The epidemic of violence against healthcare workers.
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Attitude of Health Personnel↗
Biomedical subjects
D M Gates
Publications and source records attributed to D M Gates.
Using simulations and standardized patients in intervention research.
Caregiving is both an art and a science; both knowledge and skills are necessary to improve the quality of care that professionals provide. Researchers are often limited in their assessment of skill performance due to inadequate and unrealistic measurement options. Simulation using standardized patients offers researchers an objective method to evaluate skill performance. This article describes the use of simulations by researchers in their quest to measure changes in violence prevention skills after an intervention program given to nurse assistants working in long-term care facilities.
Evaluation Studies as Topic↗
Stress and coping. A model for the workplace.
Stress, both positive and negative, is a part of personal and work life. Some stressors in the work environment are so extreme they cause strain to all employees. Such conditions require immediate response by employers to change the work environment. However, understanding most workplace stress requires an approach examining the fit between the individual and the work. Only by holistically examining the relationships between the worker's characteristics and the job's characteristics can successful intervention strategies be planned and implemented. Once occupational and environmental health nurses have completed an occupational stress assessment they can plan primary, secondary, and tertiary interventions to meet the specific needs of the employees and the organization.
Adaptation, Psychological↗
Violence against caregivers in nursing homes. Expected, tolerated, and accepted.
Violence against caregivers is not a new phenomenon. Caregivers have experienced verbal and physical assaults from nursing home residents for many years. However, because much of the violence has been associated with demented or mentally ill residents, the word aggression was used in lieu of violence. This study found that the caregivers and nursing directors considered the assaults to be violence. The study suggests that such violence occurs frequently and is of concern to caregivers and nursing directors. The study also suggests that nursing homes may not have policies or procedures in place for preventing, monitoring, and controlling violence in their workplaces. In 1996, OSHA published violence prevention guidelines for health are facilities. These guidelines support OSHA's mandate that employees are entitled to a safe and healthy workplace (OSHA, 1996b). Although it is not possible to prevent all violence against caregivers in this unique setting, nursing home directors and administrators have a legal and moral responsibility to develop an action plan to minimize the violence and plan interventions for its effects. Violence against caregivers in nursing homes no longer can be thought of as expected, tolerated, and accepted. Quality of care and employee well-being depend on it.
Adult↗
Outsourcing the preparation of parenteral nutrient solutions.
A hospital pharmacy's experience with using an outsourcing center to prepare parenteral nutrient solutions (PNs) is described. In 1994 the pharmacy at a 340-bed level 1 trauma center selected an outsourcing center located 20 miles away to provide PN-compounding services; the center is licensed as a manufacturer and has an extensive quality control program. The necessary telephone and computer links were established. When a PN order is received, the pharmacist simply dials into the outsourcing computer system and enters the order. At 1400, a pharmacist dials into the system to verify all PN orders entered for that day. After 1500, personnel at the outsourcing center print labels and compound the solutions, which are delivered by courier within a few hours. The net savings during the first year of outsourcing PNs were estimated at about $59,000. The savings were attributable to the elimination of a technician full-time equivalent (FTE), a reduction in pharmacist labor, and favorable contract provisions; money was saved even though the service's PN-preparation fees outweighed the savings from reductions in labor. The hospital's onsite inventory of PN supplies decreased by $5800, and storage space was freed for other uses. Very few problems were associated with the service provided. Outsourcing the preparation of parenteral nutrient solutions reduced personnel, inventory, and expenditures in a hospital pharmacy.
Contract Services↗
Health care in the United States is undergoing drastic changes attributable in large part to the financial crisis in health care funding.
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Health Care Reform↗
Changes in health care financing: effects on the delivery of health care services in the 1990s.
