Biomedical subjects
Publications and source records attributed to J H Larrabee.
Each year pain disables approximately 50 million Americans. This study determined the relationships among pain management and patients' and nurses' perceptions of quality nursing care. This study was a secondary analysis of data for 91 patients, with additional data collected. How patients perceive their nursing care may correlate with how well their pain is managed.
Traditionally, health care quality has been provider defined and focused, even though consumers define and evaluate health care quality. And, there is no relationship between consumer and provider perceptions of quality. Importantly, consumers use their evaluations when they decide to sue, recommend or return for services, and comply with treatment regimens. This article examines the changing role of the consumer in health care quality, explicates the need for a change in the health care paradigm, and suggests strategies for increasing patient participation in health care planning and quality assessment.
The simultaneous evaluation of quality and the cost of health care can provide information that is useful for guiding quality improvement activities while minimizing or reducing cost. Despite the evidence of concern for health care costs, a long history of concern for health care quality, and numerous efforts to evaluate the quality and cost of health care simultaneously, current methods have been relatively ineffective in decreasing or containing costs. Simultaneous monitoring of cost and quality indicators can be used to compare differences between the cost of prevention and the cost of failure and can be utilized to determine areas where failure costs can be decreased.
Larrabee's model of quality proposes a relationship between quality and value. This study tested the relationship by identifying predictors of patient-perceived quality for nursing care. Data were obtained from interviews and records of 199 adult patients. Candidate predictors of patient-perceived quality included patient goal achievement, nurse-perceived quality, and nurse goal achievement. Candidate predictors also included seven demographic, seven financial, six illness, and six hospital variables. Predictors of both patient-perceived quality global and patient-perceived quality total were pain severity on exit interview, clinic referral, unit, and patient goal achievement. Medicare nonrecipient was a predictor of patient-perceived quality global. Worry score on admission was a predictor of patient-perceived quality total. The results support the relationship between quality and value and between quality and beneficence postulated by Larrabee's model of quality. Additional investigation of these relationships in other populations and using other operationalizations of the model concepts is needed to provide further support for the model. This model is potentially useful for investigating quality in diverse cultures because the operationalization of the model concepts can be designed to reflect local, regional, or national values.
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Multiple body systems can be affected by scleroderma. Satisfactory coping and life-style alterations will depend on numerous factors, including the nature and extent of organ involvement, individual coping style, and health professional services provided. Because of the low incidence of this disease, nurses may have little knowledge about the nursing management. Because of the nature of the disease's complications, the nephrology or dialysis nurse may care for more scleroderma patients than other hospital nurses.
The incidence of scleroderma is approximately 700,000 people in the United States. Pathologic changes occur in a variety of body systems and can alter lifestyle, especially for people with diffuse scleroderma. Information from clinical practice and research concerning the nature, incidence, pathophysiology, complications, and medical management is discussed. Although there is no known cure for scleroderma, life expectancy has improved as management of renal hypertensive crisis and renal failure has improved.
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