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Care Environment (care + environment)
Kinds of Care Environment Selected AbstractsCreating a Safe, Secure Health Care EnvironmentNURSING FOR WOMENS HEALTH, Issue 1 2004Understanding HIPPA & Exploring Its Implications No abstract is available for this article. [source] Evaluations of Clinical Learning in a Managed Care EnvironmentNURSING FORUM, Issue 1 2002ACNP, Elizabeth P. Howard RN First page of article [source] Candidate's Thesis: Universal Newborn Hearing Screening in an Inner-City, Managed Care Environment ,THE LARYNGOSCOPE, Issue 6 2000Glenn Isaacson MD Abstract Objectives/Hypothesis Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the first months of life. Several states have mandated UNHS for all newborns. Such programs have been successful in small, homogeneous populations. As larger states attempt to implement such programs, important obstacles have arisen, particularly in sparsely populated rural environments and in the inner city, where poverty, unstable living situations, and inadequate access to health care make follow-up of infants failing initial testing difficult. Study Design We performed a prospective longitudinal study e-amining the effects of increasingly comple- and e-pensive interventions designed to ensure that children failing initial hearing screening returned for complete evaluation and habilitation. Methods A UNHS program based on transient evoked otoacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was assessed and modifications in follow-up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect of these interventions was reassessed 6 months later. Results In its first 12 months, the Temple University Infant and Young Child Hearing Intervention Initiative successfully screened 95% (2,031) of all newborns using transient evoked otoacoustic emissions. Collecting a complete database profile for each newborn, establishing rapport with the family, and offering immediate follow-up appointments yielded a 61% return rate after discharge. The addition of a dedicated project secretary, free day-care for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow-up yield to 75%. Conclusion Given adequate resources and planning, UNHS can be successful, even in economically depressed environments. [source] The Long Road to Better ACHD CareCONGENITAL HEART DISEASE, Issue 3 2010Gary Webb MD ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source] The role of prophylaxis in bleeding disordersHAEMOPHILIA, Issue 2010E. BERNTORP Summary., The rationale for long-term prophylaxis in more severe forms of von Willebrand's disease (VWD) is obvious, as mucosal bleeding and haemophilia-like joint bleeds resulting in chronic morbidity may occur. However, the experience with prophylactic treatment in this group is scanty. An international VWD Prophylaxis Network (VWD PN) was established in 2006. The VWD PN will investigate prophylaxis with retrospective and prospective studies. Eighteen centres in Europe and North America are recruiting patients and an additional 40 centres are preparing for or evaluating participation. In the absence of randomized prospective studies for most rare bleeding disorders, guidelines for prophylaxis are a subject of controversy. In situations where there is a strong family history of bleeding, long-term prophylaxis is administered in selected cases. Short intervals of prophylaxis can also be given before some surgeries or during pregnancy. The benefits of prophylaxis must be balanced by the risk of side effects. Therefore, it is essential to delineate its management in a specialized comprehensive care environment. In haemophilia, decades of clinical experience and numerous retrospective and, recently, prospective studies clearly demonstrate that prophylactic treatment is superior to on-demand treatment, regardless of whether the outcome is the number of joint- or life-threatening bleeds, arthropathy evaluated by X-ray or MRI, or quality of life measured by generic or haemophilia-specific instruments. Optimal prophylactic treatment should be started early in life (primary prophylaxis) but various options exist for the dose and dose interval. These depend on the objective of treatment in the individual patient, which, in turn, is dependent on resources in the health care system. [source] Abdominal compartment syndrome: a new indication for operative intervention in severe acute pancreatitisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2005K. Wong Summary The current management of severe acute pancreatitis (SAP) is maximal conservative therapy within an intensive care environment. The only commonly accepted indication for operative intervention is the presence of infected pancreatic necrosis. We present a case wherein a laparotomy performed for treatment of abdominal compartment syndrome (ACS) arising in the setting of SAP in the absence of pancreatic necrosis prevented early mortality and discuss the diagnosis and treatment of ACS as a new indication for operative intervention in SAP. [source] Managing the wandering behaviour of people living in a residential aged care facilityINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2007Brent Hodgkinson BSc MSc GradCertPubHealth GradCertHealthEcon Abstract Background, Wandering behaviour is frequently seen in older people with cognitive impairment. The prevalence of patients exhibiting wandering behaviour has been estimated to be 11.6% on traditional units and 52.7% on Alzheimer's units. Wandering is one of the core behavioural characteristics that impact on familial carers and is likely to influence the decision to place a family member in an aged care environment. Considering the possible risks associated with wandering behaviour, the successful identification and management of wandering is essential. Wandering is also a problem for caregivers in the institutionalised setting, in terms of containment, usually