Biomedical subjects
Publications and source records attributed to C H Smeltzer.
Case management has become a commonly used tool in the age of managed care. Case management is especially valuable when combined with demand management, disease management, and computerized information systems. This article presents a model that outlines each of these within the continuum of care.
Clinical documentation can take up to 25 percent of a nurse's time in an acute care setting, not to mention the time spent by other clinicians and ancillary caregivers on documentation. Institutions can reduce documentation time by systematically determining what information is crucial to the provision of patient care across all disciplines and then using a redesign process that mirrors work redesign. By following a structured process that challenges the philosophy and function of the documentation system, a hospital's multidisciplinary staff members can use their expertise to design alternatives that achieve documentation's original intent-to document diagnoses and treatment accurately-in a more efficient and useful way.
Work restructuring is an intensive, time-consuming undertaking that succeeds when proper planning and a disciplined process promote open lines of communication between administration and staff. Surveying staff members to understand their values and how they are spending their time sets the stage for work restructuring. The data collected identify opportunities for change to improve care and increase staff satisfaction and become a baseline for benchmarking success. Surveys also identify what staff members value, what they want to retain from the current system, what needs to be better integrated with other departments, what activities can be eliminated, and any changes that already have positively affected care delivery.
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It is important that the philosophy and strategic plan for a Department of Nursing support research programs which will guide current clinical and administrative decisions as well as long-term policy initiatives. Research also contributes to the maturing of the science of nursing through generating and testing knowledge.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The primary purpose of most regulatory agencies is to insure that standards for patient care are defined and adequately supported by policy, procedure, and organizational structure. In addition, the regulatory agency evaluates the effectiveness of the organization in implementing and monitoring the standards for providing safe, quality patient care. The objectives of regulatory agencies do not differ significantly from the major responsibilities of nursing administration. Despite similar accountabilities between the surveyor of the regulatory agency and the nurse administrator of an organization, there may be a great deal of anxiety and stress before an accreditation visit. A method of understanding the standards, developing tools to monitor compliance with the standards, educating staff regarding the standards, and assuring nursing practice is in compliance with the standards is presented. A mechanism for organizing materials and information for the survey that will be effective for ongoing monitoring of standards is also discussed.
Nurse administrators were faced with how to staff for a rapid expansion in number of beds in the face of a 15% nurse vacancy rate. The authors discuss how they addressed this issue through their multifaceted strategic plan.
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In summary, the findings from the study provide partial answers but also raise many new questions that are important to those whose goal is the quality of patient care. This research points to the need for (1) indepth analysis of different types of units to determine the variables that relate to the nursing staff's achievement of the nursing process and quality of care rendered; (2) study of the education and experience levels that best provide quality patient care in the most effective manner; and (3) identification of additional variables that influence delivery of quality patient care.
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Explore the source record for details and available documents.
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A position paper can be one avenue or method of providing a framework for discussing nursing issues with peers, colleagues, and health care executives. A position paper/issue paper will frequently focus on one view with subsections, but can raise many other questions as well as touching on additional nursing issues. It should be clear when developing a position paper that the goal of the paper is to provide a framework for discussion--with the major emphasis being on issues being raised, not resolved. The paper should also address how nursing is affected by these issues and how the entire hospital may be affected. Last, a position paper should also articulate your--the nurse executive's--position on the issues under discussion.
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A time and motion study of emergency department (ED) patient waiting time was conducted at the University Medical Center at the Arizona Health Sciences Center in Tucson as a follow-up to a more general study. The time and motion study examined waiting times associated with all phases of emergency care delivery and various levels of patient acuity. The time it took for other departments to provide services and procedures was seen as a significant contributing factor to ED waiting time. Data from this study have already been used to help the medical center identify and correct ED inefficiencies.