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Israel—Team nursing in public health
Inf. J. Nurs. Stud .Vol. 2. ~~361-277.
Israel-Team
Pemamoa Pres,
1966.
Printal io
Grut Britdn
Nursing in Public Health
Part 4-Summav, Proposals, and Implicationr For Further Study
REBECCA
BERGMAN,
R.N. Ed.D.
Departrnent of Social Medicine Habrew Univnsity, Hadassah Medical School, jerusalem
THE
purposes of this study were : (1) to propose a plan for Israel that would enable expansion of public health nursing services and make more effective use of available pcrsonnel, (2) to propose leaming experiences for the leadership group in the above plan, and (3) to portray the trends and needs in public health nursing in Israel. Public health nursing programs have greatly expanded in the last two decades. The supply of professional nurses has not kept abreast of the demands, resulting in the employment ofauxiliary personnel. This practice may be dangerous unless professional lcadcrship is available at the leve1 of direct patient care. The need to find an organizational pattern which would enable a safe, effective, public health nursing service in Israel, within the available resources of personnel, was the motivating factor for this study. It was hoped that the conclusions might also contribute to planning for public health nursing services in other lands with similar problems. Data were gathcred from several sources. Trends in public health nursing, particularly those related to the usc of auxiliary personnel, were reviewed in the litcraturc. Matcrials on the needs, resources, present practices, and planned changes in public health nursing in Israel were obtaincd by study of reports from Israel and also through questionnaires to the four major public health agencies, and to thc Division of Nursing in the Israel Ministry of Health. Data on the use of auxiliaries in public health nursing in the United States were procured in 53 interviews with directers, supervisors, professional staff nurses, practica1 nurses, and aides in eight selected public health agencies employing practica1 nurses, aides, or both. Interviews with instructors of team leadership in 11 selected educational programs provided background information used in formulation of leaming experiences for leadership. Nine principles of team nursing in public health, a program for the of team preparation of team leaders in Isracl, and a plan for the introduction nursing in Israel were evolved, al1 three being based on conclusions from the above data, the Lambertsen study on team nursing in hospitals,(l) and the researcher’s personal philosophy.
262
REBBtXA BERGMAN
Summqv ofjndings and cotulusions Review of the literature on public health nursing revealed two major trends. The first of these was seen in the developing countries, where vast urgent public health programs, concemed primarily with problems of communicable disease, nutrition, and sanitation, were undertaken by smal1 numbers of professional workers assisted by many auxiliaries. The second trend was found in the technically developed lands, where the needs and programs were moving from the above areas toward problems of chronic disease, ageing, and mental health. These countries had relatively more professional nurses than the developing lands, but were stil1 below the ratio of one public health nurse to 2,000 population, which is considered desirable for a comprehensive preventive and curative public health nursing service. Studies in the United States showed an increase in the use of practica1 nurses, with genera1 agreement of their positive role in public health nursing. Aides were a more recent addition to the service but it was not determined whether this group should be the responsibility of nursing, or of another authority. It was also found that in the United States, team nursing was considered by many to be a solution to the shortage of professional nurses and growing employment of auxiliaries. Team nursing was increasingly being accepted by hospitals, and gradually being introduced in public health agencies employing auxiliary nursing service personnel . Analysis of the data on Israel showed a trend away from specialized public health programs to comprehensive, family-focused programs planned on a regional basis. Miier the establishment of the State of Israel in 1948, the unselected mass immigration resulted in serious public health needs which were met and overcome by dedicated personnel in emergency programs. Problems related to matemal and child health and communicable diseases were diminishing, whereas care of the aged, chronic disease and mental health required additional services. The current public health nursing functions in these areas were limited. The sources of nursing personnel in Israel were from immigration, and from local schools of nursing, which annually graduated about 200 registered, and 400 practica1 nurses. The ratio of al1 nursing personnel to population was somewhat lower than that of the United States, but the percentage of practica1 nurses was three times as high as that of the United States. Thc shortage of professional staff was reflected in public health nursing, where 37 per cent of the personnel were practica1 nurses. Practica1 nurses were used in functional assignments in health centers, and in independent assignments in outlying areas wherc professional nurses were not available. It was concluded from the above data that public health nursing services would have to expand, and that practica1 nurses would continuc to fill at least ene-third of the staff positions. The present organizational pattern had inherent dangers in the independent assignments of practica1 nurses and did not sufficiently use the potential of the professional nurses in othcr situations. A different pattem was needed to permit expansion in a safe, effective service. Data from the interviews in the eight selected United States public health agencies depicted polities and practices in the use of auxiliaries in those agencies Al1 of the agencies were employing, or were as wel1 as opinions on the practices. considering the employment of, both practica1 nurses and aides. The major findings and conclusions from the interviews are listed below.
ISRAEL-
TEAiU NURSIX
IN PUBLIC HEALTH
263
1. Auxiiiary personnel were employed in order to enable better use of professional nurses, and to meet service needs. 2. There was a decrease in the understanding of agency objectives and services This indicated the need in staff members with less preparation and responsibility. for broader orientation of auxiliary groups. 3. There was a wide range in the proportion of auxiliary personnel to professional nurses, with many considerations entering into the determination of the proportion. 4. Criteria for the selection of practica1 nurses suggested by the interviewees were : graduation from a school for practica1 nurses and a high school, interpersonal Intellectual ski&, initiative, and responsibility ski&, and hospita1 experience. This was a surprising finding in the light of agency expectawere rarely mentioned. tions of the practica1 nurses. Criteria for the selection of aides were primarily high school education, interpersonal skills, and experience in health work. 5. Criteria for assignment of practica1 nurses varied greatly among the agencies, the total range covering many activities which had been found satisfactory in at This indicated a potential aot being utilized by many agencies. least one agency. The assignment of aides was limited to assisting activities and housekeeping. 6. Supervision of practica1 nurses was carried out by the public health nurses and the supervisors, but the onus for recognizing and reporting patient needs rested with the practica1 nurse. Orientation to a new patient was usually limited to verba1 description of the patient and his care, and fellow-up to casual office contact and intermittent home visits of the professional nurse. Supervision of the aide was the responsihility of the public health nurse or a special supervisor, with orientation conducted by description or introduction in the home and follow-up through home visits or telephone contact<. In some of the agencies the techniques of supervision This finding highlighted the importante of of auxiliaries appeared inadequate. an organizational pattern that would provide adequate communication and supervision. 7. Al1 the agencies considered orientation of new employees important, and had orientation programs for both practica1 nurses and aides. 8. Al1 agencies provided in-service education for practica1 nurses. JYhen programs were shared by practica1 and professional nurses it appeared to raise practica1 In-service education for aides was minimal, and was not considered nurse morale. important by the intervicwees. 9. Attitudes of thc professional and auxiliary staff to each other tverc reported as excellent or good by 90 per cent of the intcrvicwees, although thrrc had been some initial resistancc to thc auxiliaries. 10. Most of the intcrviewees perceived team nursing as professional and auxiliary nursing personnel working together undcr the leadcrship of a public health nurse. ll. Recommendations which the interviewces would make to another agcncy about to employ auxiliary personnel included : orientation and educational programs for al1 lcvels of staff, the involvemcnt of al1 conccrned in planning for the program, careful selection of auxiliaries, promotion of easy communication, and good staff morale. Interviews were conducted with instructors of team leadership in seven basic and four agency in-service education programs. nursing education programs, Analysis of the data showed a similarity of objectives, teaching methods, and
264
REBECCA BERGMAN
problems in most of the programs, but considerable variation in course organization, duration, theoretical content, and planned experiences in nursing practice. The interviewees emphasized the importante of assuring the cooperation of the service staff in a suitable field for nursing practice. The major conclusion from the interviews was that similar objectives could be considered in planning a course for team leadership in basic, post-basic, and in-service education programs but that leaming experiences would have to be adapted to each group. Proposals made in ths study The study presents three proposals: nine suggested principles for team nursing in public health, a program for preparing team leaders for public health nursing in Israel, and a plan for introducing team nursing in public health in Israel. These three proposals were formulated on the basis of the preceding data. The first proposal, the principles of team nursing in public health, are listed below : 1. The patient is the focus of team nursing in public health. 2. There are functions and activities in pubiic health nursing which permit the safe utilization of personnel with different levels of competente. 3. Competent leadership is a prerequisite for team nursing. 4. Supervision should be kept as near as possible to thc source of direct patient care. 5. Pre-assignment preparation and continuing education are nceded for team nursing. 6. Size and composition of the team should be flexible. 7. Good morale within the team and in the agency contributes to the improvement of team nursing. 8. Frequent, easy communication within the team is essential. 9. Continuity of assignmcnt of personnel improves patient care. The team leadership course for Israel was proposed for employed public health nurses selected by their agencies as potential team leaders. It would be offered or guided by an educational institution, and would last from four to six weeks. Leaming experiences and evaluation would be based on thc course objectives. Course sequence would be: a short introductory period, concurrent integrated classroom and field experiences, and a summarization period. Learning experiences would focus on problem-solving through guided field experiences, classroom group disEvaluation of student achievement and of cussion, and individual assignments. the course would be obtained by student self-evaluation, observations of the instructors, and a follow-up evaluation with the students and their supervisors after completion of the course. With suitable adjustments, many of the objectives of this course could be used to prepare nurses for team leadership in a basic nursing education program: or in a post-basic public health course. Tbe objectives for the course would be: 1. Understanding of the philosophy and principles underlying team nursing. 2. Knowledge and understanding of the factors which iníluence thc organization of public health nursing services. 3. Knowledge and understanding of the relationship of the nurse to members of the health team and community resources.