being addressed by securing the environment. There has been some research conducted to assist in the understanding and management of wandering behaviour; however, the findings have been diverse resulting in a level of confusion about the best approaches to take. Objectives, This review aims to present the best available evidence on the management of wandering in older adults who reside in an aged care facility (both high and low care). Search strategy, An extensive search of keywords contained in the title and abstract, and relevant MeSH headings and descriptor terms was performed on the following databases: MEDLINE, CINAHL, PsychINFO, AGELINE, Cochrane Library, Embase, APAIS Health, Current Contents, Dare, Dissertation Abstracts, Personal Communication, Social Science Index. Selection criteria, Papers were selected if they focused on the treatment of wandering in an institutional setting. Some studies were not specifically examining wanderers over the age of 65 years as per the protocol requirements, but were included as it was felt that their findings could be applied to this age group. Data collection and analysis, Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies containing count data where possible. All other data were presented in a narrative summary. Results, Searches identified one care protocol, two systematic reviews and 24 other studies that satisfied the inclusion criteria. The following recommendations are divided into four categories of interventions (environmental, technology and safety, physical/psychosocial, and caregiving support and education) with only Level 1, 2 or 3 evidence presented. Environmental modifications, Gridlines placed in front of doors or covering exit door doorknobs or panic bars may be effective at reducing exit-seeking behaviour (Level 3b). Technology and safety, Mobile locator devices may be effective at enabling quick location of wandering residents (Level 3c). Physical/psychosocial interventions, Implementation of a walking group or an exercise program may reduce the incidence of disruptive wandering behaviour (Level 3b). Use of air mat therapy may reduce wandering behaviour for at least 15 min post therapy (Level 2). Providing music sessions (and reading sessions) may keep residents from wandering during the period of the session (Level 3b). Caregiving support and education, There is no evidence to support any interventions. Conclusions, The majority of the available research for which the guidelines are based upon was derived from observational studies or expert opinion (Level of evidence 3 or 4). More rigorous research is required to demonstrate the efficacy of these recommendations. [source] Factors associated with constructive staff,family relationships in the care of older adults in the institutional settingINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2006Emily Haesler BN PGradDipAdvNsg Abstract Background, Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives, The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff,family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff,family relationships. Search strategy, A literature search was performed using the following databases for the years 1990,2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria, The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff,family relationships including organisational strategies, staff,family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. Data collection and analysis, All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Findings, Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff,family relationships. Managerial support, such as addressing workloads and staffing issues; introducing care models focused on collaboration with families; and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family,staff relationships. [source] Establishing an action research group to explore family-focused nursing in the intensive care unitINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2007Fiona Coyer RN ENB100 PGCEA PhD This paper presents the first phase of a four-phase collaborative action research study which aimed to facilitate family-focused nursing in the intensive care environment. The purpose of phase one was to determine intensive care nurses' perceptions of family-focused critical care nursing and the appropriateness of family-focused nursing in the intensive care unit. A collaborative action research group was established with six registered nurses working in the intensive care unit of a metropolitan tertiary referral hospital. Data were collected through group discussions and analysed using open coding. Findings revealed two categories related to perceptions of family-focused intensive care nursing: partnership in care and maintaining a balance. The group unanimously agreed that family-focused nursing was appropriate in the intensive care environment. The three subsequent action research phases of this study are reported elsewhere. [source] Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010BSc (Hons) Nursing, Brendan McCormack D.Phil (Oxon), PGCEA mccormack b., dewing j., breslin l., coyne-nevin a., kennedy k., manning m., peelo-kilroe l., tobin c. & slater p. (2010) Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing 5, 93,107 Aim., To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. Design., The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the ,Person-Centred Nursing Index'. Findings., Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on ,technical' aspects of care, to one where ,intimate' aspects of care were more highly valued. Relevance to clinical practice., The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships. [source] Behavioural and emotional problems of children by type of out-of-home care in CroatiaINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 3 2005Marina Ajdukovi The aim of this article is to compare the kinds of behavioural and emotional