The paediatric diabetes specialist nurse and diabetes education in childhood.

AIMS OF THE STUDY: The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process. DESIGN AND METHODS: A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full-time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82.5%). FINDINGS: The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education. CONCLUSIONS: The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.

User involvement in identifying health needs and shaping and evaluating services: is it being realised?

The rhetoric of user involvement has featured in health policy documents for over a decade. However, there is mixed evidence as to the extent to which it is being achieved. This paper explores what is meant by user involvement, proposing that it exists at a series of levels ranging from information giving to true empowerment. Examples are presented from two practice development projects. The first sought to develop multidisciplinary audit in primary care, attempting to involve users in defining health needs and determining services. Although the project co-ordinators were highly committed to user involvement this was only achieved to a limited extent. It was concluded that there was a resistance to user involvement grounded in the fear that such involvement would increase user expectations and add to the pressures of overworked primary care teams. The second project used interviews with service users to assess the effectiveness of a team building initiative. Users were found to be knowledgeable about practitioner roles and how to access the care they required. The overall conclusion is that there needs to be a shift from rhetoric to reality at governmental and practitioner level if true user involvement is to be achieved.

Effects of an oil spill on leafpack-inhabiting macroinvertebrates in the Chariton River, Missouri.

Artificial leaf packs were used to determine the effects of an oil spill on stream macroinvertebrate communities in the Chariton River, Missouri. Plastic mesh leaf retainers with approximately 10 g of leaves from five tree species were deployed at five sites (two upstream of the spill and three downstream) immediately after the spill and one year later. Four macroinvertebrate species dominating the community at upstream sites were virtually eliminated below the spill, including the stonefly Isoperla bilineata, the caddisfly Potamyia flava, the midge Thienemanniella xena, and blackfly larvae (Simulium sp.). Density of collector and shredder functional groups, and number of shredder taxa differed between upstream sites and the two furthest downstream sites during the 1990 sample period (Kruskal-Wallis w/Bonferroni paired comparisons, experiment wise error rate = 0.05). With one exception, no differences between sites were detected in the 1991-1992 sample period, indicating that the benthic community had at least partially recovered from the oil spill after one year. The odds of obtaining a sample with a small abundance of shredders (abundance < median) in 1990 was significantly greater downstream of the spill than upstream, and the odds of obtaining a sample with a small abundance of shredders at downstream sites was greater in 1990 than in 1991-1992. A similar pattern was observed in abundance and taxa richness of the collector functional group. No significant differences between the two sampling periods were detected at upstream sites. Observed effects appeared to be associated with oil sorption and substrate coating, creating conditions unsuitable for successful colonization.

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.

Effective multidisciplinary teamwork in primary health care.

The nature and development of teamwork in primary health care is discussed and some barriers to effective teamwork identified. Theories of team effectiveness are outlined and methods of applying these to primary health care teams are explored. The 'constituency approach' and the theory of team innovation are examined in more detail. Team-building interventions are described as one way of improving team effectiveness but their limitations are also acknowledged. The Health Education Authority primary health care team workshops are used as an example of a team-building intervention. Research at the MRC/ESRC Social and Applied Psychology Unit, Sheffield University, is described. This is evaluating the outcomes of the primary health care team workshops in terms of team effectiveness. The research will measure viability (the extent to which the team sufficiently sustains good relationships to continue working together) and team performance (achievement of desired outcomes) pre and post workshop. Team effectiveness will be measured through team self-assessment, patient satisfaction and family health service authority designated targets for health promotion. The overall aim is to develop a model of team effectiveness for primary health care teams, which can then be used to diagnose and guide teams in their work.