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PubMed2004

Common denominators: shared governance and work place advocacy - strategies for nurses to gain control over their practice.

It is important to the future of health care that we identify strategies that provide support for nurses as they take on the challenges of the new century. Shared governance has long been stressed as an effective strategy for enhancing autonomy and providing avenues for nurses to gain control over their practice. A newer strategy, defined at the local, state, and/or national level, is work place advocacy. This strategy builds upon many of the principles contained in shared governance. This article identifies common denominators found in both shared governance and work place advocacy.

Decision Making, Organizational↗
PubMed2003

Influenza immunization practices among pediatric oncologists.

PURPOSE: To describe the opinions of pediatric oncologists regarding the use of influenza vaccine in children with cancer and to identify factors that influence practitioners' recommendations about influenza vaccine. MATERIALS AND METHODS: A survey was sent to members of the Children's Oncology Group to inquire about their clinical experience and practice setting, opinions regarding the use of the influenza vaccine in children with cancer, and factors that influence their recommendations. RESULTS: Of 803 pediatric oncologists identified, 434 (54%) responded. Depending on the type of tumor, 65% to 69% of pediatric oncologists indicated that they routinely recommend influenza vaccine for children being treated for cancer. Respondents were much more likely to recommend influenza vaccine for children with various types of cancer if they indicated that: 1) their practice has guidelines regarding the use of influenza vaccine (odds ratios ranging from 7.2 to 11.7); 2) influenza infection is very significant (odds ratios ranging from 1.4 to 3.7); and 3) influenza vaccine is effective (odds ratios ranging from 7.2 to 14.9). CONCLUSIONS: The majority of pediatric oncologists routinely recommend influenza vaccine for children being treated for cancer; however, a significant number of pediatric oncologists do not. Clarification of the benefit of influenza vaccine for children with cancer and the institution of practice guidelines may increase the use of the influenza vaccine among pediatric oncologists.

Adult↗
PubMed1991

A private practice model for teaching and research activities.

The majority of neurologists in the United States are in fee for service patient management, dividing their time between hospital and office based practice. Many have had subspecialty training or have had research experience. It is our belief that research should be a component of a neurologist's practice. This is particularly true for an assessment of outcome. In order to accomplish this, we have developed a system which includes patient management, teaching, and clinical research, within our fee for service model.

Hospital Bed Capacity, 500 and over↗
PubMed1999

A successful practice model for the OR.

A practice model that combines shared governance and patient care teamwork to achieve optimal surgical patient care provided the framework for a successful Joint Commission on Accreditation of Healthcare Organizations visit at the Brigham and Women's Hospital, Boston, a university-affiliated teaching hospital. This article describes ways to implement this practice model. Clinical practice, quality improvement, and development councils are explained, as well as membership criteria for the councils and how they function. The need for more sharing of such quality improvement data from other hospitals is needed to establish national standards for measuring nursing performance.

Adult↗
PubMed2004

A journey, not an event - implementation of shared governance in a NHS trust.

This article describes the implementation of a trust-wide shared governance structure in Barts and The London National Health Service Trust in the United Kingdom. Barts and The London is a large teaching trust, employing over 6,500 staff. The implementation process is described in detail and is followed by details of the current shared governance structure, an overview of the evaluation of the structure, and the objectives of each of the four nursing teams: the Quality, Management, Education, and Clinical Practice Teams. Also included are examples of the achievements of each of the teams and a personal account of one nurse who joined the Trust after shared governance had been implemented.

Attitude of Health Personnel↗
PubMed1993

A collaborative approach to standards, practices. Setting the stage for continuous quality improvement.

In retrospect, the most important thing we did was work together. We analyzed, refined, and validated our philosophical approach to patient care. We provided an information data base that is readily available for on-the-job reference and serves as a starting point for CQI activities. The very act of joint documentation of practices encourages open discussions about improvements to patient care. One physician states, We know that flaws in the process through which we produce care are everywhere--waste, duplication of effort, unnecessary complexity, and unpredictability . . . I believe that modern total quality management offers enormous hope to a medical care field that is rather desperate. . . . Collaborative practice and CQI activities are one hope. The scope of what nurses and physicians traditionally consider when discussing standards and practices must widen. We should no longer look only at patient care. We must simultaneously focus on how the management of total systems influences quality care for all patients. The CQI process, a proactive method, requires an accurate data base of information that is easily retrieved when looking for systems and individual patient care improvements. Our Computerized Collaborative Standards and Practices Manual is the reservoir for documenting practice plans developed and approved by all the disciplines involved. The process described here began with two closely knit operating room disciplines; this framework, however, offers the potential for expansion into a hospital-wide system of information organization and use.

