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Biomedical subjects

M A Ray

Publications and source records attributed to M A Ray.

At least 19 recordsLinked to original sources
PubMed2001

Federal Nursing Service Award. Impact of TriCare/managed care on total force readiness.

Mission readiness is dependent on a healthy total force and the response of military medical and nursing services. Managed care has become the norm in U.S. health care, including the Department of Defense Military Health System. Cost management, health maintenance organizations, and other health plans are defined as "managed care," an aggressive cost-control effort by health care purchasers and insurers to limit health care spending and services and advance a market-oriented, profit-driven system. The impact of managed care on mission readiness and retention of active and reserve personnel is and will continue to be profound. The purpose of this research was to conduct a qualitative, phenomenological study (life experiences) of TriCare/managed care to explore the impact and the meaning of the experience on total force mission readiness of the U.S. Air Force and how managed care has changed nursing practice. The results reveal the significance of the impact of TriCare/managed care on total force readiness by identifying, through themes, meta-themes, and a representative model, the negative effect that economics is having on active duty and reserve force health and well-being.

Aerospace Medicine↗
PubMed1998

A phenomenologic study of the interface of caring and technology in intermediate care: toward a reflexive ethics for clinical practice.

A phenomenologic research study of nurse caring was conducted in an intermediate care unit of a hospital. Three narratives from the data are presented as examples to illuminate the meaning of the experience of caring for technologically dependent patients. Results revealed that vulnerability, suffering, and the ethical situations of moral blurring and moral blindness were the dynamics of caring for these patients. Identification of these phenomena cells for a new reflexive ethics in health care to increase understanding of how deep values in relation to the status of vulnerable human beings, and how moral interactions among patients, families, and caregivers, shape ethical decisions.

Empathy↗
PubMed1997

The ethical theory of existential authenticity: the lived experience of the art of caring in nursing administration.

The purpose of this research was to conduct a study of the art of caring in nursing administration. By means of a phenomenologic-hermeneutic approach, the caring experiences of six nurse administrators were revealed and analyzed. Essential themes emerged from their descriptions of their experiences. Interpretation of the data served as the lens through which the expressions of the art of caring related to archetypical philosophies of art: living form, imitation, and expression. An ethical theory, Existential Authenticity, was uncovered as the unity of meaning of nursing administrative caring art. This unity of meaning embodied statespersonship, which was viewed by Plato as the highest form of art. Implications for the transformation of nursing administrative practice as an ethical caring enterprise by the manifestation of statespersonship are presented.

Ethics, Nursing↗
PubMed1997

Consciousness and the moral ideal: a transcultural analysis of Watson's theory of transpersonal caring.

The global society in which advanced practice nurses work calls for an appreciation of cultural diversity and transcultural care. Theories to guide education, research, and practice must therefore incorporate understanding of cultural concepts. Watson's transpersonal caring theory, which is shaped by the tenets of consciousness and the moral ideal, does not address cultural care per se but does bring into focus the forces of the moral and the spiritual in the event of caring. Thus, it has the potential to be valuable in culturally diverse transcultural nursing situations.

Cultural Diversity↗
PubMed1995

Trial of labor after cesarean delivery with a lower-segment, vertical uterine incision: is it safe?

OBJECTIVE: Our purpose was to assess maternal and perinatal outcomes associated with a trial of labor and attempted vaginal birth after prior low-segment vertical cesarean delivery. STUDY DESIGN: During a 10-year period in a single tertiary hospital, all patients with a prior low-segment uterine incision (whether vertical or transverse) were considered candidates for a trial of labor in the absence of other contraindications or patient refusal. Among the 1137 women who underwent low-segment vertical cesarean delivery, 262 were subsequently delivered of 322 live-born infants, and 174 (54%) of them were identified retrospectively as having attempted vaginal birth. The maternal and perinatal outcomes of patients who did or did not undergo a trial of labor were analyzed and compared. RESULTS: No significant differences between the two patient groups were observed regarding demographic characteristics, antepartum complications, gestational age at delivery (mean 37.4 weeks), birth weight, and cord pH at delivery. Vaginal delivery was accomplished successfully in 144 of 174 (83%) patients who underwent a trial of labor. Abdominal delivery was necessary for 17 mothers with labor disorders and 13 with suspected fetal distress. Postpartum hemorrhage occurred more often in the trial of labor group (7/174 [4.0%] vs 2/148 [1.4%], p not significant), but endometritis developed significantly more often in patients with elective repeat cesarean delivery (16.9% vs 6.3%, p = 0.006). Rupture of the low-segment vertical cesarean scar occurred in 2 patients during a trial of labor (1.1%) versus none in the elective repeat cesarean group. Neither mother experienced fetal extrusion or adverse maternal or fetal sequelae. Frequency of serious neonatal complications (8.1% vs 10%) and neonatal mortality (1.7% vs 2.0%) were similar between groups. All neonatal deaths were a result of extreme prematurity or congenital anomalies. CONCLUSIONS: Our experience indicates that a mother with a prior low-segment vertical cesarean delivery can undertake a trial of labor with relative maternal-perinatal safety. The likelihood of successful outcome and the incidence of complications are comparable to those of published experience with a trial of labor after a previous low-segment transverse incision.

