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Health Care Settings (health + care_setting)
Kinds of Health Care Settings Selected AbstractsDIABETES AUDIT CAN AID PRACTICE DEVELOPMENT IN A RANGE OF INDIGENOUS HEALTH CARE SETTINGSAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2001Nadia Chaves No abstract is available for this article. [source] The Costs of Childhood Epilepsy in Italy: Comparative Findings from Three Health Care SettingsEPILEPSIA, Issue 5 2001R. Guerrini Summary: ,Purpose: To determine the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, comparing three different health care settings [i.e., teaching or clinical research (CR) hospitals, general hospitals, and outpatient services]. Methods: Patients were accepted if they had confirmed epilepsy and were resident in the center catchment area. Eligible subjects were grouped in the following categories: (a) newly diagnosed patients; (b) patients with epilepsy in remission; (c) patients with active non,drug-resistant epilepsy; and (d) those with drug-resistant epilepsy. Over a 12-month period, data regarding the consuming of all resources (i.e., consultations, tests, hospital admissions, drugs), were collected for each patient. Using the Italian National Health Service tariffs, the unit cost of each resource was calculated and indicated in Euros, the European currency. Results: A total of 189 patients was enrolled by two teaching-CR hospitals, two general hospitals, and two outpatient services. The patients were evenly distributed across the four categories of epilepsy. The mean annual cost per person with epilepsy was 1,767 Euros. Drug-resistant epilepsy was the most expensive category (3,268 Euros) followed by newly diagnosed epilepsy (1,907 Euros), active non,drug-resistant epilepsy (1,112 Euros), and epilepsy in remission (844 Euros). Costs were generally highest in teaching-CR hospitals and lowest in outpatient services. Hospital services were the major cost in all epilepsy groups, followed by drugs. Conclusions: The cost of epilepsy in children and adolescents in Italy tends to vary significantly depending on the severity and duration of the disease Hospitals services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy. [source] Nutrition and Physical Activity Interventions to Reduce Cardiovascular Disease Risk in Health Care Settings: A Quantitative Review with a Focus on WomenNUTRITION REVIEWS, Issue 7 2001Sara Wilcox Ph.D. The authors conducted a quantitative literature review of the impact of 32 diet and physical activity (PA) interventions delivered in health care settings on cardiovascular disease risk factors. Intervention effects were relatively modest but statistically significant for PA, body mass index or weight, dietary fat, blood pressure, and total and low-density lipoprotein serum cholesterol. Intervention effects were generally larger for samples with a mean age >50 years and for studies with <6 months follow-up. Type of comparison group, type of intervention, and use of a behavior theory did not have a consistent impact on intervention effects. Few studies focused on persons of color, although the results from these studies are promising. [source] Measurement in Veterans Affairs Health Services Research: Veterans as a Special PopulationHEALTH SERVICES RESEARCH, Issue 5p2 2005Robert O. Morgan Objective. To introduce this supplemental issue on measurement within health services research by using the population of U.S. veterans as an illustrative example of population and system influences on measurement quality. Principal Findings. Measurement quality may be affected by differences in demographic characteristics, illness burden, psychological health, cultural identity, or health care setting. The U.S. veteran population and the VA health system represent a microcosm in which a broad range of measurement issues can be assessed. Conclusions. Measurement is the foundation on which health decisions are made. Poor measurement quality can affect both the quality of health care decisions and decisions about health care policy. The accompanying articles in this issue highlight a subset of measurement issues that have applicability to the broad community of health services research. It is our hope that they stimulate a broad discussion of the measurement challenges posed by conducting "state-of-the-art" health services research. [source] Researchers' experience of co-operative inquiry in acute mental health careJOURNAL OF ADVANCED NURSING, Issue 2 2005Jan Kåre Hummelvoll BA DrPH RPN RNT Aim., The aim of this article is to reflect upon our experiences of using co-operative inquiry in an acute mental health care setting, with a focus on the methodology used in a 4-year intervention programme developed in Norway between 1999 and 2003. Background., Action research plays a crucial role in assisting nurses to integrate theory and research with nursing practice. The central characteristic of this approach is the grounding of research in practice in collaboration with clinical practitioners. Methods., The research was a co-operative inquiry based on a hermeneutic-phenomenological