problems of youth in relation to type of out-of-home placement in Croatia. Children living in children's homes manifest significantly more behavioural and emotional problems than other groups of children in out-of-home care or children living in their primary families. Children living in foster families or in family-type homes integrated in the community do not differ from a comparative group of children living in primary families. Regardless of differences among sub-samples regarding behavioural and emotional problems, the current problems of individual children in all groups of children in out-of-home placement were connected more to currently experienced stressors than to unfavourable circumstances before their removal. This indicates that there are benefits to be gained by improving services in the children's present care environment. [source] Nursing care quality and adverse events in US hospitalsJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Robert J Lucero Aim., To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background., Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design., Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods., Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results., The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion., The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice., The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. [source] Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistatJOURNAL OF INTERNAL MEDICINE, Issue 4 2006W. S. C. POSTON Abstract. Objective., There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug-alone in a 12-month randomized-clinical trial at a medical school obesity centre. Methods., Participants (N = 250) with body mass index (BMI) ,27 were randomized. Changes in body weight, lipids, blood pressure and serum glucose were examined. Drug adherence and attendance were also evaluated. Results., Completers analysis was conducted on 136 participants with data at baseline, 6 and 12 months and intention-to-treat analyses (ITT) for the total sample. Amongst completers, participants in the drug only (P = 0.012) and drug + brief counselling (P = 0.001) groups lost more weight (mean ± SD: ,3.8 ± 5.8 kg and ,4.8 ± 4.4 kg, respectively) than participants in the brief counselling only group at 6 months (,1.7 ± 3.3 kg), but there were no significant group differences at 12 months. ITT model results were similar to completers at 6 months and remained significant at 12 months, but the weight losses were more modest (<3 kg) for both groups receiving orlistat. For brief counselling alone, participants gained weight (1.7 ± 4.2 kg). Cardiovascular disease (CVD) parameter changes were negligible. Conclusions., Pharmacotherapy alone or combined with brief counselling resulted in modest weight losses that had minimal impact on cardiovascular parameters, but were greater than brief counselling alone. Whilst brief interventions and primary pharmacotherapy have been suggested as viable treatments for implementation in primary care settings, our study suggests that such minimal interventions provide minimal benefits. [source] The power of partnership to shape the future of nursing: the evolution of the clinical nurse leaderJOURNAL OF NURSING MANAGEMENT, Issue 5 2008FAAN, FACHE, JOLENE TORNABENI MA Aim(s), This article describes the evolution of the clinical nurse leader role and demonstrates the vital nature of partnerships between academia and practice in the design and implementation of this new role. Background, The health care system as it exists in the United States may put patients at risk in terms of safety and quality of care. Nursing leadership from across the US recognized a need for nursing practice and academia to work in partnership to develop workable and effective solutions. The vision was of a nurse generalist who would be prepared to address the complexities that make the current systems dysfunctional. Evaluation, Review, share experiences and discuss the benefits of engaging stakeholders with broad and diverse viewpoints. Key issues, Engaging a group of stakeholders with diverse backgrounds, varied world views and experiences for the purpose of developing common mutually beneficial goals, creates synergy and greater commitment to the goals, which results in success. Conclusion(s), The power of partnership in the development and implementation of the CNL is evident. Old ways of trying to ,go it alone' are no longer viable in a complex health care environment. Implications for nursing management, With continued collaboration, practice and academia can continue to confront challenges and develop effective solutions. [source] Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient servicesJOURNAL OF NURSING MANAGEMENT, Issue 2 2007BA (Hons), JO ALLEYNE DProf Aim, The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. Background, This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, ,Our Health, Our Care, Our Say' and the recent proposals from the article Modernising Nursing Career, to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. Method, The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop ,actionable knowledge'. Group clinical supervision was not practised in this study as a form of ,therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. Findings, ,,Management and leadership interventions and approaches have significantly influenced the participants' capacity to improve the quality of services provided to their patients. ,,Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence to perform. ,,A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred. Conclusion, It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that ,good nursing' is accepted as being synonymous with ,good management'. This is the future of ,new nursing'. [source] Nursing Leadership in the BoardroomJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2004Kathleen