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PubMed2002

Practical implementation of good practice in health, environment and safety management in enterprise in the Lodz region.

OBJECTIVES: Good practice in health, environment and safety management in enterprise (GP HESME) is the process that aims at continuous improvement in health, environment and safety performance, involving all stakeholders within and outside the enterprise. The GP HESME system is intended to function at different levels: international, national, local community, and enterprise. METHODS: The most important issues at the first stage of GP HESME implementation in the Lodz region are described. Also, the proposals of future activities in Lodz are presented. RESULTS: Practical implementation of GP HESME requires close co-operation among all stakeholders: local authorities, employers, employees, research institutions, and the state inspectorate. The WHO and the Nofer Institute of Occupational Medicine (NIOM) are initiating implementation, delivering professional consultation, education and training of stakeholders in the NIOM School of Public Health. The implementation of GP HESME in the Lodz region started in 1999 from a WHO meeting on criteria and indicators, followed by close collaboration of NIOM with the city's Department of Public Health. 'Directions of Actions for Health of Lodz Citizens' is now the city's official document that includes GP HESME as an important part of public health policy in Lodz. Several conferences were organized by NIOM together with the Professional Managers' Club, Labor Inspection, and the city's Department of Public Health to assess the most important needs of enterprises. The employers and managerial staff, who predominated among the participants, stated the need for tailored sets of indicators and economic appraisal of GP HESME activities. Special attention is paid to GP HESME in supermarkets and community-owned enterprises, e.g., a local transportation company. A special program for small- and medium-size enterprises will be the next step of GP HESME in the Lodz region. CONCLUSION: The implementation of GP HESME is possible if the efforts of local authorities; research institutions and state inspectorate are combined with the support of employers' organizations.

Environment Design↗
PubMed1996

Transfusion practice in a Canadian hospital. Use of a major European study of transfusion practice for comparison as a form of audit.

Blood transfusion practices in a Canadian hospital have been compared, as a form of audit, to those reported in a multi-hospital study in Europe, to identify possible deviations from desirable practice. Blood product use for four surgical procedures: laparatomic cholecystectomy, total hip replacement, coronary artery bypass graft (CABG) and abdominal aortic aneurysmectomy (AAA), was determined from this hospital's blood bank data base, and is compared to use for the same procedures in European hospitals. Blood product use here is less than in the majority of European centres, in respect of red cells for all four procedures and plasma for CABG and AAA. Platelet use in association with CABG and AAA is greater than the majority of European centres reporting data. As a consequence, platelet use here will be subjected to closer review.

Blood Transfusion↗
PubMed2005

AORN guidance statement: safe on-call practices in perioperative practice settings. Association of periOperative Registered Nurses.

Call staffing and the associated long work hours can be challenging for both perioperative staff members and the health care organization. A change in culture is needed to recognize exhaustion as an unacceptable risk to patients and perioperative personnel safety. Perioperative health care providers have a personal responsibility to arrive at work fully rested. Health care organizations have a responsibility to create work and call schedules that consider the effect of long work hours on patient safety as well as perioperative staff members' welfare. The development of standardized safe work hours and call practices should reflect current recommendations emerging from authoritative sources, legislation, and empirical data. Prolonged work periods without adequate rest may contribute to diminished performance by perioperative personnel, placing both patients and workers at risk. This guidance statement may assist managers and clinicians in developing policies and procedures for safe call practices.

Emergencies↗
PubMed1997

Practice write-ups: an assessment instrument that contributes to bridging the differences between theory and practice for student nurses through the development of core skills.

Nurse education currently faces two major challenges. The first involves deciding the best way to increase the skill level of practitioners and the second involves determining how this can be achieved within a culture of lifetime learning. Each of these challenges needs to be confronted as early as possible and preferably at undergraduate level. Practice write-ups (PWUs) enable students to demonstrate competence in a range of core nursing skills. Although PWUs are essentially an assessment instrument, they are underlined by an educational commitment to encourage students to be reflective in their practice. In doing so students should be able to question existing strategies for implementing care and decide whether care is appropriate and contributing to the well-being of the patient.

Clinical Competence↗
PubMed1997

Patient outcomes used by advanced practice psychiatric nurses to evaluate effectiveness of practice.

Health care in the 1990s requires Advanced Practice Psychiatric Nurses (APPNs), like other health care providers, to identify and evaluate the outcomes of their practices. Many APPNs report that they are not currently engaging in outcome evaluation, and many report that they would like more resources on outcome measurement. This study identifies outcome evaluations currently in use, through an analysis of the responses of 364 Certified Clinical Nurse Specialists in a survey conducted by the Society for Education and Research in Psychiatric Nursing in 1994-1995. Specific tools that APPNs report using to assess outcomes are also identified and referenced.