approach. The research methods used were ethnographic, including participant observation and face-to-face interviews, questionnaires, focus group interviews, and our process notes. Findings., The different methods used in the co-operative inquiry design of the Project Teaching Ward (PTW) had both benefits and drawbacks. In particular, the focus group method proved useful due to its ability to stimulate participants' research interest, and thus motivating them to be actively involved in the development of knowledge. The particular knowledge development process used has been described as a local knowledge dialogue. This dialogue must incorporate critical subjectivity on the part of participants in order to ensure that the research has a reflective resistance, which is decisive for its validity and quality. The findings also highlight the importance of the different roles of project leader in lengthy action research collaboration. Conclusions., The PTW has illustrated that co-operative inquiry was well suited for developing knowledge relevant to practice, thus contributing to bridging the gap between practice and theory. In order for this to happen, the research collaboration should be characterized by patience, realism and engagement. [source] The effect of structural empowerment and perceived organizational support on middle level nurse managers' role satisfactionJOURNAL OF NURSING MANAGEMENT, Issue 1 2006ALLISON PATRICK RN Background, The restructuring of Canadian health care organizations during the past decade has reduced the visibility of nursing leadership. This has resulted in job conditions that have disempowered nurse managers and influenced their ability to create positive work environments, mentor potential nurse leaders, and gain satisfaction in the leadership role. These conditions threaten the retention of a cadre of high quality nurse leaders in today's chaotic health care setting. Objective, The purpose of this study was to examine the relationship between structural empowerment and perceived organizational support and the effect of these factors on the role satisfaction of middle level nurse managers. Method, A secondary analysis was conducted as part of a larger study of 126 middle level nurse managers working in Canadian acute care hospitals, randomly selected from the Ontario provincial registry. Eighty-four nurse managers responded to a questionnaire mailed to their home addresses. Results, Structural empowerment was positively associated with middle level nurse managers' perceived organizational support. The combination of empowerment and perceptions of organizational support were significant predictors of middle level nurse managers' role satisfaction. Conclusions, The findings support R.M. Kanter's (1977, 1993; Men and Women of the Corporation. Basic Books, New York) contention that empowering work conditions have an impact on employees' feelings of support and sense of accomplishment at work. Positive perceptions of organizational support may play an important role in retaining current middle managers, and possibly attracting future leaders to management positions. [source] Operationalizing autonomy: solutions for mental health nursing practiceJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2008P. J. HARNETT rmn mbs The new Mental Health Act (2001) became a law on 1 November 2006. The new Act, reflective of international legislative norms, outlines an agenda for the mental health services in Ireland which, in part, aims to maximize patient autonomy. This paper seeks to contextualize autonomy within nurse,patient interactions in the mental health care setting. The acceptance of autonomy as an unconditional principle, as outlined within traditional bioethics, is challenged. The paper draws on the social critique of normative ethics and suggests an alternative framework within which to operationalize patient autonomy. The authors conclude that a broader, more contextualized perspective on autonomy would more suitably inform mental health nursing. Narrative ethics and a framework of ,protective responsibility' are offered as an alternative to more traditional approaches. Practice-based initiatives to maximize patient autonomy and facilitate-reasoned ethical decision making are outlined. [source] Caring Behaviors As Perceived by Nurse PractitionersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 7 2004A/G/FNP, Ann Green PhD Purpose To investigate nurse practitioners' (NPs') perceptions of their own caring behaviors and to examine NPs' demographics as a function of their caring behaviors. Data Sources Responses to the Caring Behaviors Inventory (CBI) and a demographic inquiry from 348 NPs in Louisiana. Conclusions CBI mean scores and subscale scores were high for all 348 NPs. No statistically significant difference was found between male NPs' and female NPs' total mean CBI scores or between urban or rural total mean CBI scores. The interaction between nurse gender and area of practice was not statistically significant. Implications for Practice NPs often work in clinic situations where productivity is the most valued