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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↗
PubMed1996

[University education in geriatrics. Present status and future plans of universities regarding the development of a program in geriatrics].

Because the number of people who reach an advanced age has been increasing at an unprecedented rate in Japan, geriatricians are expected to play a central role in health care for the elderly. However, only 16 out of 80 medical schools (20 percent) now have departments of geriatrics for undergraduate education. To develop undergraduate education in the field of geriatrics, a survey was sponsored by the Research Projects on Aging and Health (Health Science Research Grant the Ministry of Health and Welfare of Japan). A questionnaire regarding the present status and future plans of the university about a program in geriatrics, was sent to deans of medical faculties or vice-presidents of medical schools. The questionnaire included questions about current status and future plans regarding undergraduate geriatric education, the presence of a department or clinic of geriatrics, educational requirements in the field of geriatrics, opportunities for practice, institutions of practice, research on geriatrics, and other suggestions. The response rate was 93.7 percent (74/79). Departments or clinics of geriatrics had been established in 15 institutions (20.3 percent) and were planned in 18 (24.3 percent). Undergraduate education in geriatrics was considered necessary in 73 schools (98.7 percent) and indispensable as an obligatory subject in 56 (75.7 percent). Clinical practice was considered more important and effective than lectures in 50 schools (63.3 percent). Coordinated lectures on basic biomedical gerontology (such as mechanism of aging) and geriatric medicine for chronic degenerative diseases such as senile dementia were considered essential to the curriculum. In practicing geriatrics, experience in providing medical care to aged patients as well as social support and a welfare system for the aged is emphasized. Institutions, nursing homes, and geriatric hospitals outside medical schools be easily accessible. It was generally agreed that geriatrics should be taught in advanced classes. In conclusion, medical schools in Japan regard undergraduate education in geriatrics as necessary and agree on the optimal curriculum, but it is not universally implemented.

Education, Medical, Undergraduate↗
PubMed1979

Mexican-American views of Anglo medical and dietetic practices.

Institutions involved in health care delivery and foodservice to a population with large ethnic communities might increase their effectiveness if they knew the possible influences of the folklore or local customs of these groups on the attitudes of their patients. The observations and survey of Spanish-speaking patients by the Department of Food Services at the University of Arizona Health Science Center should be a stimulus for further study of ethnic groups by health professionals.

Arizona↗
PubMed2003

Shape-shifting discourses of anorexia nervosa: reconstituting psychopathology.

This article explores how the circuitous relationship between individuals, the media, and discursive systems replicate and reinforce the act of self-starvation in young women. Using a feminist poststructuralist methodology, the focus of this article is on how discourses and institutional practices operate to position young women who take up the subject position of wanting to be diagnosed as anorexic. Utilizing data from online accounts and individual interviews, I attend to the ways in which young women are institutionally positioned as "anorexics" and the effects that those positions have on their behaviors, in addition to reinforcing institutional practices that construct anorexia nervosa. Questions addressed through this inquiry are: How do institutional practices create and continue to constitute "anorexia nervosa"? How do discourses operate to position young women such that they are either included and/or excluded into the category of "anorexia nervosa"? What are the effects and consequences that emanate from these positionings?

Anorexia Nervosa↗
PubMedDate not supplied

Professional tensions in client-centered practice: using institutional ethnography to generate understanding and transformation.

For almost 20 years, occupational therapists have advocated client-centered practice. Yet client-centered practice is fraught with tensions that arise outside the practice of individual occupational therapists. This paper is guided by two questions: What produces professional tensions in client-centered practice? and What understanding and change might be generated using institutional ethnography? The sociological theory and method of institutional ethnography are described using data from an ongoing investigation of mental health services as a social institution. Illustrated are the research aim, research questions, and institutional analysis that distinguish institutional ethnography from conventional ethnography. Two professional tensions are associated with attempts to fulfill client-centered practice in mental health. One is that of working at cross-purposes with the prevailing hierarchical structure; the other tension is that of being celebrated yet subordinated in the medical and management hierarchies of health services. Although client-centered practice is difficult to do, the authors recommend institutional ethnography as a research approach to generate understanding and transformation of the context and practice of occupational therapy.

Anthropology, Cultural↗
PubMed1985

ASHP members' concepts of institutional pharmacy in the year 2000.

Trends in institutional pharmacy practice were identified, and ASHP members' views of these trends were evaluated in a futures study. A list of statements concerning the practice of institutional pharmacy in the year 2000 was developed using a modified Delphi method. A random sample of 3000 active ASHP members received the questionnaire and were asked to estimate the probability that each of the 42 statements would occur by the year 2000. The responses were analyzed to reduce the number of variables to common factors. A total of 1276 of the returned questionnaires were usable. Six factors were identified: pharmacy-medicine linkage, advanced training or degree, drug administration, quality assurance and accreditation, supportive personnel, and pharmacy-nursing conflict. There were differences in the mean values of responses of items related to various factors when they were compared by sex, age, position held, degree held, and residency training. The key trends predicted were that advanced training or degrees will be necessities in the year 2000, institutional practice will be composed of multiple tracks, postgraduate education will be required of clinicians and administrators, turf conflict with nurses will increase, and accreditation standards and other safeguards for quality health care will continue to be required and will increase. The trends in how ASHP members conceptualized the future of their profession can provide insight for individuals developing programs in pharmacy education, health-care administration, institutional practice, and the pharmaceutical industry.

Adult↗
PubMed1998

Preventing falls and fall-related injuries among older people living in institutions: current practice and future opportunities.

AIMS: To identify existing falls prevention activities and support for future initiatives among residential institutions for older people. METHODS: A self-administered questionnaire was sent to all principal nurses/managers of residential institutions. Information was sought on whether falls were perceived to be a problem in the Auckland region, current falls prevention practice and interest in future prevention initiatives. RESULTS: Falls were perceived to be a problem by over 75% of 175 participating institutions. Assessments of footwear, medication use and environmental audits were the most common prevention strategies employed by over 80% of institutions. Almost 70% of institutions indicated their willingness to participate in future prevention projects. CONCLUSION: The current use of fall prevention strategies in institutions is encouraging. However, the strategies that are being employed are not consistent with current evidence about effectiveness. Increased use of vitamin D and possibly calcium supplementation needs to be encouraged as does the use of hip protectors and lower extremity strength training.

Accidental Falls↗