Data Collection↗
PubMed1997

[Evaluation of transfusion practice. Surveys for evaluating the practice of nursing care in transfusion medicine in four hospital sites].

In four medical centers, transfusion medicine care practices were evaluated by testing the nursing staff with a list of questions. The anonymous test evaluated the knowledge and transfusion practices, and in one of them the bed-side compatibility control procedure in particular. These tests showed failures in the labeling of tubes during phlebotomy for immuno-hematologic testing, in blood product conservation in the ward, and in bed-side compatibility testing which is not always carried out fully at the bed-side. These results, showed on which topics the teaching program should emphasize so as to improve the quality of blood transfusion in the medical centers according to legal obligations.

Blood Transfusion↗
PubMed2003

Enhancing evidence-based practice--a controlled vocabulary for nursing practice and research.

Evidence-based practice requires flexible systems for information retrieval. Search processes in electronic databases must be based on terms, which are familiar to professionals and describe accurately the problem to be solved. The paper describes the process of evolving a controlled nursing vocabulary for indexing and information retrieval purposes. The vocabulary is based on terms of the Medline thesaurus the medical subject headings (MeSH) by National Library of Medicine and the International Classification for Nursing Practice by the International Council of Nurses. The created vocabulary consists of 10 themes central to nursing domain. The content was compiled using Delphi technique. The expert panel had four rounds and at the first stage the vocabulary consists of 558 terms. The validity of the vocabulary has been tested for indexing nursing research and based on the validation the expert panel has made some changes for the hierarchy and content. The vocabulary will be added as an independent theme to the Finnish thesaurus the FinMeSH.

Clinical Nursing Research↗
PubMedDate not supplied

Educating advanced practice nurses for practice reality.

The complexity of the current health care environment ethically mandates advanced practice nursing (APN) educators to prepare graduates with a clear understanding of APN roles and professional and regulatory issues for them to make a reasonable transition to the marketplace. Integrating both clinical content needed for APN practice and APN role issues can be a difficult balance. This article describes critical role content needed in APN programs and offers a variety of teaching strategies. Recommendations regarding the timing and placement of role content in the graduate curriculum also are offered. Although there is no one right way to build APN role content into graduate coursework, some approaches are preferable to others.

Adaptation, Psychological↗
PubMed2001

Health care modelling and clinical practice. Theoretical exercise or practical tool?

The paper looks at potential uses of health care modelling techniques in day-to-day clinical practice, adopting the viewpoint of a specialist in geriatric medicine. After a brief review of the recent literature on the practical applications of bed modelling techniques, the potential of such techniques in the future is discussed. Possible barriers to the adoption of these techniques by clinicians are presented together with suggestions about ways of overcoming these barriers.

Aged↗
PubMed2003

Education, practice and bioethics: growing barriers to ethical practice.

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from one's medical practice. I shall emphasize what I consider to be the failure of Bioethics to participate effectively in creating a context whereby what has been taught can be put into praxis. In this brief article I will discuss such barriers and suggest several approaches and remedies.

Bioethics↗
PubMed2001

Evaluating the Beta version of the International Classification for Nursing Practice for domain completeness, applicability of its axial structure and utility in clinical practice: a Norwegian project.

The purpose of this Norwegian project was to evaluate the International Classification for Nursing Practice (ICNP) Beta version for domain completeness, applicability of its axial structure and utility in clinical practice. A subset of terms addressing the areas of circulation and elimination were abstracted from the nursing records of a cardiac intensive care unit and a nursing home. Abstracted terms were mapped to terms in the ICNP. In the ICNP, the same or similar terms were found for 47% of the documented circulation terms and 69% of the documented elimination terms that addressed nursing phenomena. For nursing interventions, 27% of the documented circulation terms and 35% of the documented elimination terms mapped to the ICNP. The research team encountered difficulty in coding terms with the ICNP that expressed patients' perspectives, preferences, behaviours and experiences, and terms that represented signs-and-symptoms. Recommendations for further development of the ICNP include improvement in granularity, precision and conceptual definitions of terms; inclusion of time-related terms for representing nursing phenomena; and an easier method for navigating around the ICNP.

Abstracting and Indexing↗
PubMed2006

[Biomedical research practice and therapeutic practice: to whom does the human body belong?].