characteristic and where little time is afforded for identifying caring behaviors of the NP and/or establishing a caring relationship with the patient. NPs must be extremely conscious of the need not to "throw out the baby with the bathwater" and sacrifice characteristics that are inherent in nursing for those emphasized in primary care practice. As their responsibilities in the health care setting continue to expand, NPs must continually evaluate and validate their roles to ensure quality care that satisfies patients. [source] Periodontal Disease: Diagnosis and ManagementJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2000Elaine Embrack Ridgeway RN ABSTRACT Approximately 50% of all adults in the United States have some form of gingivitis, and 80% have experienced some degree of periodontitis. Despite the use of fluoride, a critical element in the prevention of periodontal disease, many children and adults still suffer needlessly from this "silent" destroyer of the gum tissue and its underlying bone structures. This article highlights the prevalence, pathophysiology, classifications, health risk factors and clinical management of clients with periodontal diseases. Regardless of the health care setting, the advanced practice nurse plays a critical role in the prevention, early diagnosis and intervention of periodontal disease. [source] A qualitative study examining tensions in interdoctor telephone consultationsMEDICAL EDUCATION, Issue 8 2006Anupma Wadhwa Objective, Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor,patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. Methods, Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology. Results, Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified. Conclusions, Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based. [source] Conversation analysis: a practical resource in the health care settingMEDICAL EDUCATION, Issue 1 2005Rebecca Barnes No abstract is available for this article. [source] The phenomenological ethics of K. E. Løgstrup , a resource for health care ethics and philosophy?NURSING PHILOSOPHY, Issue 1 2001Søren Holm BA MA MD PhD DrMedSci Abstract This paper gives a presentation and critical assessment of the phenomenological philosophy and ethics of the Danish theologian and philosopher K. E. Løgstrup (1905,1981). It is argued that although the ethics of Løgstrup contain valuable insights, an uncritical appropriation as the main source for a health care ethics or a philosophy of caring, is problematic. Løgstrup's philosophy contains a number of internal problems, and does not adequately deal with some problems raised by work in the modern health care setting. [source] Disparity vs Inequity: Toward Reconceptualization of Pain Treatment DisparitiesPAIN MEDICINE, Issue 5 2008CRNP, Salimah H. Meghani PhD ABSTRACT Context., "Disparity" and "inequity" are two interdependent, yet distinct concepts that inform our discourse on ethics and morals in pain medicine practice and in health policy. Disparity implies a difference of some kind, whereas inequity implies unfairness and injustice. An overwhelming body of literature documents racial/ethnic disparities in health. The debate on health disparities is generally formulated using the principle of "horizontal equity," which requires that individuals having the same needs be treated equally. While some types of health treatments are amenable to the principle of horizontal equity, others may not be appropriately studied in this way. The existing research surrounding racial/ethnic disparities in pain treatment presents a conceptual predicament when placed within the framework of horizontal equity. Objective., Using pain treatment as a prototype, we advance the conceptual debate about racial/ethnic disparities in health. More specifically, we ask three questions: (1) When may disparities be considered inequities? (2) When may disparities not be considered inequities? (3) What are the uncertainties in the disparity,inequity discourse? Discussion., Significant policy implications may result from the manner in which health disparities are conceptualized. Increasingly, researchers and policy makers use the term disparity interchangeably with inequity. This usage confuses the meaning and application of these distinct concepts. In a given health care setting, different types of disparities may operate simultaneously, each requiring serious scrutiny to avoid categorical interpretation leading to misguided practice and policy. While the science of pain treatment disparities is still emerging, the authors present one perspective toward the conceptualization of racial/ethnic disparities in pain treatment. [source] Organizational context and taxonomy of health care databasesPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 5 2001Deborah Shatin PhD Abstract An understanding of the organizational context and taxonomy of health care databases is essential to appropriately use these data sources for research purposes. Characteristics of the organizational structure of the specific health care setting, including the model type, financial