Anesthesia Department, Hospital↗
PubMed1999

Prospective evaluation of a hospital epidemiologist's activities at a European tertiary-care medical center.

OBJECTIVE: Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ). DESIGN: Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded. SETTING: A 1,040-bed tertiary-care university hospital in Zurich, Switzerland. RESULTS: Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults. CONCLUSIONS: This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.

Epidemiology↗
PubMed1999

The development and testing of the patient record pain management assessment tool.

The article reports a study whose purpose was to develop and test the Patient Record Pain Management Assessment Tool, an instrument to evaluate compliance with the American Pain Society's quality assurance standards on acute pain and cancer pain in chart documentation. Content validity, overall validity, and interrater reliability were all found to be acceptable. The instrument is therefore a useful tool for documenting the level of pain management practice in institutional settings.

Forms and Records Control↗
PubMed2003

The Australian Centre for Evidence-based Clinical Practice generic audit tool: Auditmaker for health professionals.

Audit is an important step in the process of health care evaluation and quality improvement. Some of the barriers to audit include the lack of support in initiating an audit, difficulty with data collection and lack of time. Auditmaker is a computer package that guides the clinician through the initial process of designing an audit, choosing factors and outcomes to analyse, then provides customizable data entry forms, and finally simple reports summarizing the data. It has user-friendly features, such as help buttons, drop-down lists and built in comorbidities and outcomes of common interest. It provides a generic tool for performing an audit as well as providing an opportunity for different clinicians in different institutions or practice settings to perform similar audits using the same data collection tool, which can provide the basis of benchmarking. Auditmaker is available for downloading from the ACEPBCP website: http://www.acebcp.org.au.

Australia↗
PubMedDate not supplied

Noncompliance with body weight measurement in tertiary care teaching hospitals.

BACKGROUND: Body weight provides vital information for patient care; therefore, measurement at hospital admission should be standard practice. Our objective was to test compliance with this standard. METHODS: This was a study of 300 patients, aged > or = 18 years, admitted to general medicine and surgery services of 3 tertiary care teaching hospitals in Nashville, Chicago, and San Francisco. At 24 to 36 hours after admission, participants were queried as to whether they had been weighed, and if not, they were asked whether they had been questioned by nursing personnel about their weight. Subjects were then weighed by research personnel using identical protocol at all 3 institutions. Any admission body weight documented by nursing was noted. RESULTS: Compliance was similar at all 3 institutions, with only 197 (65.7%) of patients reporting being weighed. There were 213 (71.0%) patients who had a weight documented in the nursing record. Of those who had not been weighed, 69 (67.0%) indicated that they had been queried about their weight. Comparison of documented weights in the nursing records with those measured by research personnel revealed that 55 (25.9%) differed by > or = 5 pounds (2.27 kg). Those who had a documented weight in the nursing record but were not weighed by nursing personnel were also more likely to deviate from the weight measured by research personnel by > or = 5 pounds (2.27 kg) in comparison with those who had been weighed by nursing personnel (42.8% versus 21.8%, respectively, p < .0147). CONCLUSION: Overall compliance with weight measurement is poor. Recorded weights are often inaccurate.

Adult↗
PubMed2004

Physicians practicing in methadone treatment programs: who are they and what do they do?

OBJECTIVE: This study examines the characteristics and roles of physicians practicing in methadone maintenance treatment programs (MTPs). METHODS: Physicians and clinic directors at 172 MTPs in the United States completed surveys. MTPs were selected for study participation based on their locations (large urban, urban, or nonurban area) ownership status (for profit and non-profit), and size (patient capacity of 1-100, 101-300, and 300+). Weighted data were analyzed with descriptive and multivariate methods. RESULTS. Physicians were primarily white males aged 45 or older; 44% had 10 or more years of experience working in methadone treatment. Physicians reported spending 26% of their time completing administrative tasks. Most reported that they determine dosing levels on an individual patient basis. Average maintenance dose was 69 mg/day. CONCLUSIONS: Physicians' treatment practices play a major role in overall treatment, treatment retention, and outcomes. Physicians at for-profit and large urban MTPs reported spending the most time in direct patient contact.

Accreditation↗
PubMed2001

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Abortion, Legal↗
PubMed2000

Take two dentists: a tale of root caries.

Take two dentists, whose practices are about as different as they could possibly be, who both have a healthy respect for root caries. Our paper will start by describing these two practices and then review the literature to show what is known about the management of root caries. The paper ends by returning to the two dentists, who describe how the research reviewed in the literature may affect their work.