ISRAEL-TEAM
4. Knowledge
and understanding
265
hWRSk.hG INP;UBLfC HEALTH
of the characteristics
of leadership.
5. Knowledge and understanding of the potential contribution of the various members of the nursing team to patient care, and the rationale underlying differentiation of function in the assignment for patient care.@) 6. Understanding and skills in planning, in team nursing in public health.
providing,
and evaluating
patient
care
7. Knowledge and understanding of the principles of thc dynamics of human behavior which influence relationships with individuals or groups.@) 8. Knowledge and understanding of the principles of communication which contribute to the free interchange of information, ideas, and opinions between two or more individuals in differing situations.(*) 9. Knowledge
in selected areas of public health nursing practice.
The plan proposed for the introduction of team nursing in Israel has two steps : a demonstration project and the introduction of team nursing to the agencies. The demonstration project, under the auspices of the School of Public Health and Hadassah Medical Organization, would test the suitability of the suggested nursing team in a family-focused, generalized public health service. In the second step the project report would be distributed, the center opened for observation, individual guidance made available to the agencies, and a course offered to prepare team leaders. The plan also incorporated several genera1 recommendations for nursing education and service which were considered as basic to team nursing in public health. The nursing team proposed in the plan would be comprized of public health and practica1 nurses, under the leadership of a well-qualified public health nurse. Registered nurses were excluded, as public health preparation was seen as a desirable prerequisite to employment. The aidc group was also excluded, in the belief that aide services should be provided by clerical or custodial personncl in the clinics, and by a homemaker agency or other authority in the home. Team nursing would replace independent assignments of practica1 nurses, and be introduced in services where professional nurses now perform activities which could be safely managed by practica1 nurses. Implications for further stu@v
There are many areas which could benefit from additional research. This and other studies have shown that aides can contribute to patient care and relieve professional nurses of non-nursing activities. A study to determine whether aide services should be the responsibility of the nursing division, or be supplied to nursing by other authorities, could give direction to agencies in planning their services. The wide range of activities and functions assigned to practica1 nurses, to the apparent satisfaction of the agencies, indicated that there may be many more contributions that practica1 nurses can make in public health. Study is needed to determine the possible scope of practica1 nurse assignments, and the qualifications needed for the new role. Communication between professional nurses and auxiliaries was shown to be often inadequate. The techniques of communication proposed in this study, of frequent member-leader and team conferences, are expensive land time-consuming. A study of communication as the basis for effective supervision in public health
266
REBECCA BERGMAN
nursing would be a major contribution. It was suggested in the study that preparation for team leadership should be integrated in basic nursing education programs as a senior experience, supplemented by a pre-assignment workshop. Investigation is needed on whether preparation for team leadership is more effective if obtained in the basic program, in a post-basic course, by in-service education, in a combination of these, or in other programs. An interesting sociological study could be done on the effect of a common ethnic background on patient-nurse relationships. Since team nursing wil1 probably be increasingly accepted in public health, the above suggested areas of study could make important contributions to nursing education and service.
Concluding rtmarks It is believed
that the primary purpose of this study has been fulfilled in the preceding pages-to propose a plan that would enable Israel to expand her public health nursing services within the available resources of personnel. The plan which has been proposed would permit expansion of services within the available personnel, as it drew upon adequate resources of practica1 nurses. It would assure safety of patient care through close supervision of practica1 nurses by a professional team leader on the leve1 of direct patient care. It would enable effective nursing practice by assignment of team members within the scope of their competenties. The team process of planning, providing, and evaluating patient care as a group could improve patient care by utilizing the individual abilities of the team members. The involvement of al1 levels of nursing staff should enhance morale of the personnel. Preassignment preparation and continuing education for the team leader and team members would prepare them for their roles and keep them abreast of new developwould be adapted, within ments. The team composition, size, and organization the basic principles, to the needs and resources of the specific situations. Thus, the plan for team nursing in public health in Israel meets the criteria set down in the purposes of the study.
Acknowkdgmunfs-Gratefirl acknowledgement is made to the members of my committee, Professors M. Frances Fraxier, Eleanor C. Lambertsen and David J. Fox, for their encouragement and guidance during the course of this study. 1 am deeply indebted to the administrators and staff members who gave generously of their time and knowledge in interviews which provided data for this study, of the following health agencies and nursing education programs: the Bronx Veterans Administration Hospital; Community Nursing Services of Philadelphia; Comell University; County of Westchester Department of Health; Hartford Hospital and School of Nursing; Hunter College of the City of New York; Poughkeepsie City and Town Visiting Nurse Service; New York City Department of Health; New York University; St. Vincent% Hospital; Skidmore College; Teachers College, Columbia Univenity; University of Michigan; Visiting Nurse Association of Brooklyn; Visiting Nurse Association of Detroit; Visiting Nurse Association of Hartford; and the Visiting Nurse Association of Rochester and Monroe County. My sincere appreciation is expressed to the respondents to the questionnaire in Israel for their interest and cooperation: the Israel Ministry of Health, Hadassah Medical Organization, Kupat Holim, and the Tel Aviv-Jaffa Municipality. 1 also wish to thank Professor Helen M. Cohen, Anna J. Kalmanowitz, Dr. George A. Silver, and Professor William M. Schmidt for reading and commenting on sections of the manuscript.
ISZUEL-TEAM
JVUZULNGZN PLIZXZCHEALTH Refcrmne
1. ELEANOR Teachers 2. ELEANOR 3. ELEANOR 4. ELJUNOR
C. LAMBERTSEN:.Nursing Team Organiration and Functioning. Bureau of Publications, College, Columbia University, New York (1953). C. LAMBERTSEN: Educationfw .Mming baahship, p. 119. Lippincott, Philadelphia (1958). C. LAMBERTSEN: ibid., p. 122. C. LAMBERTSEN: ibid.,p. 124.
Bibliography Books and fiamphlets American Nurses’ Association, Facts About Jvursing. New York: The Association, 1952. 112 pp. American Nurses’ Association, Facts About Jvursing. New York: The Association, 1953. 146 pp. American Nurses’ Association, Facts About Jvursing. New York: The Association, 1961. 255 pp. Brown, Esther L., .Newcr Dimensions in Patient Care. Part 2. New York: Russell Sage Foundation, 1962. 194 pp. Creighton, Helen, Zegal Zmplicationsfor ~Vurscs. A paper presented at the 42nd Convention of the American Nurses’ Association, Miami Beach, May 3, 1960. New York: The American Nurses’ Association, 1960. 12 pp. Ferguson, Marion, Pub& Health Jvursing Srvices to Patients, Public Health Monograph No. 59. Washington: United States Govemment Printing Press, 1959. 52 pp. Freeman, Ruth B., Pub& Health .h%rsing Practice, 2nd edition. Philadelphia: W. B. Saunders Co., 1957. ix + 435 pp. Gardner, Mary S., Public Health Jvursing, 3rd edition. New York: The Macmillan Co., 1936. xii + 476 pp. Gelber, Ida, Released Mental Patients on Tranquilizing Drugs and the Pub& Health _Nurs.e. New York: New York University Press, 1959. viii + 139 pp. Golenpaul, Dan, ZnformationPlease Almanac Atlas and Yearbook, 1962. New York: Simon and Schuster, 1961. 912 pp. Hillboe, Herman E., Care of the Sick at Home. Albany: New York State Department of Health, 1961. 27 PP* Israel, The Ministry of Health, Health Services in Zsrael: A Ten Year Survey, 19481958. Jerusalem: The Government Printer, 1959. xv + 214 pp. Israel, Govemment, Zsrael Govemment Yearbook, 5711 (1950). Jerusalem: The Government Printer, 1950. 536 pp. Israel, Government, Zs7ael Government Xearbook, 5721 (1966-1961). Jerusalem: The Government Printer, 1961. 541 pp. Israel, Govemment, Zsracl Government Yearbook, 5722 (1961-1962). Jerusalem: The Government Printer, 1962. LXXX + 447 pp. Kron, Thora, Jvursing Team Leaaérsh$. Philadelphia: W. B. Saunders Co., 1961. xii + 168 pp. Lambertsen, Eleanor C., Education for .&sing Leadcrship. Philadelphia: J. B. Lippincott Co., 1958. xiv + 195 pp. Lambertsen, Eleanor C., .NursingTeam Organization and Functioning. New York: Bureau of Publications, Teachers College, Columbia University, 1953. iv + 89 pp. Minnesota, Department of Health, Ihc PracticaZ .Nurse in a Rural Counv Publù Health .Nursing Service in Minnesota. Minneapolis: The Department, 1959. 13 pp. National League for Nursing, Department of Public Health Nursing, Public Health Jvursing: Achievements and Goals. New York: The League, 1957. 10 pp. Newcomb, Dorothy Perkins, 771~Team Plan. New York: G. P. Putnam’s Sons, 1953. xi + 82 pp. Shanas, Ethel, The Health of Older People. Cambridge: Harvard University Press, 1962. xii + 258 PP* Wald, Lillian D., Windows on Henry Street. Boston: Little, Brown and Co., 1934. xi + 348 pp. World Health Organization, Asjects of Public Health Jvursing. Public Health Papers No. 4. Geneva: The Organization, 1961. 185 pp. World Health Organization, Exwt Committee on Professional and Technùat Education of Medùal and Auxitia~ Personnel. Technical Report Series No. 109. Geneva: The Organization, 1956. 19 pp. World Health Organization, Pub& Health JVursing: Fourth Rufmrtof th Ex$ert Committee on Jvursing. Technical Report Series No. 167. Geneva: The Organization, 1959. 31 pp. B
