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Costly organization-based leadership/management development training gives little evidence that such training affects long-term changes in nurse manager leader style adaptability in meeting situations and staff needs.
Change and innovative nursing practice models are more the norm rather than the exception in today's acute care hospitals. Some hospitals are redesigning the workplace. A common thread in most new models of delivery include some form of managed care.
In the second of two parts, the authors discuss adjuvant therapy, treatment of locally advanced breast cancer, and management of carcinoma in situ. In last month's issue, the aspects of screening, staging, diagnosis, and treatment of early breast cancer were presented.
Stimulation of erythropoiesis by Epoetin alfa causes an increased demand for iron to facilitate hemoglobin synthesis. This article outlines how nephrology nurses can monitor and manage iron levels during Epoetin alfa therapy; including both iron-deficient and iron overloaded patients.
The emergence of the Epoetin alfa as an effective therapy in the treatment of the anemia of chronic renal failure has reemphasized the importance of nursing monitoring and intervention in the treatment of these patients. This article examines the role of nurses in monitoring and managing patients receiving Epoetin alfa and the development of medications, such as Epoetin alfa, with recombinant DNA technology.
There is a crisis in health care that has to do with the ability of health-care workers to provide the long-term care and help for AIDS patients. Although more severe, it is just an extreme form of the denial among health care professionals of their own needs, and lack of ability to manage stress. The situation also reflects absence of explicit concern in health settings for creating environments that are healthy for staff. This paper has suggested some of the forms that a comprehensive response to this problem can take.
In the previous article, the rigid use of the Friedman Curve, breathing techniques, and other management options for the second stage of labor were examined. This article concentrates on the affect of maternal positioning, on the length of the second stage of labor, and summarizes the contents of that former article and this one.
Presented below is the third installment of the series of guidelines developed jointly by the World Health Organization and the International Council of Nurses. They contain basic information on the nursing management of people with HIV infection, including guidance on the prevention of transmission, and the routine care and counselling of infected persons.
This paper discusses the aetiology, incidence and severity of post-operative pain including factors that influence post-operative pain. Current concepts and the need for effective control of post-operative pain are discussed. A review of the various methods available for post-operative pain management is presented with special reference to practice in a developing country.
Both the spinal cord physician and the spinal surgeon must be fully cognizant of the alterations of functions in multiple systems of the body caused by a spinal cord injury. Complications can easily arise, particularly within the respiratory, urinary, and integumentary systems. Most are preventable if the medical and nursing staff are sufficiently knowledgeable to anticipate them and if the necessary equipment and facilities are available. Regionalization of care with early referral to a spinal cord injury center has become a cost-effective way to manage these patients. Only if their medical needs are met and complications are prevented will surgery, performed to allow early mobilization, really accomplish the desired result. This update reviews the current medical and surgical points of view concerning diagnosis, fracture classification, spinal stability, reduction and stabilization of the fracture deformity, and spinal canal decompression.
During the past year, management engineering techniques were more widely used in departments within hospitals. This broadened dissemination is essential if the field is to thrive.
For the past 20 years, the gender treatment team formed under the auspices of the University of Texas Medical Branch Hospitals has treated 121 male individuals with gender identification disorders. The age of this group ranged between 18 and 71 years, with an average of 32.3 years. While all of them were seen regularly for 6 months after surgery, only 68 were followed for a year or longer. The regimen of surgical treatment that consisted of procedures of bilateral orchiectomy, penectomy with relocation of the urethral meatus, labial reconstruction, and neovaginoplasty was used for all patients. The castration procedure used between 1972 and 1977 included removal of both the testes and the spermatic cord. The corpora cavernosa were transected at the public symphysis. For vaginal reconstruction, a partial-thickness skin graft was used frequently, in conjunction with a skin flap fashioned from the penile skin, to line the neovaginal vault. Modifications and changes in technique were, however, introduced in 1978. Skin flaps mobilized from the inguinoperineal area instead of a partial-thickness skin graft were used to line the vaginal cavity. A proximal segment of the corpora cavernosa was retained to reconstruct a clitoris. In addition, the spermatic cord was incorporated into the reconstruction of labia majora. These technical modifications substantially reduced the incidence of vaginal stenosis and improved the external appearance of the genitalia. The experience accumulated from managing this group of patients forms the basis of this report.
