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Perinatal computerized patient record and archiving systems: pitfalls and enhancements for implementing a successful computerized medical record.

Interest in purchasing and installing a perinatal computerized patient record (CPR) and archiving system is growing in the United States as a result of increased patient satisfaction demands, cost containment, and quality improvement. Perinatal nurses are commonly charged with researching available computer software and hardware, making purchasing decisions, developing menus and forms, orienting users, and maintaining and upgrading systems. The decision to chart and archive by computer as well as installation and maintenance issues mandate that nurses increase their computer-related knowledge. The article reviews information related to CPR capabilities and rationales for purchase decisions, implementation and staff development issues, ergonomic and maintenance considerations, and realistic expectations of a CPR to provide perinatal nurses who are involved in purchasing, implementing, and maintaining these systems with a timely understanding of important elements that they need to know to make this effort successful.

Archives↗

AIDS in the workplace: implications for hospice programs.

AIDS presents health care providers with complex medical management issues as well as the need to confront their own fears and prejudices. Hospice programs provide specialized care to persons who are in the final stages of the disease. As the epidemic grows, they increasingly also must respond to HIV-infected staff. A comprehensive workplace program prepares the hospice provider for these challenges and ensures an appropriate response. The four essential elements of such a program are policy development, staff education, supervisory training, and compliance monitoring. Policies to consider include infection control, occupational exposure, confidentiality, and the response to HIV-infected patients and employees. Comprehensive education ensures quality care for AIDS patients. Particularly crucial is the education of managers and supervisors. After policy implementation and training, procedures must be instituted to monitor compliance and develop corrective action. A bibliography of additional resource materials is provided.

Acquired Immunodeficiency Syndrome↗

Brief: when to place your staff in "Jeopardy"--a CPR teaching strategy.

Staff development instructors present information to a variety of audiences. Games should be considered when developing teaching strategies because of their novelty and versatility. Our Educational Services Department developed and successfully implemented a game in which CPR recertification course material was reviewed. So far, we have incorporated CPR Jeopardy into eight sessions with participants providing positive feedback after each class. This format will be used in all CPR classes until all staff have experienced the game, at which time modifications will be developed.

Education, Nursing, Continuing↗

Training pharmacists for pediatric I.V. medication administration.

As the result of a shortage of nursing personnel, satellite pharmacists at University Hospital have assumed the responsibility of administering intravenous medications on selected pediatric nursing units. This article describes a program developed to train pediatric pharmacists to administer intravenous (I.V.) medications and provide decentralized clinical services. The Department of Pharmacy Services and Nursing Staff Development cooperated in defining the duties and responsibilities of I.V. medication pharmacists and developing the training program. Each pharmacist is required to successfully complete two weeks of classroom instruction and four weeks of clinical training conducted on pediatric nursing units. Comprehensive checklists were designed to document all training efforts. The program of I.V. medication administration by satellite pharmacists has been well received by physicians, nurses, and pharmacists. The Department of Pharmacy Services feels that the I.V. medication administration training program played an instrumental role in insuring the success of its pediatric service.

Child↗

Therapeutics bibliography for clinical pharmacists.

A therapeutics bibliography for the clinical pharmacist is presented. The bibliography concentrates on the medicinal treatment of disease and drug-induced disease. It is divided into 10 internal medicine subspecialties and consists of the important literature for January 1974 through March 1979; important earlier material also is included. Cardiology, endocrinology and gastroenterology bibliographies are included in this issue; the remaining subspecialties will be covered in consecutive issues of the Journal. The organization, uses, and search and survey methods used to develop the bibliography are described. The bibliography can be helpful to pharmacy students, residents, and educators, and can be used for professional staff development in clinical pharmacy.

Bibliographies as Topic↗

[Significance of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) by medical staff in nosocomial infection].