268
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BERGMAN
World Health Organization, Regional Office for South East Asia, R@ort on u Semànar on Categorics and Functions of jvwsing Personnel. Delhi: The Organization, 1956. 57 pp. Periodicals American Nurse.s’ Association. Statement on Auxiliary Personnel in Nursing Service, Am. 3. Nun., LXII, 72-73 (1962). Edman, Hulda. The Practica1 Nurse in the Visiting Nurse Service, .Nursing Outlook, VI 4-8 (1958). Freeman, Ruth B. Leadership in Nursing, hrs. World, CXXXII, 8-11 (1958). Gordon, Thomas. Leadership: Shall It Reside in the Leader or in the Group? Amor.3. Jvurs.,LIV, 1087-1088 (1954). Heeley, Patricia 1. Public Health Assistants, .Grsing Outlook, V, 408-410 (1957). Keller, Hiah. Maternal Care in the Health Center, Alon Hu’achot (Nursing Bulletin), XXV 46-53 (1961) (Hebrew). Netter, Miriam. Homemaker Service, Afon Ha’uchot (Nursing Bulletin), XXV, 71-74 (1961) (Hebrew) . Newton, Mildred E. Developing Leadership Potential, Jvursing Outlook, V, 400-404 (1957). “Out of Purdah Into Better Health in Afghanistan”, Amm. 3. Jvurs.,LXII, 80-81 (1962). Phillips, Elizabeth C. Visiting Home Aide Program, Jvurs~ Outlook, X, 321-324 (1962). Pollock, Arm. The Practical Nurse in the Combination Agency, hrsing Outlook, VI, 448-450 ( 1958). Rabo, Majt. Integrating Public Health in Schools of Nursing, Znternationul .Mming Zhiew, V, 23-27 (1958). Reid, Mayble. Changing Patterns in the Visiting Nurse Service, Jvursing Outlook, VII, 534-535 (1959). Sargent, Emilie G. Detroit VNA Home Aide Service, hrsing Outlook, X, 318-320 (1962). Shifri, Bracha. The Lachish Health Center, Alon Hu’achot (Nursing Bulletin), XXVI, 64-66 (1961). (Hebrew). Silver, George A. Social Medicine at the Montefiore Hospital-A Practica1 Approach to Community Health Problems, Amer. 3. @bl. HM, XLVIII, 724-731 (1958). Wilson, Dorothy. Public Health Nurses and the Brown Report, Pub. HM .Mmi.ng, XL, 496-498 (194% Unpublìshud materials Ben-mm, Judith. A letter to Rebecca Bergman, August, 1962, containing unpublished statistics of the Israel Nurses’ Association. Davis, Ellen Donnelly. “Continuity of Nursing Care”. A paper presented at the Psychiatrie-Mental Health Consultants Session, American Public Health Association Convention, Miama Beach, October 13, 1962. 10 pp. (Mimeographed). Evang, Kari. “Report on a Genera1 Evaluation of the Health Services in Israel, November 1959January 1960”. Geneva: World Health Organization, 1960. ii + 170 pp. (Mimeographed). Israel, Ministry of Health, Division of Nursing. “Nursing in Israel”. Jerusalem: The Division, 1956. 35 pp. (Mimeographed). Latorre, Saturina and Fell, Francis E. “The Preparation of the Nurse-Midwife as a Teacher and Supervisor of Midwives in the Philippines”. Unpublished paper to the World Health Organization, Geneva, 1958. 20 pp. (Mimeographed). Leino, Amelia. “A Study of Team Organization of Nursing Pcrsonnel”. Unpublished study. New York: Teachers College, Columbia University, 1950. Malben. “Annual Report, 1960”. Tel Aviv: Malben, 1961. ii + 83 pp. (Mimeographed). Morgan, Tirza. “Nuning Aspects of Mental Hygiene: Report to the Govemment of Israel”. Tel Aviv: United States Overseas Mission to Israel, 1955. 35 pp. (Mimeographed). National League for Nursing, Department of Public Health Nursing. “Practica1 Nurses Employed in Selected Public Health Services, by Type of Service”. New York: The League, 1961. 1 p. (Mimeographed) . National League for Nursing. “Report of the Conference on Utilization of Practica1 Nurses in Public Health Nursing Programs”. New York: The League, 1958. 6 pp. (Mimeographed). National League for Nursing. ‘Statement on Quality of Personnel Needed in Public Health Nursing Services”. New York: The League, 1957. 3 pp. (Mimeographed).
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269
Notter, Lucille E. “Proposals for the Use and Training of Public Health Nurses’ Aidcs”. Unpublished Doctor of Education project report. New York: Teachers College, Columbia University, 1956. vi + 198 pp. (Typewritten). Sargent, Emilia G. “The Public Health Nurse in Home Care of the Aged”. A paper presented at the White Heuse Conferenceon Aging, Washington, January 9-12,196l. 6pp. (Mimeographed). Shadel, Mark. “Health Services for Residents of Old Age Homes, 1960”. Tel Aviv: Malben, 1961. 17 pp. (Hebrew) . (Mimeographed) . Shuval, Yehudith. “Choosing tbe Profession of Nursing : Prepared for the Nursing Division, Ministry of Health”. Jerusalem: Institute for Applied Research, 1961. ii + 100 pp. (Hebrew, mimeographed). Smith, Elliot Dunlap. “Materials on General Education, Professional Education, and Teacbing”. New York: Division of Nursing Education, Teachers College, Columbia University, 1957. 57 pp.
(Mimeographed) . World Health Organixation. “Guide for Stafhng Public Health Nursing Services and Out-Patient Departments”. Geneva: The Organization, 1961. 7 1 pp. (Mimeographed).
AppesuIù A
Lettersentto ei& sele&d United Stuta public health agenciesrequesting intemàews Miss Executive Directer Visiting Nurse Service Dear 1 am a student at Teachers College, working on a research project in partial f~fillment of the requirements for a doctoral degree. The study will project a plan for team nursing in public healtb in Israel, my homeland. It is expected that this study will be of significante not only to Israel, but to other hands as well, in the light of changing health needs, and the shortage of professional nurses. One of the main areas of investigation is to leam from the experiences of United States public health nursing agencies in the use of auxiliary nursing service penonnel. Several agencies were selected for interview on the basis of their work with auxiliaries. 1 wish to conduct the interviews during the month of October, 1962, at the time and place most convenient for the agency. In your agency 1 hope to interview individually the Directer, or another key nurse in relation to policy, a professional nurse who works with practical nurses, and a practica1 nurse. The interviews wil1 be tape-recorded, and each will take lcss than one hom-. Responses will remain anonymous, and findings wil1 not not be identified with a specific agency in the report. However, 1 should like permission to acknowledge the participation of the agency in the study. 1 hope the Visiting Nurse Service of will agree to be included in the study, for 1 believe we can benefit from your experience. Enclosed is a return postcard for your reply. Thanking you, Sincerely yours, (sign@ Rebecca Bcrgman
AppendixB Zn&tviewguà& used with Direetors and Sujen~isors in eight selccted United States jullie health agencies 1. 2.
Will you please teil me briefly about your agency, its objectivu and services? Why and when were auxiliaries fint employed by your agency? How did this develop? is the turnover ?
What
270
REBECCA
BERGA4A.h'
Do you plan to increase or decrease the number of auxiharies ? Why ? What are the criteria for selection of auxiliaries in your agency ? What are the criteria for aasignment of auxiliaries in your agency ? What are the main contributions of the auxiliaries to your service? Can you envision others that they might make? 7. Should some of the present activities of the auxiliaries in your agency be expanded or limited? What? Why? 8. By whom are the auxiliaries supervised ? Please describe the method of supervision. 9. Is there an orientation program for auxiliaries? Please describe it briefly. Is there contin~g education? What? 10. How are the relations between professional staff and auxiliaries? ll. What does “team nursing in public health” mean to you? What is your opinion of this concept? 12. In the light of your experiences, what recommendations would you make to another agency about to begin work with auxiliaries? 3. 4. 5. 6.
Appendix C Intenkw guti used with professional staflnurses in eight selectcd United Stutes jublic heaith agencies
Wil1 you please tell me briefly about your agency, its objectives and services ? Do you think the number of auxiliaries in your agency should be increased or decreased ? Why ? 3. What qualifications do you think auxiliaries need for their work in this agency? 4. What kinds of assignments do you refer to an auxiliary worker ? 5. What are the main contributions of the auxiliaries to your service? Can you envision others that they might make? 6. Should some of the present activities of the auxiliaries in your agency be expanded or limited? What? Why? 7. Please describe your supervision of, or contact with, the auxiliaries. 8. Did you ever participate in an orientation or continuing education program for, or with, auxiliaries? What? 9. How do you fee1 about the auxiliaries on the job ? How do you think they fee1 about the professional staff? 10. What does “team nursing in public health” mean to you ? What is your opinion of this concept 2 ll. In the light of your experiences, what recommendations would you make to another agency about to begin working with auxiliaries? 1.
2.
AppendisD Interview guide used with fmctical nurses and aides in eight selected United States publù health agencks
1. Will you please briefly tell me about your agency, ita objectives and services? 2. Do you think the number of auxiliaries in your agency should be increased or decreased. Why ? 3. What qualifications do you fee1 you need for this job ? 4. Please tel1 me what kind of work you do, and about some of the patients that you care for. 5. In what way do you think that you and other auxiliaries have contributed to the services in this agency ? Do you think there are other additional contributions that you could make? 6. Do you think that some of your activities could be expanded or limited. What ? Why ? 7. By whom are you supervised? Please describe your contacts with public health staff nurses and the supervisor. (Tell me about how a patient was assigned to you, and your contact with the nurses about this patient).
