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PubMed1987

Nursing home case mix. Patient classification by nursing resource use.

A model is presented for classifying nursing home patients according to nursing resource use. The model is derived from a study of 558 Medicaid nursing home patients in 12 facilities in Virginia. Data were obtained from self-reports of nursing staff for care delivered over a 52-hour period. The measure of care time was validated through concurrent work sampling. Project staff also assessed the patients' health and functional status using a standardized instrument. Using AID analysis patients were classified into six groups that were homogeneous in their use of nursing resources. Patients were initially categorized by presence or absence of conditions requiring specialized care (e.g., nutritional intake problems, quadriplegia, wounds or lesions, coma, and physical rehabilitation potential). For the specialized care category, two groups were formed by presence or absence of a catheter/ostomy. In the nonspecialized care category, four groups were formed by ADL impairment score and assistance required in eating/feeding. Mean resource use for the highest group was nearly four times that of the lowest group. The model accounted for 53% of the variance in nursing resource use.

Diagnosis-Related Groups↗
PubMedDate not supplied

Clinical resource centers in nursing programs.

Whether it is called a nursing lab, clinical resource center, or something else, the need to have a place where students can observe and practice clinical skills before entering the actual clinical setting is critical. Surprisingly, nothing could be found in the literature that describes the physical structure, resources, budget, or administration of these centers. To better understand the "state of the art" of clinical resource centers in schools and colleges in the United States, a national survey was developed and administered. The findings are useful for evaluation and planning purposes by clinical resource center directors and nursing program administrators.

Clinical Competence↗
PubMedDate not supplied

Community resources for clients with mobility problems.

Clients are leaving the hospital "quicker and sicker," and they frequently have acute care needs that must be met by resources outside the hospital setting. Community resources are diverse, vary widely from place to place, and have no central administration. Thus, using them can be challenging for both the nurse, client, and family. Reimbursement mechanisms underlie a person's ability to use resources and receive health care. By presenting two actual case scenarios where clients have mobility problems commonly seen by orthopaedic nurses, the authors discuss the community resources available, avenues of access to them, and their reimbursement mechanisms.

Activities of Daily Living↗
PubMed1998

A comparison of resource costs of immediate and delayed breast reconstruction.

The resource cost (cost to our hospital) of providing mastectomy plus breast reconstruction was calculated for 276 patients who had received both mastectomy and breast reconstruction at our institution. All patients had completed the entire reconstructive process, including reconstruction of the nipple. The resource costs of providing mastectomy with immediate breast reconstruction were compared with those of mastectomy with subsequent delayed reconstruction. We found that the mean resource cost for the 57 patients who had separate mastectomy followed by delayed breast reconstruction ($28,843) was 62 percent higher than that of mastectomy with immediate reconstruction ($17,801; n = 219, p < 0.001). Similar differences were found when patients were subgrouped by type of reconstruction (TRAM versus tissue expansion and implants), by laterality (unilateral versus bilateral), and by history of preoperative irradiation. We conclude that mastectomy with immediate breast reconstruction is significantly less expensive than mastectomy followed by delayed reconstruction and can potentially conserve resources.

Breast Neoplasms↗
PubMed1983

Blood pressure, relative weight, and psychosocial resources.

Research was conducted to determine the degree to which the effect of obesity on blood pressure was modified by sociocultural factors. A measure of psychosocial resources incorporating both access to social supports and coping styles, was developed in research in St. Lucia, a West Indian culture. The study sample consisted of 98 40-49-year olds randomly selected from a community. Obesity was measured by percent overweight using weight-for-height standards. Persons with lower psychosocial resources had higher blood pressures; overweight persons had higher blood pressures. Those persons greater than 10% overweight with low psychosocial resources had significantly higher blood pressures (p less than 0.05). Further analysis indicated that the direct effect of psychosocial resources was due primarily to the effect of social supports, while the interaction effect was due primarily to the effect of coping styles. These data are consistent with the hypothesis that specific sociocultural factors provide a protective function with respect to disease through some as yet unspecified physiologic mechanism.

Adaptation, Psychological↗
PubMedDate not supplied

Blood pressure, ethnicity, and psychosocial resources.

Research on psychosocial factors and cardiovascular disease has shown that psychosocial resources (including social supports and coping styles) help to protect individuals from the risk associated with psychosocial stressors. Some evidence indicates that this protective effect may extend to standard risk factors as well. This latter hypothesis was examined in greater detail in a study conducted in Brazil, in which it was found that psychosocial resources modified black-white differences in blood pressure. Highest mean blood pressures were observed among mixed race and black Brazilians who had low psychosocial resources; Afro-Brazilians with high psychosocial resources had lower blood pressures than white Brazilians. Implications of these results for the mechanisms linking ethnicity, psychosocial factors, and blood pressure are discussed.