There is considerable disagreement among clinicians regarding the appropriate management of articular disc displacement. Research findings are difficult to interpret and compare because of the multitude of clinical variables. A number of questions remain unanswered. Is articular disc displacement truly pathology? Is diagnosis by clinical signs and symptoms adequate and accurate? Do we need to 'reposition' the disc and, if so, can we? Is reciprocal clicking a reliable sign of disc displacement and does it require treatment in the absence of other signs and symptoms? This article presents a short review of the more recent literature and provides guidelines for appropriate treatment.
In Part 1 of this two-part series (JONA, June 1994), the authors described the factors that influenced the need for a nurse manager development program and the conceptual model used to plan and implement that program at The Johns Hopkins Hospital. In Part, 2 they describe the program evaluation and implications for future work.
The authors have examined the currently accepted methods to face a chronic disease like diabetes. The person affected by this illness should learn to accept his/her limits and find a new identity. The aim of technical and scientific medicine is to teach the patient how to cope with the disease. However, in spite of the progress of the scientific research in this field, diabetes remains a poorly treated disease. A review of the literature shows that there is a deep interaction between diabetes and psychological states. Psychological disorders like depression and anxiety might be associated with the origin of diabetes and can affect its course. It seems that emotional factors have a more important role than education in diabetes care. The psychological aspect becomes even more important during adolescence, as the chronic illness can affect the normal development of the teen-ager who will deny it to protect himself. If the patient does not collaborate, his behaviour may be unconsciously aggressive and destructive. Some patients can use diabetes as a tool to act out aggressive feelings against themselves or the environment. Diabetes bad management becomes then the expression of their destructive narcissism which prevents them from finding a new identity. The collaboration of medical and psychological operators should help these patients to find a new identity which includes diabetes as an integrating part of their personality and enables them to cope with it under the guidance of the diabetes team.
Odontoiatric problems, clinical and surgical, connected with defective coagulation, are very frequent. Such cases can be divided into two groups: in the first we find patients with iatrogenic coagulopathy while in the second we find patients with hypocoagulative diseases. In this article the authors present the result of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on clinical pharmacology and the use of anticoagulants, the principal clinical cases are discussed. Various laboratory tests evaluating patients with pharmacological coagulopathy are examined. The most specific and significant tests are illustrated following up the authors experiences. In the last part the authors illustrate cases corresponding to the two serious and frequent complications that can be found in patients with iatrogenic coagulopathy: hematorrhea and thromboembolism. These matters were dealt with from an Odontostomatologic point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
Any oral and maxillo-facial surgical treatment, however urgent it may be, must not include pathological states in which the patient's life may be particularly at risk as, for example, with Disseminated Intravascular Coagulation (DIC) or throm-botic thrombocytopenic purpura. In this article the authors present the result of studies carried out on the nosology of thrombocytopathy from an odontostomatological point of view. Thrombocytopathy can be divided into two groups: the first including the pathologies with a predominant defective number of thrombocytes (i.e.: thrombocytopenia, thrombocythemia, thrombocyto-sis), the second including forms with predominant qualitative defects (commonly known as thrombocytopathies). The authors, after having presented in short the physiopathologic functions of thrombocytes, illustrate the clinical and therapeutic aspects of the most important thrombocytopathies. Morbus Maculosus Werhofii, Glanzmann's disease, Bernard-Soulier syndrome, thrombocytopathies from defective reaction of release, Thrombocytopathies from defective procoagulant activity of blood plaques, thrombocytopathies in linkage to other genetic anomalies, von Willebrand's pseudodisease and a lot of acquired thrombocytopathies are identified. In the last part the authors illustrate the most opportune clinical steps corresponding to the most important thrombocytopathies. The results obtained suggest the necessity of keeping to the management that was described, Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
Industry changes not only demand flexibility among health care workers but also require transformation of education programs that prepare leaders and managers for practice in evolving venues of delivery. Schools of nursing are responding by listening to the market and designing curricula to meet the new demand. This article describes one cutting-edge graduate program that prepares nurses for new leadership roles in health care.