arrangement, and provider access, have implications for accessing and using this data effectively. Additionally, the benefit coverage environment may affect the utility of health care databases to address specific research questions. Coverage considerations that affect pharmacoepidemiologic research include eligibility, the nature of the pharmacy benefit, and regulatory aspects of the treatment under consideration. Copyright © 2001 John Wiley & Sons, Ltd. [source] The Costs of Childhood Epilepsy in Italy: Comparative Findings from Three Health Care SettingsEPILEPSIA, Issue 5 2001R. Guerrini Summary: ,Purpose: To determine the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, comparing three different health care settings [i.e., teaching or clinical research (CR) hospitals, general hospitals, and outpatient services]. Methods: Patients were accepted if they had confirmed epilepsy and were resident in the center catchment area. Eligible subjects were grouped in the following categories: (a) newly diagnosed patients; (b) patients with epilepsy in remission; (c) patients with active non,drug-resistant epilepsy; and (d) those with drug-resistant epilepsy. Over a 12-month period, data regarding the consuming of all resources (i.e., consultations, tests, hospital admissions, drugs), were collected for each patient. Using the Italian National Health Service tariffs, the unit cost of each resource was calculated and indicated in Euros, the European currency. Results: A total of 189 patients was enrolled by two teaching-CR hospitals, two general hospitals, and two outpatient services. The patients were evenly distributed across the four categories of epilepsy. The mean annual cost per person with epilepsy was 1,767 Euros. Drug-resistant epilepsy was the most expensive category (3,268 Euros) followed by newly diagnosed epilepsy (1,907 Euros), active non,drug-resistant epilepsy (1,112 Euros), and epilepsy in remission (844 Euros). Costs were generally highest in teaching-CR hospitals and lowest in outpatient services. Hospital services were the major cost in all epilepsy groups, followed by drugs. Conclusions: The cost of epilepsy in children and adolescents in Italy tends to vary significantly depending on the severity and duration of the disease Hospitals services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy. [source] Alcohol screening and brief intervention: dissemination strategies for medical practice and public healthADDICTION, Issue 5 2000Thomas F. Babor This paper introduces the concept of risky drinking and considers the potential of alcohol screening and brief intervention (SBI) to reduce alcohol-related problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed. Potential strategies for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive services. There is an emerging consensus that SBI should be promoted in general healthcare settings, but further research is needed to determine the best ways to achieve widespread dissemination. In an attempt to provide an integrative model that is relevant to SBI, dissemination strategies are discussed for three target groups: (1) individual patients and practitioners; (2) health care settings and health systems; and (3) the communities and the general population. Dissemination strategies are considered from the fields of social change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical practice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive health services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine. [source] Determinants of late HIV diagnosis among different transmission groups in Finland from 1985 to 2005HIV MEDICINE, Issue 6 2010PS Kivelä Objectives To study determinants of late HIV diagnosis in a low-HIV-prevalence (<0.1%) country where HIV spread among men who have sex with men (MSM) and heterosexuals in the 1980s, and among injecting drug users (IDUs) in the late 1990s. Methods Newly diagnosed HIV cases referred to the Helsinki University Central Hospital between 1985 and 2005 were reviewed to identify determinants of late HIV diagnosis, defined as diagnosis when the first CD4 count was <200 cells/,L, or when AIDS occurred within 3 months of HIV diagnosis. Determinants of late diagnosis were analysed using multivariate logistic regression. Results Among 934 HIV cases, 211 (23%) were diagnosed late. In the first 4-year interval of each sub-epidemic (1985,1989 for MSM and heterosexuals, 1998,2001 for IDUs), rates of late HIV diagnosis were 13%, 18% and 6%, respectively, but increased thereafter to 29%, 27% and 37%. Late diagnosis was associated with non-Finnish ethnicity, older age, male gender, lack of earlier HIV testing, diagnosis at health care settings and later stage of the sub-epidemic. Conclusions The lower rate of late diagnosis in the first 4-year interval of each HIV sub-epidemic suggests that the early stages of the HIV epidemic in Finland were detected early. This factor may have contributed to the low prevalence of HIV infection in Finland. The stage and age of the epidemic should be taken into account when interpreting the data on late HIV diagnosis, especially