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Biomedical subjects

L O'Brien-Pallas

Publications and source records attributed to L O'Brien-Pallas.

At least 19 recordsLinked to original sources
PubMed2002

Where to from here?

Although this conceptual framework is easy to understand, the data requirements for the mathematical model that underpins the framework are complex and must be defined carefully. In our framework, simulations of the health system are used to provide needs-based estimates that are aimed at optimizing outcomes. This type of model builds on research conducted at the macro, meso, and micro levels in order to reflect the complexity of relationships in the health human resource process. The papers in this issue of the Journal provide insight into specific constructs of the model. At the macro level, Tomblin Murphy explores methodological challenges in HHRP research. She examines common assumptions and the validity of their use in modelling in all aspects of the proposed framework. Tourangeau and colleagues report on the impact of hospital nurse-staffing decisions on 30-day mortality rates. Their model adds to our knowledge of the relationships among the management, deployment, and utilization of nursing services and patient/population outcomes. Shamian and colleagues explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being for registered nurses employed in acute-care hospitals in the province of Ontario. This paper contributes to our understanding of how management decisions regarding the work environment influence nurse outcomes. Manojlovich and Ketafian explore the conflict between the practice of nursing and the organizational structure of many hospitals. This study provides insight into the management aspects of how the work unit is organized and the process of care delivery. Zboril-Benson examines the reasons for nurse absenteeism in the province of Saskatchewan. Birch describes the need for the planning process to take into account demographic changes in both populations and provider groups. A major challenge in modelling health human resources is access to meaningful databases for planning purposes. Pringle describes a unique Ontario initiative currently underway to develop and validate a nurse-sensitive set of data that will be routinely collected and will enhance HHRP in that province. Since the science that underpins HHRP is complex and rapidly changing, few books have been written on the subject. Reflecting the dynamic nature of the science, Tomblin Murphy and Barrath provide an excellent review of "grey literature" and useful Web sites for those interested in HHRP.

Canada↗
PubMed2001

Forecasting models for human resources in health care.

This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models--needs based, utilization based, and effective demand based--provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long-term forecasting or for estimating needs for large geographical areas or populations.

Forecasting↗
PubMed2000

Health human resource planning in home care: how to approach it--that is the question.

In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needs-based, utilization-based and effective demand-based models.

Canada↗
PubMed1999

An evaluation of WHA resolution 45.5: health human resource implications.

The World Health Assembly approved resolution WHA45.5 in 1992. This paper reports the findings of an evaluation of the implementation of this resolution using a survey technique. A total of 150 WHO Member States responded, for a 79% response rate. Findings suggest that the greatest strides worldwide have been made in education. While the data show that progress has been made at the country level, far more action is needed to strengthen nursing and midwifery if these cost-effective resources are to play a decisive role in improving the extent and quality of services, especially as delivered to people in the greatest need.

Cross-Sectional Studies↗
PubMed1996

A strategy to promote research-based nursing care: effects on childbirth outcomes.

Studies at area hospitals revealed many gaps between research evidence and intrapartum nursing practices. A randomized controlled trial involving 20 hospitals was used to evaluate the effectiveness of a marketing strategy to promote research-based nursing care. It was hypothesized that the strategy would result in lower rates of epidural analgesia, through increasing the amount of support nurses provided to their patients. Other outcomes included rates of narcotic analgesia, episiotomy, and operative delivery. The marketing strategy was unsuccessful in improving intrapartum nursing care. Much more research is needed about the factors that facilitate improvements in nursing practice.

Analysis of Variance↗
PubMed1996

Downsizing in the hospital system: a restructuring process.

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

Attitude of Health Personnel↗
PubMed1995

A surgical process management tool.

Inspired by a shortage of qualified nursing personnel at local facilities, a group of University of Toronto researchers has created a simulation based decision support tool that enables hospitals to determine the overall effect of making modifications to operating room schedules, as well as a number of other system parameters, including the number of inpatient beds and the amount of nursing time available on surgical wards.

Appointments and Schedules↗
PubMed1992

Different systems, different costs? An examination of the comparability of workload measurement systems.

This study examines the equivalence of the hours of care estimates of four patient classification/workload measurement systems. Although the hours of care estimates of the systems were similar, differences between the estimates could be as great as 4.53 hours per day for the same patient. The researchers developed relational statements that made hours of care estimates equivalent for all systems studied. System differences can have a profound impact on nursing unit and department budgets, if not adjusted.

Costs and Cost Analysis↗
PubMed1989

Variability in nursing workload within CMGs (case mix groups).

This study examines the differences in workload estimates of three patient classification systems in nursing, within selected Case Mix Groups (CMGs). The amount of variation explained by selected patient-specific variables within CMGs on average nursing workload by each system is also analyzed. Results show that, when patient classification data are used to explain nursing time within the Diagnosis Related Group (DRG) context, absolute hours of care estimates of the various systems may not be equivalent. This inequality may result in biased budget review practices unless relational statements are developed between systems.

Canada↗
PubMed1988

An analysis of the multiple approaches to measuring nursing workload.