E. Thorman BSN It is critical that nurse leaders, including chief nurse executives and service line directors, be part of the institutional decision-making process about resource allocation, strategic direction, and planning for the future. Nurse leaders can use numerous strategies to influence decisions made in the boardroom that affect the women's service line, including perinatal and women's health. These strategies include building on the importance of women's services to the organization, working in collaboration with senior leaders and key physician leaders, marketing, and reaching out to governing boards with information. Nurse leaders must continue to prepare for the future to thrive in the increasingly complex health care environment. [source] Reflections on a Decade of Outcomes Management in Women's ServicesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 1 2001CNAA, Susan Houston RN Outcomes management was theorized as a strategy for redesigning and continually enhancing interdisciplinary health care processes through the use of outcomes measurements. Regardless of the rapidly changing and oftentimes turbulent health care environment, this strategy successfully facilitated positive outcomes in one women's service for 10 years. Outcomes affected during these years included reduction in cost per case, length of stay, infant prematurity, and cesarean delivery rates. [source] Variability in incubator humidity practices in the management of preterm infantsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2009Lynn Sinclair Aim: To determine current practice and opinion in relation to incubator humidity use in the management of preterm infants in neonatal intensive care units (NICU's) within the Australian and New Zealand Neonatal Network (ANZNN). Methods: A survey was conducted in 26 NICU's in the ANZNN. A senior clinical nurse in each perinatal centre participated in a telephone survey that focused on local humidification practices and on the clinicians' views and experiences of humidity use. Results: All centres routinely used supplemental humidity in the management of preterm infants. The majority of centres (77%) had written protocols to guide practice. Eighty-eight per cent commenced humidity at a high level (relative humidity , 80%). There was wide practice variation in the gestational age parameters determining humidification use (all gestational ages up to 37 weeks), duration of use (3,77 days), timing of initiation (admission to 72 h after birth) and weaning practices. Perceived benefits of humidification included improved thermoregulation, skin integrity, and fluid and electrolyte balance and reduced transepidermal water loss. Perceived risks included sepsis and hyperthermia. Conclusions: Our study confirmed that incubator humidity is used routinely in the management of preterm infants in the ANZNN. Wide variation in humidification practices across NICUs reflects the paucity of research evidence. Perceived benefits and risks of humidity use were consistent with available literature. To optimise the care environment and provide an evidence base for practice further research is warranted. [source] Barriers to the optimal rehabilitation of surgical cancer patients in the managed care environment: An administrator's perspectiveJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2007Pamela Germain MBA Abstract Ensuring that surgical cancer patients obtain optimal rehabilitation care (defined here as all care provided post-operatively following cancer surgery) can be challenging because of the fragmented nature of the U.S. healthcare delivery and payment systems. In the managed care environment, surgical cancer patients' access to rehabilitation care is likely to vary by type of health insurance plan, by setting, by type of provider, and by whether care is provided in-network or out-of-network. The author of this article, who negotiates managed care contracts for the Roswell Park Cancer Institute (RPCI), gives examples of strategies used with some success by RPCI to collaborate with local payers to ensure that surgical cancer patients get optimal rehabilitation care, especially as they make the transition from hospital to outpatient care. She suggests that further collaborations of healthcare providers, payers, consumers, and policymakers are needed to help ensure optimal rehabilitation care for surgical cancer patients. J. Surg. Oncol. 95:386,392. © 2007 Wiley-Liss, Inc. [source] Nurse Practitioners and Physicians: Patients' Perceived Health and Satisfaction with CareJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2000Jo-Allyn Pinkerton PhD ABSTRACT The advent of managed care has created changes in the health care environment and nurse practitioners have found a need to evaluate their care. Perceived health and patient satisfaction were measured in a multiethnic sample of 160 clinic patients, ages 18 to 89, in a managed care setting. Results of the Medical Outcomes Study SF-20 and the Nurse Practitioner Satisfaction Instrument indicated no statistically significant difference in perceived health and satisfaction with care, whether the care was given by a nurse practitioner or a primary care physician. The findings warrant further study and may mean that nurse practitioners placed in managed care environments can be expected to perform as effectively as they have in non-managed care environments. [source] Isolation of clinically relevant fungal species from solid waste and environment of dental health servicesLETTERS IN APPLIED MICROBIOLOGY, Issue 4 2010C.D. Vieira Abstract Aims:, This study was undertaken to detect, identify and determine antifungal susceptibility of yeast strains isolated from dental solid waste and to evaluate airborne fungi in the Brazilian dental health care environment and in the waste storage room. Methods and Results:, A group of 17 yeast strains were identified by macroscopic and microscopic characteristics, API 