The evolution of health care financing has had a profound effect on the delivery of health care services. Autonomous, provider-directed care with fee-for-service reimbursement combined with expensive medical technology and an overabundance of providers has led to increasing medical costs. In an effort to reduce spending, payers are responding by demanding that providers regulate clinical and financial outcomes under managed care contracts. These contractual arrangements are administrated by a variety of managed care organizations and are forcing providers to coordinate care along the full continuum. Cardiovascular health and disease management is particularly affected because billions of health care dollars are consumed in this area. This article explores the evolution of the current crisis in health care financing and its effects on providers and payers. Future opportunities for cardiovascular providers in this changing health care environment are briefly discussed.
Cardiovascular Diseases↗
Effectiveness of a program of early hospital discharge of cardiac surgery patients.
Managed care was the impetus for a program designed to move adult patients from acute care to the lowest level of appropriate services after cardiac surgery. Clinical pathways and a home care cardiac specialty team were the major components of the Early Discharge Program. The program was evaluated based on both financial and clinical outcomes. A convenience sample of 119 pretest patients was compared with 101 posttest patients 3 months after program implementation. Hospital length of stay decreased only 0.34 days on average, but inpatient direct variable costs decreased by an average of $1,790 per patient. Based on the 101 patients in the posttest group, $180,790 in direct variable hospital costs were saved. The largest decrease in resource use was in those patients who were discharged to home care. Complications and home caregiver burden after discharge were no higher in patients discharged early. Early discharge of cardiac surgery patients appears to be safe and cost-effective.
Aged↗
Workplace violence: occupational health nurses' beliefs and experiences.
The purpose of this descriptive study was to describe occupational health nurses' beliefs about workplace violence and violence prevention education. The study examined what nurses believe about their intentions and ability to provide violence prevention education, as well as barriers they perceive to providing such programs. A survey was sent to a random sample of 700 members of the AAOHN; 357 surveys were used for data analysis. The study found that many occupational health nurses believe they and their companies are at risk for violence. In addition, many of the occupational health nurses had experienced harassment, threats, or assaults at their workplaces during the previous 12 months. Few occupational health nurses had provided violence prevention programs in their workplaces or intended to provide such programs during the following 12 months. The largest barrier to providing violence prevention education was the employer did not recognize violence prevention education as part of the nurse's job responsibilities.
Health Knowledge, Attitudes, Practice↗
Workplace violence.
Research related to workplace violence is in its infancy. The epidemiologic data, which are just beginning to appear in the literature, show that workplace violence is a growing concern for employers and employees. Experts provide suggestions on ways to prevent workplace violence, but the literature lacks studies that examine the use or results of such activities. Included in these suggestions is the need to implement violence prevention policies and procedures, security controls, screening, employee assistance programs, and workplace education/training for employees and managers. Occupational health nurses are in a unique position to provide violence prevention programs in the workplace.
Adult↗
Cardiac dysfunction in septic shock and multiple organ dysfunction syndrome.
Significant biventricular cardiac dysfunction occurs early in sepsis and multiple organ dysfunction syndrome. Multiple mediators and physiologic derangements result in the characteristic hemodynamic alterations associated with sepsis. The ability of the myocardium to compensate for this failure and continue to generate adequate flow to meet tissue oxygen needs defines the difference between survivors and nonsurvivors of sepsis and multiple organ dysfunction syndrome. This article discusses the physiologic and hemodynamic differences between survivors and nonsurvivors of sepsis and describes key monitoring techniques that guide interventions.
Critical Care↗
Risk factors for disability among U.S. adults with arthritis.
This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.
Activities of Daily Living↗
Promoting maternal-child wellness in the workplace.
With increased numbers of women in the workplace, corporations are recognizing the need for maternal-child wellness programming. Prenatal risk assessment and screenings with follow up educational programs can reduce infant mortality and morbidity, thereby reducing dollars spent by industry for health care of women and children. Occupational health nurses can serve as change agents in implementing prenatal, postnatal, and family oriented wellness programs in the workplace.
Child Welfare↗
Distribution of active gene sequences: a subset associated with tightly bound chromosomal proteins.