Adaptation, Psychological↗
PubMed2006

Health care providers' opinions on intimate partner violence resources and screening in a pediatric emergency department.

OBJECTIVES: The American Academy of Pediatrics has called upon pediatricians to routinely screen for intimate partner violence (IPV) as an active means by which to prevent child abuse. The pediatric emergency department (ED) is one potentially important site to screen and to provide women with IPV resources. This cross-sectional questionnaire investigated pediatric health care providers' (HCPs') opinions about displaying IPV posters and performing IPV screening in a pediatric ED. METHODS: This cross-sectional survey was conducted in the ED of an urban, academic, tertiary care children's hospital that serves approximately 70,000 children each year. A convenience sample of 151 HCPs, defined as any person who provided medical care, including physicians, nurses, paramedics, and respiratory therapists, in the pediatric ED was surveyed using a 4-item questionnaire, designed by investigators, about their views regarding newly displayed IPV posters and resource cards, their opinions about universal IPV screening, and their personal use of the IPV materials. Between June and August 2004, surveys were distributed, along with return envelopes to be placed in a sealed box, to HCPs during their shifts in the ED. RESULTS: Of the 158 distributed surveys, 151 (96%) were returned. Of the sample, 30% were physicians, 53% were RNs, 10% were paramedics/emergency medical technicians, and 7% were other HCPs. Pediatric ED providers supported both IPV resource information and routine screening. Female providers were more likely than men to support the IPV posters. Five percent of the sample took IPV resource information for themselves or for later use with patients. CONCLUSIONS: Our pediatric ED's providers' endorsement of IPV screening and of the presence of IPV posters demonstrates support for and recognition of the problem of IPV in their patients' families.

Adult↗
PubMed2004

The impact of diet switching on resource allocation to reproduction and longevity in Mediterranean fruitflies.

Understanding the factors that determine the allocation and utilization of organism resources may provide an insight into the mechanisms of adaptation, ageing and reproduction. Resource allocation, which is regarded as a method of adaptation, increases fitness and is genetically controlled. Experiments with variable diet feeding of female Mediterranean fruitflies (Ceratitis capitata) demonstrated that the feeding regime dramatically influences lifespan, mortality and the reproduction of flies. An analysis of experimental data and numerical experiments reveals that resource allocation could explain lifespan increase when females are switched from a sugar-only to a protein-containing diet. The heterogeneity of the initial female cohort in terms of the total amount of resources and its allocation to the processes of maintenance and reproduction plays a significant role in this.

Adaptation, Physiological↗
PubMed2006

Dispersal is not female biased in a resource-defence mating ungulate, the European roe deer.

Dispersal is frequently more prevalent in one sex compared to the other. Greenwood proposed that patterns of sex-biased dispersal among birds and mammals are linked to their mating strategies. For species where males defend resources rather than females, he predicted female-biased dispersal, because males should remain at their birth site where they are familiar with the distribution of the resources that they must defend. Greenwood's hypothesis has been extensively supported among birds, where most species exhibit a resource-defence mating strategy. However, almost no equivalent information is available for mammals as males generally defend mates in this group. An exception is the European roe deer, a resource-defence mating ungulate. We thus tested Greenwood's hypothesis on this atypical mammalian model, looking for female-biased dispersal using sex-specific inter-individual genetic distances. We conclusively show that gene flow is not higher among females compared to males in the studied roe deer population, and hence that dispersal is not female-biased, suggesting that male mating strategy is not the primary selective force driving the evolution of dispersal in roe deer. We discuss the role of female mate choice and intra-sexual competition as possible alternative selective pressures involved.

Animal Migration↗
PubMed2001

Creating the gene ontology resource: design and implementation.

The exponential growth in the volume of accessible biological information has generated a confusion of voices surrounding the annotation of molecular information about genes and their products. The Gene Ontology (GO) project seeks to provide a set of structured vocabularies for specific biological domains that can be used to describe gene products in any organism. This work includes building three extensive ontologies to describe molecular function, biological process, and cellular component, and providing a community database resource that supports the use of these ontologies. The GO Consortium was initiated by scientists associated with three model organism databases: SGD, the Saccharomyces Genome database; FlyBase, the Drosophila genome database; and MGD/GXD, the Mouse Genome Informatics databases. Additional model organism database groups are joining the project. Each of these model organism information systems is annotating genes and gene products using GO vocabulary terms and incorporating these annotations into their respective model organism databases. Each database contributes its annotation files to a shared GO data resource accessible to the public at http://www.geneontology.org/. The GO site can be used by the community both to recover the GO vocabularies and to access the annotated gene product data sets from the model organism databases. The GO Consortium supports the development of the GO database resource and provides tools enabling curators and researchers to query and manipulate the vocabularies. We believe that the shared development of this molecular annotation resource will contribute to the unification of biological information.