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important microorganisms in nosocomial infection. Healthy medical staff working in MRSA endemic wards are known to have MRSA in their nasal cavity, swabs, but the significance of their positive nasal swab cultures in infections among the patients has not been confirmed. The purpose of this study was to compare the antibiotic susceptibility and coagulase typing of strains isolated from the infected patients and from nasal swab cultures of medical staff working in ICU. Twenty-six nurses and 20 doctors working in ICU where MRSA was endemic were examined. Six nurses and 10 doctors gave positive nasal swab cultures for S. aureus, and 2 of the nurses' strain and 5 of the doctors' strains were methicillin-resistant. These strains were sensitive to IPM, GM, MINO and OFLX, while the strains clinically isolated from infected patients were resistant to these antibiotics. MRSA isolated from nasal swab cultures from medical staff developed marked resistance to IPM, GM, MINO, and OFLX by incubating with these drugs, whereas they remained sensitive to VCM when they were incubated in VCM-containing medium. Methicillin-sensitive S. aureus (MSSA) isolated from nasal swab cultures of medical staff became resistant to DMPPC, CMZ, in addition to IPM, GM, MINO, and OFLX, but these strains did not develop resistance to VCM. Resistance to these drugs developed by incubating with these drugs did not diminish by incubating in drug-free medium for 3 weeks. The patients infected by MRSA had been previously given several kinds of antibiotics, whereas the medical staff had not been exposed to any kind of antibiotics during the same period. (ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

Self-in-relation theory and the role of the clinical nurse specialist. Part I: Theory and role development.

Concepts and assumptions of the self-in-relation theory of women's development are discussed in this article. Proposed by feminist scholars at the Stone Center in Wellesley. Massachusetts, the theory is used to explore staff development and mentorship roles of the CNS. How the theory provides a new way to view these roles and applies concepts from the theory to advanced practice is examined.

Female↗

Using criticisms to elicit and meet unit-based learning needs.

A strategy using staff nurses' criticisms is described, which may be a useful addition to the repertoire of strategies used by staff development educators to elicit and meet unit-based learning needs. It is also argued that this strategy has the potential to equip staff nurses to move more independently from criticism to problem setting and problem solving.

Education, Nursing, Baccalaureate↗

A collaborative rehabilitation approach to the improvement of inpatient treatment for persons with a psychiatric disability.

With the growth of community support programs the role of the state psychiatric hospital has changed. Reduced funding levels have resulted in overcrowding, inadequate staffing and ineffective programming. In order to improve the quality of care and introduce more psychiatric rehabilitation-oriented activities into hospital programming, a large state hospital and a state health sciences university have entered into a time-limited collaborative partnership. This paper describes that partnership and its attempt to improve staff competencies, enhance service delivery and integrate a more rehabilitation-oriented philosophy of care into the hospital through undergraduate education, in-service training, program development, staff mentoring and organizational change activities.

Adult↗

Clinical integration and nursing leadership across an integrated delivery system.

As new health systems struggle to combine in today's challenging health care market, mechanisms that facilitate and enhance integration become increasingly important. This article describes the use of clinical paths in an integrated delivery system (IDS) as a methodology to establish a single standard of high-quality care. Through education and sharing of staff development resources across the IDS, the system nurse executive at one large IDS promotes professional practice. As clinical paths are developed across the system, the best clinical practice is put to paper, providing a framework for outcome-driven care. The nurse manager assesses staff's use of clinical paths as an evaluation of their skills and competency and to identify new educational and growth opportunities.

Benchmarking↗

Energizing professional orientation.

With many hospitals replacing the equivalent of their entire nursing staff every 5 years, a comprehensive orientation program is a critical strategic activity for nursing departments. Using the socialization process of new employees as a framework, orientation in health care can be restructured and energized. This article discusses current business practices designed to facilitate the entry process of new employees. Model orientation programs in business and nursing are described to assist staff development educators.

Education, Nursing, Continuing↗

Unit orientation for experienced nurses. Process and evaluation.

In order to recruit and retain registered nurses during an era of nursing shortages, staff development educators must provide orientation programs that are highly satisfactory. This article describes a program that effectively links the perspectives of nurse managers, nursing staff, and nurse educators. Orientation evaluation questionnaires completed by orientees and staff nurses who served as their buddies show that new employees believe this program meets their learning needs. Such satisfied nurses can recruit their colleagues to employment.