Who owns the human body? This issue has been formerly raised about the status of the slave. Today, it has become a prominent stake for when reflecting on biomedical research and healthcare practices. In our cultures, many answers may be given to this question : they are derived from philosophical or theological traditions ; they are borrowed from anthropological, sociological or psychological knowledge ; they may be formulated in a moral or political perspective. All of them give different insights and reveal one of the various dimensions of the question. When examining the status of the body and its relation to the human subject in the various stages of his/her life (including his/her death), one of the main difficulties is to deal with each of these answers and to understand how they meet and interact in the public debate. Another matter is related to the fact that law also plays a crucial role in the process of giving an answer to this question. In our book, A qui appartient le corps humain ? Médecine, politique et droit (Paris, Belles Lettres, 2004), Claire Crignon-De Oliveira and I have tried to deal with both difficulties. In this article, I focus on the meaning of the various law traditions. In western world, the laws are all derived, up to a certain extent, from the Roman tradition. Whether they have chosen to consider the human body as a property or to associate the body to the person, they have taken very different options. However, an examination of the ways laws are elaborated on this topic shows that these two conceptions can meet in unexpected manners and that lawmaking can give creative answers to both the problem of protecting the person and to the requirements of biomedical research and healthcare practices.

Adult↗
PubMed2001

The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement.

Humans↗
PubMed2003

Research into practice: the reality of implementing a non-pharmacological breathlessness intervention into clinical practice.

The work of Corner and colleagues in the non-pharmacological management of breathlessness in patients with lung cancer has aroused considerable interest. Cancer and palliative care nurses are encouraged to incorporate the breathlessness intervention into their clinical practice but this has not always proved easy or straightforward. This paper draws on the authors' experience as lung cancer nurse specialists to explore some of the difficulties nurses in clinical practice may encounter when attempting to translate the research findings into their own areas and suggests ways these difficulties may be overcome.

Breathing Exercises↗
PubMed2000

Fit for practice: Project 2000 student nurses' views on how well the curriculum prepares them for clinical practice.

This paper presents the findings from a small study, which compared student nurses' views on how well they felt the Project 2000 curriculum had prepared them for their first clinical placements. The views of two student nurse cohorts were obtained using a questionnaire developed for the purpose. The curriculum for the 'old' cohort allowed very little clinical time during the first 18 months and focused on academic classroom-based learning. The curriculum was subsequently restructured so that students on the 'new' curriculum experienced greater emphasis on practice and theory to practice links, and undertook their first clinical placement much earlier on in their course. Although statistical analysis of difference between the two cohorts suggests that students from the 'new' cohort felt they were better prepared, the actual differences in scores was small. The findings of this study provide only modest evidence of improvement in 'new' student nurses' views of how well they felt they had been prepared for their first placement.

Attitude of Health Personnel↗
PubMed1998

Compliance of hand washing practices: theory versus practice.

Hand washing remains an important preventative method for making the transmission of nosocomial infections redundant. Despite awareness by health workers of the practices required and of the legislation governing hand washing, the study reported here found that compliance to these procedures was quite poor. The results of two surveys distributed to health workers and direct observation by clinical staff in an aged care hospital found that 45% of health workers did not wash their hands and 24% did not change their gloves between patient consultation. Methods for increasing effective hand washing in clinical settings must be identified if hygienic practice is to be improved.

Clinical Competence↗
PubMed2004

Best practicable means (BPM) and as low as reasonably practicable (ALARP) in action at Sellafield.

Operators within the UK nuclear industry are required to employ 'best practicable means' (BPM) to control and minimise radioactive discharges. The requirement for the use of BPM is in order to ensure that doses from discharges are as low as reasonably practicable (ALARP). This facet is increasingly becoming the principal feature of discharge authorisations issued by the Environment Agencies under the Radioactive Substances Act, 1993 (RSA 93), which are enforceable by law. It is important to state at the outset, however, that scientific assessments to date indicate that there are no expectations of environmental harm from authorised discharges, even where those discharges have historically been up to two orders of magnitude higher than current levels. There is also no evidence to indicate that foreseeable future discharges from the Sellafield site will make any contribution to environmental harm.

England↗
PubMed2001

Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke.

BACKGROUND AND PURPOSE: This case report describes a patient with upper-limb hemiparesis (ULH) who received a program combining physical therapy for the affected side with mental practice. CASE DESCRIPTION: The patient was a 56-year-old man with stable motor deficits, including ULH, on his dominant side resulting from a right parietal infarct that occurred 5 months previously. He received physical therapy for an hour 3 times a week for 6 weeks. In addition, 2 times a week the patient listened to an audiotape instructing him to imagine himself functionally using the affected limb. The patient also listened to the audiotape at home 2 times a week. Pretreatment and posttreatment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment (Fugl-Meyer Scale), the Action Research Arm Test (ARA), and the Stroke Rehabilitation Assessment of Movement (STREAM). OUTCOMES: The patient exhibited reduction in impairment (Fugl-Meyer Scale) and improvement in arm function, as measured by the ARA and STREAM. DISCUSSION: Mental practice may complement physical therapy to improve motor function after stroke.

Activities of Daily Living↗