Animals↗
PubMed1994

Positioning the human resource business using service level agreements.

Explores the introduction and development of Service Level Agreements (SLAs) in relation to Human Resource Departments. Considers approaches to SLAs and highlights four dimensions necessary for the completion of an SLA. Stresses that Human Resource Specialists should have a thorough understanding of how directorates and other departments relate to one another to provide added value in terms of contribution to the organizational outcomes. Suggests the idea of adding value is an integral part of the SLA process which ensures that it operates as a means to an end and does not become an end in itself. Examines the degree of devolved freedom given to a department to seek work or sell its products outside its Trust/Unit. Scrutinizes the format of SLAs and concludes that the benefits of SLAs for users of Human Resource Departments and the benefits to the Human Resource Departments are similar.

Contract Services↗
PubMed1998

Managing human resources in healthcare: learning from world class practices--Part I.

This paper, which is presented in two parts, is intended to demonstrate that practices related to the area of human resources management, adopted by model organisations that have dominated their markets consistently, can lend themselves very well to the healthcare sector, which is primarily a "people-oriented" sector. As change in a modern business context is set to continue in an unrelenting way, most organisations will be presented with the challenge of developing the necessary skills and areas of expertise to enable them to cope with the demands on them, master technological opportunities at their disposal, learn how to exploit modern management concepts and optimise value to all the stakeholders they intend to serve. This paper draws from best practices using the experiences of quality recognised organisations and many admired names through pioneering human resource policies and practices and through clear demonstrations on the benefits of relying on people as the major "asset". Part I of this article addresses the importance of human resources as revealed through models of management for organisational excellence. In particular, the paper refers to the criteria for excellence in relation to people management using the following prestigious and integrative management models: Deming Prize (Japan); European Quality Award Model (Europe); and Malcolm Baldrige National Quality Award (USA). In addition, this paper illustrates several case studies using organisations known for their pioneering approaches to people management and which led them to win very prestigious quality awards and various international accolades. The paper concludes by reinforcing the point that human resource management in a healthcare context has to be viewed as an integrated set of processes and practices which need to be adhered to from an integrated perspective in order to optimise individuals' performance levels and so that the human potential can be exploited fully.

Awards and Prizes↗
PubMed2006

Grid commerce, market-driven G-negotiation, and Grid resource management.

Although the management of resources is essential for realizing a computational grid, providing an efficient resource allocation mechanism is a complex undertaking. Since Grid providers and consumers may be independent bodies, negotiation among them is necessary. The contribution of this paper is showing that market-driven agents (MDAs) are appropriate tools for Grid resource negotiation. MDAs are e-negotiation agents designed with the flexibility of: 1) making adjustable amounts of concession taking into account market rivalry, outside options, and time preferences and 2) relaxing bargaining terms in the face of intense pressure. A heterogeneous testbed consisting of several types of e-negotiation agents to simulate a Grid computing environment was developed. It compares the performance of MDAs against other e-negotiation agents (e.g., Kasbah) in a Grid-commerce environment. Empirical results show that MDAs generally achieve: 1) higher budget efficiencies in many market situations than other e-negotiation agents in the testbed and 2) higher success rates in acquiring Grid resources under high Grid loadings.

Journal Article↗
PubMed2004

Framing as a cultural resource in health social movements: funding activism and the breast cancer movement in the US 1990-1993.

Disease-specific funding activism in the US has required health social movements (HSMs) to draw on both structural and cultural resources in order to persuade audiences and to redefine dominant conceptions of disease. Using a social constructionist analysis of Congressional testimony and media accounts of breast cancer funding activism between 1990-1993, this paper demonstrates that the use of culturally resonant frames served as an important cultural resource for breast cancer activists in the early 1990s. The breast cancer movement's use of three interconnected and culturally resonant frames aided the movement in redefining breast cancer as a problem of individual women to a major public health problem in need of governmental attention. This research contributes to both social movement and HSM scholarship by demonstrating that cultural resources, in the form of movement frames, are as central to social movement analysis as structural resources.

Breast Neoplasms↗
PubMedDate not supplied

Experiences of breast cancer survivor-advocates and advocates in countries with limited resources: a shared journey in breast cancer advocacy.