Aged↗
PubMed2004

State involvement in professional nursing development in Israel: promotive or restrictive.

This article describes the role of the Israeli Ministry of Health's Nursing Division in regulating the development of the nursing profession and the nursing care provided. First, factors influencing professional nursing in Israel and the development of the Ministry of Health's Nursing Division are presented. Then, examples of the Nursing Division's influence on nursing practice, the process of statutory authorization used to facilitate this influence, and future Nursing Division initiatives are discussed. The article concludes by noting that, on balance, ministerial (governmental) involvement strengthens the nursing profession and the quality of nursing care provided, yet may also restrict nurses' private concerns.

Cross-Cultural Comparison↗
PubMed2006

At cross-purposes: head-to-head professionalism in not-for-profit pastoral organizations.

PURPOSE: The purpose of the paper is to explore the nature and causes of observed tensions among healthcare professionals in not-for-profit organizations such as hospices. DESIGN/METHODOLOGY/APPROACH: In the paper the narratives collected from discipline leaders in each of five New Zealand hospices are thematically analysed in order to identify consistent and recurring sources of conflict both within and between disciplinary groups. FINDINGS: The paper finds that motivational differences, poor conflict management, interdisciplinary tensions, divergent attitudes towards volunteerism, strategic planning processes, and poor consultation are identified as some of the starting-points for tensions in the participating hospices. RESEARCH LIMITATIONS/IMPLICATIONS: The research in this paper is based in New Zealand and uses qualitative methods not intended to produce generalizable results. Nevertheless it was conducted in hospices typical of the Western developed countries and identifies focal points and potential avenues for further exploration. PRACTICAL IMPLICATIONS: The paper shows that researchers and managers involved in not-for-profit healthcare organization may find the identified issues useful as starting-points for actions to minimise the tensions between and within groups. ORIGINALITY/VALUE: This paper explores aspects of a rarely discussed issue, and suggests opportunities for more research in this field.

Adult↗
PubMed1994

The development of a state-level health manpower database using an employer-based survey: a pilot project.

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database--a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel.

Alabama↗
PubMed1978

Foreign-trained physicians in American medicine: a case study.

The understanding of reliance upon foreign medical graduates (FMGs) in the United States is vague and general. Little is known about the specific roles of FMGs or the populations they serve in relation to United States medical graduates (USMGs). The recent passage of the Health Professions Educational Assistance Act calls for significant reductions in the future influx of FMGs. Hence, there is an immediate need for detailed information upon which to base predictions of legislative outcomes. The American Medical Association's 1974 physician data tape for Maryland was used as the study population. These data were analyzed, using th Gini Index of Concentration and other test stastistics, for FMG/USMG distributional differences for 1) office-based practice and hospital-based practice, 2) catchment areas aggregated by income, 3) primary, secondary, and tertiary case specialty groupings, 4) level of development of country of medical education, and 5) all of the above in relation to population. Office-based and hospital-based catchment areas were developed in order to create a valid consumer-provider relationship between the numerator and denominator of physician/population ratios. The major finding is that regardless of practice setting, FMGs are more evenly distributed relative to population than USMGs. This conclusion is in contrast with the notion that FMGs tend to locate where USMGs locate. A useful methodology has been presented for 1) development of catchment areas, and 2) examination of distributional differences in relation to population which can easily be duplicated.

Catchment Area, Health↗
PubMed2005

The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute.

OBJECTIVES: To determine the overall rate of loss of workplace teaspoons and whether attrition and displacement are correlated with the relative value of the teaspoons or type of tearoom. DESIGN: Longitudinal cohort study. SETTING: Research institute employing about 140 people. SUBJECTS: 70 discreetly numbered teaspoons placed in tearooms around the institute and observed weekly over five months. MAIN OUTCOME MEASURES: Incidence of teaspoon loss per 100 teaspoon years and teaspoon half life. RESULTS: 56 (80%) of the 70 teaspoons disappeared during the study. The half life of the teaspoons was 81 days. The half life of teaspoons in communal tearooms (42 days) was significantly shorter than for those in rooms associated with particular research groups (77 days). The rate of loss was not influenced by the teaspoons' value. The incidence of teaspoon loss over the period of observation was 360.62 per 100 teaspoon years. At this rate, an estimated 250 teaspoons would need to be purchased annually to maintain a practical institute-wide population of 70 teaspoons. CONCLUSIONS: The loss of workplace teaspoons was rapid, showing that their availability, and hence office culture in general, is constantly threatened.

Academies and Institutes↗