Biomedical subjects
Publications and source records attributed to E A Graveley.
The perioperative clinical nurse specialist (CNS) case manager has the opportunity to contribute to the demand for quality, cost-effective health care. This article discusses the perioperative CNS case manager's role in our new health care environment from administrative issues, including reducing the cost of care, through the quality and access to care issues that need to be documented when caring for the geriatric surgical patient.
The advances in electronic technology in the form of increased processing power, the ability to computerize many aspects of a patient's record, and the emergence of document imaging systems and telemedicine have enhanced health care professionals ability to more accurately document care. However, with this augmentation comes issues in liability and security of which professionals should be aware. This article discusses some of these issues from the viewpoint of the perioperative nurse.
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BACKGROUND: Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. METHODS: Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. RESULTS: There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. CONCLUSIONS: The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.
In this study we attempted to develop a profile that could be used prospectively to identify veterans over 64 years of age who might be at risk for medication noncompliance. Male veterans (N = 249) having from one to seven oral daily prescribed medications were studied. Instruments administered to determine their relationship to compliance were the Paired-Associate Test, the Mini Mental State, the Multidimensional Health Locus of Control, and the Standard Depression Scale. Compliance was determined by a pill count made at two home visits. Seventy-three percent of the subjects were noncompliant. Variables significantly related to noncompliance by bi-variate analysis were included in the stepwise logistic regression to develop a predictive model of noncompliance. Ethnicity and number of daily prescribed pills were the only significant variables in the final model. The model correctly classified the subjects as compliant/noncompliant in 77% of the cases. Discussions during home interviews revealed a number of common problems.
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Undergraduate nursing students (juniors) entering an upper division nursing program were asked to rate their overall computer skill, ability to use word processing, spreadsheet, presentation/graphics programs, and their ability to use the Internet and e-mail. Because of the number of students who rated themselves as not computer literate an intervention was planned. A graduate student, using a tutorial manual, worked with students for six 1.5-hour skill-enhancing sessions during their first semester. After the sessions students again rated their skill levels. An analysis of the before and after data showed a mean gain score of 5.5 points, with each skill showing a significant increase from the before to the after assessment.
The authors describe integration of nursing informatics concepts and computer-based instructional strategies in a financial management course for graduate level nursing administration students. Major components include: 1) computer-based instruction for financial management theory; 2) spreadsheet used for decision support; 3) utilization of forecasting software; and 4) evaluation of learning involving computer use.