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Biomedical subjects

J Shamian

Publications and source records attributed to J Shamian.

49 records · Page 3Linked to original sources
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Outcomes monitoring: adjusting for risk factors, severity of illness, and complexity of care.

Adjusting for risk factors, severity of illness, and complexity of care is important when comparing and interpreting outcomes. Current and future approaches for examining risk factors, severity of illness, and complexity of care are described within the contexts of administrative, economic, and clinical outcomes. Reasons why the current standardized instruments, computerized severity systems, and workload/intensity measurements, when used alone, are inadequate for outcomes monitoring are proposed. A more comprehensive model for outcomes monitoring is required, one that adjusts outcomes for risk factors, severity of illness, and complexity of care.

Data Collection↗
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Voices from the trenches: nurses' experiences of hospital restructuring in Ontario.

Nurses, the largest occupational group in health care, have been disproportionately affected by health care restructuring initiatives. A survey of registered nurses in Ontario was conducted in the fall of 1998 to examine factors influencing their work life quality in hospital settings. As a part of this survey, respondents were provided with an opportunity to share their concerns about work conditions in an open ended section of the questionnaire. Almost sixty percent of the nurses chose to respond to the open ended question (n = 230), divided equally between males and females. The purpose of the qualitative component of the study was to obtain a more in depth analysis of the effects of hospital restructuring initiatives on staff nurses' working conditions. All geographic areas of the province were represented in the responses. A content analysis of the data was conducted to determine major themes. Similar themes were found across all geographic areas. The four major categories of concerns that emerged from the qualitative analysis were quality of worklife, quality of patient care, relations with management, and cumulative impact of work conditions on feelings and attitudes. Nurses' perceptions of their quality of work life, concern for the quality of patient care and their emotional and attitudinal responses were very similar to those reported in a recent study of hospital staff nurses in the United States. The decade of the 1990's has been characterized as one of constant change bordering on chaos within the health care system in Canada and the United States. In Canada, government fiscal policies have resulted in less money being directed toward health care forcing the system to reorganize in order to meet new financial realities. Many of the organizing efforts have been directed toward the acute care sector of the health care system. Nurses, as the largest occupational group within the health care system, have been disproportionately affected by these efforts. The purpose of this study was to tap nurses concerns about the effects of these changes on their personal and work experiences.

Attitude of Health Personnel↗
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Nurses' reports on hospital care in five countries.

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.

Attitude of Health Personnel↗
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Nursing resource requirement and support services.

How can medical-surgical and critical care units reduce their nursing care hours per patient day (HPPD)? When nurse executives understand the impact of professional, nonprofessional, and technological support services on HPPD they can work toward further cost reduction without adversely affecting the quality of patient care.

Health Resources↗
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Working toward clinical nursing excellence.

The professional nursing literature offers limited explication of the meaning of clinical nursing excellence, thus few strategies to facilitate and maintain excellence in practice. The purpose of this paper is to describe a workshop that was designed to give definition and practice directions for the concept of "clinical nursing excellence". Workshop participants were the nursing leaders of a large Canadian university teaching hospital. The program structure was presented by a working committee from within that group and the content was provided by those in attendance. The objectives for this two-day workshop were: 1. To identify characteristics of clinical nursing excellence within the organization. 2. To describe programs, activities, and functions (current and future) that are consistent with clinical nursing excellence. 3. To identify those factors inhibiting and supporting clinical nursing excellence within the institution. 4. To promote networking and communication between nursing leaders within the Nursing Department. 5. To promote Departmental/Directorate development of a plan for further enhancement of clinical nursing excellence. This cooperative workshop was deemed a worthwhile endeavour for all participants. Nurse administrators may find the process and or products of this workshop useful for identifying departmental strategies to enhance nursing practice.

Clinical Competence↗
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The relationship between length of stay and required nursing care hours.

The average length of stay (LOS) of patients in hospitals has declined rapidly since the introduction of the prospective payment system. It has been argued by nurses that reduced LOS is associated with increased nursing resource consumption, but there has been little empirical evidence to support the argument. The authors offer evidence of a relationship between LOS and hours per patient day in eleven clinical specialty areas. These findings have major implications for budgeting and the delivery of nursing care services.

Hospital Units↗
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A model for professional nursing in organizations: the Rainbow.

This paper presents a model of professional nursing in organizations that provides cohesive direction to the development of patterns that shape how nursing is structured in an organization. Such cohesive direction can foster integration between the practice and the discipline components of nursing. The model can influence the structure of nursing on a macro level within the organization and on a micro level by influencing patterns of nursing care delivery. A set of values, assumptions, dimensions, constructs, principles and propositions have been identified and brought together in this model. As a framework, it can be used to shape the structures and processes that contribute to professional nursing excellence in practice settings.

Health Knowledge, Attitudes, Practice↗
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Towards quality and cost-effective health care.

Although rich cumulative evidence exists on nursing's effectiveness, few policymakers and healthcare executives apparently are familiar with it. To make such scientific-based knowledge more available so that it can be considered and integrated in healthcare policy and reform, the WHO Collaborating Centre at Mount Sinai Hospital, Toronto, Canada, complied and reviewed research evidence about how nursing services contribute towards cost effectiveness and quality health outcomes. Below, a summary of its findings.

Case Management↗