ABSTRACT
OBJECTIVES: To integrate public health nursing (PHN) competencies into a comprehensive performance review instrument for nurses at multiple practice levels in an urban public health department. DESIGN: Based on thorough review of PHN competency literature, the tool evaluates performance for 5 nursing practice classifications (Staff RN, Public Health Nurse, Nurse Practitioner, Clinical Nurse Specialist, Nursing Supervisor) in eight PHN domains (assessment, policy development/program planning, evaluation, communication, cultural competency, partnership/collaboration, disease prevention/health promotion, leadership/systems thinking). SAMPLE: Tool was piloted with over 50 nurses from PHN workforce (n>400) of Public Health-Seattle & King County (Washington). METHOD: Pilot testing includes all components of the performance appraisal system: Public Health Competency Grid, statement of general workplace expectations, Nursing Performance Appraisal Tool, and supporting documents defining performance elements by job classification. RESULTS: Supervisors find the tool easy to use and report that it provides opportunity for real communication between employee and supervisor. Nurses at all practice levels report that it effectively describes/evaluates their practice. CONCLUSIONS: This tool is an efficient performance appraisal instrument providing meaningful feedback to nursing employees within a framework of PHN competencies. Adopting such tools in PHN practice can help nurses to better understand their role in population-based public health efforts.
Subject(s)
Clinical Competence/standards , Employee Performance Appraisal/methods , Public Health Nursing/standards , Attitude of Health Personnel , Communication , Community Health Planning/standards , Employee Performance Appraisal/standards , Feedback, Psychological , Humans , Interprofessional Relations , Leadership , Models, Nursing , Nurse Administrators/education , Nurse Administrators/organization & administration , Nurse Administrators/psychology , Nurse Clinicians/education , Nurse Clinicians/organization & administration , Nurse Clinicians/psychology , Nurse Practitioners/education , Nurse Practitioners/organization & administration , Nurse Practitioners/psychology , Nurse's Role , Nursing Assessment/standards , Nursing Evaluation Research , Nursing Methodology Research , Nursing Staff/education , Nursing Staff/organization & administration , Nursing Staff/psychology , Pilot Projects , Program Development/standards , Program Evaluation/standards , Public Health Nursing/education , Systems Analysis , WashingtonABSTRACT
The efficacy of intradialytic parenteral nutrition (IDPN) in malnourished hemodialysis patients was studied. All patients at a large tertiary care institution who received IDPN for one month or longer between June 1997 and December 2000 were included in the study. The IDPN formulation contained 10% amino acids 250 or 500 mL, 50% dextrose 250 mL, and 20% fat emulsion 250 mL. IDPN was administered during each thrice-weekly hemodialysis session. Patient data were collected 6 and 3 months before IDPN therapy began, at baseline, and 3, 6, 9, and 12 months after the therapy began. Therapeutic efficacy was assessed by the percent change from baseline in dry body weight and serum albumin concentration. Twenty-six courses of IDPN in 24 patients met the study's inclusion criteria. The mean duration of treatment was 4.3 months. Dry body weights were significantly lower 6 and 3 months before the start of IDPN therapy than at baseline and significantly higher 6, 9, and 12 months after the start of therapy. Serum albumin levels were also significantly higher at 3 and 9 months than at baseline. The percentage of treatment courses in which patients had a serum albumin concentration of > or = 34 g/L was 12% at baseline, 39% at 6 months, and 47% at 9 months. Adverse effects consisted primarily of excess fluid gain and hyperglycemia. IDPN therapy significantly increased body weight and serum albumin levels in malnourished hemodialysis patients.