in cross-country comparisons. [source] Nonlinear dynamics, complex systems, and occupational accidentsHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 4 2003Stephen J. Guastello This article explains how some concepts of nonlinear dynamics,attractors, bifurcations, catastrophes, chaos, and self-organization,contribute to the explanation of deterministic processes in occupational accidents. Empirical results from factory, transportation, and health care settings are compared. The complex dynamics of chaos and self-organization have recently become more important as work systems themselves have become more complex. © 2003 Wiley Periodicals, Inc. Hum Factors Man 13: 293,304, 2003. [source] The relationship between training and organizational commitment: A study in the health care fieldHUMAN RESOURCE DEVELOPMENT QUARTERLY, Issue 4 2001Kenneth R. Bartlett This study examines the relationship between employee attitudes toward training and feelings of organizational commitment among a sample of 337 registered nurses from five hospitals. Using social exchange theory as a framework for investigating the relationship, the researcher found that perceived access to training, social support for training, motivation to learn, and perceived benefits of training are positively related to organizational commitment. Using a three-component model of organizational commitment, the strongest relationships appear with the affective form of commitment. The relationship between perceived access to training opportunities and the affective form of organizational commitment is moderated by job satisfaction but not job involvement. The findings are discussed for their theoretical and practical application to HRD, for the management of HRD in health care settings, and for researchers interested in outcomes of HRD. [source] Professional competence: factors described by nurses as influencing their developmentINTERNATIONAL NURSING REVIEW, Issue 1 2006R. Tabari Khomeiran bs mscn phd Aim:, To discuss the results of a study that explored factors that may influence competence development. Background:, Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. Methods:, A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. Findings:, Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. Conclusions:, The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study. [source] Nursing attitudes towards acute mental health care: development of a measurement toolJOURNAL OF ADVANCED NURSING, Issue 5 2005John A. Baker BNurs MSc MPhil RN Aim., This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. Background., The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. Methods., A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. Results., Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant ,Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0·72. Conclusion., The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care. [source] A review of outcomes of individualised nursing interventions on adult patientsJOURNAL OF CLINICAL NURSING, Issue 7 2008Riitta Suhonen PhD Aims and objectives., This review describes the outcomes of individualised nursing interventions on adult patients. Background., Although the delivery of individualised nursing interventions is important there is limited evidence about how these interventions enhance patient outcomes. Methods., A computerised search was undertaken using the Cochrane Library, MEDLINE, CINAHL and PsycINFO. The selection criteria chosen were: reports of individualised nursing interventions focusing on adult patients in a variety of health care settings and using experimental designs. These involved randomised controlled trials, clinical controlled trials and pre- and posttest controlled studies. After a four-stage inclusion strategy 31 documents were accepted for the review. Results., The studies were mostly focused in preventative arenas such as health promotion and counselling. Others were care of older people in the community and in hospital and patients with chronic diseases. Over half of the nursing interventions (58%) involved educational or counselling activities which seem to be more effective than ordinary, standardised or routine education and counselling. Overall, 81% of the studies reported a positive impact of individualised interventions on patient outcomes showing that there is evidence, though limited, that individualised interventions can produce positive patient outcomes. Conclusions., There is sufficient evidence, especially in specific areas such as patient education and counselling, to acknowledge that individualised interventions are superior to non-individualised interventions. Evidence for this effect within clinical nursing interventions on patient outcomes was limited by the scarcity of research in this area. There is a need for additional intervention studies to determine the effect of individualised interventions in a wide variety of contexts. Relevance to clinical practice., Experience of health is individual. Therefore, nursing interventions should also be individualised to each patient. These findings show some