Attitude of Health Personnel↗

An educational documentation system for a hospital nursing education department.

This article explains the development of a computerized, educational record-keeping system. Steps in the decision-making process, as well as options to be considered, are detailed. This information will help nursing staff development educators implement or change their own nursing education documentation system.

Decision Making, Organizational↗

Heart Smart: a school health program meeting the 1990 Objectives for the Nation.

The importance of health promotion is recognized throughout the nation. The Surgeon General's report of 1980, Promoting Health/Preventing Disease, delineates objectives for intervention in 15 health priority areas. Approximately one-third of the objectives relate directly to the health of children, and many are addressed by a comprehensive cardiovascular (CV) health promotion program for elementary school children--Heart Smart. Priority areas addressed by this program are high blood pressure control, nutrition, fluoridation and dental health, smoking, misuse of alcohol and drugs, physical fitness and exercise, and control of stress and violence. Heart Smart is a cognitive behavioral intervention designed to address health enabling and reinforcing factors within the school environment. It is based on data from the Bogalusa Heart Study which clearly document the need for CV health intervention beginning early in life. Heart Smart includes a longitudinal classroom curriculum, an aerobic fitness program taught within physical education classes, a school lunch program offering CV healthy foods, and a teacher staff development program. The goal is to reduce CV risk factors in children. With health-enhancing behavior change of the students, family, and elementary school staff, objectives for CV risk reduction in our nation can be achieved.

Adolescent↗

Staff support groups: helping nurses to help themselves.

When the goals of staff development programming include increased introspection, problem-solving skills, or team effort, nursing administration may find that nurses are their own best resources. A nursing staff support group, run by a qualified leader, can offer nurses mutual help in reducing stress and managing conflict.

Burnout, Professional↗

Organizational change in an adolescent inpatient unit.

This paper describes a two-year process of evolution toward a more open, yet more structured therapeutic orientation in a large adolescent inpatient psychiatric unit. The rationale for alterations in structural organization, therapeutic modalities, and staff development are discussed. Issues of treatment team leadership, physical organization of the treatment center, integration of family, group and individual therapy, continuity of care and staff training are examined. Assessment of the impact of the changes were accomplished by administration of the Moos Ward Atmosphere Scale to clients and staff prior to and two years following the implementation of the changes. Adolescents perceived the ward environments as engendering more involvement, being more oriented toward personal problems, and encouraging less anger and aggressiveness. In addition, they saw the program as increasing in clarity, and the staff as being in greater control. Staff's perceptions, shifted in a more positive direction on nine of ten WAS subscales. Implications for the direction of change and its relationship to the organizational changes is discussed.

Adolescent↗

Decentralized unit orientation: a model for professional practice.

Facilitating use of professional practice models is a goal of nursing administrators and educators. A plan for decentralized unit orientation designed to foster use of nursing process and nursing standards was developed within the division of surgical nursing. Conceptual frameworks, topic selection, behavioral objectives, content outline, teaching strategies, operationalization of the plan, and methods to evaluate learning are described in this article. Staff development educators can use the information to assist unit managers in developing a decentralized unit orientation plan that emphasizes professional practice.

Curriculum↗

Assessing perceived agency adherence to the values of community inclusion: implications for staff satisfaction.

Measures of staff members' knowledge (N = 518) of the values of community inclusion, perception of agency adherence to community inclusion, and satisfaction with relevant components of their jobs were developed. Staff represented 130 agencies in a state-wide program of individualized community living supports for adults with developmental and/or mental disabilities. Results suggest relatively high levels of knowledge about values of inclusion and perceived agency adherence to the inclusion philosophy among employees regarding the need to provide individuals who have disabilities with opportunities for engaging in community daily activities and their rights for services. Employees, however, had significantly less knowledge of and noted less agency adherence to activities intended to provide consumers with opportunities to make choices. Staff who perceived more agency adherence to the philosophy of inclusion were more satisfied with their jobs.

Activities of Daily Living↗