The future of nursing education is inextricably linked to structural changes in the health care delivery system, changes brought about by health care reform, integrated health care delivery systems, and the use of "managed care." Multiple entry points to nursing education cause overlap in skills of graduates and result in rework. This article discusses this problem, the impact of the changing job market and case management on nursing education, and two new emerging advanced practice roles: the primary care nurse practitioner and the acute care nurse practitioner.

Case Management↗

PubMed1995

Integrated health care and the advanced practice nurse.

As state-designed Medicaid reforms are enacted and commercial insurance carriers begin to manage care, advanced practice nurses (APNs) must be ready to aggressively pursue opportunities for clinical participation. Understanding the contractual obligations of becoming a provider, as well as adopting strategies for successful participation in these emerging integrated networks, will be critical for APNs. Successful contracting requires a carefully defined set of practice activities and a willingness to become a team player in a complex organization.

Delivery of Health Care, Integrated↗

PubMed1991

Embracing the challenge of change.

Explore the source record for details and available documents.

Delivery of Health Care↗

PubMed1991

Issues surrounding the distribution and utilization of nurse nonphysician providers in rural America.

The cost and quality of health care is an ever-increasing concern. Responsible people are looking for logical solutions. One solution is the increased involvement of nurse practitioners and certified nurse midwives in the delivery of health care services to patients. This paper reviews the supply, education, and responsibilities of nurse practitioners and certified nurse midwives, government studies of the need for nonphysician providers, the cost-effectiveness of health care delivered by nurse practitioners and certified nurse midwives, and impediments to practice.

Cost-Benefit Analysis↗

PubMed1990

Female ejaculation: perceived origins, the Grafenberg spot/area, and sexual responsiveness.

Despite earlier contrary claims, some researchers have recently reported a possible homologous female prostate gland that is potentially involved in a sudden spurt of fluid being released at the moment of orgasm. A number of medical authorities have speculated that this fluid is urine. To alleviate concerns about the possible release of urine during orgasmic response as well as to contribute to a further understanding of physiological and psychological sexual satisfaction, we examined a series of variables thought to be associated with female ejaculation [(expulsion of fluid during orgasm and its relationship, if any, to a sensitive anatomic area (Grafenberg spot)]. An anonymous questionnaire was distributed to 2350 professional women in the United States and Canada with a subsequent 55% return rate. Of these respondents, 40% reported having a fluid release (ejaculation) at the moment of orgasm. Further, 82% of the women who reported the sensitive area (Grafenberg spot) also reported ejaculation with their orgasms. A number of variables were associated with this perceived existence of female ejaculation.

Arousal↗

PubMed1989

The role of the Grafenberg Spot and female ejaculation in the female orgasmic response: an empirical analysis.

Despite earlier contrary claims, researchers have found evidence that a sensitive area (Grafenberg Spot) exists in the vaginal barrel. This area is a potential source of orgasm independent of clitoral stimulation. Other researchers have reported that some women experience a sudden spurt of fluid at the moment of orgasm. In the interest of contributing to further understanding of physiological and psychological sexual satisfaction, and alleviation of concerns about perceived urination during orgasm, the investigators explored a series of variables thought to be associated with perceptions of the Grafenberg Spot and its relationship, if any, to the female orgasmic response and female ejaculation. An anonymous questionnaire was distributed to 2,350 women in the United States and Canada, with a subsequent 55% return rate. A number of factors were found to be associated with perceived existence of a sensitive area in the vaginal barrel which, when properly stimulated, activates orgasm. Women who reported sensitive area orgasms were also more likely to report a spurt of fluid at moment of orgasm.

Body Fluids↗

PubMed1989