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Pharmaceutical care: new management and leadership imperatives.

The management imperatives for pharmaceutical care concern themselves with complexity, while leadership imperatives are concerned with effecting change. Both "species" of action are needed to support the paradigm shift associated with pharmaceutical care. Pharmacy managers must be the architects and engineers of the new dimensions of complexity associated with pharmaceutical care while also serving as zealots of change for pharmaceutical care within their departments and hospitals. In the final analysis, departments of pharmacy do not practice pharmaceutical care. They are, however, the borne fruit of pharmacy managers and leaders who provide for an appropriate environment inclusive of resources and systems necessary for individual pharmacists to make the commitment to making pharmaceutical care a reality.

Drug Utilization↗

Mavericks.

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Clinical Competence↗

Will managed care change our way of being?

The authors studied psychotherapeutic practices commonly used in managed care settings and the theories and rhetorical strategies that justify them to speculate about if or how they are beginning to influence societywide understandings about the proper way of being human at the turn of the millennium. The practices--and effects--of managed care regulations on the self are interpreted by studying how the patient, the therapist, and the therapeutic relationship come to light in managed care settings. These categories are then used to speculate about the configuration of the newly emerging, 21st-century self. By extending hermeneutic concerns about instrumentalism and technicism, the authors suggest a new way of thinking about psychotherapy modeled less on positivist science and more on moral discourse. Finally, given this more hermeneutic understanding of psychotherapy, the authors speculate about alternative conceptions and arrangements of care.

Evidence-Based Medicine↗

Professional?

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Analgesia, Epidural↗

Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.

Adult↗

[A free market is unfavourable for health care].

The new health care system in the Netherlands introduces a free market into the health care sector. Because health care lacks some essential conditions, a free market will not provide effective resource allocation in this sector. In addition, a free market leads to more bureaucracy and less solidarity, cooperation and freedom of choice. It also impairs the autonomy of the medical professional.

Capitalism↗

The nurse practitioner and autonomy: contributions to the professional maturity of nursing.

In 1990 we celebrated the 25th anniversary of the nurse practitioner (NP) movement. We now have had considerable experience with the role, and it is appropriate to examine our contributions to the maturity of nursing as a profession. Nursing's future health care delivery role in an increasingly competitive health care arena may well depend on the autonomy, of the practice of professional nursing. This article focuses on NPs, their autonomy, and their contributions to the professionalization of nursing.

Humans↗

Processes of persuasion: social interests and total quality in a UK hospital trust.

This paper examines some of the processes which have contributed to the development of a 'total quality' (TQ) approach within British health care. The paper challenges the idea that TQ is part of a redistribution of power within the NHS. Rather it is argued that through the elaboration of consumer-led market identities TQ misrepresents the interests of management and constructs a version of the self which obscures new forms of managerial control. TQ constrains alternative forms of social organisation, local knowledge and the social interests invested in them. An example of a competing set of assumptions is discussed. It is suggested that clinical groups--who are primarily motivated by the principles of professional, collegiate control--seek to free themselves from the constraints of TQ. Thus clinical discourse appropriates a professionally led version of the market and protects the traditional autonomy of professionals whilst seeming to render their interests synergistic with those of management. This casts 'quality', and perhaps even the 'market', as conceptual sites upon which different groups strive to construct and legitimate their own interests. It is concluded that the changes explicitly associated with TQ are not as fundamental as they seem.

Data Collection↗