20C Aux system and Multiplex PCR. All 104 airborne fungal colonies were identified by macroscopic and microscopic morphology. The CLSI broth microdilution method was utilized as the susceptibility test. Candida parapsilosis was the prevailing yeast species recovered from waste, followed by Rhodotorula glutinis. Three strains of Candida guilliermondii presented minimal inhibitory concentration values considered to be susceptible dose dependent (2 ,g ml,1) to voriconazole. Of all airborne fungal species, 69% were recovered from the waste storage room and 31% were recovered from the clinical/surgical environment. Most of them were identified as Cladosporium spp. Conclusions:, These findings reinforce the potential risk of waste handling and point out the need for safe management to minimize the spread of these agents to the environment. Filamentous fungi isolation in almost all sampled environments indicates that a periodic monitoring of airborne microbiota in the dental health care service environment is required. Significance and Impact of the Study:, The survival of yeast strains for 48 h suggests that dental waste should be carefully controlled and monitored. [source] Clinical teaching: maintaining an educational role for doctors in the new health care environmentMEDICAL EDUCATION, Issue 10 2000D Prideaux Context and objectives Good clinical teaching is central to medical education but there is concern about maintaining this in contemporary, pressured health care environments. This paper aims to demonstrate that good clinical practice is at the heart of good clinical teaching. Methods Seven roles are used as a framework for analysing good clinical teaching. The roles are medical expert, communicator, collaborator, manager, advocate, scholar and professional. Results The analysis of clinical teaching and clinical practice demonstrates that they are closely linked. As experts, clinical teachers are involved in research, information retrieval and sharing of knowledge or teaching. Good communication with trainees, patients and colleagues defines teaching excellence. Clinicians can ,teach' collaboration by acting as role models and by encouraging learners to understand the responsibilities of other health professionals. As managers, clinicians can apply their skills to the effective management of learning resources. Similarly skills as advocates at the individual, community and population level can be passed on in educational encounters. The clinicians' responsibilities as scholars are most readily applied to teaching activities. Clinicians have clear roles in taking scholarly approaches to their practice and demonstrating them to others. Conclusion Good clinical teaching is concerned with providing role models for good practice, making good practice visible and explaining it to trainees. This is the very basis of clinicians as professionals, the seventh role, and should be the foundation for the further development of clinicians as excellent clinical teachers. [source] An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unitNURSING IN CRITICAL CARE, Issue 6 2007Brian McFetridge Abstract The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. [source] Health care assistants' role, function and development: results of a national surveyNURSING IN CRITICAL CARE, Issue 4 2003The British Association of Critical Care NursesArticle first published online: 31 JUL 200 Summary ,,Intensive care has developed as a speciality since the 1950s; during this time there have been major technological advances in health care provision leading to a rapid expansion of all areas of critical care ,,The ongoing problem of recruiting appropriately qualified nurses has affected staffing levels in many units and continues to be a national problem. For many, the answer lies in employing health care assistants to support the work of registered nurses ,,A key aim of the British Association of Critical Care Nurses is to promote the art and science of critical care nursing by providing representation for its members, by responding to political and professional change and by producing and publishing position statements ,,A primary component of the work surrounding the development of this second position statement was the gathering of contemporary information in relation to the role of health care assistants within critical care units throughout the UK, through a survey of 645 critical care units within the UK ,,At present the impact upon the role of the critical care nurse is not fully understood, with research in this area suggesting that although there is a role for the health care assistant in the critical care environment, this should only be undertaken with a full analysis of this impact upon the work of the registered nurse [source] Financing the Treatment of Chronic Pain: Models for Risk-sharing among Pain Medicine Physicians, Health Care Payers, and ConsumersPAIN MEDICINE, Issue 1 2000FABPM, Richard L. Stieg MD Chronic pain patients are among a growing group of medically underserved Americans. Despite increasing public awareness about pain and widespread legislative activity that is focusing on the needs of pain patients, there remain significant roadblocks in bringing the expertise of Pain Medicine specialists to these unfortunate people. This paper explores how the managed care revolution has impacted the practice of Pain Medicine in the United States. The dissolution of many prominent multi-disciplinary pain treatment centers has been paralleled by the evolution of pain management as an area of interest by several competing medical specialty societies. Despite this fragmentation, the American Academy of Pain Medicine continues to grow and to promote the needs of Pain Medicine specialists and their patients. The advantages and disadvantages of various practice patterns for Pain Medicine specialists is explored against a backdrop of discussions about: (1) the problems