ISRAEL-TEAM 8. 9. 10. ll.
NURSING IN PUBLIC HEALTH
271
How were you introduced to your job ? Do you continue leaming ? How ? What ? How do you fee1 about the professional nurses ? How do you think they fee1 about the auxiliaries? (Optional, depending on the level). What does “team nursing in public health” mean to you? Do you think this is desirable? In the light of your experiences as an auxiliary worker in public health nursing, what do you think could be done in agency about to employ auxiliaries, which would help the service and the auxiliary worker ?
AppendixE Lettarsenttofour Israeiijublù hcalth agcncies requesting infmtion
on pub& health nursing in Isme1
Miss Diiector of Nursing Services Agency Israel Dear As you know from our previous correspondence, 1 am now working on a research project at Teachers College, Columbia University, in partial fulfillment of the requirements for a doctoral degree. The study wil1 project a plan for team nursing in public health in Israel. This may be of aignificance for Israel and other lands in the light of changing health needs and the shortage of professional nurses. There are two main areas of investigation: a review of data related to public health nursing in Israel and interviews in selected United States public health nursing agencies on their experiences with auxiliary nursing service personnel. 1 would be most grateful for your cooperation in filling out the attached questionnaire on public health nuning in your agency. This questionnaire is being sent to the Ministry of Health, Hadassah Medical Organization, Kupat Holim, and the Tel Aviv-Jaffa Municipality. The responses wil1 be presented as overall trends, and your agency identified with specific responses only with your agreement. To be of most value in the study, it is important that the completed questionnaire reach me before September 15, 1962. Thank you very much for your help, and awaiting your early reply, 1 am Sincerely yours, (signed) Rebecca Lyons Bergman
AppendisF Questionnaire onpublù health nursìng in Isme1 sent tofour Ismlì publìc health agencies The following questions refer 07th to public health nursing in your agency. RN
-
(registered nurse)
Graduate of an approved three-year school of nursing.
PHN
-
(public health nurse)
PN
-
(practica1 nurse)
RN and a graduate of an approved public health course.
Graduate of an approved school for practica1 nurses.
REBECCA BERGMAN
272 Aide
-
StaiInurse
-
(nursc’s aide) Auxihary nursing service personnel with less recogniaed preparation than a practical nurse. nursing personnel giving direct service to clients.
1. Please write in the numbcr of public health nursing personnel employed by your agency in the appropriate spaces below : Year
PHN
RN
Aide
PN
Total
1962 1958 1955 1952 1948
2a. Please list the three main reasons for the employment of practica1 nurses in public health in your agency. b. What do you drink should be done to the present number of practical nurses employed in your agency in public health? (circle one) increased decreased no change c. Why? 3a. If your agency employs nurse aides in public health please list the three main reasons for this employment. b. What do you think should be done with the present number of nurse aides? increased decreascd no change C.
4.
(circle one)
Why ? What are the criteria for employment of practical nurses in public health in your agency ? a.
in regard to genera1 education
. ... ............................ .......__.............................
b.
in regard to nursing education
....
c.
in regard to othcr criteria @lease specify)
..
.. ... ..._
....
_... ............. ._.._.
.. .. .... . .. .. ... .. ... .. .. ... .. . ... ... . .. ... . .. *. .. .. . .... . ... ... . .. ... . ... ... . ... .. .. ... ... ... . .. ... .. ... .. .. ... .. ... .. .. .. 5.
Are there any dií%rences in the assignments given to PHN and RN? Ifycs, please list three main differences.
(circle one)
Yes
NO
6.
Are there any diffcrenccs in the assignments given to RN and PN? Ifyss, please list three main differences.
(circle one)
Yes
NO
7.
.. . By whom is the PN supervised ? . . . . . .. . . . Please briefly describe how this supervision is carried out.
8.
Below are listed the usual areas of service given by nursing service personnel in public health. Please add any others which you think are important. In column A indicate whether your agency provides the service. In columns B and C indicate your agency’s plans for the service. In column D give the reason for these plans, considering such factors as: need for the service, agent responsibility, availability of personnel, funds, etc.
.
.
ISRAEL--TEAM
A Do you provide this service
NURiING
IN PUBLIC HEALTH
C If no
B Ifyes do you plan to
isthe
under consideration?
_-
-‘_
YeS
YeS
NO
9
xil __
Infant health su pervision
Preschool health supervision School health progrCare of acute paticnts in the home Care of chronic patients in the home Tuberculosis progrMental health progrGeriatrie program Occupational health Epidemiology
...... ........................................ ..............................................
NO ---
6
Prenatal care
D
program
now ? Areas of Service
273
l
E --
Reason for thii plan
REBECCA BERGMAN
274 9.
Has your agency an orientation program for new nursing service personnel in public health? NO (circle one) Yes Ifycs, please describe brietly. For whom is this program plarmed ?
10.
Has your agency an in-service education program for nursing service personnel in public Yes NO health? (circle one) Ifyes, please deacribe brietly. For whom is this program planned ?
11.
Please add any additional information which you consider pertinent about public health numing in your agency.
12.
Do you want the response to thii questionnaire to be identified by name with your agency in NO Yes the study? (circle one)
.
. Title
Signature Please return this completed questionnaire to: (Mrs.) Rebecca Ilergman 509 West 121st Street New York 27, New York U.S.A.
To be of greatest value in the study, it is important that 1 receive the completed questionnaire before September 15, 1962. THANK YOU FOR YOUR
COOPERATION
Letterto theDiztisionofJVming in th Israd Mùistry of Health reqwsting infonnation on nuring education in IJrocl . ... ...*.........................
Chief Nurse, Division of Nursing Ministry of Health Jerusalem, Isme1 Dear Mrs.. .. . .... .. ... ... .. ... ... .. . AS you know from our previous correspondence, 1 am now working on a research project at Teachers College, Columbia University, in partial fulfillment of the requirements of a doctoral degree. The study will project a plan for team nursing in public healtb in Israel. It is expected that this study wil1 be of significante not only for Israel, but also for other lands as well in the light of changing needs and the shortage of professional nurses. One scction of the study is devoted to the status and problems of public health nursing in Israel. 1 am obtaining data from the literature and by questionnaire from the health agencies in Israel. However, some of the information on nursing education is available only in the Ministry, and 1 would be most grateful if you would complete the attached questionnaire and return it so that 1 receive it before September 15, 1962. Rest regards to the nurses at the Ministry. Sincerely yours, (signed) Rebecca Lyons Ikrgman
ISBAEL-TEAM
NVRTING LNPVBLIC
HEALTH
275
Qu&onnaire on nursing eduation in Isme1 sent to thc Division of Nursing of thc Isme1 Ministry of HcBlth 1. Please write in the statistics for the number of schools and graduates
of nursing, as indicated
-Post-Basic Courses in PHN No. of COUlXS
No. of Grads.
Registered Nurse Schqols No. of schools
No. of Grads.
Practica1 Nurse Schools -No. of Schools
No. of Grads.
Baby-Nurse Schools No. of Schools
No. of Grads.
1921 to 1948 1948
-1949
t-
1950 1951 1952 1953
_- --
1954 1955
_-
1956 1957 1958 1959 1960 1961 Total
THANK YOU FOR YOUR
COOPERATION
REBECC.4 BERGMAN
276
AppentaI Lutursmt to dam sckxted United Swes schools and agenctk requestìng intnoisws witlr instnsctors of team leaakship . . .. ... . .. .. . .. . .. ... ... . .. ... .. .. .. Nursing Education Program School (Agency) Dear. ...
. . .. 1 am a student at Teachers College, Columbia University, working on a research project in
partial fùlfillment of the requirements for a doctoral degree. The study wil1 project a plan for team nursing in public health in Israel, my homeland. This study may be of signifkance to Israel and other lands in the light of changing health needs and the shortage of professional nurses. The study wil1 include suggested leaming expcnences for team leadership. 1 wish to interview instructors of team leademhip in nursing education programs of educational institutions, and inservice education of service agencies. Each interview would take less than one hour, and lx scheduled at the time and place most convenient for the interviewee. Responses will be anonymous, but the agency participation cited U this is agreeable. 1 hope you wil1 allow me to include your school (agency) in the study. If your answer is positive, 1 should like to conduct the interview during the month of October, 1962. Thanking you, and awaiting your early reply, Sincerely yours, (signed) Rebecca Rergman
Intmì6wguide used with instructors of team leaabship in eleven selected United States schools and ogen& 1. Will you please tel1 me the title of your course, its duration, the number of credit hours, and its sequence in the over-al1 program. 2.
What are the course objectives?
3.
What are the main content areas in the course ?
4.
What field experience is provided?
5.
What teaching methods do you use?
6.
How do you evaluate student learning?
7.
What problems have you encountered in any phase of the course?
8.
What recommendations would you make for a new course in team leadership?
ZSRAEL-TEAM Appendix
277
NURTING IN PUBLJC HEALTH
K l’?uoretùal program fm post-basù publù health nursing tourses in Ismel*
Numberof Theoretùal Program 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. 12. 13. 14. 15. 16. 17. 18. 19.
Introduction to public health Sociology Demography and biostatistics Anthropology Rituals, tradition, rabbinical laws in Judaism Psychology Group dynamics Social pathology Case work approach and interview techniques Social aspects of chronic diseases Epidemiology Hygiene, sanitation, and industrial hygiene Nutrition Growth and development Matemity and child health, including nursing Family health Community organiaation Government national insurance Health education
*As offeredby Hadassah Medieal Organisation in rg6 I .
HOWS 16 26 18 10 18 20 14 16 30 16 20 30 16 40 50 25 as needed 4 as needed
Israel-Team
Pemamoa Pres,
1966.