The distribution of active polyadenylate-messenger RNA sequences in fractionated chicken liver chromatin was examined. A portion of these active gene sequences is concentrated in a DNA fraction retained by tightly bound nonhistone chromosomal proteins, while the nonretained DNA fraction is substantially depleted of a portion of these sequences. These findings suggest that the tightly bound nonhistones are physically associated with a subset of active gene sequences.
Animals↗
DNA-binding activity of tightly-bound nonhistone chromosomal proteins in chicken liver chromatin.
We have isolated a nonhistone chromosomal protein fraction from chicken liver chromatin which possesses high affinity and preferential sequence DNA binding. Residually DNA-bound nonhistone chromosomal proteins after 2.0 M NaCl extraction of bulk chromatin are isolated. Bound proteins are released by dissociation of the complexes in 5.0 M urea/3.0 M NaCl. We have investigated the in vitro DNA-binding properties of this class. In contrast to other DNA-binding NHCP whose activities have been studied, direct DNA-binding activity is observed which is not abolished under conditions of high ionic strength (to 3.0 M NaCl). Strong preference in binding fractionated homologous DNA is observed, while binding of heterologous (E. Coli) DNA is negligible. The fractionation of homologous DNA permits the isolation of DNA for which this protein class displays strong binding preference, presumably through a concentration of binding sites. The composite data suggest sequence-specific interaction between this protein class and DNA, which is not abolished by high ionic strength.
Animals↗
DNA sequence selection by tightly-bound nonhistone chromosomal proteins.
Extraction of chicken reticulocyte chromatin with 2.0 M NaCl removed 96% of chromosomal protein and yields two DNA components after dialysis and high-speed centrifugation. The bulk of chromosomal DNA (ca. 99%) is rendered free of protein, and is thus soluble in 10 mM Tris-HCl, pH 8.0. The other component (ca. 1%) displays a high protein/DNA ratio, and is insoluble in 10mM Tris-HCl, pH 8.0. These DNAs can be separated on the basis of their solubilities. Analysis of the reassociation kinetics with total chicken DNA of these DNAs reveals marked differences. Whereas total DNA and the soluble component (DNA-S) have rapidly reassociating components, the insoluble component (DNA-P) is devoid of these components, and is therefore composed completely of unique sequence DNA. Cot 1/2 values indicate that DNA-S is substantially depleted of some DNA-P sequences. We conclude that this segregation, as determined by tightly-bound nonhistone chromosomal proteins, selects a subset of total genomic DNA sequences, and suggests sequence-specific interaction between the tightly-bound nonhistones and DNA.
Animals↗
Use of the Hungate anaerobic technique in the isolation of phloroglucinol-negative mutants of Coprococcus species.
The Hungate anaerobic technique was used with a standard procedure for bacterial mutagenesis employing N-methyl-N-nitro-N'-nitrosoguanidine to obtain mutants of an obligate anaerobe. Three mutant strains were derived from a Coprococcus sp., strain Pe15, a rumen anaerobe capable of growing on phloroglucinol. The mutants did not grow on phloroglucinol but did degrade the compound in anaerobic washed-cell suspensions, producing the same end products in approximately the same proportions as the wild type. It was concluded that the mutants were blocked in a unique step or steps necessary for carbon skeleton or energy synthesis from phloroglucinol and not in formation of an enzyme involved in the pathway of phloroglucinol degradation.
Anaerobiosis↗
Products of anaerobic phloroglucinol degradation by Coprococcus sp. Pe15.
Under anaerobic conditions, resting cell suspensions of Coprococcus sp. Pe15 degraded 1 molecule of phloroglucinol to 2 molecules of acetic acid and 2 molecules of carbon dioxide. The organism metabolized the flavonoids rhamnetin and quercetin anaerobically in 20% rumen fluid medium but failed to grow under similar conditions at the expense of any of 39 other aromatic or flavonoid compounds tested.
Acetates↗