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Interdependence between the GI unit and inpatient nurses.
Developing and nurturing professional relationships with support departments enhance the function of any nursing area. Building mutual goals and sharing common knowledge of patient cases can create improved patient care in the endoscopy suite and the inpatient unit. This article discusses possible methods to achieve team spirit and a sense of common purpose for the gastrointestinal nurses and associates who share a client in the procedure area and the ward.
Generation interaction and the development of cyclical processes.
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Ethical and interpersonal conflicts experienced by nursing QA/QI professionals: justice or care?
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Collaboration: the pivotal point for quality patient outcomes.
The article describes a study designed to monitor the patency of heparin locks and intravenous (IV) lines of patients presenting to the cardiovascular department for diagnostic testing. Findings revealed that 60 percent of the invasive lines were nonpatent. Data analysis found that adverse patient outcomes may affect a small subset of patients and may not be reflected in overall hospital or unit trends. Recommendations included an evaluation of the current heparin lock/IV policy utilized to assess patency and increased emphasis on interdepartmental collaboration so as to prevent this adverse patient outcome.
More quality bang for your healthcare buck.
The quality management department at North Shore-Long Island Jewish Health System has designed a collaborative process that improves patient safety, is accountable to the public, and increases efficiency on the basis of sound data management. By forging strategic alliances between the quality, finance, and materials support services departments at the health system level, a quality economic business model was developed that led to greater efficiencies in length-of-stay management, improved resource utilization in critical care, and standardization of skin care products and equipment. This article describes these quality initiatives.
The development of a behavioral science model for a family practice program.
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The practicing physician's involvement in the training of medical students.
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Collaboration between nurses and physicians: no longer a choice.
Collaboration, a relationship of interdependence, requires the recognition of complementary roles. Traditionally, physicians generally have not demonstrated collaboration in their work with nurses; nurses, on the other hand, have more often sought a collaborative relationship. But the rapidly changing, increasingly complex and constraining world of health care requires that doctors, nurses, and the institutions that educate and employ them reevaluate the doctor-nurse relationship and assess the value of making it a more collaborative one. This essay deals with the phenomenon of collaboration, why there are compelling reasons to promote it, the barriers that exist between nurses and physicians in achieving collaborative relationships, and strategies to promote change. Comments of experienced observers and summaries of the pertinent research literature are presented.
Tensions within the academic health center.
A variety of forces are converging to unbalance the internal environment of the academic health center, and the dean of the medical school sits uneasily in the resulting vortex of conflicting needs and demands. For example, the introduction of Medicare in 1965 profoundly changed the size and complexity of medical school departments and greatly stimulated the growth of hospitals. More stresses have come from rising health care expectations of the public; the replacement of free-for-service indemnity health care by managed care and vertically integrated health care systems; the proliferation of academic specialties and subspecialties; and the recent growth in the academic medical center, which is seen as a threat to the academic integrity of the university. Within the medical school there are tensions between basic and clinical research, between education and research, between education and clinical practice, and between the dean and department chairs over allocation of resources. Perhaps the most complex tensions exist between the medical school dean and the academic hospital director. The overarching tension in the academic health center results from striving to balance the need to fulfill academic goals with the need to fill hospital beds to maintain financial solvency. This tension will not lessen so long as there is no common vision for the academic health center as a whole, and will probably increase with the forthcoming changes in health care reform. The dean and the hospital director must forge a strong alliance, and the hospital must realize that for its continuing success, it must support the academic program.(ABSTRACT TRUNCATED AT 250 WORDS)
Time to put managed care into medical and public health education.
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Teaching an integrated approach to health care: lessons from five schools.