Printal io
Grut Britdn
Nursing in Public Health
Part 4-Summav, Proposals, and Implicationr For Further Study
REBECCA
BERGMAN,
R.N. Ed.D.
Departrnent of Social Medicine Habrew Univnsity, Hadassah Medical School, jerusalem
THE
purposes of this study were : (1) to propose a plan for Israel that would enable expansion of public health nursing services and make more effective use of available pcrsonnel, (2) to propose leaming experiences for the leadership group in the above plan, and (3) to portray the trends and needs in public health nursing in Israel. Public health nursing programs have greatly expanded in the last two decades. The supply of professional nurses has not kept abreast of the demands, resulting in the employment ofauxiliary personnel. This practice may be dangerous unless professional lcadcrship is available at the leve1 of direct patient care. The need to find an organizational pattern which would enable a safe, effective, public health nursing service in Israel, within the available resources of personnel, was the motivating factor for this study. It was hoped that the conclusions might also contribute to planning for public health nursing services in other lands with similar problems. Data were gathcred from several sources. Trends in public health nursing, particularly those related to the usc of auxiliary personnel, were reviewed in the litcraturc. Matcrials on the needs, resources, present practices, and planned changes in public health nursing in Israel were obtaincd by study of reports from Israel and also through questionnaires to the four major public health agencies, and to thc Division of Nursing in the Israel Ministry of Health. Data on the use of auxiliaries in public health nursing in the United States were procured in 53 interviews with directers, supervisors, professional staff nurses, practica1 nurses, and aides in eight selected public health agencies employing practica1 nurses, aides, or both. Interviews with instructors of team leadership in 11 selected educational programs provided background information used in formulation of leaming experiences for leadership. Nine principles of team nursing in public health, a program for the of team preparation of team leaders in Isracl, and a plan for the introduction nursing in Israel were evolved, al1 three being based on conclusions from the above data, the Lambertsen study on team nursing in hospitals,(l) and the researcher’s personal philosophy.
262
REBBtXA BERGMAN
Summqv ofjndings and cotulusions Review of the literature on public health nursing revealed two major trends. The first of these was seen in the developing countries, where vast urgent public health programs, concemed primarily with problems of communicable disease, nutrition, and sanitation, were undertaken by smal1 numbers of professional workers assisted by many auxiliaries. The second trend was found in the technically developed lands, where the needs and programs were moving from the above areas toward problems of chronic disease, ageing, and mental health. These countries had relatively more professional nurses than the developing lands, but were stil1 below the ratio of one public health nurse to 2,000 population, which is considered desirable for a comprehensive preventive and curative public health nursing service. Studies in the United States showed an increase in the use of practica1 nurses, with genera1 agreement of their positive role in public health nursing. Aides were a more recent addition to the service but it was not determined whether this group should be the responsibility of nursing, or of another authority. It was also found that in the United States, team nursing was considered by many to be a solution to the shortage of professional nurses and growing employment of auxiliaries. Team nursing was increasingly being accepted by hospitals, and gradually being introduced in public health agencies employing auxiliary nursing service personnel . Analysis of the data on Israel showed a trend away from specialized public health programs to comprehensive, family-focused programs planned on a regional basis. Miier the establishment of the State of Israel in 1948, the unselected mass immigration resulted in serious public health needs which were met and overcome by dedicated personnel in emergency programs. Problems related to matemal and child health and communicable diseases were diminishing, whereas care of the aged, chronic disease and mental health required additional services. The current public health nursing functions in these areas were limited. The sources of nursing personnel in Israel were from immigration, and from local schools of nursing, which annually graduated about 200 registered, and 400 practica1 nurses. The ratio of al1 nursing personnel to population was somewhat lower than that of the United States, but the percentage of practica1 nurses was three times as high as that of the United States. Thc shortage of professional staff was reflected in public health nursing, where 37 per cent of the personnel were practica1 nurses. Practica1 nurses were used in functional assignments in health centers, and in independent assignments in outlying areas wherc professional nurses were not available. It was concluded from the above data that public health nursing services would have to expand, and that practica1 nurses would continuc to fill at least ene-third of the staff positions. The present organizational pattern had inherent dangers in the independent assignments of practica1 nurses and did not sufficiently use the potential of the professional nurses in othcr situations. A different pattem was needed to permit expansion in a safe, effective service. Data from the interviews in the eight selected United States public health agencies depicted polities and practices in the use of auxiliaries in those agencies Al1 of the agencies were employing, or were as wel1 as opinions on the practices. considering the employment of, both practica1 nurses and aides. The major findings and conclusions from the interviews are listed below.
ISRAEL-
TEAiU NURSIX
IN PUBLIC HEALTH
263
1. Auxiiiary personnel were employed in order to enable better use of professional nurses, and to meet service needs. 2. There was a decrease in the understanding of agency objectives and services This indicated the need in staff members with less preparation and responsibility. for broader orientation of auxiliary groups. 3. There was a wide range in the proportion of auxiliary personnel to professional nurses, with many considerations entering into the determination of the proportion. 4. Criteria for the selection of practica1 nurses suggested by the interviewees were : graduation from a school for practica1 nurses and a high school, interpersonal Intellectual ski&, initiative, and responsibility ski&, and hospita1 experience. This was a surprising finding in the light of agency expectawere rarely mentioned. tions of the practica1 nurses. Criteria for the selection of aides were primarily high school education, interpersonal skills, and experience in health work. 5. Criteria for assignment of practica1 nurses varied greatly among the agencies, the total range covering many activities which had been found satisfactory in at This indicated a potential aot being utilized by many agencies. least one agency. The assignment of aides was limited to assisting activities and housekeeping. 6. Supervision of practica1 nurses was carried out by the public health nurses and the supervisors, but the onus for recognizing and reporting patient needs rested with the practica1 nurse. Orientation to a new patient was usually limited to verba1 description of the patient and his care, and fellow-up to casual office contact and intermittent home visits of the professional nurse. Supervision of the aide was the responsihility of the public health nurse or a special supervisor, with orientation conducted by description or introduction in the home and follow-up through home visits or telephone contact<. In some of the agencies the techniques of supervision This finding highlighted the importante of of auxiliaries appeared inadequate. an organizational pattern that would provide adequate communication and supervision. 7. Al1 the agencies considered orientation of new employees important, and had orientation programs for both practica1 nurses and aides. 8. Al1 agencies provided in-service education for practica1 nurses. JYhen programs were shared by practica1 and professional nurses it appeared to raise practica1 In-service education for aides was minimal, and was not considered nurse morale. important by the intervicwees. 9. Attitudes of thc professional and auxiliary staff to each other tverc reported as excellent or good by 90 per cent of the intcrvicwees, although thrrc had been some initial resistancc to thc auxiliaries. 10. Most of the intcrviewees perceived team nursing as professional and auxiliary nursing personnel working together undcr the leadcrship of a public health nurse. ll. Recommendations which the interviewces would make to another agcncy about to employ auxiliary personnel included : orientation and educational programs for al1 lcvels of staff, the involvemcnt of al1 conccrned in planning for the program, careful selection of auxiliaries, promotion of easy communication, and good staff morale. Interviews were conducted with instructors of team leadership in seven basic and four agency in-service education programs. nursing education programs, Analysis of the data showed a similarity of objectives, teaching methods, and
264
REBECCA BERGMAN
problems in most of the programs, but considerable variation in course organization, duration, theoretical content, and planned experiences in nursing practice. The interviewees emphasized the importante of assuring the cooperation of the service staff in a suitable field for nursing practice. The major conclusion from the interviews was that similar objectives could be considered in planning a course for team leadership in basic, post-basic, and in-service education programs but that leaming experiences would have to be adapted to each group. Proposals made in ths study The study presents three proposals: nine suggested principles for team nursing in public health, a program for preparing team leaders for public health nursing in Israel, and a plan for introducing team nursing in public health in Israel. These three proposals were formulated on the basis of the preceding data. The first proposal, the principles of team nursing in public health, are listed below : 1. The patient is the focus of team nursing in public health. 2. There are functions and activities in pubiic health nursing which permit the safe utilization of personnel with different levels of competente. 3. Competent leadership is a prerequisite for team nursing. 4. Supervision should be kept as near as possible to thc source of direct patient care. 5. Pre-assignment preparation and continuing education are nceded for team nursing. 6. Size and composition of the team should be flexible. 7. Good morale within the team and in the agency contributes to the improvement of team nursing. 8. Frequent, easy communication within the team is essential. 9. Continuity of assignmcnt of personnel improves patient care. The team leadership course for Israel was proposed for employed public health nurses selected by their agencies as potential team leaders. It would be offered or guided by an educational institution, and would last from four to six weeks. Leaming experiences and evaluation would be based on thc course objectives. Course sequence would be: a short introductory period, concurrent integrated classroom and field experiences, and a summarization period. Learning experiences would focus on problem-solving through guided field experiences, classroom group disEvaluation of student achievement and of cussion, and individual assignments. the course would be obtained by student self-evaluation, observations of the instructors, and a follow-up evaluation with the students and their supervisors after completion of the course. With suitable adjustments, many of the objectives of this course could be used to prepare nurses for team leadership in a basic nursing education program: or in a post-basic public health course. Tbe objectives for the course would be: 1. Understanding of the philosophy and principles underlying team nursing. 2. Knowledge and understanding of the factors which iníluence thc organization of public health nursing services. 3. Knowledge and understanding of the relationship of the nurse to members of the health team and community resources.
ISRAEL-TEAM
4. Knowledge
and understanding
265
hWRSk.hG INP;UBLfC HEALTH
of the characteristics
of leadership.
