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PubMed1993

Satisfaction and dissatisfaction in institutional practice: results from a survey of U.S. military physicians.

Because of recent concerns about the professional satisfaction of physicians in general and of military physicians in particular, the authors surveyed a national sample of 1,392 military physicians; 88% responded. Two-thirds of physicians were at least somewhat satisfied with the professional abilities of their peers and with the quality of care they were able to provide, but only 19% were satisfied with salary and 27% with practice efficiency. Characteristics of physicians that were independently related to overall satisfaction included age, recruitment pathway, workload, specialty, and perceived availability of key resources. Indicator variables for the individual medical facilities were also significantly related to global satisfaction, suggesting a separate "hospital effect" that bears additional investigation. Efforts to improve satisfaction may enhance recruitment and retention of military physicians.

Adult↗
PubMed1993

Advance directives: partnership and practicalities. Institute of Medical Ethics Working Party on the Ethics of Prolonging Life and Assisting Death.

When patients are no longer able to participate effectively in decision making, an advance directive or living will may assist clinicians faced with choices about whether or not to prolong their lives. But living wills are an imperfect substitute for active patient participation. The opinion of an informed proxy could help to interpret what a patient's wishes might have been in the light of his or her present condition and its possible treatment. Practical suggestions are made about informal arrangements whereby general practitioners might help to make such an opinion available when needed.

Advance Care Planning↗
PubMed1980

Tardive dyskinesia and institutional practice: current issues and guidelines.

Despite increasing public and legal pressures to minimize the occurrence of tardive dyskinesia, the practicing clinician often feels there are no alternatives to the use of neuroleptic medication in the treatment of psychosis. However, there are many clinical situations in which the use of neuroleptics may be avoided; guidelines for such situations, including the treatment of affective disorders and of chronic schizophrenia, are presented. The authors also discuss the use of alternative treatment programs and psychosocial interventions that may allow significant reduction in neuroleptics, and they describe new areas of research aimed at preventing and treating tardive dyskinesia.

Affective Symptoms↗
PubMed1998

Preventing mismanagement of community-acquired pneumonia at an urban public hospital: implications for institution-specific practice guidelines.

STUDY OBJECTIVES: To assess institutional performance of key diagnostic and therapeutic interventions and to identify areas amenable to improvement in the management of community-acquired pneumonia (CAP). DESIGN: A chart-based retrospective study. SETTING: Cook County Hospital, a large, urban, public teaching hospital. PATIENTS: Adult inpatients with a hospital discharge diagnosis of CAP. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Fifty hospital admissions were reviewed. Only 25 patients (50%) had two specimens obtained for blood culture, and sputum was sent for Gram's stain and culture for only 11 patients (22%). Approximately one third of the patients had portable anterior-posterior instead of standard posterior-anterior and lateral chest radiographs performed. Physicians in the emergency department (ED) tended to be less likely to note the presence of multilobar infiltrates or pleural effusions than the attending radiologists. The antibiotic regimens employed in the ED and on the inpatient wards were widely variable. The mean time from hospital entry until administration of the first dose of antibiotics was 5.5 h for the 18 patients for whom treatment was initiated in the ED vs 16.1 h for the 27 patients admitted through the ED for whom therapy was deferred until ward admission (p < 0.001, Student's t test). CONCLUSIONS: Institutional variations in the performance of basic diagnostic and therapeutic interventions for patients with CAP may be substantial. The local performance of these key processes of care should be assessed to help direct the formulation of institutional practice guidelines for the management of CAP.

Adult↗
PubMed2002

The paradoxical use of interpreting in psychiatry.

Changes in the official status of African languages in South Africa suggested an examination of the impact of multi-lingualism on the practice of institutional psychiatry. For a range of theoretical and institutional reasons, a 'language gap' between clinician and patient can be rendered irrelevant in terms of the routine production of psychiatric texts in which 'symptoms' are described and 'cases' are constructed. In contrast to the way in which the role of interpreting is obscured in some hospital settings, it is highlighted in forensic settings. Here the extent of the dependency of the clinician on the interpreter is made more visible. Through this ethnographic exploration of the institutional management of multi-lingualism, the status of 'the patient who requires interpreting' emerges as an institutional construct, being determined in large measure by the routines of institutional practice. The requirements of the institution that the patient move through the process of a hospital admission, and the different requirements of each stage of this process, inform the decision as to whether interpreting is necessary. Furthermore, the differing requirements of the members of the multi-disciplinary teams renders the status of 'the patient who requires interpreting' as variable and contested. Through this analysis the institutional management of multi-lingualism emerges as a site at which discourses of race in psychiatry are reproduced.

Communication Barriers↗
PubMed1975

Resident-care practices in institutions for retarded persons: a cross-institutional, cross-cultural study.

Institution-oriented and resident-oriented care practices for institutionalized retarded persons investigated in 166 Living units in 19 institutions in the United States and 11 institutions in a Scandinavian country. Living units in the Scandinavian country were found to be more resident-oriented than those in the United States. Large central institutions were characterized by the most institution-oriented care practices, group homes by the most resident-oriented practices, with large and small regional centers falling between these extremes. Within types of institution, care practices were generally homogeneous. Living units for more severely retarded residents were characterized by more institution-oriented practices. Large living-unit size was found to be predictive of institution-oriented practices while cost/resident/day, number of aides/resident, and number of professional staff/resident did not predict care practices. Characteristics of the Child Management Inventory were also examined.

Allied Health Personnel↗
PubMed1986

Cost-benefit and cost-effectiveness in institutional pharmacy practice.

Patient care in health institutions has become more intensive, with greater use of drugs. Pharmacy departments have not been able to keep abreast of the demands placed on them by advances in clinical medicine. Medication errors occur too frequently and place the patient at risk. Use of the unit dose system would reduce these errors. Patient safety should be used as a measure of the effectiveness of pharmacy programs. Greater patient participation in the therapeutic process would improve the effectiveness of pharmacy services, as would therapeutic drug monitoring.

Canada↗
PubMed1981

A strategy for surveying nursing practice in institutional settings.

Two major obstacles encountered when surveying nursing practice in institutional settings are obtaining a representative sample and collecting an adequate number of observations at a reasonable cost. Past efforts to deal with these problems are reviewed briefly, and results are reported from a two-stage mail survey of a national sample of critical-care nurses. The first stage involved attempts to procure a list of staff nurses from head nurses of critical-care units at 240 randomly selected institutions. An 86% response rate was obtained. The second stage involved mailing questionnaires to a random sample of 600 critical-care nurses listed. Completed, mailed questionnaires were obtained from 87%. Little evidence of bias due to administrative selection and/or volunteerism was found in the lists of staff nurses. An analysis of membership in professional nursing organizations indicates that more than one half of the nurses who responded to this survey would not have been included had the sample been selected from organizational membership lists.

Data Collection↗