Factors affecting the retention of nurses. A survival analysis.

OBJECTIVE: To identify and explore factors that mostly influence nurses' turnover and retention, and to estimate the length of employment for nurses in the hospital. METHODS: This is a retrospective cohort study examining the standard Exit Questionnaires completed by all the female pediatric nurses who joined and left the hospital during the period between January 2006 and October 2010. The Developed Questionnaires where completed by nurses who were still employees in October 2010. The nurses who left the job will be considered as events and the nurses who are still working will be considered as censored. The study took place at the Pediatric Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. RESULTS: A total of 254 nurses were included in the study. Most of the nurses left their jobs due to family reasons (39.7%) followed by other reasons (37.3%). Seventy five percent of all the pediatric nurses remained in their jobs, on average, for 2.2 years. Both simple and multivariate analysis indicated a strong positive correlation between length of employment (turnover) and the demographic and organization factors. CONCLUSION: This study has identified several factors that played a key role in staff retention, which can help in predicting nursing turnover at PSMMC. The findings of this study could help PSMMC and its Nursing Administration, in particular, to understand the seriousness of the high turnover rates, to develop and implement strategies to reduce this problem, and improve the retention of nursing staff.

Research-policy partnerships - experiences of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia.

BACKGROUND: Partnerships are increasingly common in conducting research. However, there is little published evidence about processes in research-policy partnerships in different contexts. This paper contributes to filling this gap by analysing experiences of research-policy partnerships between Ministries of Health and research organisations for the implementation of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. METHODS: A conceptual framework for understanding and assessing research-policy partnerships was developed and guided this study. The data collection methods for this qualitative study included semi-structured interviews with Ministry of Health Partners (MOHPs) and Research Partners (RPs) in each country. RESULTS: The term partnership was perceived by the partners as a collaboration involving mutually-agreed goals and objectives. The principles of trust, openness, equality and mutual respect were identified as constituting the core of partnerships. The MOHPs and RPs had clearly defined roles, with the MOHPs largely providing political support and RPs leading the research agenda. Different influences affected partnerships. At the individual level, personal relationships and ability to compromise within partnerships were seen as important. At the organisational level, the main influences included the degree of formalisation of roles and responsibilities and the internal structures and procedures affecting decision-making. At the contextual level, political environment and the degree of health system decentralisation affected partnerships. CONCLUSIONS: Several lessons can be learned from these experiences. Taking account of influences on the partnership at individual, organisation and contextual/system levels can increase its effectiveness. A common understanding of mutually-agreed goals and objectives of the partnership is essential. It is important to give attention to the processes of initiating and maintaining partnerships, based on clear roles, responsibilities and commitment of parties at different levels. Although partnerships are often established for a specific purpose, such as carrying out a particular project, the effects of partnership go beyond a particular initiative.

Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia.

BACKGROUND: Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. METHODS: The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. RESULTS: Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. CONCLUSIONS: Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.

Visualization, reconstruction, and integration of neuronal structures in digital brain atlases.

Brain atlases are used in neuroanatomy to define the spatial layout of neuronal structures. Their digital variant can serve as a database and common reference frame for integrating data from different biological experiments. This article presents an overview of methods for three-dimensional visualization of neuroanatomical image data, reconstructing neuronal structures from image data, creating digital brain atlases, and registering data in an atlas. This enables analysis of spatial relations between individual structures imaged in different experiments as well as between these structures and the atlas.

Decentralisation and TB control in Nepal: understanding the views of TB control staff.

Experience shows that planners need to consider the effect of the process of decentralisation on national health programmes. The aim of this article is to explore the relationship between decentralisation and a national disease control programme by seeking to understand the views and attitudes of staff working in a national TB control programme on the process of change and their involvement in that change. The study to which this paper refers was performed in Nepal, where, in common with several low- and middle-income countries, a Local Self Governance Act has been passed and decentralisation is in the process of being introduced in the health sector. The aim of the study was to develop a process of initial dialogue among programme staff with a view to exemplifying those enabling and disabling factors which could influence the process and content of health systems development and its impact on health and health care. The study used individual interviews and group discussions to increase our understanding of the experience of different stakeholders at both national and district levels. Important problems identified include: confused lines of authority, difficulties of integrated supervision, poor career paths and promotion possibilities, unclear performance management, lack of priority to be given to health and TB control, lack of local accountability, lack of capacity and the risk to the drug supply. The study highlights the need to (a) develop consensus techniques, achieve a balanced appreciation and include all stakeholders in the process of change and (b) define central and local responsibilities, limiting political bias, maintaining quality control, organising different lines of authority, maintaining priorities and programme integration.