5. Knowledge and understanding of the potential contribution of the various members of the nursing team to patient care, and the rationale underlying differentiation of function in the assignment for patient care.@) 6. Understanding and skills in planning, in team nursing in public health.
providing,
and evaluating
patient
care
7. Knowledge and understanding of the principles of thc dynamics of human behavior which influence relationships with individuals or groups.@) 8. Knowledge and understanding of the principles of communication which contribute to the free interchange of information, ideas, and opinions between two or more individuals in differing situations.(*) 9. Knowledge
in selected areas of public health nursing practice.
The plan proposed for the introduction of team nursing in Israel has two steps : a demonstration project and the introduction of team nursing to the agencies. The demonstration project, under the auspices of the School of Public Health and Hadassah Medical Organization, would test the suitability of the suggested nursing team in a family-focused, generalized public health service. In the second step the project report would be distributed, the center opened for observation, individual guidance made available to the agencies, and a course offered to prepare team leaders. The plan also incorporated several genera1 recommendations for nursing education and service which were considered as basic to team nursing in public health. The nursing team proposed in the plan would be comprized of public health and practica1 nurses, under the leadership of a well-qualified public health nurse. Registered nurses were excluded, as public health preparation was seen as a desirable prerequisite to employment. The aidc group was also excluded, in the belief that aide services should be provided by clerical or custodial personncl in the clinics, and by a homemaker agency or other authority in the home. Team nursing would replace independent assignments of practica1 nurses, and be introduced in services where professional nurses now perform activities which could be safely managed by practica1 nurses. Implications for further stu@v
There are many areas which could benefit from additional research. This and other studies have shown that aides can contribute to patient care and relieve professional nurses of non-nursing activities. A study to determine whether aide services should be the responsibility of the nursing division, or be supplied to nursing by other authorities, could give direction to agencies in planning their services. The wide range of activities and functions assigned to practica1 nurses, to the apparent satisfaction of the agencies, indicated that there may be many more contributions that practica1 nurses can make in public health. Study is needed to determine the possible scope of practica1 nurse assignments, and the qualifications needed for the new role. Communication between professional nurses and auxiliaries was shown to be often inadequate. The techniques of communication proposed in this study, of frequent member-leader and team conferences, are expensive land time-consuming. A study of communication as the basis for effective supervision in public health
266
REBECCA BERGMAN
nursing would be a major contribution. It was suggested in the study that preparation for team leadership should be integrated in basic nursing education programs as a senior experience, supplemented by a pre-assignment workshop. Investigation is needed on whether preparation for team leadership is more effective if obtained in the basic program, in a post-basic course, by in-service education, in a combination of these, or in other programs. An interesting sociological study could be done on the effect of a common ethnic background on patient-nurse relationships. Since team nursing wil1 probably be increasingly accepted in public health, the above suggested areas of study could make important contributions to nursing education and service.
Concluding rtmarks It is believed
that the primary purpose of this study has been fulfilled in the preceding pages-to propose a plan that would enable Israel to expand her public health nursing services within the available resources of personnel. The plan which has been proposed would permit expansion of services within the available personnel, as it drew upon adequate resources of practica1 nurses. It would assure safety of patient care through close supervision of practica1 nurses by a professional team leader on the leve1 of direct patient care. It would enable effective nursing practice by assignment of team members within the scope of their competenties. The team process of planning, providing, and evaluating patient care as a group could improve patient care by utilizing the individual abilities of the team members. The involvement of al1 levels of nursing staff should enhance morale of the personnel. Preassignment preparation and continuing education for the team leader and team members would prepare them for their roles and keep them abreast of new developwould be adapted, within ments. The team composition, size, and organization the basic principles, to the needs and resources of the specific situations. Thus, the plan for team nursing in public health in Israel meets the criteria set down in the purposes of the study.
Acknowkdgmunfs-Gratefirl acknowledgement is made to the members of my committee, Professors M. Frances Fraxier, Eleanor C. Lambertsen and David J. Fox, for their encouragement and guidance during the course of this study. 1 am deeply indebted to the administrators and staff members who gave generously of their time and knowledge in interviews which provided data for this study, of the following health agencies and nursing education programs: the Bronx Veterans Administration Hospital; Community Nursing Services of Philadelphia; Comell University; County of Westchester Department of Health; Hartford Hospital and School of Nursing; Hunter College of the City of New York; Poughkeepsie City and Town Visiting Nurse Service; New York City Department of Health; New York University; St. Vincent% Hospital; Skidmore College; Teachers College, Columbia Univenity; University of Michigan; Visiting Nurse Association of Brooklyn; Visiting Nurse Association of Detroit; Visiting Nurse Association of Hartford; and the Visiting Nurse Association of Rochester and Monroe County. My sincere appreciation is expressed to the respondents to the questionnaire in Israel for their interest and cooperation: the Israel Ministry of Health, Hadassah Medical Organization, Kupat Holim, and the Tel Aviv-Jaffa Municipality. 1 also wish to thank Professor Helen M. Cohen, Anna J. Kalmanowitz, Dr. George A. Silver, and Professor William M. Schmidt for reading and commenting on sections of the manuscript.
ISZUEL-TEAM
JVUZULNGZN PLIZXZCHEALTH Refcrmne
1. ELEANOR Teachers 2. ELEANOR 3. ELEANOR 4. ELJUNOR
C. LAMBERTSEN:.Nursing Team Organiration and Functioning. Bureau of Publications, College, Columbia University, New York (1953). C. LAMBERTSEN: Educationfw .Mming baahship, p. 119. Lippincott, Philadelphia (1958). C. LAMBERTSEN: ibid., p. 122. C. LAMBERTSEN: ibid.,p. 124.
Bibliography Books and fiamphlets American Nurses’ Association, Facts About Jvursing. New York: The Association, 1952. 112 pp. American Nurses’ Association, Facts About Jvursing. New York: The Association, 1953. 146 pp. American Nurses’ Association, Facts About Jvursing. New York: The Association, 1961. 255 pp. Brown, Esther L., .Newcr Dimensions in Patient Care. Part 2. New York: Russell Sage Foundation, 1962. 194 pp. Creighton, Helen, Zegal Zmplicationsfor ~Vurscs. A paper presented at the 42nd Convention of the American Nurses’ Association, Miami Beach, May 3, 1960. New York: The American Nurses’ Association, 1960. 12 pp. Ferguson, Marion, Pub& Health Jvursing Srvices to Patients, Public Health Monograph No. 59. Washington: United States Govemment Printing Press, 1959. 52 pp. Freeman, Ruth B., Pub& Health .h%rsing Practice, 2nd edition. Philadelphia: W. B. Saunders Co., 1957. ix + 435 pp. Gardner, Mary S., Public Health Jvursing, 3rd edition. New York: The Macmillan Co., 1936. xii + 476 pp. Gelber, Ida, Released Mental Patients on Tranquilizing Drugs and the Pub& Health _Nurs.e. New York: New York University Press, 1959. viii + 139 pp. Golenpaul, Dan, ZnformationPlease Almanac Atlas and Yearbook, 1962. New York: Simon and Schuster, 1961. 912 pp. Hillboe, Herman E., Care of the Sick at Home. Albany: New York State Department of Health, 1961. 27 PP* Israel, The Ministry of Health, Health Services in Zsrael: A Ten Year Survey, 19481958. Jerusalem: The Government Printer, 1959. xv + 214 pp. Israel, Govemment, Zsrael Govemment Yearbook, 5711 (1950). Jerusalem: The Government Printer, 1950. 536 pp. Israel, Government, Zs7ael Government Xearbook, 5721 (1966-1961). Jerusalem: The Government Printer, 1961. 541 pp. Israel, Govemment, Zsracl Government Yearbook, 5722 (1961-1962). Jerusalem: The Government Printer, 1962. LXXX + 447 pp. Kron, Thora, Jvursing Team Leaaérsh$. Philadelphia: W. B. Saunders Co., 1961. xii + 168 pp. Lambertsen, Eleanor C., Education for .&sing Leadcrship. Philadelphia: J. B. Lippincott Co., 1958. xiv + 195 pp. Lambertsen, Eleanor C., .NursingTeam Organization and Functioning. New York: Bureau of Publications, Teachers College, Columbia University, 1953. iv + 89 pp. Minnesota, Department of Health, Ihc PracticaZ .Nurse in a Rural Counv Publù Health .Nursing Service in Minnesota. Minneapolis: The Department, 1959. 13 pp. National League for Nursing, Department of Public Health Nursing, Public Health Jvursing: Achievements and Goals. New York: The League, 1957. 10 pp. Newcomb, Dorothy Perkins, 771~Team Plan. New York: G. P. Putnam’s Sons, 1953. xi + 82 pp. Shanas, Ethel, The Health of Older People. Cambridge: Harvard University Press, 1962. xii + 258 PP* Wald, Lillian D., Windows on Henry Street. Boston: Little, Brown and Co., 1934. xi + 348 pp. World Health Organization, Asjects of Public Health Jvursing. Public Health Papers No. 4. Geneva: The Organization, 1961. 185 pp. World Health Organization, Exwt Committee on Professional and Technùat Education of Medùal and Auxitia~ Personnel. Technical Report Series No. 109. Geneva: The Organization, 1956. 19 pp. World Health Organization, Pub& Health JVursing: Fourth Rufmrtof th Ex$ert Committee on Jvursing. Technical Report Series No. 167. Geneva: The Organization, 1959. 31 pp. B