currently faced by chronic pain patients; (2) the role of organized Pain Medicine in helping patients to access and finance care; and (3) the future of American health care and the new responsibilities that will bring to physicians. Finally, we have some specific recommendations for pain medicine specialists about: (1) sharing risk; (2) exerting individual leadership; and (3) simplifying one's professional life in the new health care environment, that we hope will enable them to continue caring for as many chronic pain patients as possible. It is opined that the development of sophisticated regional specialty networks is the best model to accomplish this task in the future. [source] Advances in optical imaging of the newborn infant brainPSYCHOPHYSIOLOGY, Issue 4 2003Jeremy C. Hebden Abstract New methods of imaging the oxygenation, hemodynamics, and metabolism of the newborn infant brain are being developed, based on illumination of the head with near-infrared light. Techniques known as optical topography and optical tomography have the potential to provide valuable information about the function of the normal brain, and about a variety of cerebral pathology such as hypoxic-ischemia. Optical methods provide a unique means of monitoring brain oxygenation safely in an intensive care environment without interference with the normal handling of the infant. Studies on infants have focused on the assessment of steady-state regional cerebral perfusion and tissue oxygenation, as well as monitoring hemodynamic changes in response to sensory stimulation. Recent technological and methodological advances in this research field are reviewed, and the likely impact of optical imaging methods on the care of newborn infants is assessed. [source] Privacy protection, health care and quality controlQUALITY ASSURANCE JOURNAL, Issue 3 2002Rudolf Bruppacher Abstract In the past three decades, patient rights on the one hand, and health care and research activities in health services on the other hand, have experienced unprecedented development. Requirements of privacy protection, particularly the restrictions on ,secondary analysis' of health data, have become a problem in an increasingly complex health care environment and have become a hindrance to research. Legal regulations have developed differently in different countries. Recent attempts, such as the European Community directive on privacy protection promise effective harmonization, at least for developed countries. However, many questions regarding their interpretation remain and they are discussed in this article. Copyright © 2002 John Wiley & Sons, Ltd. [source] Point of care measurement of plasma creatinine in critically ill patients with acute kidney injuryANAESTHESIA, Issue 4 2009A. Udy Summary We report the utility of an enzymatic point of care system for estimation of plasma creatinine concentration in critically ill patients with acute kidney injury. Multiple measurements were obtained from a heterogenous population admitted to a multi-disciplinary intensive care unit. The acute kidney injury network guidelines were used to identify and stratify patients based on the creatinine concentration. Central laboratory values were used as comparators to assess the precision and bias of the system. Overall, point of care measurements correlated well with central pathology results (R2 = 0.991, p < 0.001), although there tended to be a small negative bias in patients with acute kidney injury (3 ,mol.l,1). The accuracy of point of care measurement is within clinically acceptable limits and given the much shorter turn around time can be used to identify and monitor patients with acute kidney injury in the critical care environment. [source] Enhancing resilience in registered aged care nursesAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2010Fiona Cameron Aim:, To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. Method:, This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. Results:, This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work,life balance are important determinants of resilience in aged care nurses. Conclusions:, Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace. [source] Prehospital Ultrasound by Paramedics: Results of Field TrialACADEMIC EMERGENCY MEDICINE, Issue 6 2010William Heegaard MD Abstract Objectives:, The objective was to determine if 9-1-1 paramedics trained in ultrasound (US) could adequately perform and interpret the Focused Assessment Sonography in Trauma (FAST) and the abdominal aortic (AA) exams in the prehospital care environment. Methods:, Paramedics at two emergency medical services (EMS) agencies received a 6-hour training program in US with ongoing refresher education. Paramedics collected US in the field using a prospective convenience methodology. All US were performed in the ambulance without scene delay. US exams were reviewed in a blinded fashion by an emergency sonographer physician overreader (PO). Results:, A total of 104 patients had an US performed between January 1, 2008, and January 1, 2009. Twenty AA exams were performed and all were interpreted as negative by the paramedics and the PO. Paramedics were unable to obtain adequate images in 7.7% (8/104) of the patients. Eighty-four patients had the FAST exam performed. Six exams (6/84, 7.1%) were read as positive for free intraperitoneal/pericardial fluid by both the paramedics and the PO. FAST and AA US exam interpretation by the paramedics had a 100% proportion of agreement with the PO. Conclusions:, This pilot study shows that with close supervision, paramedics can adequately obtain and interpret prehospital FAST and AA US images under protocol. These results support a growing body of literature that indicates US may be feasible and useful in the prehospital setting. ACADEMIC EMERGENCY MEDICINE 2010; 17:624,630 © 2010 by the Society for Academic Emergency Medicine [source] | ||||||||||||||||||||||||||||||||||