Cesarean Section↗
PubMed1995

The edge of chaos: caring and the bottom line.

Nurse managers need to provide quality health care within a framework of human caring with limited economic resources. Seeking only "bottom line" solutions would seriously affect the well-being of nurses and clients. On the other hand, seeking only human caring solutions would seriously influence the well-being of health care organizations. A composite model balances economics or the "bottom line" and human caring.

Empathy↗
PubMed1994

Transcultural nursing ethics: a framework and model for transcultural ethical analysis.

Increased awareness of cultural diversity in contemporary society and nursing mandates the need for transcultural nursing ethics. The core of this ethics assumes that all discourse and interaction is transcultural because of strengths and differences in values and beliefs of individuals and groups within global society. Transcultural ethics addresses how people ought to live when subjectively sharing a common world. This article presents a framework and model with four parts: Transcultural Caring Dynamics, Principles, Transcultural Context, and Universal Source. These incorporate the ethics of virtue, principle, values, and belief, respectively. Interactive parts of the holistic process provide the foundation for assessing and analyzing transactions to facilitate understanding and direction toward culturally based ethical decision making.

Beneficence↗
PubMed1993

A descriptive study of care processes using total quality management as a framework in a USAF regional hospital emergency service and related services.

The purpose of this descriptive study was to investigate access to care processes in a military regional hospital Emergency Service (ES) and related services using a Total Quality Management framework. Tabulations of demographic survey data revealed that the ES is used mainly as a primary care clinic, with a greater proportion of pediatric care provided during peak hours. An analysis of patterns of care processes in the organizational system revealed that there was little in common between Total Quality Management and Continuous Quality Improvement principles and the care processes. The results of the analysis lend support to the proposed USAF decentralized, coordinated health care system with more authority and control given to local commands and emphasis upon increased responsibility and accountability within professional and beneficiary communities.

Adolescent↗
PubMed1993

Preoperative skin preparation and intraoperative pelvic irrigation: impact on post-cesarean endometritis and wound infection.

OBJECTIVE: To determine the impact of two skin preparation methods and two techniques of pelvic irrigation on the incidence of post-cesarean endometritis and wound infection in an indigent patient population. METHODS: A randomized study was performed in 100 cesarean patients. Subjects were assigned to one of four groups, involving either standard skin preparation (povidone-iodine [7.5%] scrub followed by povidone-iodine [10%] solution) or special skin preparation (5-minute scrub with parachlorometaxylenol followed by povidone scrub and solution), and either normal saline or antibiotic (cefazolin sodium, 1 g in 500 mL normal saline) irrigation of the pelvis and subcutaneous tissue at uterine and fascial closure. Four groups of patients were formed: standard skin preparation plus normal saline irrigation, standard preparation plus antibiotic irrigation, special preparation plus normal saline irrigation, and special preparation plus antibiotic irrigation. RESULTS: Endometritis occurred significantly more often in the combined groups that did not include antibiotic irrigation than in the combined groups involving antibiotic irrigation (P < .001). In contrast, comparison of skin preparation methods between povidone-iodine alone versus preparation including parachlorometaxylenol indicated no significant difference (P = .22). CONCLUSION: Skin preparation with an antibacterial scrub in addition to standard povidone-iodine scrub and solution does not appear to play as significant a role in the reduction of post-cesarean endometritis or wound infection as does intraoperative pelvic irrigation with antibiotic solution.

Adult↗
PubMed1991

Studying the human-environment phenomenon using the science of complexity.

The principal argument of the present article is that a new theoretical paradigm capable of facilitating the understanding of complex phenomena is necessary to study nursing's claim to its science as the science of unitary human beings, or the integrality between humans and the environment. A research study of the complex human-environment phenomenon illuminating a four-phase methodology is presented. It is argued that much can be learned by the use of the science of complexity to integrate data gleaned from different approaches to knowledge generation into a comprehensive understanding of the human being in the environment as a unified whole.

Adaptation, Psychological↗
PubMed1989

The theory of bureaucratic caring for nursing practice in the organizational culture.

Changes in the health care environment have raised many questions related to patient care. How are political, economic, legal, and technological caring decisions made? How is spiritual caring fostered? How can ethical caring be the grounds on which moral decisions are made? What new policies must be designed to enhance the human perspective in corporate policy, and how will these principles and policies guide actions? The impact of the Theory of Bureaucratic Caring on the corporate enterprise will necessitate a system shift from a narrow to a broad focus where management and caring views can exist side by side and realistically represent the transformation of health care organizations to benefit humankind.

Administrative Personnel↗