268
REBECCA
BERGMAN
World Health Organization, Regional Office for South East Asia, R@ort on u Semànar on Categorics and Functions of jvwsing Personnel. Delhi: The Organization, 1956. 57 pp. Periodicals American Nurse.s’ Association. Statement on Auxiliary Personnel in Nursing Service, Am. 3. Nun., LXII, 72-73 (1962). Edman, Hulda. The Practica1 Nurse in the Visiting Nurse Service, .Nursing Outlook, VI 4-8 (1958). Freeman, Ruth B. Leadership in Nursing, hrs. World, CXXXII, 8-11 (1958). Gordon, Thomas. Leadership: Shall It Reside in the Leader or in the Group? Amor.3. Jvurs.,LIV, 1087-1088 (1954). Heeley, Patricia 1. Public Health Assistants, .Grsing Outlook, V, 408-410 (1957). Keller, Hiah. Maternal Care in the Health Center, Alon Hu’achot (Nursing Bulletin), XXV 46-53 (1961) (Hebrew). Netter, Miriam. Homemaker Service, Afon Ha’uchot (Nursing Bulletin), XXV, 71-74 (1961) (Hebrew) . Newton, Mildred E. Developing Leadership Potential, Jvursing Outlook, V, 400-404 (1957). “Out of Purdah Into Better Health in Afghanistan”, Amm. 3. Jvurs.,LXII, 80-81 (1962). Phillips, Elizabeth C. Visiting Home Aide Program, Jvurs~ Outlook, X, 321-324 (1962). Pollock, Arm. The Practical Nurse in the Combination Agency, hrsing Outlook, VI, 448-450 ( 1958). Rabo, Majt. Integrating Public Health in Schools of Nursing, Znternationul .Mming Zhiew, V, 23-27 (1958). Reid, Mayble. Changing Patterns in the Visiting Nurse Service, Jvursing Outlook, VII, 534-535 (1959). Sargent, Emilie G. Detroit VNA Home Aide Service, hrsing Outlook, X, 318-320 (1962). Shifri, Bracha. The Lachish Health Center, Alon Hu’achot (Nursing Bulletin), XXVI, 64-66 (1961). (Hebrew). Silver, George A. Social Medicine at the Montefiore Hospital-A Practica1 Approach to Community Health Problems, Amer. 3. @bl. HM, XLVIII, 724-731 (1958). Wilson, Dorothy. Public Health Nurses and the Brown Report, Pub. HM .Mmi.ng, XL, 496-498 (194% Unpublìshud materials Ben-mm, Judith. A letter to Rebecca Bergman, August, 1962, containing unpublished statistics of the Israel Nurses’ Association. Davis, Ellen Donnelly. “Continuity of Nursing Care”. A paper presented at the Psychiatrie-Mental Health Consultants Session, American Public Health Association Convention, Miama Beach, October 13, 1962. 10 pp. (Mimeographed). Evang, Kari. “Report on a Genera1 Evaluation of the Health Services in Israel, November 1959January 1960”. Geneva: World Health Organization, 1960. ii + 170 pp. (Mimeographed). Israel, Ministry of Health, Division of Nursing. “Nursing in Israel”. Jerusalem: The Division, 1956. 35 pp. (Mimeographed). Latorre, Saturina and Fell, Francis E. “The Preparation of the Nurse-Midwife as a Teacher and Supervisor of Midwives in the Philippines”. Unpublished paper to the World Health Organization, Geneva, 1958. 20 pp. (Mimeographed). Leino, Amelia. “A Study of Team Organization of Nursing Pcrsonnel”. Unpublished study. New York: Teachers College, Columbia University, 1950. Malben. “Annual Report, 1960”. Tel Aviv: Malben, 1961. ii + 83 pp. (Mimeographed). Morgan, Tirza. “Nuning Aspects of Mental Hygiene: Report to the Govemment of Israel”. Tel Aviv: United States Overseas Mission to Israel, 1955. 35 pp. (Mimeographed). National League for Nursing, Department of Public Health Nursing. “Practica1 Nurses Employed in Selected Public Health Services, by Type of Service”. New York: The League, 1961. 1 p. (Mimeographed) . National League for Nursing. “Report of the Conference on Utilization of Practica1 Nurses in Public Health Nursing Programs”. New York: The League, 1958. 6 pp. (Mimeographed). National League for Nursing. ‘Statement on Quality of Personnel Needed in Public Health Nursing Services”. New York: The League, 1957. 3 pp. (Mimeographed).
ISRAEL-TEAM
NURSING INPUBLIC HEALTH
269
Notter, Lucille E. “Proposals for the Use and Training of Public Health Nurses’ Aidcs”. Unpublished Doctor of Education project report. New York: Teachers College, Columbia University, 1956. vi + 198 pp. (Typewritten). Sargent, Emilia G. “The Public Health Nurse in Home Care of the Aged”. A paper presented at the White Heuse Conferenceon Aging, Washington, January 9-12,196l. 6pp. (Mimeographed). Shadel, Mark. “Health Services for Residents of Old Age Homes, 1960”. Tel Aviv: Malben, 1961. 17 pp. (Hebrew) . (Mimeographed) . Shuval, Yehudith. “Choosing tbe Profession of Nursing : Prepared for the Nursing Division, Ministry of Health”. Jerusalem: Institute for Applied Research, 1961. ii + 100 pp. (Hebrew, mimeographed). Smith, Elliot Dunlap. “Materials on General Education, Professional Education, and Teacbing”. New York: Division of Nursing Education, Teachers College, Columbia University, 1957. 57 pp.
(Mimeographed) . World Health Organixation. “Guide for Stafhng Public Health Nursing Services and Out-Patient Departments”. Geneva: The Organization, 1961. 7 1 pp. (Mimeographed).
AppesuIù A
Lettersentto ei& sele&d United Stuta public health agenciesrequesting intemàews Miss Executive Directer Visiting Nurse Service Dear 1 am a student at Teachers College, working on a research project in partial f~fillment of the requirements for a doctoral degree. The study will project a plan for team nursing in public healtb in Israel, my homeland. It is expected that this study will be of significante not only to Israel, but to other hands as well, in the light of changing health needs, and the shortage of professional nurses. One of the main areas of investigation is to leam from the experiences of United States public health nursing agencies in the use of auxiliary nursing service penonnel. Several agencies were selected for interview on the basis of their work with auxiliaries. 1 wish to conduct the interviews during the month of October, 1962, at the time and place most convenient for the agency. In your agency 1 hope to interview individually the Directer, or another key nurse in relation to policy, a professional nurse who works with practical nurses, and a practica1 nurse. The interviews wil1 be tape-recorded, and each will take lcss than one hom-. Responses will remain anonymous, and findings wil1 not not be identified with a specific agency in the report. However, 1 should like permission to acknowledge the participation of the agency in the study. 1 hope the Visiting Nurse Service of will agree to be included in the study, for 1 believe we can benefit from your experience. Enclosed is a return postcard for your reply. Thanking you, Sincerely yours, (sign@ Rebecca Bcrgman
AppendixB Zn&tviewguà& used with Direetors and Sujen~isors in eight selccted United States jullie health agencies 1. 2.
Will you please teil me briefly about your agency, its objectivu and services? Why and when were auxiliaries fint employed by your agency? How did this develop? is the turnover ?
What
270
REBECCA
BERGA4A.h'
Do you plan to increase or decrease the number of auxiharies ? Why ? What are the criteria for selection of auxiliaries in your agency ? What are the criteria for aasignment of auxiliaries in your agency ? What are the main contributions of the auxiliaries to your service? Can you envision others that they might make? 7. Should some of the present activities of the auxiliaries in your agency be expanded or limited? What? Why? 8. By whom are the auxiliaries supervised ? Please describe the method of supervision. 9. Is there an orientation program for auxiliaries? Please describe it briefly. Is there contin~g education? What? 10. How are the relations between professional staff and auxiliaries? ll. What does “team nursing in public health” mean to you? What is your opinion of this concept? 12. In the light of your experiences, what recommendations would you make to another agency about to begin work with auxiliaries? 3. 4. 5. 6.
Appendix C Intenkw guti used with professional staflnurses in eight selectcd United Stutes jublic heaith agencies
Wil1 you please tell me briefly about your agency, its objectives and services ? Do you think the number of auxiliaries in your agency should be increased or decreased ? Why ? 3. What qualifications do you think auxiliaries need for their work in this agency? 4. What kinds of assignments do you refer to an auxiliary worker ? 5. What are the main contributions of the auxiliaries to your service? Can you envision others that they might make? 6. Should some of the present activities of the auxiliaries in your agency be expanded or limited? What? Why? 7. Please describe your supervision of, or contact with, the auxiliaries. 8. Did you ever participate in an orientation or continuing education program for, or with, auxiliaries? What? 9. How do you fee1 about the auxiliaries on the job ? How do you think they fee1 about the professional staff? 10. What does “team nursing in public health” mean to you ? What is your opinion of this concept 2 ll. In the light of your experiences, what recommendations would you make to another agency about to begin working with auxiliaries? 1.
2.
AppendisD Interview guide used with fmctical nurses and aides in eight selected United States publù health agencks
1. Will you please briefly tell me about your agency, ita objectives and services? 2. Do you think the number of auxiliaries in your agency should be increased or decreased. Why ? 3. What qualifications do you fee1 you need for this job ? 4. Please tel1 me what kind of work you do, and about some of the patients that you care for. 5. In what way do you think that you and other auxiliaries have contributed to the services in this agency ? Do you think there are other additional contributions that you could make? 6. Do you think that some of your activities could be expanded or limited. What ? Why ? 7. By whom are you supervised? Please describe your contacts with public health staff nurses and the supervisor. (Tell me about how a patient was assigned to you, and your contact with the nurses about this patient).
