workforce were actively involved. There is scope to improve the implementation of evidence-based guidance to improve workers' health.

Is it possible to "achieve a balance" and meet the "safety net"? Paediatric Advisory Subcommittee to the North West Thames Regional Health Authority.

The government's document Hospital Medical Staffing--Achieving a Balance--Plan for Action introduced the concept of a "safety net"--that is, a minimum safe level of staffing--of junior doctors in the acute specialties. The North West Thames Paediatric Advisory Group has therefore reviewed the implications and consequences of implementing the safety net in respect of children's services. The group found that if a reasonable safety net was to be provided that enabled the services to stay within the projected junior staffing levels, maintain a balance, meet training needs, and reduce junior doctors' hours of work, then changes in the organisation of the services would be required. Examining the options available showed that to achieve a safety net within the projected numbers of junior staff at least six paediatric units in the region would have to close. It is doubtful if there is the political will to support the very radical changes that would be needed in the distribution of services if the government's recommendations in Achieving a Balance were to be implemented. The profession, the Department of Health, and the public must be made aware that the proposed changes in medical staffing will cause a fundamental change in the traditional pattern of delivery of health care.

The development of the paediatric nurse specialist.

Paediatric nurse specialists have, in the past, pioneered new roles in response to clients' needs. As a result, clinical practice and the service provided to families have been innovatory. Future paediatric nurse specialists will continue to lead and develop clinical practice through audit and research.

Nebulised therapy and nursing knowledge.

Authoritative training from a multidisciplinary resource provides nurses with an excellent breadth and depth of knowledge. This study examines the impact of such training on nurses' knowledge of nebulised therapy and shows an encouraging improvement. Follow-up measures are also described.

How I help managers understand and value an occupational health department.

A professional occupational health department is more valuable to businesses than an old-style medical department. Occupational health professionals need to rise to the challenge of promoting the contribution they can make. This article discusses some of the key points which need to be addressed when helping managers understand occupational health's important role.

The extended role of the nurse: the United Kingdom perspective.

There has been considerable discussion and debate in the United Kingdom regarding the role and function of the nurse. This article outlines the main tenets of the debate, namely the extended/expanded role and function, and gives a brief overview of the situation to date. Professional guidance from the United Kingdom Central Council for Nurses, Midwives and Health Visitors is explored and the implications this has for the nurse in the exercise of accountability. The legal implications of the nursing function in an expanded role capacity is discussed, in particular in relation to legal accountability, with reference to existing case law. Recommendations are made for the development of the expanded role.