The last decade has been marked by rapid growth in the breast cancer advocacy movement around the world. Today such movements are well established in North America and western Europe, and are emerging and gaining momentum in regions of the world with limited resources--Africa, Asia, eastern Europe, and Latin America. Internationally breast cancer advocates have faced the challenges of dealing with many languages, cultures, countries, and health systems. Because of these differences, existing models of breast cancer advocacy are not always appropriate or reproducible across countries. At the second biennial Global Summit Consensus Conference on International Breast Health Care, 12 breast cancer survivor-advocates and advocates from around the world gave statements describing the experiences of women with breast cancer and with advocacy in their countries, and attended a roundtable meeting to discuss breast cancer advocacy from a global perspective. We used the "long table" method to analyze their comments and identify common experiences. Although participants came from diverse settings, the analysis revealed five common experiences that were consistent across cultures: 1) the experiences and fears of breast cancer survivors, 2) beliefs and taboos about breast cancer that hinder awareness programs and treatment, 3) the need for public education and breast cancer awareness programs in countries with limited resources, 4) difficulty in translating the concept and ethos of advocacy into many languages, and 5) the experiences in establishing and maintaining advocacy groups to promote breast cancer awareness and to inform public policy. These themes constitute an action agenda for breast cancer advocacy groups in countries with limited resources. In addition, they provide invaluable insight for policymakers, program planners, and others undertaking efforts to improve breast cancer outcomes in low-resource settings.

Breast Neoplasms↗
PubMed1980

The learning resources movement: its relationship to nurse education.

This paper addresses the place, position and potential of what is characterized as the 'Learning Resources Movement' in nurse education. It is based on experiences drawn from 10 years viewing resource use in general and nursing education, and, more recently, on observations arising from a research project looking at the growth within the school of nursing, of organizational structures for their development. It claims that the true potential of the movement has nowhere been fully realized. It sees the present position as indeterminate and misconceived. It claims that further development of such resources as are and will be available is intricately tied up with the professional development of nursing in a 'chicken-and-egg' situation. It argues that the stage has now been reached where the successful development of the one cannot proceed without the successful development of the other. Drawing on a fairy-tale analogy the paper views the Learning Resources Movement as a powerful tool for seeing through the shining surfaces of what to many are new curricular clothes and dealing with the basic truths of the situation underneath.

Audiovisual Aids↗
PubMed1996

Considering nursing resource as "caring time'.

The present constrained economic climate faced by health care agencies underscores the need for nurse administrators to have an in-depth appreciation of how nursing services are being used. The purpose of this investigation was to increase the understanding of nursing as a resource. Using phenomenological research methodology, the investigator purposefully selected six patients and a chain sample of 14 professionals responsible for their care, including nurses, nurse managers and physicians. Data collection methods included in-depth interviews, document reviews, and participant observation. The inductive interpretation depicts the nature of nursing resource to be "caring time'. Caring was understood primarily in terms of time and was experienced by all participants as "spending time'. Caring time was spent through "being with' and "doing to/doing for' the patient. Study participants experienced tension with regard to how best to spend precious "caring time'. Nursing resource was inextricably linked to both quantitative and qualitative expressions of nursing, and "being with' patients was a highly valued, under-allocated, and unintentionally provided component of nursing resource. The researcher concluded that nursing administrators, nurse managers and practitioners all have leadership roles to play in achieving recognition, allocation and promotion of caring time within their agencies.

Adult↗
PubMed2004

Making patient safety the focus: crisis resource management in the undergraduate curriculum.

BACKGROUND: This paper examines the role of high fidelity simulation and crisis resource management in bridging the gap between theory and practice. Patient safety is fundamental to healthcare professional practice and is a common goal for healthcare providers. It provides a focus to motivate practitioners. Patient safety issues are not a priority in undergraduate curricula. Raising the profile at this level is crucial to improving the safety and quality of healthcare delivery. This paper explores the role of simulation in providing a realistic, safe environment for participants with different levels of experience to manage evolving crises in the context of their work environment. METHODS: The Southern Health Simulation and Skills Centre uses a patient safety focus in delivering a specialised educational programme adapted from aviation to healthcare. The programme, crisis resource management, enables participants to consolidate knowledge, attitudes and skills to achieve a deeper understanding of how their performance impacts on patient safety and the quality of healthcare provided. Self-reported written evaluation data was collected from participants of three different courses at Southern Health. RESULTS: Participants consistently report that these courses offer unique learning experiences that address aspects of workplace learning in ways that have not previously been possible. A video-assisted reflective process powerfully reinforces learning. CONCLUSION: Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

Clinical Competence↗