ISRAEL-TEAM 8. 9. 10. ll.
NURSING IN PUBLIC HEALTH
271
How were you introduced to your job ? Do you continue leaming ? How ? What ? How do you fee1 about the professional nurses ? How do you think they fee1 about the auxiliaries? (Optional, depending on the level). What does “team nursing in public health” mean to you? Do you think this is desirable? In the light of your experiences as an auxiliary worker in public health nursing, what do you think could be done in agency about to employ auxiliaries, which would help the service and the auxiliary worker ?
AppendixE Lettarsenttofour Israeiijublù hcalth agcncies requesting infmtion
on pub& health nursing in Isme1
Miss Diiector of Nursing Services Agency Israel Dear As you know from our previous correspondence, 1 am now working on a research project at Teachers College, Columbia University, in partial fulfillment of the requirements for a doctoral degree. The study wil1 project a plan for team nursing in public health in Israel. This may be of aignificance for Israel and other lands in the light of changing health needs and the shortage of professional nurses. There are two main areas of investigation: a review of data related to public health nursing in Israel and interviews in selected United States public health nursing agencies on their experiences with auxiliary nursing service personnel. 1 would be most grateful for your cooperation in filling out the attached questionnaire on public health nuning in your agency. This questionnaire is being sent to the Ministry of Health, Hadassah Medical Organization, Kupat Holim, and the Tel Aviv-Jaffa Municipality. The responses wil1 be presented as overall trends, and your agency identified with specific responses only with your agreement. To be of most value in the study, it is important that the completed questionnaire reach me before September 15, 1962. Thank you very much for your help, and awaiting your early reply, 1 am Sincerely yours, (signed) Rebecca Lyons Bergman
AppendisF Questionnaire onpublù health nursìng in Isme1 sent tofour Ismlì publìc health agencies The following questions refer 07th to public health nursing in your agency. RN
-
(registered nurse)
Graduate of an approved three-year school of nursing.
PHN
-
(public health nurse)
PN
-
(practica1 nurse)
RN and a graduate of an approved public health course.
Graduate of an approved school for practica1 nurses.
REBECCA BERGMAN
272 Aide
-
StaiInurse
-
(nursc’s aide) Auxihary nursing service personnel with less recogniaed preparation than a practical nurse. nursing personnel giving direct service to clients.
1. Please write in the numbcr of public health nursing personnel employed by your agency in the appropriate spaces below : Year
PHN
RN
Aide
PN
Total
1962 1958 1955 1952 1948
2a. Please list the three main reasons for the employment of practica1 nurses in public health in your agency. b. What do you drink should be done to the present number of practical nurses employed in your agency in public health? (circle one) increased decreased no change c. Why? 3a. If your agency employs nurse aides in public health please list the three main reasons for this employment. b. What do you think should be done with the present number of nurse aides? increased decreascd no change C.
4.
(circle one)
Why ? What are the criteria for employment of practical nurses in public health in your agency ? a.
in regard to genera1 education
. ... ............................ .......__.............................
b.
in regard to nursing education
....
c.
in regard to othcr criteria @lease specify)
..
.. ... ..._
....
_... ............. ._.._.
.. .. .... . .. .. ... .. ... .. .. ... .. . ... ... . .. ... . .. *. .. .. . .... . ... ... . .. ... . ... ... . ... .. .. ... ... ... . .. ... .. ... .. .. ... .. ... .. .. .. 5.
Are there any dií%rences in the assignments given to PHN and RN? Ifycs, please list three main differences.
(circle one)
Yes
NO
6.
Are there any diffcrenccs in the assignments given to RN and PN? Ifyss, please list three main differences.
(circle one)
Yes
NO
7.
.. . By whom is the PN supervised ? . . . . . .. . . . Please briefly describe how this supervision is carried out.
8.
Below are listed the usual areas of service given by nursing service personnel in public health. Please add any others which you think are important. In column A indicate whether your agency provides the service. In columns B and C indicate your agency’s plans for the service. In column D give the reason for these plans, considering such factors as: need for the service, agent responsibility, availability of personnel, funds, etc.
.
.
ISRAEL--TEAM
A Do you provide this service
NURiING
IN PUBLIC HEALTH
C If no
B Ifyes do you plan to
isthe
under consideration?
_-
-‘_
YeS
YeS
NO
9
xil __
Infant health su pervision
Preschool health supervision School health progrCare of acute paticnts in the home Care of chronic patients in the home Tuberculosis progrMental health progrGeriatrie program Occupational health Epidemiology
...... ........................................ ..............................................
NO ---
6
Prenatal care
D
program
now ? Areas of Service
273
l
E --
Reason for thii plan
REBECCA BERGMAN
274 9.
Has your agency an orientation program for new nursing service personnel in public health? NO (circle one) Yes Ifycs, please describe brietly. For whom is this program plarmed ?
10.
Has your agency an in-service education program for nursing service personnel in public Yes NO health? (circle one) Ifyes, please deacribe brietly. For whom is this program planned ?
11.
Please add any additional information which you consider pertinent about public health numing in your agency.
12.
Do you want the response to thii questionnaire to be identified by name with your agency in NO Yes the study? (circle one)
.
. Title
Signature Please return this completed questionnaire to: (Mrs.) Rebecca Ilergman 509 West 121st Street New York 27, New York U.S.A.
To be of greatest value in the study, it is important that 1 receive the completed questionnaire before September 15, 1962. THANK YOU FOR YOUR
COOPERATION
Letterto theDiztisionofJVming in th Israd Mùistry of Health reqwsting infonnation on nuring education in IJrocl . ... ...*.........................
Chief Nurse, Division of Nursing Ministry of Health Jerusalem, Isme1 Dear Mrs.. .. . .... .. ... ... .. ... ... .. . AS you know from our previous correspondence, 1 am now working on a research project at Teachers College, Columbia University, in partial fulfillment of the requirements of a doctoral degree. The study will project a plan for team nursing in public healtb in Israel. It is expected that this study wil1 be of significante not only for Israel, but also for other lands as well in the light of changing needs and the shortage of professional nurses. One scction of the study is devoted to the status and problems of public health nursing in Israel. 1 am obtaining data from the literature and by questionnaire from the health agencies in Israel. However, some of the information on nursing education is available only in the Ministry, and 1 would be most grateful if you would complete the attached questionnaire and return it so that 1 receive it before September 15, 1962. Rest regards to the nurses at the Ministry. Sincerely yours, (signed) Rebecca Lyons Ikrgman
ISBAEL-TEAM
NVRTING LNPVBLIC
HEALTH
275
Qu&onnaire on nursing eduation in Isme1 sent to thc Division of Nursing of thc Isme1 Ministry of HcBlth 1. Please write in the statistics for the number of schools and graduates
of nursing, as indicated
-Post-Basic Courses in PHN No. of COUlXS
No. of Grads.
Registered Nurse Schqols No. of schools
No. of Grads.
Practica1 Nurse Schools -No. of Schools
No. of Grads.
Baby-Nurse Schools No. of Schools
No. of Grads.
1921 to 1948 1948
-1949
t-
1950 1951 1952 1953
_- --
1954 1955
_-
1956 1957 1958 1959 1960 1961 Total
THANK YOU FOR YOUR
COOPERATION
REBECC.4 BERGMAN
276
AppentaI Lutursmt to dam sckxted United Swes schools and agenctk requestìng intnoisws witlr instnsctors of team leaakship . . .. ... . .. .. . .. . .. ... ... . .. ... .. .. .. Nursing Education Program School (Agency) Dear. ...
. . .. 1 am a student at Teachers College, Columbia University, working on a research project in
partial fùlfillment of the requirements for a doctoral degree. The study wil1 project a plan for team nursing in public health in Israel, my homeland. This study may be of signifkance to Israel and other lands in the light of changing health needs and the shortage of professional nurses. The study wil1 include suggested leaming expcnences for team leadership. 1 wish to interview instructors of team leademhip in nursing education programs of educational institutions, and inservice education of service agencies. Each interview would take less than one hour, and lx scheduled at the time and place most convenient for the interviewee. Responses will be anonymous, but the agency participation cited U this is agreeable. 1 hope you wil1 allow me to include your school (agency) in the study. If your answer is positive, 1 should like to conduct the interview during the month of October, 1962. Thanking you, and awaiting your early reply, Sincerely yours, (signed) Rebecca Rergman
Intmì6wguide used with instructors of team leaabship in eleven selected United States schools and ogen& 1. Will you please tel1 me the title of your course, its duration, the number of credit hours, and its sequence in the over-al1 program. 2.
What are the course objectives?
3.
What are the main content areas in the course ?
4.
What field experience is provided?
5.
What teaching methods do you use?
6.
How do you evaluate student learning?
7.
What problems have you encountered in any phase of the course?
8.
What recommendations would you make for a new course in team leadership?
ZSRAEL-TEAM Appendix
277
NURTING IN PUBLJC HEALTH
K l’?uoretùal program fm post-basù publù health nursing tourses in Ismel*
Numberof Theoretùal Program 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. 12. 13. 14. 15. 16. 17. 18. 19.
Introduction to public health Sociology Demography and biostatistics Anthropology Rituals, tradition, rabbinical laws in Judaism Psychology Group dynamics Social pathology Case work approach and interview techniques Social aspects of chronic diseases Epidemiology Hygiene, sanitation, and industrial hygiene Nutrition Growth and development Matemity and child health, including nursing Family health Community organiaation Government national insurance Health education
*As offeredby Hadassah Medieal Organisation in rg6 I .
HOWS 16 26 18 10 18 20 14 16 30 16 20 30 16 40 50 25 as needed 4 as needed