promise that individualised interventions may be useful in delivering positive patient outcomes. [source] Pharmacist prescribing in the UK , a literature review of current practice and researchJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2007A. P. Tonna MRPharmS MSc Abstract Objective:, To review the research literature to date on pharmacist prescribing in the United Kingdom (UK) and to explore the main areas of care and practice settings including any benefits and limitations. Findings:, There are two models of pharmacist prescribing in the UK: pharma\cist supplementary prescribing (SP) introduced in 2003, involving a voluntary partnership between the responsible independent prescriber (a physician or a dentist), the supplementary prescriber and the patient, to implement an agreed patient-specific clinical management plan; and pharmacist independent prescribing (IP) introduced in 2006, responsible for the assessment and consequent management, including prescribing of both undiagnosed and diagnosed conditions. There have been narrative reports of pharmacist SP in different health care settings including primary care, community pharmacies, secondary care and at the primary/secondary care interface; published research within these areas of care is conflicting as to which setting is more suitable for pharmacist prescribing. Initial research reports that almost 50% of pharmacist supplementary prescribers self-reported prescribing with both benefits of and barriers to implementing SP. Research involving other healthcare professionals has indicated that encroachment of traditional roles is likely to occur because of the advent of pharmacist prescribing. A small-scale study has concluded that patients are likely to accept pharmacist prescribing favourably, with another study showing pharmacist prescribing leading to improved adherence to guidelines. There is no published research yet available about practices involving pharmacist IP. Discussion:, Most of the literature focuses on pharmacists' perceptions of SP, with little information referring to other stakeholders, including patients. There is also limited published research focusing on clinical and economic outcomes of pharmacist SP. Conclusion:, This is a rapidly changing aspect of pharmacy practice in the UK, particularly with the more recent introduction of pharmacist IP. It is likely that this area of research will expand rapidly over the coming years. [source] Efficient assessment of social problem-solving abilities in medical and rehabilitation settings: a rasch analysis of the social problem-solving inventory-revisedJOURNAL OF CLINICAL PSYCHOLOGY, Issue 7 2009Laura E. Dreer Abstract The Social Problem Solving Inventory-Revised Scale (SPSI-R) has been shown to be a reliable and valid self-report measure of social problem-solving abilities. In busy medical and rehabilitation settings, a brief and efficient screening version with psychometric properties similar to the SPSI-R would have numerous benefits including decreased patient and caregiver assessment burden and administration/scoring time. Thus, the aim of the current study was to identify items from the SPSI-R that would provide for a more efficient assessment of global social problem-solving abilities. This study consisted of three independent samples: 121 persons in low-vision rehabilitation (M age=71 years old, SD=15.53), 301 persons living with diabetes mellitus (M age=58, and SD=14.85), and 131 family caregivers of persons with severe disabilities (M age=56 years old, SD=12.15). All persons completed a version of the SPSI-R, Center for Epidemiological Studies Depression Scale (CES-D), and the Satisfaction with Life Scale (SWLS). Using Rasch scaling of the SPSI-R short-form, we identified a subset of 10 items that reflected the five-component model of social problem solving. The 10 items were separately validated on the sample of persons living with diabetes mellitus and the sample of family caregivers of persons with severe disabilities. Results indicate that the efficient 10-item version, analyzed separately for all three samples, demonstrated good reliability and validity characteristics similar to the established SPSI-R short form. The 10-item version of the SPSI-R represents a brief, effective way in which clinicians and researchers in busy health care settings can quickly assess global problem-solving abilities and identify those persons at-risk for complicated adjustment. Implications for the assessment of social problem-solving abilities are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1,15, 2009. [source] The clinical nurse leader: a catalyst for improving quality and patient safetyJOURNAL OF NURSING MANAGEMENT, Issue 5 2008FAAN, JOAN M. STANLEY PhD Aim, The clinical nurse leader (CNL®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice. Background, Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources. Method, A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region. Results, Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model. Conclusions, With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs. Implications