This article reviews the multiple theoretical approaches to the measurement of nursing workload. A focus on current measurement issues provides direction for future research questions in this area. The underlying assumption is that workload measurement tools must focus on the complexity of the patient situation in determining nursing workload rather than on the traditional focus of tasks in which nurses are involved.

Humans↗
PubMedDate not supplied

Practice patterns of acute care nurse practitioners.

This study was undertaken to examine the practice pattern of nurse practitioners employed in Ontario acute care settings. A descriptive design, incorporating quantitative and qualitative methods for data collection, was used. The acute care nurse practitioners' practice pattern varied in terms of scope of practice, model guiding practice, reporting relations, and extent of role implementation. Role implementation encompassed activities representing the four role components: clinical practice, education, administration or management, and research. The acute care nurse practitioners engaged most frequently in the clinical component of the role. They performed medical and advanced nursing functions. They emphasized that they do not work in isolation and that they do not replace physicians or residents.

Acute Disease↗
PubMedDate not supplied

Organizational factors influencing nurse practitioners' role implementation in acute care settings.

The purpose of this study was to explore the influence of organizational factors on the Acute Care Nurse Practitioner (ACNP) role implementation. A descriptive correlational design, incorporating quantitative and qualitative methods for data collection was used. The sample of convenience consisted of 57 ACNPs assigned to various medical and surgical programs within acute care hospitals. Ten ACNPs participated in the unstructured qualitative interviews. In addition to the interviews, data pertinent to various organizational factors, including role formalization, receptivity of the role by others, perceived autonomy, role strain, and additional factors that may interfere with role implementation, were collected through a self-report structured questionnaire. A four-diary day was completed to gather data on role implementation. Descriptive and correlational statistics were used to analyze the quantitative data. The qualitative data were content analyzed. The ACNPs engaged most frequently in activities reflective of the clinical practice component of the role and less frequently in the non-clinical components (i.e., education, administration, and research). Results of the quantitative and qualitative analyses indicated that lack of formal clear job description, conflicting demands and expectations, lack of receptivity of the role by others, lack of autonomy, and increased workload were negatively correlated with the ACNP role implementation. The ACNP role implementation varies across practice settings. This variability should be accounted for when examining outcomes of ACNP care.

Acute Disease↗
PubMedDate not supplied

Healthcare restructuring: the impact of job change.

Restructuring, particularly redeployment and job change, had a dramatic impact on the working conditions and practices of nursing personnel. This study was conducted to determine whether nurses (RNs and RPNs) who experienced job change perceived their work-lives differently than those who did not undergo job change and, whether nurses who experienced different types of job change (new role, new unit, or new hospital) varied in their perceptions. A questionnaire exploring themes relevant to redeployment was administered to all nurses (N = 3,408) in two large teaching hospitals that had undergone restructuring. The response rate was 50.7% (n = 1,728). Of the responses, 1,662 were used in the analysis. T-tests and ANOVAs were used to compare groups of nurses. Nurses who changed their jobs perceived their commitment to the organization, their work environment and quality of care differently than those who did not change jobs. Nurses with different types of job change differed in their organizational commitment, perceptions of work-related injuries, attitudes towards job change, need for orientation and new knowledge, and feelings about the health care team. Results will assist managers to address the specific needs of nurses with different experiences of job change in the restructured workplace.

Adult↗
PubMedDate not supplied

Redesigning nursing work in long-term care environments.

The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.

Adult↗
PubMedDate not supplied

Quality of nursing worklife issues--a unifying framework.

This article describes a theoretical view of the many variables that influence nurses' worklife. It summarizes the national perspective and the provincial initiatives undertaken during the last decade that focus on issues of nursing worklife. The authors present a model that unifies the many dimensions that must be examined in studying this important problem. Nurse administrators will find this review valuable as a guide to research and practice initiatives associated with quality of working life.

Employment↗
PubMedDate not supplied

Overview of nursing research in health care within the current economic context.

This is an overview of nursing research findings in the following areas: forecasting the need for nursing personnel; evaluating the effectiveness of nursing care; and, costing nursing services. The author suggests the models for forecasting the need for nursing person power require further development and should incorporate more of the multitude of intricate factors that impact on nursing and the demands for care. Research in nursing case costing, workload measurement systems and the cost effectiveness of nursing care are also addressed in leading to the conclusion that there is an urgent and timely need for more nurse researchers to examine all of these complex nursing issues in relation to the whole health care system and thus be ready and in position to influence health policy and costs.

Canada↗
PubMedDate not supplied

A comparison of workload estimates using three methods of patient classification.

This research examined the equivalence of the workload estimates of three commonly used patient classification systems in nursing (GRASP, PRN and Medicus). Patient classification systems are used for program costing and formulation of the nursing budgets. The findings suggest that the estimates of absolute hours of care provided by the three systems differ significantly when all three tools are used on the same patient population, particularly in the Intensive Care Units (ICUs). The data suggest that these differences result from the weights assigned to individual indicators within each system. Although hours of care estimates are significantly different, they are highly correlated. This research suggests that the estimates of hours and costs provided by different patient classification systems may involve clinically important differences. These discrepancies could result in inequitable funding practices unless mechanisms are developed for showing the relationships between systems.

Evaluation Studies as Topic↗