Medical education has excelled in bringing a sound biomedical base to the practice of medicine; however, there is now growing interest in helping students and residents learn an integrated approach to health care that addresses the complex interaction of many factors influencing health and illness. The authors' purpose was to learn about how some medical schools teach students a more integrated approach to health care. They used a qualitative, multiple-case-study design and collected data through document review and interviews with faculty, administrators, students, and residents at five U.S. and Canadian medical schools, chosen for their reputed excellence in addressing an integrated approach to care. Visits to the schools were made in the spring of 1993. Data analysis focussed on the institutional factors associated with teaching such an approach and the ways in which the schools help students and residents learn about this approach. The interviewees described the strong presence of an institutional mission or philosophy that is unique to each school but that generally has a service-oriented, patient-centered perspective. They reported that the primary means for learning about an integrated approach was the attention, woven into the curriculum, to four relationships; physician-patient, physician-community, physician-other practitioners, and faculty-student. A broad-based shared mission or philosophy was important in focusing attention on the integration of biomedical and non-biomedical concerns and promoting a perspective that focuses outward toward the community and its people. The pervasive attention to the four relationships suggests that such attention is intimately related to each school's underlying mission or philosophy.(ABSTRACT TRUNCATED AT 250 WORDS)
A data-generated basis for medical ethics education: categorizing issues experienced by students during clinical training.
PURPOSE: To use issues identified by students in order to establish an experience- and evidence-based approach to medical ethics education. METHOD: A total of 628 sophomore and senior students at the State University of New York at Buffalo School of Medicine and Biomedical Sciences were asked to identify incidents during their clinical training that had raised ethical concerns. The sophomores were surveyed during two time periods: 1979-80, and 1991-92 and 1992-93; the seniors were surveyed in 1991-92 and 1992-93. Responses were analyzed and categorized through content analysis. RESULTS: In all, 249 students (45% of the sophomores and 20% of the seniors) responded. The categories of issues identified were professional norms, limits of intervention, defensive shielding of professional colleagues, respect toward patients, communication, and student boundaries (situations where the student feels uncomfortable). The most frequently reported incidents reflected the students' perceptions of lapses in level of care (under- or over-treatment), communication, respect toward patients, and maintenance of professional norms. The seniors and the 1979-80 sophomores reported respect toward patients as an issue less often than did the 1991-92 and 1992-93 sophomores. The seniors most often identified concerns raised over limits of intervention and resource allocation. CONCLUSION: The differences between the responses of the sophomores and seniors tend to support other research suggesting a retardation of moral sensitivity in the course of medical education. It may be that clinical teaching and faculty behavior model values at odds with what is taught in the classroom. Ethics education should focus on issues relevant to students' experience.
Professional networks: the influence of colleagues on the academic success of faculty.
BACKGROUND: Successful higher education faculty, those who get promoted and tenured, who get recognized for contributions, who produce more and significant research, frequently consult colleagues. This article summarizes what is known about colleague relationships with the hope of stimulating further research to extend current conclusions to medical school faculty. METHOD: In the spring of 1992, a systematic literature review was conducted using database searches and author review of 137 selected books and articles using a standard protocol; preference was given to articles that were data-oriented, used quality designs, and related directly to the topic. RESULTS: Forty-seven "best" sources, published between 1963 and 1991, were included in the review of (1) types and configurations of colleague relationships, (2) forming and maintaining colleague relationships, (3) colleague effects on faculty success, (4) functions of colleague relationships, (5) changes in colleague relationships over a career, and (6) effects on methods, size, and configuration of colleague relationships. CONCLUSION: Among the conclusions reached are that (1) there are a variety of types or configurations of colleague relationships, all with different functions and effects on faculty performance; (2) dyadic conceptions of colleague relationships are insufficient to explain the functions of colleague relationships; and (3) the most important source for developing colleague relationships is professional associations, while the least important source is one's own institution.
How one teaching hospital system and one medical school are jointly affirming their academic mission.
The economic forces that are reshaping the practice of medicine and the funding of medical research will have great impact on clinical education and research in teaching hospitals and their associated medical schools. Changes in the setting of and approach to medical education will need to be made in order to continue to train physicians at the same high level as in the past and to maintain the productivity of our national biomedical research enterprise and its contributions to health. Academic leaders, such as department chiefs who have clinical service responsibilities, are finding it more and more difficult to manage simultaneously the demands of the clinical business, education, and research. In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, Harvard Medical School and the Beth Israel Hospital created a joint venture in 1996. The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission. In addition to the challenges it faces from changes in the external environment, the Institute for Education and Research will need to establish a new pattern of interactions internally within the parent institutions. Collaborations with department chairs and faculty are an essential ingredient for its success. It is hoped that this structure will prove to be a useful template for organizing other medical school-hospital collaborations on behalf of the academic mission.
A role for academic medical centers in the era of managed care: immediate, interactive, free information.
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