for nursing management, Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings. [source] Evidence-based practice: implications and concernsJOURNAL OF NURSING MANAGEMENT, Issue 4 2008BEd (Hons), PETER NOLAN BA (Hons) Aims, The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings. Background, The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people's preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. Methods, After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. Results, The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. Conclusions, Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management, In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek. [source] Leadership behaviours: effects on job satisfaction, productivity and organizational commitmentJOURNAL OF NURSING MANAGEMENT, Issue 4 2001J. CHIOK FOONG LOKE RN MBA BN CCNC Background, Research in the west has shown that job satisfaction, productivity and organizational commitment are affected by leadership behaviours. The purpose of this study is to determine the effect of leadership behaviours on employee outcomes in Singapore. Very little research related to this subject has been done in health care settings in this country. The comparison of the results of the different types of settings and samples will allow a better understanding of the relationshiop between leadership behaviours and employee outcomes and thus help to determine if leadership is worth the extra effort. Method, The study explored the relationships between five leadership behaviours identified by Kouzes and Posner and the employee outcomes of registered nurses practising in the general wards, intensive care units and the coronary care unit in an acute hospital. Survey questionnaires were used to elicit responses from 100 registered nurses and 20 managers belonging to the organization. Data collected included demographic characteristics and the degree to which the five types of leadership behaviours were used as perceived by the nurse managers and the registered nurses. In addition, the level of nurse job satisfaction, the degree of productivity and the extent of organizational commitment are described. Findings, The findings show a similar trend to the original studies in the United States of America. Use of leadership behaviours and employee outcomes were significantly correlated. The regression results indicate that 29% of job satisfaction, 22% of organizational commitment and 9% of productivity were explained by the use of leadership behaviours. Recommendations are made in the light of these findings. [source] Legal Implications of Fetal Heart AssessmentJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2000Laura Mahlmeister RN The standard of care requires perinatal nurses to perform fetal heart (FH) assessment competently and safely. Failure to adhere to established guidelines and standards for FH assessment may result in negative outcomes for the fetus or newborn and contributes to claims of nursing negligence. The perinatal nurse must be fully cognizant of professional guidelines and standards for FH assessment and comply with agency policies and procedures when conducting assessment of the fetal heart. Guidelines for FH assessment during the antepartum and intrapartum period are discussed within the context of restructured health care settings and today's medicolegal climate. [source] Comparative study of four candidate strategies to detect cervical cancer in different health care settingsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007Meherbano M. Kamal Abstract Aim:, Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. Methods:, In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR ,2. Results:, Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. Conclusions:, In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances. [source] Binge Drinking and Suboptimal Self-Rated Health Among Adult DrinkersALCOHOLISM, Issue 8 2010James Tsai Background:, Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self-rated health among the general population of adult drinkers in all 50 states and territories in the United States. Methods:, The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ,5 drinks on 1 occasion for men or ,4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30-day period. Odds ratios were produced with multivariate logistic regression models using binge-drinking levels as a predictor; status of suboptimal self-rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors. Results:, We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge-drinking episodes in a 30-day period. Binge drinking with such levels was associated with a 13,23% increased likelihood of reporting suboptimal self-rated health, when compared to the nonbinge drinkers. Conclusions:, Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self-rated health. Our findings underscore the importance of broad-based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population-based prevention strategies to reduce alcohol-related morbidity and mortality. [source] | ||||||||||||||||||||||||||||